• Health Policy and Management
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• v.30 no.2
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• pp.192-198
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• 2020

Background: Korea National Health Insurance Service (NHIS) is operated as a social insurance system in which people pay a portion of their monthly income as insurance premiums and receive benefits when they experience illness or injury. Since 2005, the national health insurance remained surplus accumulating cumulative reserves each year. However, as of 2018, NHIS revenue recorded 62.11 trillion won and spending of 62.29 trillion won. The deterioration of NHIS finances is expected to accelerate with the aging population, income growth, new medical technology development, and enhanced security policies. Methods: To examine the financial health and sustainability of NHIS, we estimated the future revenue and spending until 2030 using the data from Korea Health Insurance Review and Assessment Service statistical yearbook. 2004-2018 average percentage change in NHIS revenue and spending was calculated. We estimated the future NHIS financial status using two methods. In the first method, we calculated the revenue and spending of the future NHIS by applying the 2004-2018 average percentage change to the subsequent years consecutively. In the second method, we estimated the future NHIS financial status after adjusting for the predicted demographic changes such as the aging population and declining birth rate in South Korea. Results: The estimates from this study suggest that the NHIS's cumulative reserves will run out by 2024. Conclusion: In terms of spending on current health insurance, there should be a search for ways of more efficient spending and funding options.

• Health Policy and Management
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• v.18 no.2
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• pp.19-38
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• 2008

Financial ratios are key indicators of an organization's financial and business conditions. Among various financial indicators, profitability, financial structure, financial activity and liquidity ratios are frequently used and analyzed. Using the structural equation modeling(SEM) technique, this study examines the structural causal relationships among key financial indicators. Data for this study are taken from complete financial statements from 142 hospitals that passed the standardization audit undertaken by the Korean Hospital Association from 1998 to 2001 for the purpose of accrediting teaching hospitals. In order to improve comparability, ratio values are standardized using the Blom's normal distribution. The final model of the SEM has four latent constructs: financial activity(total asset turnover, fixed asset turnover), liquidity(current ratio, quick ratio, collection period), financial structure(total debt to equity, long-term debt to equity, fixed assets to fund balance), and profitability(return on assets, normal profit to total assets, operating margin to gross revenue, normal profit to gross revenue). While examining several model fit indices(Chi-square (df) = 178.661 (40), likelihood ratio=4.467, RMR=.11, GFI=.849, RMSEA=.157), the final SEM we employed shows a relatively good fit. After examining the path coefficient of the constructs, the financial structure of the hospital affects the hospital's profitability in a statistically significant way. A hospital which utilizes its liabilities, more specifically fixed liabilities, and makes a stable investment decision for fixed assets was found to have a higher profitability than other hospitals. Then, the standard path coefficients were examined to directly compare the influence of variables. It was found that there were no statistically significant path coefficients among constructs. When it comes to variables, however, statistically significant relationships were found. between. financial activity and. fixed. asset turnover, and between profitability and normal profit to gross revenue. These results show that the observed variables of fixed asset turnover and normal profit to gross revenue can be used as indicators representing financial activity and profitability.

• International Journal of Human Ecology
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• v.6 no.1
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• pp.1-16
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• 2005

Due to increasing life expectancy, Americans live nearly 20 years after retirement. During this period, elderly persons have to stretch finances to manage the level of living without earnings. However, decision making ability decreases with age. One coping strategy for this problem would be seeking help from others. We examine factors affecting elderly persons' assistance use with respect to financial management using the 2000 Health and Retirement Study (N=3,823). It was found that age, education, health status, and ethnicity significantly affect elderly persons' financial management assistance use. The older-olds, those with lower educational attainment and poorer health status were more likely to use financial management assistance. However, Hispanic elderly were less likely to use financial management assistance.

• Korean Journal of Social Welfare
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• v.48
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• pp.150-178
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• 2002

The elderly have higher potential for contracting chronic diseases and suffering from development of a complication. Also, the extended old age period leads the elderly to demand more medical services. All those facts indicate that the elderly need more medical services than any other age groups. Consequently, medical care for the elderly with chronic diseases causes high costs burden. However, there is few studies researching the financial burden of chronic illness of the elderly. This study aimed to 1) understand how much the elderly with chronic diseases pay for medical expenses; 2) find out some specific factors related to health care financial burden; 3) suggest the alternative policies to decrease excessive financial burden of caring for the elderly with chronic illness. National Health and Nutrition Survey, which was surveyed by the Korea Institute for Health and Social Affairs in 1998, was used in this study. 4,707 persons with chronic diseases out of 5385 persons over age 60 were selectively sampled. Using SPSSWIN, correlation analysis, T-test, ANOVA and Regression were used as statistical methods in this study. Stepwise multiple regression was employed to analyze the data with a ratio of health care expenditure to income(financial burden) as a dependent variable. Out of Korean old people, 87% had the chronic diseases and their health care financial burden rate showed the average of 17.9%, which meaned they expended almost 20% income to buy medical services. The variables having a great influence on financial burden were monthly income, activity, limitation and single household of an old person. The excessive financial burden was experienced by people who had more than 4 activity limitations(37.1%) and were in the lowest Income level(32.6%), and single household of an old person(31.4%). The new policies should be considered to 1) reduce the financial burden in these groups and to develop the sliced medical cost system considering the characteristics of chronic illness and income level; and 2) develop the medical management system to care for the elderly with chronic illness.

• Health Policy and Management
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• v.11 no.4
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• pp.38-53
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• 2001

The price of the hospitals' services is regulated by the governmental health insurance reimbursement schedule in Korea. On the other hand, the emphasis on the quality of care of hospitals service is ever increasing. Under the environment, hospitals have to understand the effects of the activities to improve quality of care on efficiency and on financial performance so that they develop a management strategy that allows quality of care, operational efficiency, and financial achievement simultaneously. This study investigates the relationship among the concepts. The sample for the study includes 23 hospitals that have more than 300 beds. The concept of quality of care is measured by the score reported by the Hospital Standardization Survey (HSS) instituted by Korean Hospital Association. Efficiency is measured by the ratio of number of employee to the number of patients served. Financial performance is measured by the financial ratios indicating the profitability of a hospital. An analysis is performed using the multiple regression. The results show significant positive relationships between the HSS score and efficiency indicators, md between the HSS score and profit measures. However, the significant positive relationship between the HSS score and profit measures disappeared when efficiency indicators were introduced to the model. This study concludes that the structural quality of a hospital has a positive effect on efficiency of the hospital and that the structural qualify indirectly affects the financial performance of a hospital through the improvement of efficiency. Based on the findings, the implications on hospital management and health policy are discussed.

• Korean Journal of Social Welfare
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• v.57 no.4
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• pp.321-342
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• 2005

The finance of the National Health Insurance(NHI) in nearly every Nation in the world has been traditionally based on premiums of the workers and employers. But in Korea, the government has been guaranteeing financial supports to regional health corporations. After the unification of the different corporations in the NHIC, the government will not have to give financial support to the NHIC. Then this will be a serious financial challenge to NHIC, which has usually had financial deficit. The purpose of this paper is to review the problems of the premium based financing of the NHI and to exam whether such problems will be solved through the financial support from the state to the NHI. The analysis in this paper focused on five viewpoints; 1) work relatedness 2) redistribution effect 3) financial burden of business firms through the premium 4) risk pooling 5) management hegemony of the NHI. As a result, it was found that there are many problems in every five aspects and these problems could be solve through the financial aid from the state. But, it does not without any restriction mean to suggest that the financing mode of the korean NHI should be wholly transformed to a tax based financing mode. Because there are many things to be considered in oder to alter the financing mode of the NHI. Nevertheless, this paper would give a logical background to enlarge the financial aid form the state to NHI, or at least, to maintain it at a present level.

• Health Policy and Management
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• v.12 no.3
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• pp.54-76
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• 2002

This study investigated how much EVA which evaluate firm's value can explain hospital bankruptcy prediction as a explanatory variable including financial indicators in Korea. In this study, artificial neural network and logit regression which are traditional statistical were used as the model for bankruptcy prediction. Data used in this study were financial and economic value added indicators of 34 bankrupt and -:4 non-bankrupt hospitals from the Database of Korean Health Industry Development Institute. The main results of this study were as follows: First, there was a significant difference between the financial variable model including EVA and the financial variable model excluding EVA in pre-bankruptcy analysis. Second, EVA could forecast bankruptcy hospitals up to 83% by the logistic analysis. Third, the EVA model outperformed the financial model in terms of the predictive power of hospital bankruptcy. Fourth, The predictive power of neural network model of hospital bankruptcy was more powerful than the legit model. After all the result of this study will be useful to future study on EVA to evaluate bankruptcy hospitals forecast.

• The Korean Journal of Health Service Management
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• v.14 no.2
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• pp.15-27
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• 2020

Objectives: The purpose of this study is to compare analysis of financial performance in university hospitals. Methods: Data from 2005 to 2017 were collected from income statement, balance sheet, and annual reports in 23 university hospitals. The dependent variables are used financial performance, namely, medical profit to total assets, medical profit to medical revenue, and net profit to medical revenue. The independent variables are establishment type, hospital province, bed, open liquidity, stability, and activity. Results: From 2005 to 2007, university hospitals steadily increased medical revenues, nonmedical revenues, medical profit, net profit, and reserve fund for essential business by investing fixed assets using financial leverage. From 2015 to 2017, the debt ratio was minimized based on existing management performance. Results showed that university hospitals maintained high profitability by actively investing in medical equipment, medical environment, and facilities using reserve fund for essential business. Conclusions: Results suggest that this will be the basic data for efficient management of university hospitals.

• Health Policy and Management
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• v.33 no.3
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• pp.355-362
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• 2023

Background: Financial efficiency in monetary units and operational efficiency in non-monetary units are separately classified and evaluated. This is done to prevent the duplication of monetary units and non-monetary units in inputs and outputs. In addition, analyses are conducted to determine the factors that affect each aspect of efficiency. To prevent duplication of monetary and non-monetary units in inputs and outputs, financial efficiency, consisting of monetary units, and operational efficiency, comprising non-monetary units, are separately classified and evaluated. Furthermore, an analysis is conducted to identify the factors that affect each aspect of efficiency. Methods: This study conducted a panel analysis of 34 regional public hospitals and influencing factors on efficiency for 5 years from 2015 to 2019. Financial efficiency and operational efficiency were calculated through data envelopment analysis. Moreover, multiple regression analysis was conducted to identify the factors that influence both financial efficiency and operational efficiency. Results: The factors that affect financial efficiency include the number of medical institutions within the treatment area and the ratio of patients receiving medical care. Additionally, operational efficiency is influenced by the type of medical institution, the number of medical institutions within the treatment area, and the number of nursing positions per 100 beds. Conclusion: In order for regional public hospitals to faithfully fulfill their functions and roles as regional base public hospitals, several measures are necessary. Firstly, continuous monitoring and reasonable support are required to ensure efficient operation and performance. Secondly, a financial support plan tailored to the characteristics of local medical centers is needed. Additionally, local medical centers should strive to enhance their own efficiency.

• Health Policy and Management
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• v.7 no.1
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• pp.73-99
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• 1997

This study was carried out by using questionnaires with 126 insurance societies from Sept. 30, 1995 to Oct. 18, 1995. The primary data collected bythe survey have been significantly supplemented by secondary data obtained from sources such as health insurance statistical year books and internal data in the Ministry of Health and Wolfare. Major findings were summarized as follows: Two financial coordinating programs have significantly improved financial status of regional health insurance societies: the catastrophic program for high cost medical care that was initiated in 1991 and the program for hospitalization cost of the aged in 1995. Another finding is that there existed ambiguity and inconsistency of equity index that had been used by stabilization programs and its side effects could not be ignored. Regression analyses were made to identify factors that affect financial transfers. Inde pendent variables in the regression include utilization frequency, dependancy ration, insurance contribution per insured and medical expense per insured. All these variables were statistically significant in the equations of applying distribution rate (distribution/contribution) and transfer rate (transfer/contribution) as dependent variables. Policy suggestions for the catastrophic program for high cost medical care are modifying the definition of catastrophic case and setting the maximum amount of subsidies for each society based on distribution rates. To solve the problems of the financial coordinating program for the aged, we could consider reimbursing more than 50% of the copayment incurred by the aged 65 or more and determining the maximum amount of outpatient copayment at 10,000 Won per day or per visit for the elderly. More fundamental improvement could be made by amending the Welfare Benefit Act to establish and expand medical and welfare facilities for the elderly.