• 대한지역사회영양학회지
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• 제13권3호
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• pp.396-404
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• 2008

This study aimed to evaluate the amount of patients' satisfaction with hospital foodservices among those who were benefited from national health insurance during their hospitalization. A total of 3,094 inpatients from 191 medical institutions were enrolled in this survey. The survey was carried out from July 23 to September 14, 2007 through the face-to-face interview method. All analyses were made using the SPSS software (version 13.0). The mean age of the participants was 53.3 years, 57.0% were women; 34.7% were high-school graduates. Among the respondents, 30.9% stayed in the hospital for $7{\sim}14$ days long, and 52.0% were hospitalized in multi-patient rooms for six persons. The 87.7% of total population had a general diet, and 9.6% selected the food menu that was notcovered by health insurance. In addition, 38.3% of patients regarded the fee of foodservice as inexpensive. Overall, the satisfaction score with hospital foodservice was 3.63 on a Likert-type scale ranging from 1 (extremely dissatisfied) to 5 (extremely satisfied). However, the limitations were indicated including the lack of providing nutritional information and quality of taste. In conclusion, the quality of hospital foodservice might not deteriorate even after enforcement of national payment of medical insurance. Further efforts are required for the diversification of menus and legislative work for improving quality of food service for a successful hospital foodservice policy.

• 한국치위생학회지
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• 제21권1호
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• pp.89-98
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• 2021

Objectives: The purpose of this study was to investigate the perception and satisfaction of caregivers and parents after being covered by health insurance for light-curing composite resin fillings, and to contribute to the settlement of the expansion and coverage of health insurance. Methods: A survey was conducted on caregivers who visited two dental institutions in the Gyeonggi-do area, and parents who joined internet cafes (online communities) in the Gyeonggi-do area from June 2 to September 2, 2020. 225 responses were collected eventually, and 212 valid responses were used as analysis data. Results: 67.0% of the study subjects were aware of the permanent teeth resin fillings being covered by health insurance and the satisfaction was relatively high (91.5%). There was a statistically significant difference in the perception of permanent tooth resin filling benefits according to the child's oral condition (p=0.025) and the parents' own interest in oral health (p=0.039). Conclusions: Based on the results of this study, it is necessary to increase the accessibility to the initial treatment for dental care of children through active promotion of detailed items of permanent teeth resin fillings.

• Journal of the Korean Data and Information Science Society
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• 제22권3호
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• pp.467-476
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• 2011

우리나라의 건강보험제도권 내 해당되지 않은 상해상병 진료건 중 국민건강보험으로 부당 잘못 청구되는 진료건을 적발하여, 환수조치하기 위해서는 정확한 상해상병 조사대상자 선정이 필요하다. 그러나, 국민건강보험공단의 한정된 인력으로 증가하는 상해조사관련 업무량을 보다 효율적으로 대처하고, 수행하기 위해서는 상해요인조사 업무 효율화 및 환수 결정율 제고를 위한 조사대상자 발췌기준의 고도화 방안을 마련해야 한다. 이에 본 연구에서는 상해상병 유형에 대해 일정금액 이상 진료건의 발췌 등과 같은 과거의 발췌기준에서 데이터마이닝 기법과 같은 통계적 모형과 업무규칙을 함께 적용한 하이브리드 모형으로서 상해상병 조사대상자 선정기준을 제시하고자하였다.

• 보건행정학회지
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• 제30권2호
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• pp.164-177
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• 2020

This study aims to compare the experience of selected countries in operating separate payment system for new healthcare technology and to find implications for price setting in Korea. We analyzed the related reports, papers, laws, regulations, and related agencies' online materials from five selected countries including the United States, Japan, Taiwan, Germany, and France. Each country has its own additional payment system for new technologies: transitional pass-through payment and new technology ambulatory payment classification for outpatient care and new technology add-on payment for inpatient care (USA), an extra payment for materials with new functions or new treatment (C1, C2; Japan), an additional payment system for new special treatment materials (Taiwan), a short-term extra funding for new diagnosis and treatment (NUB; Germany), and list of additional payments for new medical devices (France). The technology should be proven safe and effective in order to get approval for an additional payment. The price is determined by considering the actual cost of providing the technology and the cost of existing similar technologies listed in the benefits package. The revision cycle of the additional payment is 1 to 4 years. The cost or usage is monitored during that period and then integrated into the existing fee schedule or removed from the list. We conclude that it is important to set the explicit criteria to select services eligible for additional payment, to collect and analyze data to assess eligibility and to set the payment, to monitor the usage or cost, and to make follow-up measures in price setting for new health technologies in Korea.

• 의료법학
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• 제7권2호
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• pp.219-268
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• 2006

In July 1989, Korea had achieved the national medical insurance system comprehensively covering the whole population since its inception of 12 years before, and subsequently the plural medical insurers had integrated to the unique health insurer system in July 2000. But there yet remain some problems to be improved under low contributions rates and poor benefit packages, especially the shortage of assuring beneficiaries' rights. The Health Insurance Appeal System is composed of a two-tiered system of committee. The Formal Objection Committees built in the National Health Insurance Corporation and in the Health Insurance Review Agency respectively examine the formal objections to the decisions of the Corporation, or the Review Agency. And the Dispute Mediation Committee built under the command of the Minister of Health and Welfare reviews the protests against the decisions on the formal objections by each Formal Objection Committee. To cope with the appellant in relation to the administration on the qualification of the insureds, contributions, and insurance benefits etc, is found to be unsatisfactory. There's the reason of poor function on right-relief caused by the loose composition of the Appeal Committee, the deficit of people's recognition and P.R., the lack of professional manpower and the Committee's independency, and time lag in making decisions and so on. Consequently the Appeal System should be improved to secure the rights-relief function, to empower the professionalism of the Appeal Committee, to strengthen P.R. for the beneficiaries, to build up the staff's proficiency through training, and to develop the quality of administrative services.

• KDI Journal of Economic Policy
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• 제12권3호
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• pp.47-69
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• 1990

한국(韓國)의 의료보험제도(醫療保險制度)는 일본제도(日本制度)를 거울삼아 서둘러 적용대상자(適用對象者)를 확대하여 1989년 전국민의료보험(全國民醫療保險)을 달성하였으나 제도(制度)와 효율적(效率的) 운영(運營)을 위한 장치가 결여되어 있고 직장(職場), 공교(公敎), 지역의보간(地域醫保間)에 형평문제(衡平問題) 제기되는 등 구조적인 과제를 안고 있다. 앞으로 제도(制度)의 개혁추진(改革推進) 노력으로 이 분야의 정책수립(政策樹立)과 집행(執行) 에 있어서 경직성을 줄이고 비용효과적(費用效果的)인 의료이용(醫療利用)을 도모해 나가지 못할 경우 낭비요인(浪費要因)이 점점 더 크게 불어나 국민의료비(國民醫療費)가 계속적으로 급속히 증대될 전망이다. 이와 같은 제도(制度)의 질적개선(質的改善)의 필요성에 비추어 최근 네덜란드가 시도하고 있는 제도개혁(制度改革)은 우리에게 여러가지 귀중한 교훈을 던져주고 있다고 판단된다. 네덜란드의 개혁안은 시장경쟁원리(市場競爭原理)를 폭넓게 수용하여 제도(制度)의 능률(能率)을 높이고 의료비(醫療費)를 절감하려는 취지를 담고 있다. 특히 의보가입자(醫保加入者)가 보험자(保險者)를 선택할 수 있고 또한 보험자(保險者)가 의료기관(醫療機關)을 선택할 수 있도록 관계(關係) 집단간(集團間) 상호경쟁(相互競爭)을 유도함으로써 효율(效率)을 증진시켜 나가겠다는 정책방향이 뚜렷히 제시되고 있어 우리의 주목을 끌고 있다.

• 보건교육건강증진학회지
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• 제16권2호
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• pp.205-233
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• 1999

This study is an effort to make policy suggestions by analysing the current health examination program as a benefit service provided by the national health insurance system, including health screening for the insured, screening of cancer and chronic diseases for their dependents. Analyses found some issues being gave attention to; 1) The insured under the community health insurance system do not get the health examination benefit. A program for them should be set to have equity in benefit services. 2) Low rates of using screen services compromise purpose and the efficiency the services have first intended to. An immediate attention should be made to increase low rate of use of screen test to detect chronic diseases in particular. 3) Selection of diseases and test items covered by health examination program does not reflect the need of the insured, but to reflect financial resources of the national health insurance system. 4) Lack of health screening facilities and their geographical maldistribution is observed, which with preference of a general hospital as a screening post by the insured may lead to unreliable test. 5) A follow-up system should have been developed for the suspected classified by test results of carrying chronic diseases. They should be cared for within the health examination program. Public health care systems incorporate such a system, along with caring for those who are in need of having a health counselling on preventive care. In conclusion, the national health insurance system should be a medical insurance of giving a higher priority on preventive care benefits, health examination program in particular. That could be done by making rearrangements of test items, screening methods and system, rationalizing current reimbursement system of service fee, increasing accessibility to and utilization of the services, and making an establishment of follow-up system.

• 보건행정학회지
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• 제18권3호
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• pp.90-109
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• 2008

Government has extended the benefit coverage and reduced out-of-pocket (OOP) payment for cancer patients in 2005. This paper intends to examine the impact of the above policy on the equity in health care utilization. This paper analyzed the national health insurance data and compared the health care utilization of cancer patients before and after the policy change for people with 10 different income levels. For the equity in health care utilization, we examined the change in concentration index (CI) for visit days, inpatient days, and health expenditure. In the case of outpatient care, CI of visit days and health expenditure were positive(favoring the rich) in both regional and employee health insurance members and both 'before' and 'after' the policy change. CI values rarely changed after the policy change, and the policy change seems to have little impact on the equity of outpatient care utilization except expenditure of regional subscriber. In the case of inpatient care, CI of inpatient days was negative and CI of health expenditure was positive in both regional and work subscriber and both 'before' and 'after' the policy change. After the policy change, CI of inpatient expenditure in both groups of members decreased. CI of inpatient days changed in the direction favoring the poor in regional insurance members, but it rarely changed in employee insurance members. These results suggest that the policy of reducing OOP payment has a positive impact and reduced the inequity particularly in the utilization of inpatient care of cancer patients.

• Journal of Periodontal and Implant Science
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• 제48권1호
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• pp.3-11
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• 2018

Purpose: This study utilized a strong quasi-experimental design to test the hypothesis that the implementation of a policy to expand dental care services resulted in an increase in the usage of dental outpatient services. Methods: A total of 45,650,000 subjects with diagnoses of gingivitis or advanced periodontitis who received dental scaling were selected and examined, utilizing National Health Insurance claims data from July 2010 through November 2015. We performed a segmented regression analysis of the interrupted time-series to analyze the time-series trend in dental costs before and after the policy implementation, and assessed immediate changes in dental costs. Results: After the policy change was implemented, a statistically significant 18% increase occurred in the observed total dental cost per patient, after adjustment for age, sex, and residence area. In addition, the dental costs of outpatient gingivitis treatment increased immediately by almost 47%, compared with a 15% increase in treatment costs for advanced periodontitis outpatients. This policy effect appears to be sustainable. Conclusions: The introduction of the new policy positively impacted the immediate and long-term outpatient utilization of dental scaling treatment in South Korea. While the policy was intended to entice patients to prevent periodontal disease, thus benefiting the insurance system, our results showed that the policy also increased treatment accessibility for potential periodontal disease patients and may improve long-term periodontal health in the South Korean population.

• Clinical and Experimental Pediatrics
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• 제51권4호
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• pp.339-342
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• 2008

The Korean Health Insurance (KHI) has been introduced since 1977 and it took only 12 years that KHI had accomplished the total coverage of Korean population. The remarkable success of KHI can be compared with other OECD countries which had taken some 30 years to over 100 years to establish the total coverage of the population. Life expectancy at birth and the infant mortality rate in Korea in 2005 both surpassed the average figures of the OECD countries, The main reason for the success of KHI can be delineated with the three characteristics in KHI development; low premiums, low benefits, and low fee-schedule charges. However, these three characteristics of KHI, which had been the key for the rapid development of the system, have become terrible disadvantages for the stable development of KHI. The dissatisfaction and discontent of health care providers are ever increasing. The population is reluctant to pay more premiums though it seems essential for the better care coverage. The health care system has been heavily distorted toward high technology-oriented expensive care. There should be several factors seriously tackled for the secure development of KHI in the future. This paper will review a brief history of KHI development, and I would like to make a suggestion of health insurance for children.