• Health Policy and Management
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• v.33 no.3
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• pp.243-252
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• 2023

This paper aims to introduce Korea's total current health expenditure (CHE) and National Health Accounts of the year 2021 and their 2022 preliminary figures constructed on the basis of the System of Health Accounts 2011. As CHE includes expenditures for prevention, tracking, and treatment of coronavirus disease 2019 (COVID-19) and compensation for losses to medical institutions from 2020, the details are also introduced. Korea's total CHE in 2021 is 193.3 trillion won, which is 9.3% of gross domestic product (GDP). The preliminary figure in 2022, 209.0 trillion won, exceeded the 200 trillion won line for the first time, and its "ratio to GDP" of 9.7% is expected to exceed the average of Organisation for Economic Co-Operation and Development member countries for the first time. Korea's health expenditures, which were well controlled until the end of the 20th century, have increased at an alarming rate since the beginning of the 21st century, threatening the sustainability of national health insurance. The increase in health expenditure after 2020 is partly due to a temporary increase in response to COVID-19. However, when considering the structure of Korea's health insurance price hike, where the ratchet effect of increased medical expenses works particularly strongly, it is unlikely that the accelerating growth trend that has lasted for more than 20 years will stop easily. More aggressive policies to control medical expenses are required in the national health insurance which not only constitutes the main financing sources of the Korean health system but also has the most powerful policy means in effect for changes in the health care provision.

• Health Policy and Management
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• v.22 no.4
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• pp.561-578
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• 2012

This study was performed in order to compare a change in pharmaceutical expenditures per outpatient of clinic and to analyze factors relevant to a systems as part of evaluating policies for the incentive scheme to reduce total prescribed drug expenditure and for the drug utilization review system("DUR system" hereafter). For this, it had finally analytical subjects as 21,320 clinics nationwide without a change in location, clinics symbol and signed subject during both terms of the first half of 2010 and the first half of 2011. As a result, the odds ratio with reduction in pharmaceutical expenditures of clinic was statistically higher significantly in the shorter year number of opening clinic, in the larger number of doctors, when the classification of establishment is other, not individual, and when the signed subject is surgical division. Also, the odds ratio was significantly higher in the less patient number of clinic and in the lower ratio of patients aged over 65. Finally, the odds ratio was significantly high when a clinic had been located in DUR system demonstrative project area. Through this, a case of policy for improvement in doctor's autonomous prescription behavior like DUR system can be known to be effective for reduction in pharmaceutical expenditures. A future research on evaluation of policy for pharmaceutical expenditure management system will need to be performed in-depth analysis in consideration of diverse characteristics on the participatory entities.

• Korea Journal of Hospital Management
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• v.23 no.2
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• pp.18-27
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• 2018

Purposes: This study aims to investigate the policy effect of mandatory application of DRG for 7 disease groups in general and tertiary hospitals. Methodology: As DRG was fully implemented in July 2013, this study compares two periods before and after the change(from July 2012 to June 2013, and from July 2013 to June 2014). The benefit claim data of the National Health Insurance Service was used for the comparison. Target patients were those who visited general or tertiary hospitals between July 2012 to June 2014. For pharmaceutical consumption, Interrupted Time Series (ITS) analysis was used to see the effect of DRG mandatory application. Findings: The number of drugs prescribed per patient and pharmaceutical expenditure both showed significant reduction compared to before the DRG implementation. Practical Implications: This study used 2 sets of 1 year period data from before and after the full implementation of DRG to analyze pharmaceutical consumption. When the comparison data accumulates further, it would be possible to conduct more diverse analysis to assess policy effect and to provide way forward for the future.

• Korea Journal of Hospital Management
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• v.8 no.2
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• pp.93-110
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• 2003

Fiscal crisis in the medical insurance has put the pressure upon hospitals by increasing the rate of curtailment, since the implementation of the separation between prescription and dispensing of Drug. The purpose of this study is to analyze the curtailment for antibiotics, injected drug and other drugs expenditure before and after the system of separation between prescribing and dispensing. Data were gathered from 13 general hospitals and used for analysis of trends on antibiotics and injected drug expenditure, and curtailment in 2000-2001 at three months intervals. The results were as follows; The curtailment rate of antibiotics expenditure has been increased in outpatient and inpatient since 2000. The curtailed antibiotics cost and injected drug cost in outpatient under the prescription within the hospital and in inpatient increased. The ratios of curtailment versus expenditure had increased in antibiotics, injected drugs, anticancer drugs, antiulcer drugs, albumine, antiinflammatory drugs. These results suggest that claim review system in social health insurance were over-focused mainly to control the cost and it might to impede the validity of claim review function in health insurance system. Therefore, it's needed to develope the scientific and reasonable parameter & criteria for claim review of drug expenditure.

• Quality Improvement in Health Care
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• v.17 no.1
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• pp.69-78
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• 2011

Objectives : The purpose of this study was to determine whether the published AMI report card could reduce in-patient mortality, 7-day after discharge mortality, and length of stay (LOS). Methods : Interrupted time-series intervention analysis was used to evaluate the impact of the report card for AMI care quality in November 2005 in terms of risk-adjusted in-patient mortality, risk-adjusted 7-day after discharge mortality, and DRGs case-mix LOS using the claim data of Health Insurance Review and Assessment Service. Results : Public disclosure of AMI care quality decreased risk-adjusted in-patient mortality and DRGs case-mix LOS by 0.00050% per month and 0.042 days per month respectively, however there was no effect on risk-adjusted 7-day after discharge mortality. Patterns of effect of public disclosure on AMI outcomes were a fluctuating pattern on risk-adjusted mortalities and a pulse impact for 1 month on DRGs case-mix LOS. Conclusions : We found the public disclosure of AMI care quality had decreasing effects on risk-adjusted in-patient mortality and DRGs case-mix LOS, but the size of the effect was marginal.

• Quality Improvement in Health Care
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• v.11 no.1
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• pp.62-70
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• 2004

• Research in Community and Public Health Nursing
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• v.19 no.4
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• pp.660-672
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• 2008

Purpose: To analyze the home care services provided to the elderly aged 65 and older by a hospital-based home care agencies and to investigate the effects of long-term care insurance for the elderly. Method: The subjects were the home care service recipients aged 65 and older in 172 hospital-based, home care agencies registered in Health Insurance Review & Assessment Service in January, 2007. The data were collected using a questionnaire from March 16 to April 15, 2007. The questionnaire return rate was 43.8%. Result: The hospital-based home care agencies were able to visit 66.5% of the national administrative districts. Of the home care service recipients, over 50% were 65 years old and older. About 43% of the agencies reported that over 50% of their patients would be subject to the long-term care insurance. They expressed concern that home care services would be withdrawn once the insurance system is initiated. Conclusion: This study suggests that hospital-based home care agencies need to manage home care services with long-term care insurance. It also recommends developing guidelines for the use of services and referrals.

• Korean Journal of Clinical Pharmacy
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• v.30 no.3
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• pp.177-184
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• 2020

Background & objective: The Korean government has expanded its benefit coverage to enhance patients' access to orphan drugs and cancer medicines. However, the number of new drugs whose indications were not applied to reimbursement in health insurance was increased. This study aimed to understand the perspectives of experts and various stakeholders on the introduction of a new funding program for cancer treatment and orphan drugs. Methods: We conducted email surveys comprising 19 questions, from September 9 to 26, 2016. We distributed questionnaires to members of the Pharmaceutical Benefit Appraisal Committee and Cancer Assessment Committee. We also conducted a qualitative study through group interviews with stakeholders, including pharmaceutical companies and some patient groups for diseases. Results: A total of 35 survey respondents recommended the introduction of a funding program for orphan drugs, whereas 66% recommended the launch of funding for anticancer drugs. In addition, most pharmaceutical companies and patient groups recommended the introduction of new funding programs targeting patients with cancer and rare diseases. However, some participants asserted that it would be more appropriate to modify the existing reimbursement scheme than launch new funding. Conclusion: This study concluded that introducing new funding needs a social consensus to relieve financial hardships at the patient level.

• Health Policy and Management
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• v.14 no.2
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• pp.58-77
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• 2004

Cost containment has become high political issues since financial crisis of the Korean Health Insurance fund in 2000. Korean Government has developed and implemented several measures to reduce the pharmaceutical expenditures. Pharmaceutical economic evaluation can be a tool in decision to allocate scare resource efficiently. In order to increase the quality of economic evaluation for pharmaceuticals, the Korean Health Insurance Review Agency(HIRA) is considering the development of a guideline for economic evaluation. It mandates that pharmaceutical companies could submit the result of an economic evaluation when demanding reimbursement of new pharmaceutical drugs. The purpose of this study is to provide a critical review of the economic evaluations of health care technologies published in the Korean context whether they have been performed according to current guidelines and therefore whether their results are directly useful for decision making. We found there exist important problems and deviation from, good practice' both in the general features of the studies, like the study design and perspective, and in terms of cost measurement and valuation. There are needs to develop clear guidelines and to educate and train researchers in performing economic evaluations.

• Journal of Preventive Medicine and Public Health
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• v.45 no.5
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• pp.291-300
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• 2012

Objectives: We aimed to estimate the annual socioeconomic burden of coronary heart disease (CHD) in Korea in 2005, using the National Health Insurance (NHI) claims data. Methods: A prevalence-based, top-down, cost-of-treatment method was used to assess the direct and indirect costs of CHD (International Classification of Diseases, 10th revision codes of I20-I25), angina pectoris (I20), and myocardial infarction (MI, I21-I23) from a societal perspective. Results: Estimated national spending on CHD in 2005 was $2.52 billion. The majority of the spending was attributable to medical costs (53.3%), followed by productivity loss due to morbidity and premature death (33.6%), transportation (8.1%), and informal caregiver costs (4.9%). While medical cost was the predominant cost attribute in treating angina (74.3% of the total cost), premature death was the largest cost attribute for patients with MI (66.9%). Annual per-capita cost of treating MI, excluding premature death cost, was $3183, which is about 2 times higher than the cost for angina ($1556). Conclusions: The total insurance-covered medical cost ($1.13 billion) of CHD accounted for approximately 6.02% of the total annual NHI expenditure. These findings suggest that the current burden of CHD on society is tremendous and that more effective prevention strategies are required in Korea.