• 보건행정학회지
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• 제27권4호
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• pp.273-275
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• 2017

It has been forty years since the implementation of National Health Insurance (NHI) in South Korea. Following the 1977 legislature mandating medical insurance for employees and dependents in firms with more than 500 employees, South Korea expanded its health insurance to urban residents in 1989. Resultantly, total expenses of the National Health Insurance Service (NHIS) have greatly increased from 4.5 billion won in 1977 to 50.89 trillion won in 2016. With multiple insurers merging into the NHI system in 2000, a single-payer healthcare system emerged, along with separation policy of prescribing and dispensing. Following such reform, an emerging financial crisis required injections from the National Health Promotion Fund. Forty years following the introduction of the NHI system, both praise and criticism have been drawn. In just 12 years, the NHI achieved the fastest health population coverage in the world. Current medical expenditure is not high relative to the rest of the Organization for Economic Cooperation and Development. The quality of acute care in Korea is one of the best in the world. There is no sign of delayed diagnosis and/or treatment for most diseases. However, the NHI has been under-insured, requiring high-levels of out-of-pocket money from patients and often causing catastrophic medical expenses. Furthermore, the current environmental circumstances of the NHI are threatening its sustainability. Low birth rate decline, as well as slow economic growth, will make sustainment of the current healthcare system difficult in the near future. An aging population will increase the amount of medical expenditure required, especially with the baby-boomer generation of those born between 1955 and 1965. Meanwhile, there is always the problem of unification for the Korean Peninsula, and what role the health insurance system will have to play when it occurs. In the presidential election, health insurance is a main issue; however, there is greater focus on expansion and expenditure than revenue. Many aspects of Korea's NHI system (1977) were modeled after the German (1883) and Japanese (1922) systems. Such systems were created during an era where infections disease control was most urgent and thus, in the current non-communicable disease (NCD) era, must be redesigned. The Korean system, which is already forty years old, must be redesigned completely. Although health insurance benefit expansion is necessary, financial measures, as well as moral hazard control measures, must also be considered. Ultimately, there are three aspects that we must consider when attempting redesign of the system. First, the health security system must be reformed. NHI and Medical Aid must be amalgamated into one system for increased effectiveness and efficiency of the system. Within the single insurer system of the NHI must be an internal market for maximum efficiency. The NHIS must be separated into regions so that regional organizers have greater responsibility over their actions. Although insurance must continue to be imposed nationally, risk-adjustment must be distributed regionally and assessed by different regional systems. Second, as a solution for the decreasing flow of insurance revenue, low premium level must be increased to an appropriate level. Likewise, the national reserve fund (No. 36, National Health Insurance Act) must be enlarged for re-unification preparation. Third, there must be revolutionary reform of benefit package. The current system built a focus on communicable diseases which is inappropriate in this NCD era. Medical benefits must not be one-time events but provide chronic disease management. Chronic care models, accountable care organization, patient-centered medical homes, and other systems that introduce various benefit packages for beneficiaries must be implemented. The reimbursement system of medical costs should be introduced to various systems for different types of care, as is the case with part C (Medicare Advantage Program) of America's Medicare system that substitutes part A and part B. Pay for performance must be expanded so that there is not only improvement in quality of care but also medical costs. Moreover, beneficiaries of the NHI system must be aware of the amount of their expenditure through a deductible payment system so that spending can be profiled and monitored. The Moon Jae-in Government has announced its plans to expand the NHI system; however, it is important that a discussion forum is created so that more accurate analysis of the NHI, its environments, and current status of health care system, can take place for reforming NHI.

• 정보화정책
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• 제25권1호
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• pp.60-81
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• 2018

보건의료와 ICT가 결합된 형태인 디지털 헬스케어는 보건의료 패러다임을 진단 치료에서 예방 관리로 변화시키고 있다. 또한 부가가치가 매우 높은 경제 발전의 신성장 동력으로 인식되고 있으며, 우리 정부도 이의 발전을 위해 관련 제반 기술 및 정보에 대한 합리적 법적 기준과 규제체계를 마련하고자 노력하고 있다. 하지만 이러한 노력에도 불구하고, 정부의 디지털 헬스케어 발전을 위한 규제 개선 전략에 변화가 필요하다는 주장이 지속적으로 제기되고 있다. 이에 본 연구에서는 우선 우리나라와 해외 주요국의 디지털 헬스케어 발전을 위한 규제 개선 전략을 비교 분석하여 차이점을 확인하였다. 이어서 본 연구는 디지털 헬스케어와 관련된 신문기사 분석과 전문가 인터뷰를 실시하여 국내 디지털 헬스케어 관련 규제 쟁점과 발전을 위한 규제 개선 전략을 도출하였다. 전문가들은 디지털 헬스케어 관련 규제 개선을 위해 특히 부처 간 협업구조의 구축, 부처의 전문역량 강화와 전문가 확보, 폭넓은 이해관계자의 참여 보장, 그리고 의료 정보의 처리에 대한 명확한 기준 마련을 중요하게 인식함을 확인하였다. 마지막으로 본 연구는 전문가 인터뷰 결과를 중심으로 하여 연구의 시사점을 제시하였다.

• 보건행정학회지
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• 제13권3호
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• pp.52-70
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• 2003

The rate of conversion to Medical-juridical-persons' ownership of medical institutions has increased rapidly since its start in 1970s in Korea. The most sensitive issue to introduce for-profit medical institutions, ignited particularly by the WTO/DDA negotiations, has sparked considerable debate, stemming largely from conflicting views on the theoretical effects of ownership status on organizational behavior. This study surveyed health-related experts' opinions on allowing for for-profit-firms-owned medical institutions. Some fear that the obligation to maximize the share-holders' return on their investment will cause the medical institutions to eliminate necessary but less lucrative services. They may easily fall under more pressure to generate income, and respond more aggressively than not-for-profit medical institutions to financial pressures. Advocates of for-profit ownership of medical institutions argue that greater responsiveness to the demands of the marketplace will lead to larger investment, higher quality and lower costs to consumers. Referring to both foreign countries' experience and domestic experts' opinions, this study suggests for reform of the current Korean Medical-Juridical-Person(MJP) System. Introduction of so-called “Capital-investment” MJPs is recommended where the properties left in case of their dissolution can be distributed to original investors according to the procedures stipulated in their statutes. However, their annual profits are not allowed to be allocated to investors, but should be reinvested for their medical institutions, as is the case in current MJPs. Their legal aspects are also reviewed in this study.

• 보건행정학회지
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• 제8권1호
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• pp.97-111
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• 1998

Do managers in health center perceive red tape in their organizations\ulcorner Most people would think so, but researchers have often found that health center organizations do not necessarily have higher levels of rule intensity than private hospitals. It there are higher levels in health center organizations, what explains their existence\ulcorner In this article, I discuss the results of a survey of health center managers that explored their perceptions of red tape in their organizations. Red Tape can be defined as rule and procedures that occured a excessive regulation. The survey included two dimensions and two hypotheses of red tape in health center managers. The hypotheses included health center and size that claims cause managers to create red tape. 119 managers who working in health center and private hospitals in Chonbuk area, participated in this study which was conducted by direct interview. The results show some support for two hypothses. The results showed some differences between health center and private hospital managers' perceptions about certain aspects of red tape. I also found differences between large size and small size managers' perceptions. The study call for more systematic analysis of red tape, including the use of methods, in support of current reform efforts aimed at reducing red tape.

• 한국직업건강간호학회지
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• 제19권2호
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• pp.246-257
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• 2010

Purpose: The purpose of this study was to explore the factors related to physical and affective well-being of taxi drivers. The main factors of interests were workplace hazards and work environment. Method: This was a cross-sectional descriptive study. A convenience sampling method was utilized. 181 taxi drivers in Seoul metropolitan area completed survey questionnaires. Result: In bivariate analysis, payment system, workplace hazards, and work environment were associated with physical health of taxi drivers. Multiple regression analysis revealed payment system and workplace hazards were significant predictors of physical health. On the other hand, age and workplace hazards, and work environment were significantly associated with affective health in the bivariate analysis. Moreover, workplace hazards and environment were significant predictors of affective health in the multiple regression analysis. Conclusion: To improve taxi drivers' health status, it is critical to reform payment system to monthly payment, establish prevention policies of workplace hazards, and encourage employers and taxi drivers to make efforts for better work environment.

• 보건행정학회지
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• 제23권4호
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• pp.303-313
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• 2013

During last 65 years, Korea has achieved very rapid economic growth and social reformation including healthcare system. Many foreigners have praised that Korea healthcare system is very good in the respect of ease accessibility to healthcare under the lowest cost among the industrialized countries. Whole population are covered by the National Health Insurance. Also utilizations of healthcare among different income classes are even. However Korea healthcare system faced with several challenges, in terms of the an aging population and a rise in chronic disease problem, new threats of communicable disease due to globalization, the rapid increase of healthcare expenditure and high financial burden of patients even though they are insured. To cope with these challenges, we need reconsider the healthcare system as followings; to set up ideology of healthcare as normative public goods, to rebuild paradigm of healthcare for 21 century, to reform public health for strengthening health promotion, to develop new method for healthcare management including quality improvement and consumer responsiveness, to build new governance for health and to view new perspective on healthcare as a kind of industry.

• 보건행정학회지
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• 제14권2호
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• pp.17-33
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• 2004

The present study attempts to examine the progressivity of health care financial sources based on the income approach, for which it decomposes redistributive effects into vertical, horizontal, and re-ranking components. The study data include Korean Household Expenditure Survey (2000) conducted every 5 year by Korea National Statistical Office. The data were sampled from the national population by the multistage probabilistic sampling method, and amounts to 23,270 households. For the better application of the income approach, the study employs household total expenditure in Korea instead of total income, because the former data source is more reliable and less fluctuated over time. Progressivity of health care financing was measured by Kakwani index. Aronson's decomposition equation was used in case of the analysis where differential treatment of health care expenditure needs to be considered. Despite the progressivity of Korea's governmental contributions, total expenditure of health care showed regressive pattern, which may largely be attributable to the higher regressivity in out-of-pocket money. With the result of negative Kakwani index, differential treatment increased income redistribution biased for better-off. It is worth to note that social insurance displays not only negative Kakwani index, but also horizontal inequality, suggesting that the first step of health care financing reform should be the revision of social insurance premium rates toward effective and equable way.

• 한국전자거래학회:학술대회논문집
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• 한국전자거래학회 2005년도 e-Biz World Conference 2005
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• pp.125-129
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• 2005

The recent push for healthcare reform has caused healthcare organizations to focus on ways to streamlined processes in order to secure high quality care as well as reducing costs. Healthcare enterprises involve complex processes that span diverse groups and organizations. These processes involve clinical and administrative tasks, large quantities of data, and large number of patients and personnel. We propose the mobile-based workflow system of passable communication as an important factor in the B2B healthcare. Based on the above proposal the workflow system of business process was designed and implemented on the basis of Java, UML and XPDL.

• 보건행정학회지
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• 제14권4호
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• pp.21-47
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• 2004

There is general agreement that the Korean health care delivery system has two basic structural problems. One is the limited capacity and role of public hospitals, and the other is the absence of functional differentiation and referral arrangement between the clinics and hospitals of various technological sophistication levels. This study is intended to make an empirical observation of the system's growth process from the viewpoint of the population ecology model of organizations so as to understand the background of these problems and to find out ways of approaching them. As predicted from the population ecology model of organizations, all the types of medical care facilities have expanded in response to the environmental changes for the past three decades or so, and the differences in the extent and pattern of expansion among the types are related to what have taken place in the environment. These findings suggest that the efforts for reforming the health care delivery system should be directed not only to medical care institutions but also to the environmental context under which they function. It is believed that the usefulness of the population ecology perspective on organizations for studying the health care delivery system has been demonstrated. Thus further studies along this line based upon more strict design would improve systematic understanding of the system that is needed for developing policy approaches needed to increase its effectiveness.

• Journal of Preventive Medicine and Public Health
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• 제48권6호
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• pp.265-270
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• 2015

The recent Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak has originated from a failure in the national quarantine system in the Republic of Korea as most basic role of protecting the safety and lives of its citizens. Furthermore, a number of the Korean healthcare system's weaknesses seem to have been completely exposed. The MERS-CoV outbreak can be considered a typical public health crisis in that the public was not only greatly terrorized by the actual fear of the disease, but also experienced a great impact to their daily lives, all in a short period of time. Preparedness for and an appropriate response to a public health crisis require comprehensive systematic public healthcare measures to address risks comprehensively with an all-hazards approach. Consequently, discussion regarding establishment of post-MERS-CoV improvement measures must focus on the total reform of the national quarantine system and strengthening of the public health infrastructure. In addition, the Korea Centers for Disease Control and Prevention must implement specific strategies of action including taking on the role of "control tower" in a public health emergency, training of Field Epidemic Intelligence Service officers, establishment of collaborative governance between central and local governments for infection prevention and control, strengthening the roles and capabilities of community-based public hospitals, and development of nationwide crisis communication methods.