• Asian Pacific Journal of Cancer Prevention
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• v.15 no.13
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• pp.5265-5270
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• 2014

Background: In Korea, the National Health Insurance program has initiated various copayment policies over a decade in order to alleviate patient financial burden. This study investigated healthcare spending and utilization in the last 12 months of life among patients who died with lung cancer by various copayment policy windows. Materials and Methods: We performed a retrospective cohort study using nationwide lung cancer health insurance claims data from 2002 to 2012. We used descriptive and multivariate methods to compare spending measured by total costs, payer costs, copayments, and utilization (measured by length of stay or outpatient days). Using 1,4417,380 individual health insurance claims (inpatients: 673,122, outpatients: 744,258), we obtained aggregated healthcare spending and utilization of 155,273 individual patient (131,494 inpatient and 103,855 outpatient) records. Results: National spending and utilization is growing, with a significant portion of inpatient healthcare spending and utilization occurring during the end-of-life period. Specifically, inpatients were more likely to have more spending and utilization as they got close to death. As coverage expanded, copayments decreased, but overall costs increased due to increased utilization. The trends were the same in both inpatient and outpatient services. Multivariate analysis confirmed the associations. Conclusions: We found evidence of the higher end of life healthcare spending and utilizations in lung cancer patients occurring as coverage expanded. The practice pattern within a hospital might be influenced by coverage policies. Health policy makers should consider initiating various health policies since these influence the long-term outcomes of service performance and overall healthcare spending and utilization.

• Journal of Preventive Medicine and Public Health
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• v.56 no.5
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• pp.475-480
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• 2023

Objectives: This study examined differences in health care spending and characteristics among older adults in Korea by high-cost status (persistently, transiently, and never high-cost). Methods: We identified 1 364 119 older adults using data from the Korean National Insurance Claims Database for 2017-2019. Outcomes included average annual total health care spending and high-cost status for 2017-2019. Linear regression was used to estimate differences in the outcomes while adjusting for individual-level characteristics. Results: Persistently and transiently high-cost older adults had higher health care spending than never high-cost older adults, but the difference in health care spending was greater among persistently high-cost older adults than among transiently high-cost older adults (US$20 437 vs. 5486). Despite demographic and socioeconomic differences between transiently high-cost and never high-cost older adults, the presence of comorbid conditions remained the most significant factor. However, there were no or small differences in the prevalence of comorbid conditions between persistently high-cost and transiently high-cost older adults. Rather, notable differences were observed in socioeconomic status, including disability and receipt of Medical Aid. Conclusions: Medical risk factors contribute to high health care spending to some extent, but social risk factors may be a source of persistent high-cost status among older adults in Korea.

• Health Policy and Management
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• v.28 no.4
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• pp.360-368
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• 2018

Background: The proportion of pharmaceutical expenditure out of total health-care expenditure in South Korea is high. In 2016, 25.7% of national health insurance (NHI) spending was for pharmaceuticals. Given the increasing demands for the access to newly introduced medicines and following increase in pharmaceutical spending, the management of NHI pharmaceutical expenditure is becoming more difficult. Methods: This study analyzed the data claimed to NHI for pharmaceutical reimbursement from 2010 to 2016. Results: The policy implications with respect to the trends and problems in spending by drug groups were elicited. First, the proportion of off-patent drugs spending which were treated to chronic disease was much higher than anti-cancer drug spending. Second, the spending to the newly introduced high-costed medicine increased, however, current price-reduction mechanism was not sufficient to manage their expenditure efficiently. Conclusion: Our system seems to need several revisions to improve the efficiency of pharmaceutical expenditure and to cope with high-costed medicines. This study suggested that the prices of off-patent drugs need to be regularly readjusted and the Price-Volume Agreement System should be operated more flexibly as well.

• Health Policy and Management
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• v.17 no.2
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• pp.1-17
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• 2007

Limited coverage for health care services of National Health Insurance(NHI) in Korea has been ongoing policy issue but additional NHI financing through raising contribution or taxes in order to improve coverage faces substantial obstacles. Private health insurance(PHI) is often considered as an alternative financing source to improve coverage. Recent reform that attempted to stretch the role of PHI allowed life insurance companies to provide complementary PHI, indemnity plan which will pay for uncovered services by NHI and out-of-pocket spending for covered services. Although complementary PHI may relieve financial burden of patients, it may significantly raise NHI spending as well as total health expenditure since little out-of-pocket spending may increase utilization of health care. So far, there has not been enough discussion about concerns of potential adverse effect resulting from extended role of PHI. This study investigated potential increase of NHI spending followed by extension of complementary PHI through sensitivity analysis. The amount of NHI spending for services that would be covered by complementary PHI was calculated using 2005 NHI statistics and expected complementary PHI enrollment rate by age and sex. Expected utilization increases were obtained based on price elasticities$(-0.2{\sim}-0.5)$ from previous studies and expected coverage rate$(50{\sim}80%)$ of complementary PHI and then converted to monetary figures. Because coverage rate of complementary PHI has not been determined yet, we employed the sensitivity analysis using coverage rate of $50{\sim}80%$. Findings demonstrate that additional spending for health care services is expected to be $426{\sim}1,702$ billion won, corresponding amount payed by NHI $298{\sim}1,192$ billion won. In conclusion, since complementary PHI may raise NHI spending significantly, there should be an agreement whether this additional cost would be accountable and acceptable in our society. Potential inefficiency resulting from extended role of complementary PHI should be considered since public and private financing do not operate in isolation and there should be more discussion on proper role of PHI in Korea.

• 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.

• Journal of Korean Academy of Nursing Administration
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• v.5 no.1
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• pp.99-111
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• 1999

The purpose of this study was to investigate the relationship between public health nurse's decentralization, participation of decision-making and organizational commitment and to provide basic data for the improvement of public health nurse's organizational effectiveness. Data were collected from Aug. 1 to Aug. 30, 1998 (collection rate-96%) through questionnaires by 163 public health nurses working in Taejon and Chungnam. The instruments were used Van de Ven and Ferry's Job Authority scale, Hage and Aiken's Hierarchy of Authority scale. Participation of Decision-making scale. and Mowday's Organizational Commitment Questionnaires. Collected data were analyzed by SPSS PC+. The results were as follows 1. There were significant differences of age(P<.05), career, spending time for major study, and experience who called expert(P<.01) to decentralization. 2. There were significant differences of career (P<.05), educational level, and spending time for major study(P<'OOl) to participation of decision-making. 3. There were significant differences of career. spending time for D1ajor study, self-evaluation to specialty(P<.01) and experience who called expert (P<.001) to organizational commitment. 4. 1) A significant correlation was found between decentralization and self-evaluation to specialty (P<.05), age, career, spending time for major study, and experience who called expert (P<.01.). 2) A significant correlation was found between participation of decision-making and self-eval-uation to specialty(P<.05), age, career, spending time for major study, experience to call expert, and decentralization (P<.01). 3) A significant correlation was found between organizational commitment and age(P<.05). career. spending time for major study, self-eval-uation to specialty, experience who called expert. decentralization, and participation of decision-making (P<.01). 5. Decentralization w·as the best predictor of or ganizational commitment(17%), also experience who called expert, self-evaluation to specialty explained the organizational commitment.

• Journal of Society of Preventive Korean Medicine
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• v.24 no.2
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• pp.31-41
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• 2020

Background : The introduction of policies expanding the coverage of uninsured Korean Medicine (KM) services have requires an understanding of the following components of the service : current financial expenses, degree of financial burden on the patient, and financial effect of the coverage expansion. Objectives : This study aims to determine the annual trend of outpatients' characteristics and the category of out-of-pocket spending in KM. Methods : This study uses data from the Korea Health Panel to analyze use of KM in the Korean population. Using the user characteristics and behavior drawn from the Korea Health Panel data, out-of-pocket spending trends of KM were analyzed by year. The diagnosis and prescription of out-of-pocket spending were also analyzed. Results : The proportion of patients receiving uninsured medical treatment and the number of uninsured medical treatment in outpatient clinics have increased. However, the average out-of-pocket spending per person and out-of-pocket spending per visit are consistent or have decreased. Meaningful trends are the increase of R00-R99 (unclassified symptoms) and the decrease of K00-K93 (digestive system disease) and J00-J99 (respiratory system disease). Conclusions : Expansion of KM medical service and insurance is influenced by uninsured medical treatment of KM. Hence, research to increase medical treatment categories for out-of-pocket spending or explore diseases where KM diagnosis has been proven effective should be further developed.

• Journal of Families and Better Life
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• v.26 no.6
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• pp.181-192
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• 2008

This study investigated the usefulness of Consumer Expectation Index to predict real household spending. Specifically, the forecasting impact of the index on clothing, eating-out, entertainment, education, and health consumption area was examined. The results showed that the CEI was a good indicator for the future household spending of clothing, eating-out, entertainment and total consumption but it was not true for the spending of education and health. Most of CEls were significantly correlated with household spending even when household income and CPI were controlled. The impact of CEls on household spending tended to be lagged by one or two quarters.

• Journal of Korean Public Health Nursing
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• v.12 no.2
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• pp.1-11
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• 1998

This study was performed to analyze the occupational health nursing of support-project of health management skill for small-scale industries. The 2 subject centers were under the umbrella of Korean Industrial Health Association and data collection period was 2weeks from September 1 to 13. 1997 and time and motion study method was used. Data was handled by SPSS win 7.5 program. results were worked out number. percentage. F-value. (1) The weekly time spending of occupational health nurses was distributed into indoor service 46.9%, outdoor service 26.6%, movement 26.5%. The mean visiting times were 2-3 times per week. and spending time was about 1 hour per industry. (2) There are statistically significant difference among the distribution of time spending according to industrial works(F=23.08. p=.000). and the special education for occupational disease prevention takes the most mean time. (3) There were statistically significant difference among the spending time for the health coach of occupational health nurses(F=188.79. p=.000). and the activity time for workers (58.4%) was more than that of for monitors(41.6%). The frequency of health coachs were 155 times for monitors during two weeks. but health coach for worker was 87 times. As a results. the contents of health coach for workers was proved to take more time than that for monitors. Perhaps we think that monitors has limitation for health management. therefore we should be consider flexible management of visiting time and health coach guidelines for occupational health nurses. (4) There were statistically significant differences among the distribution of time spending according to health coach methods for industrial health nurses(F=66.31. p=.000). The most frequent method of all was guide transmission. 159 times(65.7%), and the mean spending time for instruction was 19.78 min. the longest time. Our suggestion for occupational health nursing of support-project of health management skill for small-scale industry is that the need of each industry is very complex because of various conditions. therefore need assessment for industries should be conducted professionally. And occupational health nurses should apply occupational health nursing process autonomously. and their activities be guaranted by the guideline

• Korea Journal of Hospital Management
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• v.15 no.4
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• pp.1-26
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• 2010

We achieved both industrialization and democratization during the shortest period in the world. We also achieved good performance in national health insurance: universal coverage, solidarity in financing, equitable access of health care. However, national health insurance system has faced the problem of sustainability: various expenditure and financing problems. The problem of sustainablity has two facets of economic sustainability and fiscal sustainability. Economic sustainability refers to growth in health spending as a proportion of gross domestic product(GDP). Rapid increasing rate of health spending exceeds the growth rate of domestic product. Growth in health spending is more likely to threaten other areas of economic activity. Concern on fiscal sustainability relates to revenue and expenditure on health care. Health care financing face demographic and technical obstacles. Democratic obstacle is aging problem. Technical obstacle is collection of contribution. Expenditure of health care has various problems in benefit structure and efficiency of health care system. In this article, I suggest several policy reforms to enhance sustainability: generating additional revenue from value added tax, changing method of levying contribution, increasing efficiency of health care system by introducing the competition principle. restructuring of benefit scheme of health insurance. contracting with health care institutions to provide health care services.