• 디지털융복합연구
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• 제17권5호
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• pp.77-88
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• 2019

본 연구는 소득보장 정책에서의 기본소득 보장이 빈곤해소와 생활자립에 미치는 영향력을 밝히는데 목적을 갖고 실증분석 하였다. 변수는 기본소득보장의 노령연금의 국민연금과 기초연금 및 고용보험으로서의 실업급여와 생계급여에 따른 빈곤해소와 생활자립을 종속변수로 하여 한국복지패널 10차 자료를 이용하여 통계 패키지 프로그램으로 분석하였다. 전체적인 결과를 보면 소득보장정책에서의 기본소득보장이 빈곤해소와 생활자립에 미치는 영향력은 노령연금의 일환인 국민연금과 기초연금이 빈곤해소와 생활자립에 긍정적인 영향을 미치고 고용보험의 실업급여와 생계급여는 유의적이지 않아 기각되었다. 그리고 빈곤해소는 생활자립에 유의한 영향을 미쳐 채택되었다. 이는 노령연금은 모든 하위소득 노인에게 일괄적으로 지급되는 연금성 소득보장책으로 매우 기본적인 소득을 보장해 주는데 유용함을 뒷받침하고 일정한 기본소득의 보장을 통해 빈곤해소는 생활자립으로 이어져 상호 밀접한 연관성을 가짐을 시사한 것으로 결론지을 수 있다.

• 농촌의학ㆍ지역보건
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• 제16권2호
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• pp.179-194
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• 1991

Despite its universal coverage of health insurance, the rural health insurance program(RHIP) stands at the crossroads in Korea. The RHIP has weaknesses in stability of financing, problems of inequities in the provision of health services and has suffered from high cost of running the program. The author has analyzed these problems from the perspective of health insurance policy and presented several options for improvement. First of all, this study urged the importance of a firm Governmental commitment of RHIP with the 50% subsidization of contributions as the Government had promised, instead of the current 40%. This can be justified from the 20% subsidization by the Government for the contributions of private school teachers and their dependents, who belong to richer segments of the population. Second, various cost containment measures ought to be sought curbing the rising demand for medical through strengthening health education and increasing individual responsibility, and tightening the claim review process. Third, this study requires the Government to run a demonstration project on the introduction of case payment system for primary health care. Fourth introducing an income-related cost sharing scheme is another possibility. Reforming the cost sharing formula for large medical expenditures is recommendable for a beginning. This measure can take the form of tax credit for medical expenditures of the poor. Fifth, the degree of financial adjustment among health insurance plans should be levelled up for enhancing stability of RHIP and social solidarity. Sixth, health policy should be redirected toward development of rural health resources and higher priority should be put on relieving difficulties in access to care. Seventh. the insurance plan owned-hospital needs to be developed or provision of health services in the medically underserved areas, and the need of such facilities is particularly acute for geriatric care, rehabilitation and renal dialysis, etc. Eighth, more generous insurance benefits are required of the elderly who are suffering the most : elimination of the maximum 180 days of benefit period and provision of glasses and artificial dentures, etc. Ninth. the economies of scale principle is working for the operating expenses of regional self-employed insurance plan. Thus, measures should be instituted to pursue an optimum size of health insurance plans. Lastly, excessive dependence on exclusion items is an evil so that some radical remedies are urgently required to cut them.

• 보험의학회지
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• 제27권1호
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• pp.33-36
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• 2008

BACKGROUND : The medical claims review(MCR) is unique methodology of medical consultation in terms of insurance claim administration in Korean insurance market. The most important practical matter in the MCR is formatted question. In Korea, medical specialty is composed of 26 legally defined hospital departments. It is worth of studying to investigate type of MCR by hospital departments. METHODS : Fifty Cases of the MCR were selected randomly by statistical program SPSS among 1,032 cases which were performed between April 1, 2006 and March 31 2007. All of selected cases were evaluated one insurance doctor and made a score points from 0 to 10 in terms of hospital department. RESULTS : Multidimensional scaling was performed. The MCR types - diagnosis, malignancy and cause of death are located in the same 2-dimensional configuration area. It can be called as verification of benefit. Others are advice. - such as causality, interpretation, translation, independent medical examination, and so on. DISCUSSION : We can conclude the classification of MCR typology are two main subjects, verification and advice. Theses results are same as previous article which was based on experience.

• 지역사회간호학회지
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• 제21권3호
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• pp.362-373
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• 2010

Purpose: The purpose of this study is to evaluate the costs and benefits of individual home visiting health care using secondary data and literature review. Methods: The total number of subjects was 1,008,837. A specific program was classified into disease management, care of infant, child and women, or elderly care. The costs and effects of a program were identified from a societal perspective, and the effects were converted into monetary terms or benefits. The total cost was calculated in the way that medical expenses, travel costs and productivity losses were offset by the decrease in benefits and thus only the program budget was included in the total cost. Results: The total program cost was 47.6 billion won per year and the total annual benefit was estimated at 435.6 billion won. The benefits of arthritis management were the biggest among disease management programs. The net benefit was 388.0 billion won per year and the benefit/cost ratio was 9.16. Conclusion: Home visiting health care was validated to be economically effective. It made a positive contribution to improving the health status of vulnerable populations and reducing medical expenses. These results suggest that home visiting care should be extended more broadly to vulnerable populations.

• 대한예방한의학회지
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• 제21권3호
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• pp.29-42
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• 2017

Background : Efforts towards increasing insurance coverage for traditional Korean medicine (TKM) are being continued. However, various difficulties are faced in generating evidence for TKM due to limited financial support and the low quality of research methodology. Objectives : The objectives of this study were to review the Swiss evaluation program for complementary and alternative medicine (CAM) and assess the expansion in public health insurance coverage of complementary medicine as approved by referendum in Switzerland. Methods : The regulations of CAM in the European Union were assessed. Research articles, reports, government publications and websites which deal with the 'Programm Evaluation $Komplement{\ddot{a}}rmedizin$ (PEK)' and the referendum in Switzerland were searched for and analyzed. Results : The PEK was conducted from 1998 to 2005. The PEK evaluated the efficacy, utilization and cost-effectiveness of anthroposophical medicine, homeopathy, neural therapy, phytotherapy and traditional Chinese medicine. However, clear conclusions could not be drawn from the evaluation according to the PEK Report. Later, a referendum was implemented in which 5 therapies would be added to the Switzerland Constitution with the support of the public. The coverage of CAM was approved by Swiss a plebiscite with an approval rate of 67.0%. Conclusions : The reason for the successful referendum is suggested to be public support and the solidarity with CAM experts and politicians. It may be surmised that recognition of the political efforts and scientific aspects required to expand insurance coverage of TKM, and towards obtaining public support, is necessary.

• 치위생과학회지
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• 제16권3호
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• pp.249-255
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• 2016

본 사례보고는 대전 동구보건소에서 7년간 실시하고 있으며 매년 천 명 이상이 참가하는 노인 불소도포 스케일링 사업의 진행과 만족도, 논의사항 등을 보고하여 노인 구강보건사업 실행에 도움을 주고자 함이다. 2009년 시범사업은 대한노인회 대전동구지회와의 협의를 통해 각 경로당에 관련 공문을 보내고 신청 경로당에 직접 방문하거나 인근지역의 여러 경로당을 합하여 주민센터에서 사업을 진행하였으나 이후에는 경로당 중심 사업보다는 복지관이나 주민센터를 중심으로 진행하였다. 대전 동구치과의사회와 사전 협의 후 사업이 진행되었기 때문에 사업진행에 문제가 없었으나, 스케일링 후 지혈이 되지 않는 1건의 의료사고가 있었으며 이후로 지혈관련 전신질환이나 약물복용에 관한 사전 조사를 강화하였다. 2013년 본 사업에 대한 만족도 조사 동의자 355명 중 홍보 95.2%, 대기시간 73.2%, 스케일링 99.7%, 불소도포 91.5%, 틀니관리교육 96.6%, 칫솔질교육 98.6%가 만족한다고 하였다. 사업 참여 이유에 대한 구두대면조사 대상자 137명 중 44.9%는 무료라서, 12.5%는 치과에 가면 불필요한 치료를 받으라고 할까 봐 마음이 불편해서, 8.1%는 치과보다 제대로 치아관리를 해주는 것 같아서, 8.1%는 이동이 편리해서, 7.4%는 노인 우대를 잘 해주어서 등의 순으로 나타났다. 본 사업에 다시 참여하지 않겠다는 의견은 치과에 가서 하면 된다 1.5%, 다른 치료를 해주지 않는다 1.5%, 답변 거부 1.5% 등의 순으로 나타났다. 본 사업담당자의 의견은 사업의 지속적 참가자들의 구강환경관리 향상에 사업이 효율적이라 판단되나 농촌지역이나 취약계층 밀집지역의 경로당들은 사업 신청을 하지 않거나 신청인원 부족으로 사업의 효율성 때문에 배제되는 점, 스케일링의 보험급여화 이후 사업의 비용에 대한 고려가 필요하다고 하였다. 따라서, 취약계층을 사업에 포함하기 위한 방안 마련과 건강보험 급여화와 중복이 되는 보건소 사업에 대한 평가가 필요하다고 제안한다.

• 디지털융복합연구
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• 제11권3호
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• pp.1-12
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• 2013

우리나라의 사회보험제도는 외형상 성중립성 및 보편주의를 지향하는 제도로 확대되어 왔다. 그러나 남성부양자모델에 기초하여 가정 내의 성별분업 및 노동시장의 성차별적 지위를 그대로 반영함으로써 여성들의 종속적 지위를 유지 및 강화하는데 기여하고 있다. 본 연구는 지면의 한계상 우리나라 사회보험의 대표 격인 국민연금을 성인지적으로 분석한다. 우리나라 국민연금의 규정을 보면 남성정규직 임금노동자 중심이어서 정규직 임금노동자로의 진입에 제한받는 여성들을 국민연금에서 배제하거나 주변화 되게 한다. 그리고 여성들의 가사 및 보살핌 노동은 권리자격으로 인정받지 못하고 있다. 본 연구는 이러한 성인지적 분석 결과를 기초로 국민연금의 성차별적 속성을 파악하고 이 제도가 보다 성인지적이고 성평등적인 방향으로 변화될 수 있는 대안을 제시한다.

• 대한방사선기술학회지:방사선기술과학
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• 제44권5호
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• pp.495-502
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• 2021

This study aims to provide basic data for elderly health insurance policy and medical radiation safety management by analyzing the general radiography usage and exposure dose of the elderly in Korea. The effective dose for each general radiography was calculated using the ALARA-GR program for 260 general radiography codes selected from 'National Health Insurance Care Benefit Cost'. The usage of general radiography was analyzed in the 2016 elderly patient data of the Health Insurance Review and Assessment Service, and the effective dose for each general radiography was applied. The general radiography usage and exposure dose per person aged 65 years and over was 6.47 cases and 0.56 mSv. Females showed higher value than males as 7.15 cases and 0.66 mSv(p<.001). By age, those between 75 and 79 showed the highest number as 6.97 cases and 0.62 mSv(p<.001). Those who were supported by Medical Aid showed higher value than those who were insured by National Health Insurance as 8.82 cases and 0.76 mSv(p<.001). In addition, the ratio by radiography was in the order of Chest 20.85%, Knee Joint 15.58%, and L-spine 14.67%, and the exposure dose was L-spine 29.40%, Chest 15.82%, Abdomen 7.97%, and Entire Spine 7.20%. General radiography, which is widely used due to the high frequency of diseases in the elderly population should be taken into consideration when establishing health insurance policies. In addition, it is necessary to check whether the general radiography with high exposure dose is performed as a routine examination without considering medical necessity.

• 보건행정학회지
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• 제24권3호
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• pp.283-290
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• 2014

Background: This study aimed to examine the relationship between home-visit nursing services and health care utilization under the public long-term care insurance program in Korea. Methods: We analyzed the long-term care need assessment database and the long-term care and the health insurance claim databases of National Health Insurance Service between July 2011 and June 2012. The sample includes a total of 20,065 home-visit nursing recommended-older beneficiaries who use home-visit nursing and/or home-visit care, based on a standard benefit model developed by the Health Insurance Policy Institute of National Health Insurance Service. The beneficiaries were categorized into home-visit nursing use and non-use groups, and the home-visit nursing use group was again divided into high-use and low-use groups home-visit nursing, based on their total annual home-visit nursing expenditure. Two-part models and negative-binomial regression models were used for the statistical analysis. Results: The home-visit nursing use was negatively associated with the number of outpatient visit and cost, while adjusting for all covariates. The home-visit nursing use was also negatively associated with the inpatient cost among the high home-visit nursing use group. Conclusion: The findings implies home-visit nursing use prevents health care utilization. Further studies and policy strategies that can promote and strengthen home-visit nursing services under the public long-term care insurance are necessary in Korea.

• 한국치위생학회지
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• 제12권5호
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• pp.999-1006
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• 2012

Objectives : The purpose of this study was to understand and compare the knowledge of the adolescents and adults among the residents of Seoul metropolitan city about water fluoridation program. Methods : A total of 613 adolescents and adults between the age of 15 and 31-49 was surveyed by the questionnaire. Among them, the source of drinking water, the source of cooking water, awareness of caries prevention effect of water fluoridation program, awareness of cost benefit of health insurance of water fluoridation program, approval of water fluoridation program, awareness of health safety of water fluoridation program were surveyed. Results : 85.5% of adolescents and 88.9% of adults were surveyed to use public water supply for drinking water, and 95.3% of adolescents and 96.8% of adults were surveyed to use public water supply for cooking water. But only 14.0% of adolescents, comparing to the 42.1% of adults, were surveyed to be aware of the caries prevention effect of water fluoridation, and only 6.0% of adolescents, comparing to the 24.6% of adults, were surveyed to be aware of the caries prevention effect of water fluoridation to reduce to health insurance expenditure. About 82.6% of adolescents, comparing to the 92.1% of adults, were surveyed to vote for the fluoridation program, and only 6.8% of adolescents, comparing to the 28.6% of adults, were surveyed to be aware of health safety of water fluoridation program. Conclusions : Extensive oral health education program to the adolescents are necessary about using water fluoridation to prevent the dental caries.