• Journal of Preventive Medicine and Public Health
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• 제22권3호
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• pp.398-405
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• 1989

A change in the consumer's surplus was measured in order to evaluate the social benefit to be derived from expanding health insurance to the entire population. The most refined and correct way to measure a project's net benefit to society is to determine a change in the consumer's surplus. Benefits from introducing the health insurance program to the uninsured people can be classified into two elements. The first is the pricing-down effect(E1) which results from applying the insurance price system, which is lower than the actual price, to the uninsured patients. The second effect(E2) is a decrease in actual payment because an insured patient pays only a portion of the total medical bill(copayment). We collected medical price information from the data banks of 93 hospitals, and obtained information of medical utilization by referring to the results of other research and from data published by the Korean Medical Insurance Societies. The total net benefit was estimated as \214 billion, comprising the first effect(E1) of \57 billion and the second effect(E2) of \157 billion. The price elasticity of physician visits is less than that of hospital admissions: however, benefits from the increase in physician visits are greater than those from hospital admissions because there are considerably more of physician visits than hospital admissions. The sensitivity analysis also shows the conclusion that expansion of the health insurance program to the entire population would result in a positive net benefit. Therfore, we conclude that the National Health Insurance Program is socially desirable.

• 한국유기농업학회지
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• 제24권3호
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• pp.369-383
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• 2016

Crop yield insurance program in Korea has rapidly grown not only in quantity but in quality for 15 years since it was introduced in 2001. Despite growth of Crop insurance, performance evaluation for crop yield insurance has not fully been evaluated at the farm, consumer and national level. The purpose of this study is to conduct the performance evaluation for crop yield insurance through estimating the effects of farm revenue stabilization and social welfare increase with three popular insurance items: apple, pear and sweet persimmon. Based on the analysis of social welfare effect, cost-benefit analysis of operating crop yield insurance was conducted at the national level. We found that crop yield insurance stabilizes farm revenue based on the estimated four risk indicators: Coefficient of Variation, Value at Risk, Certainty Equivalence, and Risk Premium. The result of cost-benefit analysis shows that crop yield insurance increases social net benefit by 44.1 billion won for the three items. As a result, crop yield insurance program has contributed remarkably on social welfare as well as farm management and its role will be more important in the future.

• 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.

• 보건교육건강증진학회지
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• 제29권5호
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• pp.37-48
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• 2012

Objectives: The economic evaluation of health promotion programs has increasingly become an imperative activity for securing public fund or budget. The purpose of this study is to conduct an economic evaluation for the healthy school canteen program using the contingent valuation method(CVM). Methods: To estimate the benefit from the healthy school canteen program, double-bounded dichotomous choice method as a sort of willingness to pay was employed. Four hundred parents who lived in Seoul and have students at middle or high schools, were administrated by semi-constructive questionnaire containing the necessary information for benefit estimation. Cost estimation of healthy school canteen program was made referring to three types of pilot programs. Finally, the benefit against the cost was worked out according to the three levels of estimated cost. Results: Cost estimate is 8,488 and 9,311 won depending on the two senarios about how to invest on the program, respectably. The results of benefit estimate shows that the average cost willingness to pay(WTP) for healthy school canteen program is 21,275 won(16,963-59,838 won, 95% CI) and total benefits turned out 14.7 billion won. According to the cost-benefit analysis, average benefit-cost ratio is from 2.3 to 3.6. Conclusions: Healthy school canteen program could be economically accepted, and government can take consideration of expanding beneficiaries of healthy school canteen program for health promotion.

• Journal of Preventive Medicine and Public Health
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• 제13권1호
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• pp.47-51
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• 1980

This study attempts to assess the effect of the 1st class health insurance program to the income redistribution among the participants in a unit health insurance cooperative. One health insurance cooperative, located in Seoul, with 1558 members and 768 households was selected for this purpose. The relationships between amount of premium payed and benefits from the cooperative were compared. Necessary data were obtained from the bills submitted to the health insurance cooperative by the contracted medical institutions from 1st January 1977 to 30th June 1979. Households and individuals were the unit of the assessment. The indicators measuring income redistribution effect were the ratios between the benefit and expected benefit and the ratios between the benefit and the mean benefit. The major findings were: 1. The ratios between the benefits and the expected benefits were lower than 1 in the high income group and greater than 1 in the middle and lower income groups. This fact imply that the income redistribution effect was shown in the studied groups. It was shown that the middle income group received the greatest benefit, and then the lower income group. 2. The ratios between the benefit ana the mean benefit of the households in the higher standard income grade, were found to be higher. This means that the equity of the benefits of households were not achieved by the policy of the health insurance plan. 3. The health insurance utilization rates of the higher standard income group, measured by the household unit, were higher, and by the individual unit, the same rates of the middle income group were higher than other groups.

• 한국임상약학회지
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• 제30권3호
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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.

• 보건행정학회지
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• 제19권2호
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• pp.36-50
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• 2009

Korean Government had performed three pilot programs to introduce the long term care insurance system. Persons aged 65 or older who are dependent on others for daily living could use long term care services in the pilot program. The long-term care insurance covered nursing home services, home care services and cash benefits. The cash benefits are included that for elderly at home and for patients in geriatric hospital. This study investigated whether there had been any change in the medical care utilization according to cash benefits for geriatric hospitalization. This study used National Health Insurance claims and Long term Care Insurance claims 2003 through 2006. Data were composed of subjects who undertook both insurance coverage. The subjects was divided into two groups. Case group included participants with the cash benefits of geriatric hospitalization. Control group included persons without the cash benefits selected by random sampling according to the distribution of case group. This study showed that the amount of medical care utilization of the case group is more significantly increased than the control group after adjusted their health condition and functional condition. This result will be helpful for making decisions on whether the cash benefit of geriatric hospitalization can be introduced into long term care insurance system.

• 보건행정학회지
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• 제7권1호
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• pp.73-99
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• 1997

This study was carried out by using questionnaires with 126 insurance societies from Sept. 30, 1995 to Oct. 18, 1995. The primary data collected bythe survey have been significantly supplemented by secondary data obtained from sources such as health insurance statistical year books and internal data in the Ministry of Health and Wolfare. Major findings were summarized as follows: Two financial coordinating programs have significantly improved financial status of regional health insurance societies: the catastrophic program for high cost medical care that was initiated in 1991 and the program for hospitalization cost of the aged in 1995. Another finding is that there existed ambiguity and inconsistency of equity index that had been used by stabilization programs and its side effects could not be ignored. Regression analyses were made to identify factors that affect financial transfers. Inde pendent variables in the regression include utilization frequency, dependancy ration, insurance contribution per insured and medical expense per insured. All these variables were statistically significant in the equations of applying distribution rate (distribution/contribution) and transfer rate (transfer/contribution) as dependent variables. Policy suggestions for the catastrophic program for high cost medical care are modifying the definition of catastrophic case and setting the maximum amount of subsidies for each society based on distribution rates. To solve the problems of the financial coordinating program for the aged, we could consider reimbursing more than 50% of the copayment incurred by the aged 65 or more and determining the maximum amount of outpatient copayment at 10,000 Won per day or per visit for the elderly. More fundamental improvement could be made by amending the Welfare Benefit Act to establish and expand medical and welfare facilities for the elderly.

• Perspectives in Nursing Science
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• 제7권1호
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• pp.23-35
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• 2010

Purpose: The purpose of this paper is to analyze the demand and supply of advanced practice nurses and suggest alternative benefit strategies in the Korean national health insurance. Methods: A revised demand & supply model was used to estimate the excess supply of APNs, and policy making process and key actors in the Korean health insurance were considered to develop a political approach to the APN issue. Results: The social demand for APNs is currently estimated to be less than 50% of its supply and the APN education program fell into difficulties in recruits. No reimbursement mechanism for APN's services in the national health insurance has given no economic incentive to hospital managers who have monopsony power in nursing labor market, which has caused the demand shortage of APNs in hospital industry. Payment for APN's services recognized as one of the most significant strategies to booster the social demand for APN's services should be carefully designed and implemented in the national health insurance. In line with this, key actors in health insurance policy decision-making include government, national assembly, labor unions, NGOs, civic groups, medical associations, and academia. Conclusion: The basic researches for APN's activities and cost-effectiveness analysis in clinical settings are required to support the strategies aforementioned. Constructing a policy network among key actors is able to make the payment strategy feasible, which will increase the socal demand for APNs.

• 의료법학
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• 제8권2호
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• pp.69-118
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• 2007

In providing general medical treatments, the medical service contract between the patient and the doctor is the mutually responsible onerous contract. However, the nature of the mutually assumed contract standings of the patient and the doctor has been changing since the implementation of the national health insurance program. For instance, besides the cases of beyond excessive medical charges and medical negligence, if the doctor charged for his/her medical treatments violating the post-treatment/nursing cover criteria, the overpaid medical charge, regardless of being collected with the patient's consent, has to be refunded back to the patient. Medically needed aspects, treatment results, and unfair benefits favoring the patient are not at all taken into consideration in the health insurance scheme. This makes it easier for patients to get refunds for their share of the medical payments by involving the Health Insurance Review & Assessment Service or the National Health Insurance Corporation, without engaging in civil law suits (for reimbursement claim) against doctors. In other words, the doctor's responsibility to provide medical treatments and the patient's responsibility to pay for the medical treatment provided within the contractual realm are being demolished by the administrational arbitration of the National Health Insurance system. The basic rights of medical service providers, and the patient's right to choose are as important constitutional rights, as the National Health Insurance program, which is essential in the social welfare system. Furthermore, the development of the medical fields should not be prevented by the National Health Insurance system. If the medical treatment services can be divided into necessary treatments, general treatments, and high quality treatments, the National Health Insurance is supposed to guarantee the necessary and general treatments to provide medical treatments equally to all the insured with limited financial resources. However, for the high quality treatments, it is recommended that they should not be interfered by the National Health Insurance system, and that they should be left to the private contract between the patient and the doctor.