• Health Policy and Management
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• v.11 no.4
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• pp.1-20
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• 2001

Korean government had introduced copayment system as cost sharing to office-based medical care in order to reduce the demand for care in 1986. This review focuses on trends and characteristics of copayment on office-based medical care from 1991 to the end of Jan. 2001. Objectives of this study is ${\circled}1$ to analyse historical trends of copayment on office-based medical care during the last decade, ${\circled}2$ to analyse the effect of copayment introduced to office-based medical care on NHI finance, ${\circled}3$ to analyse the changing trends of the size of copayment in utilizing office-based medical care for the past 10 years, ${\circled}4$ to evaluate the meaning of copayment alteration implemented after the introduction of new prescription system and finally ${\circled}5$ to draw a some policy implications from the results of this review. We found that the main purpose of copayment introduction had been reduction in the expenditure of NHI finance. But, the reduction effect of insurer's expenditure has turned out to be negative and NHI finance has been in crisis after the introduction of new prescription system. Also, the copayment level of the insured has increased actually on a large scale. It seems that the introduction of new prescription system has changed the meanings and its policy implications of copayment system.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.3 no.4
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• pp.325-332
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• 2002

In the process of designing pareto optimal insurance contract, it is necessary to assume that insurance contract conditions are endogenous to build a model. The expected utility, the non-expected utility and the state-dependent utility function can be applied as a insurance decision making principle. The insurance costs may have the linear, convex, and concave ralationship with the indemnity schedule. However, the sunk cost and fixed cost must be recognized. The deductible which decides whether an insurance contract to be a full or partial insurance contract can exist in the forms of straight deductible or diminishing deductible. Indeciding the level of deductible, the types of the insurance and the risks to be insured should be the deciding factors. Especially for recall insurance, there is relatively high chance that the recalling company being bankrupt. Therefore, the possibility of bankrupcy should be the considering factor in deciding the policy limit. The existence of the incomplete market and uninsurable background risk should be understood as restricting conditions of the pareto-optimal insurance contract.

• Health Policy and Management
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• v.18 no.4
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• pp.66-84
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• 2008

Objectives: This study aimed to. offer some fundamental evidences for the stroke management policy by investigating the trends of medical care utilization and regionalization in stroke inpatients. Methods: We used the National Health Insurance claims and registry data for stroke inpatients from 1998 to 2005. Among all stroke inpatient claims data, self-employed insured and their dependents were only included in this study. The classification of stroke was based on ICD-10(I60-I69) and its subtype was divided by hemorrhage(I60-I62) and infarction(I63-I64) type. To evaluate regionalization of medical care utilization, relevance index was calculated by regions. The regions were classified 8 large catchment areas and 163 self authorized areas. Results: The overall medical care utilization rate of stroke inpatient has been increased, especially infarction subtype. Among medical care institutions, the utilization of hospital has been the most rapidly increased. Although considered annual rate of interest, total medical cost of stroke inpatients has been increased, Totally, more than 84% of stroke inpatient were admitted to medical care institutions in their own large catchment area during 1998-2005. The relevance indices in their own large catchment area (self sufficiency rates) were more than 70% in most areas regardless of stroke subtype except Chungbuk catchment area. Self sufficiency rates of stroke inpatients among 163 self authorized areas in 1998 and 2005 were 84.2% and 83.1% in metropolitan, 46.7% and 45.5% in urban, and 19.5% and 22.6% in rural areas, respectively. Conclusion: Stroke management policy for improvement of distribution at the district level, especially in rural areas, may be helpful for reducing regional inequality in stroke.

• Health Policy and Management
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• v.5 no.1
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• pp.80-105
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• 1995

Assuming that we introduced integration of medical insurance society for self-employed, this study was conducted to examine effects and results after the integration and to research more effective method for integration. To assess effects and results of the finacial status of 266 insurance societies after intergration, the data were obtained from "The Medical Insurance Program for Self-Employeds Statistical Yearbook in 1992". The major finding are as follows : 1. Three alternative integration proposals were made. First alternative proposal was consisted of 232 medical insurance societies, second was 187, and third was 115. 2. As the results of average number of the insured per insurance societies of medical insurance program for self-employed every alternative proposal, first was 88, 119 persons, second was 108, 576, and third was 178, 967 from 76, 576 persons of present socienties. 3. It was true that the more average size of societies increased, the more average administration expenditure per 1, 000 insured reduced. 4. The average size of societies grew bigger, the rate of general expenditure to general revenue more improved. Also, the rate of benefits to contributions was changed for better. But if not to have had correct analysis and precise preparation for integration, effects and results of integration were always not optiized. 5. According to results of simple regression formulas, it was proved that the more the average size of societies was increased, the more result was advantaged. 6. The law of majority and the economy of scale were applied in this study, and it was necessary to analyze and assess effectiveness and efficiency of integration. Therefore, when the integration of medical insurance societies for self-employeds will be performed, it must be taken into consideration. Among three alternative proposals, third was showed more effective alternative than anothe, second was presented more ineffective result than present system. To achieve more effective and efficient integration of regional medical insurance societies throughout the result of the regression formula on present cost curve, it is necessary to operate well-integrated societies and to know appropriative countermeasures of present situation of each societies. Also, for integrating regional medical insurance societies, it is necessary to continue more deep research through practical model activity and to investigate the effective size and managed method of the societies.societies.

• The Journal of the Korea Contents Association
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• v.21 no.3
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• pp.314-323
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• 2021

The purpose of this study is to analyze the status of medical service use of foreigners living in Korea by their nationality and types of national health insurance. As of 2018, 1,058,886 people were extracted from the qualification DB, excluding people whose insurance premium is missing. The data analysis showed that nearly 78% of foreigners with national health insurance used medical services and the countries with the largest number of users were China, Vietnam, and the United States. The total cost of treatment per capita was highest in the United States regardless of hospitalization and outpatient. The number of medical treatments per person, and the medical expenses of outpatients & inpatients services were highest among the regionally-insured and the length of stay per person was highest among the workers' dependents. Lastly, it was found that Chinese and regionally-insured received much more benefits than other groups compared to the premium they pay. After July 2019, foreign nationals residing in Korea for six months or longer are obligated to enroll in the national health insurance program. Since the latest data was in 2018, the result did not properly reflect the current situation, but it is meaningful that it made basic data for future comparative analysis.

• Korea Journal of Hospital Management
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• v.10 no.1
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• pp.48-70
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• 2005

The purpose of this study was to make an analysis of the impact of the DRG payment system on medical care pattern and cost of cataract surgery in a general hospital. The subjects were 173 patients whose DRG severity grade was zero, selected from among the hospitalized who underwent cataract surgery before and after the joining to the demonstrational operation of the third year DRG payment system. Their medical records and the details of their medical bills were examined to find out the length of hospital stay, medical care pattern provided to them, the cost of medical care, and the quality of medical care. The length of stay and the amount of medical care supplied during being in hospital dropped significantly for both single-eye and double-eyes cataract surgery groups. The amount of antibiotic use went down during the hospitalization and upon discharge from the hospital, but decreased after discharge. The total medical bills and the rate of basic examination implementation increased in the OPD before hospitalization but after discharge dropped. For double-eyes cataract patients, the rate of double-eyes cataract surgery went down. The total medical bills of DRG payment system converted into the fee-for-service system was greater by 113.3% for the single-eye cataract surgery group and by 102.9% for the doble-eyes cataract surgery group, compared to that by the fee-for-service. The contribution shared by the insurance corporation increased for both single-eye and double-eyes cataract surgery groups, but the copayment by the insured went down. Regarding the treatment outcome, no difference was found in complication rate, resurgery rate and mortality rate before and after the joining to the DRG payment system was implemented. The use of special lens lessened significantly. The amount of medical care supplied during hospitalization decreased but the complication rate didn't increase. But the increased use of low-price artificial cataract and the avoidance of double-eyes cataract surgery was observed. The phenomenon decreased number of OPD visit and the decreased total medical bills of OPD care after discharge in this hospital required further evaluation.

• Journal of Preventive Medicine and Public Health
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• v.27 no.1 s.45
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• pp.117-134
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• 1994

The effects of regional medical insurance on utilization of medical care in urban population was examined in this study. The data was collected in a 2-year follow-up household survey conducted at Taegu city before and after implementation of the regional medical insurance. The study population was divided into 2 groups. Cohort I was the uninsured in 1989 and cohort II was the insured in 1989. After the coverage of medical insurance, physician visit rate per 1,000 population, use-disability ratio and use-restricted activity ratio in cohort I were increased compared to cohort II in both of acute and chronically ill people. The use-disability ratio and use-restricted activity ratio of the insured poor were lower than those of the insured nonpoor in both of cohort I and cohort II. The major reasons for pharmacy use were accessibility and affordability before the coverage of medical insurance in cohort I, however, after the coverage of medical insurance, the important reason was accessibility rather than affordability. In logistic regression analysis of physician visit, the significant independent variables were acute illness episode (+), chronic illness episode (+) and income (+) in both of cohort I and cohort II. In cohort I, after the coverage of medical insurance, more people replied that the medical cost of hospital and clinic was reasonable. The people who covered by the regional medical insurance were more dissatisfied with the imposed premium than those who covered by other types of medical insurance in both of cohort I and cohort II. More people in cohort II than cohort I were dissatisfied with the services from hospitals and clinics after implementation of the regional medical insurance. In conclusion. after the coverage of medical insurance, the gap between the poor and the nonpoor still exists in terms of medical care utilization.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.10 no.1
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• pp.9-21
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• 2014

This study aims to help utilize the dental treatment institutions for the disabled and provide high quality of medical services in the future by identifying the satisfaction factors for the patients of the dental clinics for the disabled. As a study method, surveys were completed 200 patients who visited the dental hospital for the disabled. Among these, the surveys from 187 patients were statistically analyzed. The main findings of this study are as follow. Since the study showed that there were differences in the satisfaction factors between the disabled and non-disabled people, subsequent studies needs to be done to develop measuring tools to accurately accommodate the satisfaction factors of the disabled. In addition, as the low spatial accessibility in terms of distance and location was found in this study, more dental treatment institutions for the disabled are required. In the meantime, the survey results found that the most satisfactory aspect was the lower treatment cost compared to other clinics, and that the most important factor when choosing a clinic was also treatment. In addition, given the fact that the group that took a prosthetic treatment, which was non-insured treatment, showed higher satisfaction compared to the group that did not, it suggests that the economic burden plays an important role for the dental treatment of the disabled.

• Journal of Preventive Medicine and Public Health
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• v.27 no.4 s.48
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• pp.807-814
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• 1994

This study is to find out changes in medical practice at a university hospital before and after covering intraocular lens (IOL) from the health insurance benefit. The coverage started on March 1, 1993 and a total of 596 cases who were discharged from July 1 to December 31, 1992 and 580 cases who were discharged from July 1 to December 31, 1993 were analyzed. Since the standard reimbursement scheme was changed from March 1, 1993, the charges for 1992 were transformed into 1993 scheme. Major findings are as follows: Average length of stay was statistically significantly decreased from 8.24 days in 1992 to 6.86 days in 1993. Charges except IOL has been statistically significantly decreased from 501,000 Won in 1992 to 444,000 Won in 1993. Charges for drugs and injection have been reduced. However, charge per day for them was not much different. This is due to decrease in length of stay. Charges for laboratory tests and radiologic examination were quite the same. Charges which are not covered by the insurance remained the same. The revenue of the hospital was reduced as expected. However, the hospital reduced the length of stay and increase the turnover rate In order to compensate the potential loss of revenue due to the difference of reimbursement between the out-of-pocket expense and the insurance coverage. By introducing the IOL benefit in the insurance, the insured pays less, hospital generates more revenue through shortening the hospital stay, and the total medical care cost becomes less nationwidely.

• Journal of Technologic Dentistry
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• v.25 no.1
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• pp.119-142
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• 2003

In the present work the knowledge of dental health as well as dental prosthesis has been studied on the basis of analysis of current dental prosthetic treatments for dental diseases prophylaxis and the final decision for dental prosthetic appliance. The results have been analyzed by the current dental health care and the subjective acknowledgement from 700 people of urban as well as rural inhabitance in our country. The results from the present work have been summarized as following: Depending dental status has been shown worse to be in the cases of divorce and bereavement, age and less educated or jobless. It is also interesting to note that the dental status has shown to be even worse than health status. It has been shown that the dental prosthetic treatments have been mainly caused by the oral disease (62.2%) and depend on the age and the educational level. According to the actual status of dental prosthetic treatments, the fixed partial denture was the most case (78.9%) that increased as divorced, bereavement and as less educated, less income, retired and jobless as well as from urban to rural. As a clinic for the dental prosthetic treatments, dental clinics have been most frequent visited as indicated by 59.6%, then the un-licensed dentist (6.5%), then the hospitals (3.7%), then the public health centers (2.2%). Most of those who are older in age, less educated and jobless have been treated by the un-licensed dentists. In point of view on the cost for dental prosthetic treatments, 93.1% have claimed to be too expensive, in as the divorced and the bereaved, the older age, the less educated and the jobless. About satisfaction of dental prosthetic treatments, 51.4% was satisfied, 39.4% was normal and 9.2% was dissatisfied. Most of people experienced increasing levels of satisfaction as their income increase. Most in the age range of 40-60 have wanted to be insured for the dental prosthetic treatments. It is also interesting to note that the older age and the less educated wanted to apply this kind of insurance.