• 보건행정학회지
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• 제8권1호
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• pp.135-154
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• 1998

In Korea, the institutional reform for the national medical insurance system is in process. Eventually, three kinds of the national medical insurance system, i.e., medical insurance program for the industrial workers, the govemment employees and the private school teachers, and the self-employeds, would be merged into an unifed system. In this study, I analyzed the annual trends of the finance in the medical insurance system in Korea, in which I found the financial instability especially in the medical insurance program for the self-employeds. The regression analysis was carried out to forecast the accumulated reserve at the end of this year for the medical insurance program for the self-employeds. I also analyzed the economic effect of the merge of the medical insurance program for the self-employeds by using the case of Japan and Korea. I found that the medical insurance for the self-employeds is expected to have financial deficit at the end of the year 1998 after the merge. In onclusion, it seems to be quite difficult to solve the financial instability in the medical insurance program for the self-employeds after it would be merged. That means that there would be a lot of problems on the way to the merge.

• Journal of Preventive Medicine and Public Health
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• 제28권1호
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• pp.153-174
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• 1995

This study was conducted to examine the determinant factors for expenditure of the medical insurance program for self-employeds based on the analysis of 1991 'The Medical Insurance Program for Self-Employeds Statistical Yearbook', and also similar yearbooks in the metropolitan and other provinces. The major findings are as follows : We have divided benefits into these four components such as the utilization rate for out-patients, expenses per claim for out-patients as paid by the insurer, utilization rate for in-patients, and the expenses per claim for in-patients as paid by the insurer, in order to examine the determinant factors for it. The results of the study revealed the following findings, in urban areas, the supply of medical care had more influence on the benefits than other demographic and economic variables, while, in county areas, both the supply of medical care and the rate of those aged over 65 affected the provision of benefits. The determinant factors for financial balance of the medical insurance program for self-employeds are, first, the determinant factor for administrative expenses was the number of households. The more the number of households, the less the administrative expenses per the insured. This shows that the economy of scale is being. And so, the administrative district must be taken into consideration in the incorporation of small regional medical societies and should be re-organized for more efficient management. Second, in urban areas, the supply of medical care had more influence on utilization rate and expenses per claim as paid by insurer, and therefore it is necessary to control it. In county areas, the supply of medical care and the rate of those aged over 65 raised the utilization rate and expenses per claim as paid by insurer. For the financial stability of county areas, a common fund for medical care for the aged and expansion of finance stabilization fund would be necessary. But, in county areas, it would be unnecessary to control the supply of medical care because it was much more insufficient than in urban areas. The vitalization of public health facilities must be carried out in county areas, for they reduced benefits. Sice the more insured in a single household, the less the utilization of the medical insurance program, benefits for habilitation at home should be given consideration. The law of majority and the economy of scale were applied here, and therefore the incorporation of regional medical societies must be taken into consideration. In integrating regional medical societies, it would be absolutely necessary to review the structural differences among all regional medical societies, the medical demand of each region, and also the local characteristics of each region.

• 보건행정학회지
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• 제4권1호
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• pp.77-106
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• 1994

This study attempts to evaluate the beneficial equity and operational efficiency of the three Korean medical insurance programmes and thereby suggest directions for their policy improvement. Concepts of the equity and effciency were reviewed to develop indicators for comparative analysis. For the analysis, statistical and financial accounting data for 1991, issued by the National Federation of Medical Insurance and the Korea Medical Insurance Corporation, on the operational status and performances of the programmes, were collected and rearranged to be suited to the purpose of the study. The analysis reveals that beneficial inequity exists between self-employed and employee programs. and that operational inefficiency is prominent in both programms for self-employeds and for Government employees and private school teachers. In order to improve the beneficial inequity of the self-employed program, it is suggested that policies be formulated and implimented toward increasing the program revenue through increasing subsidies from the Government, and through inter- program finance adiustment. For the operational inefficiency of the two programs, it is judged that, toghether with the administrative support and control from the Government and the insurance society bodies, self- efforts be initiated to improve the internal mangement styles and systems of the insurance societies. Finally, from the viewpoint of the structural efficiency, expansion of the preventive insurance benefits by the insurance soceties is recommended both for beneficial equity and operational efficiency.

• 보건행정학회지
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• 제5권1호
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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.

• 보건행정학회지
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• 제11권2호
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• pp.85-122
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• 2001

This study compared and analyzed the effect of income-redistribution, collecting data on the basis of the estimated details of insurance contribution and individual money wage lists for each one year before and after the combination of medical insurance program for industrial workers, by systematic sampling, extracting 4,160 families(14,764 people) among people applied to medical insurance program for self employees in Taegu City on the basis of Oct. 1st in 1998 with 227 associations of medical insurance program for self employees and medical insurance program for government employees and private school teachers combined, comparing the effect of income redistribution of before and after the combination of medical insurance program for self employees. The insurance contribution by household after the combination of medical insurance program for self employees showed the increase rate of average 20.9%, among them households of 68.8% increased and 31.2% decreased. The effect of income-redistribution was more positive because the degree of inequality was more deepened from 0.64 of the before-combination to 0.45 of the after-one in decile distribution ratio, from 0.26 to 0.34 in Gini -coefficient. Decile distribution ratio on the basis of insurance benefits by household was from 0.09 in the before-combination to 0.14 in the after-one, Gini-coefficient from 0.16 in the before-combination to 0.57 in the after-one was a little lowered. And decile distribution ratio of insurance benefits on the basis of insurance contribution was higher from 1.08 in the before-combination to 1.23 in the after-one, concentration index was a little lowered from 0.14 to 0.11, the effect of income-redistribution was improved in the phase of insurance benefits. The income-transfer rate of medical insurance program for self employees (the occupied rate of insurance benefits/ the occupied rate of insurance contribution) showed a lower trend in all of the before and after-combination towards upper classes, it was known that the income-transfer rate was higher from 1st degree to 7th degree in the after-combination in comparison with the before-one, but the effect of income¬redistribution was high because the income-transfer rate was lowered from 8th degree to 10th degree. The rate of medical insurance benefits (insurance benefits/ insurance contribution) increased from 0.79 in the before-combination to 1.07 in the after-one, and showed over 1.0 under 3th degree before the combination, but all of it was higher than 1.0 under 7th degree after the combination, the after-combination was more improved than the before-one in view of the rate of insurance benefits. As the result of above, on the basis of Oct. 1st in 1998 that 227 associations of medical insurance program for self employees was combined into one, we could say that the equality of imposing medical insurance contribution was more re-considered in the after-combination than in the before-one. But this study analyzed with classes divided, anyway, on the basis of insurance contribution, we have limit in explaining the correct effect of income-redistribution, because it was not analyzed according to classes of income, though it helps to analogize the effect of income-redistribution. So there must be analysis about the effect of income-redistribution, on the basis of the system, building up the system to grasp the correct income of the insureds of medical insurance program for self employees.