• Journal of Korean Academy of Oral Health
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• v.41 no.1
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• pp.43-49
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• 2017

Objectives: In this study, we strived to determine the possibility of socioeconomic welfare in oral healthcare by analyzing the National Health Insurance (NHI) coverage rate. To date, efforts to realize the "social economy" of healthcare are active. While oral disease is common and chronic among Koreans, the rate of NHI coverage of dental clinics is substantially lower than that of the medical clinics. Methods: We defined the NHI coverage of dental clinics as a proxy for "social skills" to improve oral health problems. The data were collected through a comparative analysis of the NHI coverage of dental clinics and that of non-dental clinics, in health welfare social cooperatives. Results: The NHI coverage rate of the dental clinics in health welfare social cooperatives ranged from 0.97 to 2.62 times that of the non-dental clinics in health welfare social cooperatives. Conclusions: In conclusion, responsible management is recommended for making health welfare social cooperatives meaningful as a social economy.

• Journal of Sasang Constitutional Medicine
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• v.23 no.1
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• pp.8-11
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• 2011

1. Objectives: Sixty eight kinds of single herbal medicine extracts and fifty six kinds of mixed herbal medicine extracts have been used under a national health insurance since 1987. The number of herbal medicine extracts under an insurance coverage remains unchanged. The demand for covering complex herbal medicine extracts and Sasang Constitutional medicine extracts in a national health insurance increases. This study is to investigate the needs for the insurance coverage. 2. Methods: Advantages and disadvantages between herbal medicine decoction and extracts were explained and Sasang Constitutional medicine extracts according to Sasang constitution were surveyed in production nowadays. 3. Results: Herbal medicine decoction has many advantages of treating patients but herbal medicine extracts have advantages of the rapid adminstration and being easy to carry. From eleven to twenty two products of Sasang Constitutional medicine extracts have been in production in several factories. There are eleven kinds of Soyangin medicine extracts, nine kinds of Taeeumin medicine extracts and five kinds of Soeumin medicine extracts. 4. Conclusions: Complex herbal medicine extracts and Sasang Constitutional medicine extracts have to be in use under a national health insurance as soon as possible.

• Journal of Gastric Cancer
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• v.24 no.4
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• pp.464-478
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• 2024

Purpose: Endoscopic submucosal dissection (ESD) is the standard treatment for early gastric cancer (EGC) with a low risk of lymph node metastasis. In Korea, ESD was included in the National Health Insurance (NHI) coverage in 2011, which was expanded in 2018. In the present study, we investigated the status and trends of ESD for EGC over the past decade since its incorporation into the NHI system. Materials and Methods: We analyzed the data from the National Health Insurance Service (NHIS) database from 2011 to 2021, focusing on patient characteristics, number of ESD procedures, in-hospital length of stay (LOS), and total medical cost (TMC) per admission. In addition, we conducted an interrupted time series analysis to assess the impact of changes in insurance coverage on these variables. Results: Overall, 95,348 cases of ESD for EGC were identified. A consistent annual increase in ESD procedures was observed, particularly in tertiary care hospitals and among patients aged >60 years. The overall median LOS and TMC were 4 days and 2,123,000 KRW, respectively. The 2018 insurance coverage expansion did not significantly affect the number of ESD procedures or LOS; however, the TMC increased significantly. Conclusions: Our study illustrates decade-long trends in the ESD for EGC in Korea. The policy needs to be revised continuously to optimize ESD use and improve resource allocation within healthcare systems.

• Health Policy and Management
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• v.24 no.3
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• pp.205-218
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• 2014

Background: Most studies on the national health insurance benefit expansion policy have focused on policy tools or decision-making process. Hence there was not enough understanding on how policies are actually implemented within the specific policy context in Korea which has a national mandatory health insurance system with a dominant proportion of private providers. The main objectives of this study is to understand the implementation process of the benefit coverage expansion policy. Unlike other implementation studies, we tried to examine both the process of implementation and decision making and how they interact with each other. Methods: Interviews were conducted with the ex-members of the Health Insurance Policy Review Committee. Medical doctors who implement the policy at the 'street-level' were also interviewed. To figure out major variables and the degree of their influences, the data were analyzed with Winter's Policy Implementation Model which integrates the decision making and implementation phases. Results: As predicted by the Winter model, problems in the decision making phase, such as conflicts among the members of committee, lack of applicable causal theories application of highly symbolic activities, and limited attention of citizen to the issue are key variables that cause the 'implementation failure.' In the implementation phase, hospitals' own financial interests and practitioners' dependence on the hospitals' guidance were barriers to meeting the policy goals of providing a better coverage for patients. Patients, the target group, tend to prefer physicians who prescribe more treatment and medicine. To note, 'fixers' who can link and fill the gap between the decision-makers and implementers were not present. Conclusion: For achieving the policy goal of providing a better and more coverage to patients, the critical roles of medical providers as street-level implementers should be noted. Also decision making process of benefit package expansion policy should incorporate its influence on the implementation phase.

• The Journal of Korean Medicine
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• v.39 no.3
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• pp.51-60
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• 2018

Objectives: This study aimed to investigate the opinions of Korean medical doctors on how to elucidate possible remedial measures for expanding the health insurance benefits coverage item of Korean medicine (KM). Methods: An online survey was conducted to all members who had registered e-mail address in the association of Korean medicine from 1 to 17 November, 2016. Statistical analysis was performed and odds ratio with 95% confidence interval were calculated by each subgroup. Results: A total of 743 members answered the questions and the response rate was 4.1%. The priorities for expanding health insurance benefits were as follows: thermographic imaging, Sasang constitution typing test, and pulse wave among examinations; pharamacopuncture, embedding acupuncture, and acupotomy among procedures; Chuna manual therapy, manual therapy for meridian muscle, and Daoyin exercise therapy among manual therapies; low-frequency electrical therapy, traction, paraffin bath, and light therapy among physical therapies; and aromatherapy, enema therapy, and color therapy among activities of KM. Conclusions: It should be covered by the national health insurance (NHI) of KM that thermographic imaging, pharmacoacupuncture, Chuna manual therapy, low-frequency electrical therapy, aromatherapy as a top priority. We also suggest that basic medical tests, such as blood, urine, or imaging, should be included in the coverage of the NHI of KM. It is necessary to review the expertise and public opinions about the plans and priorities for the conversion of the desired medical services to be covered by the NHI.

• The Journal of the Korean dental association
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• v.54 no.8
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• pp.604-612
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• 2016

The aim of this study was to evaluate the effect of national health insurance coverage of periodontal scaling using the National Health Insurance Service-National Sample Cohort for 2009-2013. After the enforcement of periodontal scaling covered by national health insurance, the number of patients diagnosed with periodontal disease and received treatment, has increased from 35,234 to 99,576 people in the last 4 years. Further, the number of patients who received the treatment of periodontal disease more than once, have also increased to around 69% in 2013 when compared to 2012. Moreover, the number of patients receiving periodontal scaling has been steadily increasing every year. Among the patients who visited hospital for periodontal disease, there has been an increase of 280%. As a result, continuous public relations and long-term research on the effect of periodontal scaling as a prophylactic treatment is necessary.

• Health Policy and Management
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• v.19 no.3
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• pp.142-165
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• 2009

Although providing universal coverage for health care through the National Health Insurance(NHI) is a remarkable achievement, the issue of limited benefit coverage of the NHI has been at the core of national debate over how to improve its coverage. This study aims to evaluate benefit extension strategies and implemented policies with regard to the NHI since 1989 using 'policy window theory' proposed by John W. Kingdon. Understanding problem stream, policy stream, political stream, and coupling streams regarding the NHI, in particular benefit extension, would contribute to broaden policy debates and to develop more effective strategies for the future. Historically, political stream had opened policy window in the past two decades and policy streams can be characterized by three waves. Three streams have been coupled since 2003 and the government had a strong will to fulfill better performance of NHI coverage. Study findings indicate that identification of problem structure regarding NHI benefit was not connected with policy stream tightly. In addition, there has been limited discussion on policy goal and principles for extension coverage of the NHI. Policy strategies to improve coverage of the NHI should be linked to characteristics of problem and sought solutions under the principle which is expected to be sustainable through consensus in the society.

• Journal of dental hygiene science
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• v.18 no.3
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• pp.182-187
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• 2018

As the elderly population increases, they are increasingly affected by oral health problems. Therefore, efforts are being made to improve the oral health of older people, alleviate mental discomfort, and reduce unmet dental needs. This study was conducted to confirm the relationship between the National Health Insurance Elderly Denture Coverage and the unmet dental need for the edentulous elderly, as part of the protection policy. We analyzed the 2011 and 2013 Community Health Survey data of the edentulous elderly, aged 75 years or older, before 2012. In order to more precisely confirm the effects of the denture donation policy on unmet dental care, basic life recipients who were subject to the free elderly prosthetic project were excluded from the analysis. The final analysis included 20,400 subjects. According to our investigation of the factors that affect the unmet dental needs of the elderly, the National Health Insurance Elderly Denture Coverage did not affect unmet dental needs. The statistically significant variables that affected the unmet dental needs of the elderly were education and income levels, which are representative socioeconomic status variables. The lower the level of education, the unhealthier the dental care experience, and income levels showed a similar tendency. The elderly who have a low socioeconomic status are more likely to experience unmet dental needs because they lack the knowledge and socioeconomic ability to pay for dental care. Therefore, the policy for health protection of the entire elderly population should be continuously expanded. In addition, the socioeconomically vulnerable groups may have health problems due to the restriction of medical use, which may lead to quality of life deterioration.

• Health Policy and Management
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• v.30 no.2
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• pp.253-262
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• 2020

Background: The public health care system of a country is shaped and driven by its historical background as well as social, economic, and cultural structures. This study sheds light on the unique features, strengths, and weaknesses of the health insurance systems of South Korea (Korea) and Peru. Methods: The capacity mapping tool was used to explore the Korean and Peruvian population and geographical structures; health insurance laws, regulations, and policies; payment systems; eligibility and contribution collection; and long-term care insurance. Results: The study found that the Korean government took the lead in integrating multiple insurers into a single-payer system in an effort to reinforce and stabilize its health insurance system in 2000. Peru has been developed mixed model such based on taxes and contributions, to address a gap between different social classes. Peruvian government developed a two-axis system, one for low-income earners, financed by taxes, and another financed by contributions paid by workers and government officials in the formal sector. Peru has introduced many variations to its fee payment and insurer systems, target population, and coverage scope, and maintains its health insurance system accordingly to this day. Conclusion: The current study provides observation of the Health Insurance System in two different countries and helps to understand possible ways to improve the health insurance system in both countries. Based on this study, Peru will be able to see how its system differs from Korea's and benefit from the related policy implications.

• Journal of Convergence for Information Technology
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• v.11 no.10
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• pp.194-204
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• 2021

This study was conducted to find out the status and factors of private health insurance subscriptions by life cycle and to identify differences in medical usage behavior by life cycle. Using the SPSS 26 program as the 12th-15th (2016-2019) data of the Korea Welfare Panel, the difference subscriptions was identified as Chi-square by demo social and health characteristics of 58,223 people, and the factors affecting subscription were analyzed by polynomial logistic analysis and average analysis was performed for medical use behavior. As a result of the analysis, the biggest factor in purchasing private health insurance was household income, private health insurance coverage is the highest in growth period, and multiple subscriptions were made depending on household income. In youth, household income, spouse, and no disability, and middle age, household income, economic activities, spouses, and health levels were largely influential factors. The rate of private health insurance coverage in old age was the lowest, and low-income households, poor health levels, and people with disabilities were lower. The increase in medical use by private health insurance subscribers also occurred during growth and youth. It is necessary to strengthen the national health insurance coverage, and the role of private health insurance to supplement it should be established in time for the life cycle to complement each other, eliminating blind spots of medical security and maximizing people's health and well-being.