• 한국안전학회지
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• 제16권2호
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• pp.103-109
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• 2001

When workers get accidents in doing their works, industrial accident insurance covers the compensation for the accidents. Generally, this kind of costs is applied in terms of Direct Cost. In our society circumstance to terminate the accident, many kinds of cost (Non-Insurance Cost) are also discharged. Non-Insurance Cost resulted from additional compensation for insurance allowance, is the important basic data source to estimate Loss Cost. Several studies have been done for the output of accident cost, but companies have difficult to apply these studies into practice and generalize the amount of accident loss cost. This study means to suggest improving solutions for the output of Accident Loss Cost and to reduce Opportunity Cost caused by Industrial Accident.

• The Journal of Korean Physical Therapy
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• 제25권2호
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• pp.43-48
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• 2013

Purpose: The aim of this study was to demonstrate that non-participation of physical therapists on the political decision-making committee results in invasion of their interests. Methods: To demonstrate the effects, we analyzed the change of medical insurance score decided by the Health Insurance Policy Deliberation Committee between 2001 and 2012 years, focusing on medical examination as the interest of the participation group and physical therapy cost as interest of the non-participation group. Results: Total medical insurance cost increased by 23.72%, on average. Medical examination cost increased by 23.90% and 37.66% in medical examination for new and established patients, respectively. However, physical therapy cost was reduced by 5.01%. The medical examination cost for physical therapy without medical checkup increased by 2.62%. Conclusion: This study shows that the physical therapy cost, related on the interest of the non-participative group in the Health Insurance Policy Deliberation Committee, rather decreased while the total medical insurance cost increased.These findings demonstrate the invasion of the non-participative group on the Health Insurance Policy Deliberation Committee. Thus, aggressive participation in political decision-making committee is necessary in order to protect and increase rights and interests of Korean physical therapists.

• 보건행정학회지
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• 제22권1호
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• pp.145-162
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• 2012

The purpose of this study is to understand magnitude and its related factors of user's cost-sharing for non-covered services in long-term care facilities. We corrected data for 1,016 subjects, based on the long-term care benefits cost specification. Eighteen subjects were excluded from the data analysis due to missing data on family care-givers characteristics. Finally, 998 subjects were included in the study. The average cost of non-covered services per month was 209,093 won and distributed from 0 to 1,011,490 won. There was a significant difference by the characteristics of family care-givers and long-term care facilities. The monthly average cost for meal materials per person was 199,181 won(0~558,000), average cost of additional charge caused by using private bed was 232,992 won (50,000~600,000), and costs for haircut and cosmetics were 8,599 won. For the rest, there were various programs costs(93,328 won), diaper and its disposal cost(109,628 won), purchase cost for daily necessaries(24,435 won) and etc. The related factors for the magnitude of non-covered services expenditures were education level of family care-givers, occupancy rate and location of LTC facilities, and the costs of using private bed, haircut and cosmetics, and various programs among non-covered services. These findings suggest that present level range of LTC facilities users' cost-sharing is wide and it is urgent to prepare the standard guideline for cost and level in non-covered services.

• 보험의학회지
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• 제33권2호
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• pp.15-17
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• 2014

All Korean people are eligible for National Health Insurance(NHI). But large non-coverage of NHI is a big problem. The origin of this problem is from medical fee schedules. NHI calculate all hospital income including insurance medical practice, non-insurance medical practice and non-medical income(i.e. a funeral hall, a parking lot, stores in hospital).

• 한국보건간호학회지
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• 제3권2호
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• pp.5-46
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• 1989

The current medical payment Insurance Rates in Korea stipulate charges for medical treatment by the doctor, pharmaceutist, medical technician and maternity nurse. But unfortunately didn't specify those charges for nursing done by the professional nurse. Only basic nursing fee is accounted insufficiently in current medical insurance fee schedule. therefore, Being face with covering entire people by medical insurance by 1991, It seems that the problems pertaining to operating the hospital and medical insurance system would be incessantly expanded in that no mention is made of medical charges rendered by major medical producer service in the current system, For that reason, this study made an attempt to clarify the importance the professional nursing puts of the current medical payment. The purpose of this study was to accounting nursing fee which diveded into the current medical fee schedule. (Method) 1. Data collection; Importance and difficulties in nursing activities was conducted in 'S' National University Hospital. Total nursing activities were selected 72 items which included direct care and indirect care. This study was conducted to evaluating the degree of importance and difficulties according to nursing activities through questionnaire to 204 RN. and so relative difficulties (acuity) were computered because the nursing cost level of each nursing service was differently established by the equivalent coefficient according to degree of relative difficulty and time required. 2. Calculation of cost according to nursing activities; After 47 nursing activities were selected in General surgery nursing units, calculation of nursing cost was as follows Cost of Nursing activity = (relative difficulty X Average hourly wage and benefits of nurse) + material cost of nursing -t- Average nursing administration cost So, Calculated cost by nursing activities was compared to current non-insured and insurance rate. 3. Calculation of nursing cost by K - DRG ; Total of 578 patients who were hospitalized in General Surgery units from January to March 1988 ware classified by K - DRG After estimation of total nursing cost based on the K-DRG, verified the appropriateness of basic nursing fee in medical insurance rate (Results) 1. Analysis of degree of importance and difficulties were 4.16 and 3.67 based on 5 point scale. This score were judged that it is worthy specifying the nursing fee 2. The nursing cost of 47 nursing service items in general surgery patients showed that the average cost of nursing activity was \1374.5 and The lowest cost was \217 of 'oral administration nursing' item, The highest cost was \11,025 of 'saline enematill clear' item 3. The result of comparison between the calculated cost by nursing activities against the current non-insured and insurance rate showed that 13 items(27.7%) involved to payment of insurance rate, 9 items(19.1%) involved to non-insured rate, remainder 25 items (53.2%) were not charged anywhere of total 47 nursing activities 4. When calculated cost by nursing activities was 100. current insurance rate was 62.3, non-insured rate was 176.6. Therefore this showed that most of non-insured rate were higher than calculated nursing cost. The insurance rate, however, were lower than it. Reim-bursement was imputed to non-insured patients. So the current rate system became estrainged from cost system. When Remainder 25 items of nursing activities compared' to \1390 of daily basic nursing fee per patient belonged to payment as a insurance fee schedule, basic nursing fee schedule was 1-2% of calculated cost of nursing activities. Therefore it showed that nursing fee was not counted adequately in it. 5. Nursing cost by K-DRG estimated in chart review based on counting number of nursing activities and length of stay The result showed that average amount of total nursing cost was \183828.1 Comparison of nursing cost calculated by K- DRG and basic nursing fee schedule showed that only 12.3% of nursing cost was charged (Conclusion) From the above research result, It is fact that nursing prime cost should be estimated more accurately and included adequately in current medical payment system. The payment system of nursing activities should be introduced not only nursing activities of drug administration and injection fee belonged to insurance fee schedule but also most nursing activities belonged not to mekical fee schedule. Even if introducing payment system of nursing activities, It should be estimated scientific method of Accounting nursing cost So nurses could offer nursing care of good quality, thereby they could make a great contribution not merely to the convalescence of the patient but to the promotion of the people's health.

• Journal of Acupuncture Research
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• 제33권2호
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• pp.61-76
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• 2016

Objectives : This study was designed to clarify population-social characteristics that influence the utilization patterns of hospitalized patients in a traditional korean hospital, thereby providing clinical data which would help further improvements of traditional korean medical service in particular the Acupuncture and Moxibustion. Methods : We investigated population-social characteristics and annual utilization patterns of all patients who were hospitalized for more than 24 hours in a Korean Medical Hospital from January 2005 to December 2014. The obtained data were recorded in the EMR chart and statistical analysis was performed using SPSS 21.0. Additionally, data from the patients admitted to the department of Acupuncture and Moxibustion were analyzed separately. Results : 1. All inpatients had a significant annual difference in age, gender, hospitalized department, and disease code annually but not in re-hospitalization number. Inpatients of the department of Acupuncture and Moxibustion also varied in their age, gender, and disease code annually, but not in re-hospitalization number. 2. Pearson correlation analysis on all inpatients showed that the mean days of hospital treatments had a negative correlation with all variables except medical care insurance. Total cost, cost per day per person and recuperation cost had a positive correlation with all variables except medical care insurance. There was no meaningful relationship between nonrecuperation cost and the variables. 3. Stepwise multiple regression analysis on all inpatients showed that the mean days of hospital treatments had a negative correlation with all variables except automobile insurance. The total hospitalization costs had a positive correlation with both general insurance and medical care insurance. Cost per day per person and recuperation cost had a positive correlation with the females. There was no meaningful relationship between non-recuperation cost and the variables. 4. Pearson correlation analysis on inpatients of the department of Acupuncture and Moxibustion inpatients showed that the mean days of hospital treatments had a positive correlation with all variables except general insurance and automobile insurance. Total cost and recuperation cost had a positive correlation with all variables except medical care insurance, and cost per day per person had a positive correlation with females and general insurance. There was no meaningful relationship between non-recuperation cost and the variables. 5. Stepwise multiple regression analysis on inpatients of the department of Acupuncture and Moxibustion inpatients, the mean days of hospital treatments, total cost, cost per day per person and recuperation cost had a positive correlation with general insurance. There was no meaningful relationship between non-recuperation cost and the variables. Conclusion : Population-social characteristics of inpatients annually varies, and the change influences the utilization pattern.

• 보건행정학회지
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• 제33권3호
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• pp.325-337
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• 2023

Background: While there are many studies estimating the effects of private health insurance on various types of health care utilization, few have examined how such effects change in conjunction with important policy reforms in national health insurance (NHI). This study examined how the effect of private health insurance (supplemental and fixed cash benefit) on high-cost outpatient imaging test utilization changed following the expansion of magnetic resonance imaging (MRI) coverage in 2018, which is a key example of the NHI benefit expansion policy in recent years. Methods: Data from the 2017 and 2019 Korea Health Panel Survey, which contained information about healthcare utilization before and after the expansion of MRI coverage in 2018, were used. The incremental effect of private health insurance on high-cost outpatient imaging test utilization for each period were quantified and compared, with special attention given to the type of private health insurance. Results: While people with supplemental private health insurance were more likely to use high-cost outpatient imaging tests than those without, both before and after the expansion of MRI coverage, the incremental effect increased from 1.6% points in 2017 to 2.5% points in 2019. Conclusion: Benefit expansion in NHI does not necessarily reduce disparities in the use of health care between private health insurance subscribers and non-subscribers. The results of our study also suggest that the path through which private health insurance affects healthcare utilization may not be limited to the price mechanism alone but can be more complex.

• 대한간호학회지
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• 제10권1호
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• pp.41-55
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• 1980

The medical care insurance system, being put into practice nearly for three years, seem to have brought about some considerable problems as serious for the government as to consider a revision of that system. As one of the most serious problems of present system, the treatment cost of insurance patients is so remarkably low in comparison with than of non-insurance cases that normal operation of hospitals is threatened and care services of low quality are induced. The researcher carried out this survey to analyze and bring to light several aspects of treatment cost of non-insurance patients as a material for a re-assessment of the cost of insurance cases which shows a a considerable difference in amount at the standpoint of hospitals with than of non-insurance cases and further, hoping the significant blind spot of present insurance system(that is, the absence of regulations' for cost assessment by patterns or types of health care treatment) will be mended in near future. The survey was carried out with the treatment invoice sheets of total 902 in-hospital Patients of a general hospital in Seoul during the period of the 2 nd quarter of the year(1979). Among total 902 patients, 694 cases were used for analysis, because those disease or syndromes shared by less than 10% of the patients were put aside before procession. The data were analyzed by kinds or types of diseases, demographic characteristics of patients, hospitalization patterns, types of nursing treatment, etc. The result of analysis was as follows 1. Among all the non-insurance cases, those who received one or more kinds of nursing treatment mounted up to 96. 7 ％. The invoice issue frequency per person was 7.2 times, while that frequency per day for a person was 0.8, : the treatment cosr per person was ￦22,650 while its daily average was ￦2,430, due to the average 9.3 in-hospital days per person. 2. As to the nursing treatment types by the demographic characteristics of patients and hospitalization patterns. a. The unit cost female patients was generally more expensive them that of males, and independent nursing service was more given than other types of treatment. As to age, higher age groups received independent nursing service most, while the youngest group received instrumental and integrated nursing services. b. As to room grade, the unit cost of I.C.U. cases was the highest : and the cast of private room patients was higher than that of public room patients. By in-hospital days, the curve of function showed L. type : that is, the longer stay, the lower function. 3. State of treatment types by kinds of disease were ; a. Dependent nursing service showed comparatively high availability in surgical and neurologic disease and independent nursing service was most received by medical, obstetrical and urological patients, while instrumental and integrated services were most available for respiratory disease and obstetrical and neurologic diseases next. b. The invoice issue frequency per day for a patient was highest in obstetrical disease 3.8 times, and the unit cost(per one invoice sheet) was also highest in obstertrical disease(￦10,880) and next in neurologic cases(￦ 4,690 ). 4. As to the pertained departments. a. Cost amount per person was highest in department of Psychiatries daily cost was highest in obstetrical cases : while the invoice issue frequency was highest in obstetrics and next in pediatrics. b. In departments in need of surgical operation, dependent nursing care was highly availabl : while in internal medicine and obstetrics, independent service was higher. Psychiatrics showed the highest the of integrate nursing while pediatrics and obstetrics higher of instrumental services. The variation co-efficien of treatment cost came out to be relatively in high in special surgery, opthalmology and internal medicine. 5. State of treatment cost by types of nursing behavior was. a. The average frequency of invoice issue was 3.5 (times). Among the type four types of treatment, instrumetal service (4.3) and independent nursing behavior(3.9) showed higher frequency than average respectively. But as to unit cost (per invoice). dependent (￦5,200) and integrated (￦5,340) nursing care services were higher than average and considerably higher than the other two types. b. In repect patient distribution. independent nursing behavior(80.3% ) was the highest and depend ent nursing (31.7% ) the lowest. The variation co-efficient of treatment cost appeared highest in dependent nursing be havior as a whole, and among that, doctor's diagnosis showed the highest coefficient value (100.7). In conclusion, the variaty of treatment cost(treatment itself ) by various characteristics and treatment types pro- that treatment various sort of patients and treatment cost of various types of nursing behavior cannot be uniform. Therefore, to attain the equalization of health care service and its cost both for insurant and non-insurant patients, a more specific provision for assessment of cost should be added to the present medical care insurance system and, in addition, the cost of nursing treatment is desired to be inserted into the treatment invoice.

• 한국병원경영학회지
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• 제19권2호
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• pp.1-11
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• 2014

The purpose of this study is to investigate awareness on medical insurance on the caregivers cost for hospital administrative staff and to provide the basic data for realization of legislation. The subjects were caregivers living in Busan, the survey was conducted from February 18 to March 9, 2013, 283 except for 17 copies of non-response and error response among a total of 300 questionnaires were analyzed. As a result, To improve the quality of care services, there were 51.8% of refresher training needs in refresher training items, 72.7% in favor of premiums increases in health insurance details, as for health insurance coverage subjects, patients' income were 32.0%, copayment for caregivers cost was 20.0%, which was 42.3%. Refresher training item, premiums increases, health insurance applied subjects, variables for copayment for care fee were related to medical insurance on the caregivers cost. On legislation on the medical insurance, systematic and standardized criteria should be provided to provide standardized curriculum for caregivers, to relieve patients and guardians of economic burden for caregivers cost and offer the stability of the cost.

• 한국병원경영학회지
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• 제26권3호
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• pp.13-27
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• 2021

Purpose: We examined the relationship between operating income and volume of medical services provided at general hospitals in 2018 according to characteristics of general hospitals and measured as operating income(net income) and volume(adjusted inpatient days) covered or non-covered by National Health Insurance(NHI). Methodology: Finance data from income statement reports in 212 general hospitals and the national health insurance claim data of these hospitals were used. The characteristics of the general hospital were divided into structural, operational, financial, and patient aspects. Operating income and volume were divided into covered and non-covered by NHI. Findings: The results showed high volume hospitals tended to be more profitable than low volume hospitals, especially in non-covered services. Operating income was more likely to be sensitive to non-covered services volume than to covered services volume. Practical Implications: It is necessary to understand the volume of services in non-covered, in order to obtain reliable cost information to be used for the fee schedule. Researches on small size hospitals(<160 beds) are needed, with a large variation in the volume of services and a strong tendency to compensate for the loss in the covered part in non-covered part.