• 한국산학기술학회논문지
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• 제16권11호
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• pp.7463-7473
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• 2015

본 연구는 장기요양 1등급 건강보험가입자를 대상으로 장기요양서비스 이용자와 미이용자의 의료비 지출 차이를 비교하고, 의료비 지출에 미치는 영향 요인을 규명해 보고자 시도하였다. 연구 대상은 건강보험가입자로 2009년 1월 1일부터 12월 31일까지 1등급 판정을 받은 21,213명 전수를 대상으로 국민건강보험공단의 장기요양급여, 건강보험급여 자료를 활용하였다. 연구결과 2007년부터 2009년의 연간 총 진료비 변화량의 경우 서비스 이용자에 비해 미이용자는 5,337천원 증가하였으며, 연간 요양병원 진료비 변화량은 5,449천원 증가하였다. 연간 총 입원일 변화량의 경우 서비스 이용자에 비해 미이용자는 87.31일 증가하였으며, 요양병원 입원일 변화량은 79.47일 증가한 것으로 나타났다. 이 같은 결과는 장기요양 서비스 미이용자의 의료이용, 특히 요양병원의 의료이용이 높게 나타남에 따라 미이용자에 대한 적정의료와 요양서비스 지원 정책을 통해 장기요양과 의료서비스의 효율적 연계가 필요로 된다.

• 보건행정학회지
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• 제33권4호
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• pp.400-410
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• 2023

Background: As the government has recently been discussing the expansion of the disaster health expenses support project, we would like to confirm the characteristics of beneficiaries of the support project, particularly those of high-cost beneficiaries. Methods: Using the database of catastrophic health expenditure support project from 2019-2020, this study aims to confirm the characteristics of high-cost beneficiaries focusing on the overlap of the relieved out-of-pocket systems, known as the out-of-pocket ceiling system and the system for rare incurable diseases. Logistic regression analysis is used to examine this issue. Results: In order to analyze the factors influencing high-cost beneficiaries, five models were created and analyzed, including the status of duplicated beneficiaries for relieved out-of-pocket systems, sociodemographic and economic factors, and individual health status as sequential independent variables. All five models were statistically significant, of which economic factors had the greatest impact on the model's predictions. The main results indicated that those who benefited from multiple systems in duplicate were more likely to be high-cost beneficiaries, and there is a higher probability of incurring high health expenses among the underage. In addition, within the beneficiaries of catastrophic health expenditure support project, it was observed that higher health insurance premium percentiles are associated with a higher proportion of high-cost beneficiaries. Conclusion: This study examined the characteristics of high-cost beneficiaries by encompassing reimbursement and non-reimbursement. According to this study, it is expected to be used as basic data for setting priorities and improving the current criteria of catastrophic health expenditure support project, aiming to sequentially expand the program.

• 대한예방한의학회지
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• 제16권2호
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• pp.41-52
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• 2012

Objectives : This study aimed to analyze the trend of financial balance of Korean medicine clinics during 20 years, and to provide basic information for adjusting the fee schedule of Korean medicine procedures in national health insurance(NHI). Methods : We collected 6 financial analysis reports for Korean medicine clinics from the Association of Korean Oriental Medicine(AKOM). The data on incomes, costs and EBIT(earning before interests and taxes) of subject clinics were abstracted, and their long-term trends were evaluated. Results : The proportion of insurance income in total income increased from 23% to 56% during 20 years. Among 5 treatment groups, 'non-insurance medication' took up 65~67% of total incomes in 1997, but its proportion decreased to 42.4% in 2007. 'medical procedure, physical therapy and others' increased from 12.4% in 1987 to 29.2% in 2007. The labor cost was major part of total cost and its proportion maintained from 52% to 54%. Cost of 'non-insurance medication' was on the decline from 41% in 1996 to 31.6% in 2007. EBIT were -17.4 million won in 1996, and 18.4 million won in 2007. Conclusions : Financial balance of Korean medicine clinics improved until early 2000, but it became worse in 2007. Though deficits from NHI procedures has been covered up by profit from 'non-insurance medication', health insurance became a major source of income during last two decades.

• 보건행정학회지
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• 제27권3호
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• pp.191-198
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• 2017

Moon Jae-in Government announced the Government's 5-Year Plan on July 19, 2017, President Moon directly announced the Government's Plan for Benefit Expansion in National Health Insurance on August 7, 2017. The main contents of the announced expansion include benefit coverage for all medically necessary services with control over non-covered service occurrence, a decrease in the cost-sharing upper limit, and monetary support for catastrophic medical costs. Although past governments have been continuously striving for benefit expansion in the last 15 years, this plan has its breakthrough aspect in that all medical services will be covered by the National Health Insurance. In alignment, there are important tasks to solve: attaining a proper fee schedule, reforming the healthcare delivery system, and improving healthcare quality. This plan is a symptom oriented action in that it is limited in reducing patients' out-of-pocket money, unlike the systematic approach of the National Health Insurance. The sustainability of the National Health Insurance is being threatened due to South Korea's low birth rate, rapidly aging society, and low economic growth, in addition to the unification issue of the Korean Peninsula, medical utilization of the elderly, management of non-communicable diseases, and so on. Therefore, the Government needs to plan the National Health Insurance system reformation including actions addressed toward medical consumers.

• 보건행정학회지
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• 제28권2호
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• pp.186-193
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• 2018

Background: The aim of our study was to review the findings of health insurance fraud investigations and to evaluate their impacts on medical costs for target and non-target organizations. An interrupted time series study design using generalized estimation equations was used to evaluate changes in cost following fraud investigations. Methods: We used National Health Insurance claims data from 2009 to 2015, which included 20,625 medical institutions (1,614 target organizations and 19,011 non-target organizations). Outcome variable included cost change after fraud investigation. Results: Following the initiation of fraud investigations, we found statistically significant reductions in cost level for target organizations (-1.40%, p<0.001). In addition, a reduction in cost trend change per month was found for both target organizations and non-target organizations after fraud investigation (target organizations, -0.33%; non-target organizations of same region, -0.19%; non-target organizations of other regions, -0.17%). Conclusion: This study suggested that fraud investigations are associated with cost reduction in target organization. We also found similar effects of fraud investigations on health expenditure for non-target organizations located in the same region and in different regions. Our finding suggests that fraud investigations are important in controlling the growth of health expenditure. To maximize the effects of fraud investigation on the growth of health expenditure, more organizations needed to be considered as target organizations.

• Asia pacific journal of information systems
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• 제8권3호
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• pp.165-180
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• 1998

In this study, we analysed the current situation of Internet-based insurance services which can provide a non-traditional and cost effective communication channel between the customers and insurance companies. The service of Internet-based cyber-insurance extends from mere advertisement to on-line contracts through planning simulations and, furthermore, to customer monitoring. This cyber-insurance is the demand of the times and is not to be overlooked-by the Korean insurance companies which are suffering from accumulated loss and are facing severe economic depression. We performed a comparative analysis between the domestic cyber-insurance service and pioneers'. Also, we suggested future possibilities of cyber-insurance services, presenting an architecture for the construction of a cyber-insurance management module within the meta financial investment system.

• 지역사회간호학회지
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• 제27권3호
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• pp.272-283
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• 2016

Purpose: This is a comparative study using secondary data from the Korean national long term care (LTC) insurance. Methods: Visiting nursing (VN) service users (n=666) and non-users (n=4,375) were extracted and compared in terms of medical expenditures, length of hospitalization, and annual number of ambulatory care visits to investigate effects of VN services in LTC. Results: Total health care expenditures were compared between the two groups and it was found that VN service users spent about $ 1700 than non-users for their medical costs between 2009 and 2011. The average length of in-hospital stay for VN service users was 19.4 days shorter than that of non-users. However, using VN services did not significantly influence the annual number of ambulatory care visits. Conclusion: The study has found that VN services are effective ways of providing community-based LTC services. We recommend LTC policy makers to further utilize VN services to deliver cost effective health care services.

• 산경연구논집
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• 제8권2호
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• pp.21-31
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• 2017

Purpose - The total amount of advanced Corporate Pension Insurance products exceed 148 trillion Korean Won at the end of 2016. For a firm with over 300 employees, when a bill on compulsion of introduction of Corporate Pension Insurance products, currently pending in court, is passed, Corporate Pension shall be an essential. The findings of the paper will provide a guideline for understanding on firm's attributes and its effects towards introduction of Corporate Pension Insurance products. Research design, data, and methodology - The data were collected using statistics of employer panel survey from Korea Labour Institute in 2013. The study analyses a sample survey on 1,775 outstanding enterprises and their HR department among whole corporations in Korea. For analysis of data, empirical testing by Logistic Regression was utilized. Results - As an outcome of empirical testing, variables on share of regular employees and the aged employees in over 50's generates a significant statistical meaning. It eventually gives a great impact on purchase of Corporate Pension scheme. Moreover, variables on corporate financial statement, current sales, current net income, total amount of the debts, labor cost per person also has a vital influence on introduction of Corporate Pension Insurance products. Lastly, variables on firm's labor relationship have no effect except for the execution or non-execution of HR consulting. Meanwhile, Variables affecting a choice on pension schemes types among firm's attributes are a share of regular employees, current net income, execution or non-execution of HR consulting etc. These variables represents a statistical implication. According to their each features, they prefer DB or DC plan. Conclusions - Introduction of corporate pension scheme is apposite to contemporary Korea's situation entering a hyper-aging society and firms with a high share of regular employees, the weight of aging, current sales, current net income and labor cost per person are exceedingly active in purchasing Corporate Pension Insurance products. However, after the introduction of corporate pension scheme, firms which has an implementation of consultation on human resource management, flexible benefits plan, job security and welfare system prefer DC plan whereas from financial perspective firms with high net income prefer DB plan.

• 한국융합학회논문지
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• 제8권5호
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• pp.61-68
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• 2017

이 연구는 2015년 1월부터 12월까지 1년간의 자동차보험으로 진료 받은 치과와 한방을 제외한 의과 8,589,602건에 대해 자동차보험회사별로 진료특성과 진료비 차이를 분석한 것으로 그 결과는 다음과 같다. 첫째, 일반적 특성 중, 연령에서는 손해보험과 공제조합 모두 50-59세가 22.8%로 가장 높은 것으로 나타났다(p<0.001). 둘째, 진료과별 입원 건당진료비는 손해보험과 공제조합 모두 내과계가 외과계보다 높은 것으로 나타났으며, 외과계 세부과목별로는 손해보험회사와 공제조합 모두 흉부외과가 가장 높게 나타났다. 이상의 연구결과를 볼 때, 심사평가원에서는 자동차보험 청구요양기관에 대한 적정성평가를 실시하여 불필요한 진료비를 증가시키는 문제와 환자의 재활 및 일상생활의 복귀가 지연되어 발생하는 사회적 비용 문제를 해결하여야 할 것으로 사료된다.

• 한국산학기술학회논문지
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• 제3권4호
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• pp.325-332
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• 2002

본 논문은 최적리콜보험계약의 설계와 관련된 논문의 survey이다. 리콜보험 뿐만이 아니라 최적보험계약을 만들기 위해서는 보험계약의 조건들이 내생적이라는 가정하에서 연구모형을 구축하고 분석의 과정에서는 보험구매를 위한 의사결정 원칙으로 기대효용이론, 비기대효용이론, 및 상태귀속적인 (state-dependent) 효용함수를 사용하였다. 어떠한 이론을 사용하더라도 최적보험의 조건들은 존재한다. 다만 계약조건에 관련되어서는 보험의 비용, 자기부담금, 보상한도액 등이 차이가 날 수 있다. 보험의 비용은 지급보험금과 선형, 오목형, 볼록형의 관계가 성립할 수 있으나 잠식비용과 고정비용의 존재를 인정하여야 한다. 이를 바탕으로 최적보험을 위한 비용 설계가 이루어져야 한다. 또한 전부보험이냐 일부보험이냐를 결정하는 자기부담금의 존재는 일률자기부담금형태와 점감식자기부담금형태가 가능하다. 자기부담금 수준의 결정과 관련하여 담보되는 모든 위험에 동일한 수준을 적용시킬 것인가 혹은 차별화시킬 것인가는 보험의 종류에 따라 달라질 수밖에 없다. 보상한도와 관련되어서는 특히 리콜보험에 있어서는 기업의 파산위험성이 상당히 존재하고 있으므로 계약당사자의 파산선고를 포함한 이익이 충분히 고려되어야 한다. 또한 제약조건으로는 불완전시장에 대한 이해를 필요로 하며 담보할 수 없는 배경위험의 존재에 대한 배려가 있어야 한다.