• Health Policy and Management
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• v.21 no.1
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• pp.44-60
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• 2011

Background : Surgical site infection(SSI) is one of the important nosocomial infections with pneumonia, urinary tract infection. SSI increases mortality, morbidity, length of stay, and costs for postoperative patients. The purpose of this study was to estimate length of stay(LOS) and health care costs from SSI using the large observational data. The ultimate objective was to show the effect of prevention of SSI. Method : This study used antibiotic prophylaxis evaluation data and claims data of the HIRA(Health Insurance Review and Assessment Service). The study population included 18,361 patients who underwent gastric surgery, endoscopic cholecystectomy, colon surgery, hysterectomy, cesarean section in nationwide hospitals from August to October 2007. SSI group and non-SSI group were matched according to propensity score resulted from logistic regression. The paired t-test was used to compare the difference of the LOS and health care costs between SSI group and non-SSI group. Results : The 598 cases of SSI were detected of total subjects, and the crude SSI rate was 3.3%. For each surgery, SSI rates were 5.5% for gastric surgery, 4.7% for cholecystectomy, 6.6% for colon surgery, 2.6% for hysterectomy, and 1.6% for cesarean section. The 596 cases of SSI and the 596 cases of non-SSI were matched by propensity score. The LOS of SSI group was longer than that of non-SSI group, and the difference was statistically significant. Health care costs of SSI group was more than that of non-SSI group which was significant. Conclusions : SSI increased apparently the LOS and healthcare costs. The economic loss might affect the cost of national healthcare as well as patients and hospitals. This study provided the evidence that the healthcare expenditure could be reduced by preventing SSI.

• Health Policy and Management
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• v.24 no.3
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• pp.283-290
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• 2014

Background: This study aimed to examine the relationship between home-visit nursing services and health care utilization under the public long-term care insurance program in Korea. Methods: We analyzed the long-term care need assessment database and the long-term care and the health insurance claim databases of National Health Insurance Service between July 2011 and June 2012. The sample includes a total of 20,065 home-visit nursing recommended-older beneficiaries who use home-visit nursing and/or home-visit care, based on a standard benefit model developed by the Health Insurance Policy Institute of National Health Insurance Service. The beneficiaries were categorized into home-visit nursing use and non-use groups, and the home-visit nursing use group was again divided into high-use and low-use groups home-visit nursing, based on their total annual home-visit nursing expenditure. Two-part models and negative-binomial regression models were used for the statistical analysis. Results: The home-visit nursing use was negatively associated with the number of outpatient visit and cost, while adjusting for all covariates. The home-visit nursing use was also negatively associated with the inpatient cost among the high home-visit nursing use group. Conclusion: The findings implies home-visit nursing use prevents health care utilization. Further studies and policy strategies that can promote and strengthen home-visit nursing services under the public long-term care insurance are necessary in Korea.

• Health Policy and Management
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• v.27 no.3
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• pp.211-218
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• 2017

Background: Korea set up new diagnosis related group (DRG) as demonstration project in 2009. The new DRG was reformed in 2016. The main purpose of study is to identify the effect of reform on accuracy of payment. Methods: This study collected inpatient data from a hospital which contains medical information and cost from 2015 to 2016. The dependent variables were accuracy of total, bundled, unbundled payment, and payment for procedures. To analyze the effect of reform, this study conducted a multi-variate regression analysis adjusting for confounding variables. Results: The accuracy of payment increased after policy reform. The accuracy of total, bundled, unbundled payment, and payment for procedures significantly increased 3.90%, 2.92%, 9.03%, and 14.57% after policy reform, respectively. The accuracy of unbundled payment showed the largest increase among dependent variables. Conclusion: The results of study imply that policy reform enhanced the accuracy of payment. The government needs to monitor side effects such as increase of non-covered services. Also, leads to a considerable improvement in the value of cost unit accounting as a strategic play a role in development of DRG.

• The Korean Journal of Health Service Management
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• v.6 no.4
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• pp.143-152
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• 2012

This study analyzes Korea health panel data (2008) (beta version 1.2) of Korea Institute for Health and Social Affairs, and National Health Insurance Corporation to figure out determinants of healthcare expenditure. In result of Multiple Logistic Analysis, in-patents felt burden on the medical expenditure were 70.0%. As to the patients' payment of medical expenditure, patients over 65 years old had 4.765 times higher than those under 14 years, disabled patients 2.778 than non-disabled patients, chronic patients 1.632 times than non-chronic patients, patients belonging to 12 million won ~ 46 million won and under 12 million won in family income had 1.680 times and 2.168 times respectively than patients with over 46 million won, patients in professional recuperation facility 1.546 times than patients in hospital, patients in private medical institutions 1.700 times than patients in national and public medical institutions, patients using upper grade rooms 1.701 times than patients in non-upper grade rooms. As a health care safety net mechanism to protect people from medical expenditure burden, there is the patients' payment ceiling in the National Health Insurance System. Thus, in order to facilitate the patient's payment ceiling, it is required that the level of ceiling is to be specified according to the income level, and self-payment items is to be included.

• Health Policy and Management
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• v.30 no.2
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• pp.178-184
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• 2020

Background: Korea set up a new diagnosis-related group as a demonstration project in 2009. The new diagnosis-related group was reformed in 2016. The main purpose of the study is to identify the effect of reform on coverage of national health insurance. Methods: This study collected inpatient data from a hospital that contains medical information and cost from 2015 July to 2016 June. The dependent variable was the coverage of national health insurance. The dependent variable was divided by total, internal medicine partition, surgical partition, and psychiatric partition. To analyze the effect of the reform, this study conducted an interrupted time series analysis. The final sample included 23,695. Results: The health insurance coverage of internal medicine has the highest, followed by surgery and psychiatry. The health insurance coverage of bundle payment is higher than that of unbundled payment. The proportion of bundled payment and non-benefit decreased and the proportion of unbundled payment increased. The coverage of national health insurance significantly increased after policy reform in internal medicine partition (p-value=0.0356). Conclusion: The results of the study imply that policy reform enhanced the coverage of national health insurance in internal medicine. The government needs to monitor side effects such as an increase of unbundled payment.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.15 no.11
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• pp.6746-6755
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• 2014

This study examined the effect of long-term care utilization on the health care utilization of Medicaid elderly. The subjects were 5,834 long-term care insurance with the level 1 Medicaid elders, who received either service or non-service. This study examined the impact of long-term care service on the probability of health care utilization and the costs of health care utilization. The total medical cost and inpatient day between 2009-2007 were significant factors affecting long-term care utilization (${\beta}=.29$, p< .001, ${\beta}=.33$, p< .001 ) and this variable explained 22.6% of the total medical cost and 22.4% of the inpatient day. The results showed that non-service in long-term care was associated with an increase in health care utilization. The current long-term care insurance system should place higher priority and more resource allocation on long-term care utilization to increase the efficiency of the insurance system.

• The Korean Journal of Financial Management
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• v.23 no.2
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• pp.57-83
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• 2006

The purpose of this paper is to analyze the efficiency and productivity change and inefficiency cause of the korean non-life insurance companies of the before($1993{\sim}1996$) and after($1998{\sim}2004$) of IMF. we use DEA (Data Envelopment Analysis) model to measure company efficiency and MPI(Malmquist productivity indices) to measure company productivity change and Tobit regression to analyze inefficiency cause. we utilize ten non-life insurance companies in korea and the time-series data for eleven from 1993 to 2004 except 1997. The empirical results show the following findings. First, total cost efficiency shows that the after of IMF decrease of 3.7% over the before of IMF and MPI change indicates that the after of IMF increase 7.7% over the before IMF. Second, the results of Tobit regression to analysis the cause of inefficiency show that total cost efficiency is positively related invested assets, acquisition expenses ratio, collection expenses ratio and is negatively related solicitors ratio, personnel expenses ratio, land & buildings expenses ratio, loss ratio, net operating expenses ratio. Especially inefficiency of small-to-mid sized companies is main cause of total cost efficiency of non-life insurance companies in korea. Small-to-mid sized companies endeavored various aspects of business strategies.

• Health Policy and Management
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• v.31 no.1
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• pp.17-23
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• 2021

With the introduction of national health insurance, the burden of health care costs decreased and choices of medical services widened. However, because of the rapid expansion of non-covered medical services by health insurance, financial security for health care expenditure is still low. This gives patients barriers to choose medical services especially for non-covered medical services, and it becomes narrower. Compared to Korea, Japan has high financial protection in health care utilization, but there exists a limitation using covered and non-covered medical services both together. This is called a prohibition of mixed treatment in health care. This study reviews the Japanese health care system that limits choosing medical services and the burden of health care costs. The prohibition of mixed treatment can alleviate the out-of-pocket burden in the non-benefit sector, but it can be found that it has a huge limitation in that it places restrictions on choices for both healthcare professionals and patients.

• Health Policy and Management
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• v.27 no.2
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• pp.139-148
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• 2017

Background: The purpose of this study is to investigate family caregivers' opinions about out-of-pocket payment for long-term care (LTC) facilities, and find the differences in the opinions for family caregivers of all different levels of income. Methods: We used the data of the study on out-of-pocket payment in national long-term care insurance, including 1,552 family caregivers with the elderly in long-term care facilities. Results: The average out-of-pocket payment per month was 511,635 Korean won and distributed from 230,750 to 1,365,570 Korean won. The amount of out-of-pocket payment might be affected by not co-payment but the cost of non-covered service. There were differences in them for family caregivers of all different levels of income. Opinions were surveyed about 5 issues. By levels of income, there were differences in their opinions about 3 issues, the financial burden on LTC, the necessity of reducing out-of-pocket payments, and to be willing to pay more for a high quality service. But there were not different opinions about the interruption of LTC service and staying with LTC facilities. Conclusion: These findings suggest that the range of out-of-pocket payment for LTC facility is wide and it can be a burden to lower income group. It should be to prepare the policies to ease the financial burden and support the appropriate LTC use.

• Korean Journal of Social Welfare
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• v.37
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• pp.307-326
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• 1999

The primary purpose of this study is to analyze changes, if any, in the financial status and the intensity of health care service utilization of the regional health insurance societies following the 1995 merger of some rural and urban regional health insurance societies. Ultimately, this study is aiming at providing an empirical basis for predicting the impact of the 1998 merger of the Regional Health Insurance Program and the Health Insurance Program for Government Employees and Teachers and, further, predicting the impact of the merger of the entire health insurance programs scheduled for the year 2000. The study results did not suggest that the 1995 merger had brought about notable changes in the rate of increase in the total expenditures or the insurance payment of the merged regional insurance societies in comparison to non-merged ones. Neither did it show that the merger had resulted in significant changes in the intensity of the use of health services. The study, however, found that the 1995 merger had reduced the rate of increase in the management and operational cost of the merged insurance societies. Based on these findings, some policy implications are discussed, and suggestions are made for the total merger plan scheduled for the year 2000.