• Korea Journal of Hospital Management
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• v.17 no.3
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• pp.23-36
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• 2012

Objectives : The coverage of Korean National Health Insurance is limited to basic level. Korean government encourages private health insurance for covering medical securities. So, many studies examined the determinants of purchasing private health insurance. However, 11% of Korean population is older than 65 in 2011. Considering the elderly is important to establish a health policy. The aim of this study is to examine factors determining the purchase of private health insurance among middle-aged and elderly Korean adults. Methods : We used the second Korean Longitudinal Study of Ageing (KLoSA), selected 8,688 sample of the aged 47 or older for the analysis. KLoSA collected information on demographic characteristics, income, health- related factors. KLoSA data include in the number of outpatient, inpatient, oriental hospital visit, dental clinic visit for two years. Logistic regression was used to examine the relationship between the determinants of purchasing private health insurance and the factors which include age, gender, education, residential district, marital status, smoking, drinking, physical exercise, economic activity status, national health insurance type, income, the number of chronic disease, and the number of outpatient, inpatient, oriental hospital visit, dental clinic visit for two years. Results : People who were older, did not live in a city, had higher IADL, currently drunk alcohol, did exercise regularly and had chronic diseases more than three were inclined not to purchase private health insurance. Females, the married, well-educated, past & currently smokers, the employed, high income earners, national health insurers, metropolitan citizens and someone who got high MMSE were more likely to purchase private health insurance. The more people experienced outpatients, inpatients, dental clinics and Chinese medicine clinics, the more private health insurance was purchased. The elderly people over 75 had more private health insurance than the aged 65-74. The strongest factors for private health insurance is gender, and economic status such as income. Conclusion : In this study, we found healthy-high income people were more likely to purchase private health insurance. In contrast, unhealthy-low income and older people did not. The economic factors were strongly related with private health insurance in aged over 75. These mean inequality exists in the using private health insurance. Therefore, the government should consider vulnerable social group before expanding private health insurance.

• The Journal of Korean Medicine
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• v.30 no.1
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• pp.1-16
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• 2009

Objectives: To study the standard herb prescriptions based on the specific names of the sick and wounded for the application of Eastern Medicine Health Insurance. Methods: We selected 678 herb prescriptions from the eleven Eastern medical books recognized by the Ministry for Health of Korea and then researched the concrete opinions of Korean Oriental Medicine Societies (KOMS) on those herb prescriptions from July 31, 2006 to August 31, 2006. Results and Conclusions: KOMS said that 80 herb prescriptions must be included and 26 herb prescriptions must be excluded. They also said that the proper numbers of the specific names of the sick and wounded for the application of Eastern Herbal Medicine Health Insurance were 20-29 and the proper range of herb prescription change was within 30 percent.

• The Korea Journal of Herbology
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• v.24 no.4
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• pp.17-23
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• 2009

Objectives : This study aimed to provide basic data for future policies regarding the expansion of health insurance, through investigating the current status of Oriental herbal medicine insurance as perceived by the public. Methods : Questionnaire was developed through literature searches, in-depth interviews, item generation and item reduction. The questionnaires were further refined by a focus group. 221 surveys were retrieved from the general public. Results : The in-depth interviews, reveal that the public is aware of the various forms of Oriental herbal medicine formulas, except for the use of mixture of which are soluble granules covered by insurance. The public awareness of the soluble granules turned out to be so low that enhanced awareness of it is required. The public identified decoctions as the most preferred formula as well as the most effective formulas out of all Oriental herbal medical formulas. They also suggested that it should be the first to be included when the insurance policy expands in the future. The public had frequent experienced not choosing Oriental herbal prescription due to the high cost. Insurance coverage of Oriental herbal prescription is much needed. The public indicated that they will make frequent visits to the KMD if the insurance covers Oriental herbal prescriptions. Conclusions : The current status quo of Oriental herbal medicine insurance showed that the public identified decoctions as the most preferred, most effective and the top priority to be covered by insurance.

• Journal of Society of Preventive Korean Medicine
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• v.1 no.1
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• pp.137-148
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• 1997

The Serial Securities and the Social Welfare, as the national policy aimed at securing generals' lives, are the policies or systems for the stabilization in lift; especially of law-incomers and workers, for which the povernment has to establish the Social Security System. No wonder the Social Insurance System is a part of the Social Security System and the most important. The Social Insurance System, along with Public Assistance, is underlying the Social Security System. Social Security System includes medical insurance, industrial accident Compensation insurance, national pention insurance and employment insurance. The study is on 'The Oriental Medical Insurance and the Industrial Accident Compensation in the Social Security System' . The rate of industrial accident in Korea marks the highest rank in the world. for laborer, industrial accident do not merely mean the loss of health but the question of the right to live in terms of their loss of opportunity of life. The industrial accident compensation system should be established as the es post facto remedy system to guarantee the injured worker and his/her family's life. The oriental medical insurance system which began to operate in 1987 in Korea is based on unionism and divided into 3 parts; one part for the worker, a second part for the community inhabitants, and a third part for the public service personnel and private school personnel. Today the medical problem must be the most important social assignment to be considered. The medical system of contemporary industrial society has began greatly stood out in relief as a part of social welfare not emphasized on gainings of physicians. Accordingly systematization of the oriental medical insurance was strongly Pursued and it was developed to to the extent of entire nation insurance. Though the history of it is very short, most of the people are getting benefit from the insurance system by the social security system method. This study develops the Oriental Medical Insurance, the Workmen's Accident Compensation Insurance, the Pension System in relation to the industrial accident compensation of Employees, along with the ideas and principles of social insurance.

• Journal of Society of Preventive Korean Medicine
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• v.10 no.2
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• pp.147-158
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• 2006

The purpose of this paper is to review the empirical study results of conversion factors(unit prices) for relative values of health care services in the national health insurance system and establish optimal classification of health care institutions for feasible contract of conversion factors between National Health Insurance Corporation(NHIC) and provider groups, based on legal backgrounds and types of health care service delivery system. some empirical research evidences shows the validity of applying multiple conversion factors to annual contract for reimbursement in the national health insurance. Policy recommendations suggest that clinic, hospital, general hospital, tertiary hospital, dental clinic, oriental medical clinic, pharmacy, and public health centers would be a basic category of provider groups for a meaningful price contract between the NHIC and providers.

• Journal of Korean Medical classics
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• v.23 no.1
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• pp.133-142
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• 2010

Preconditions for the separation of prescribing and dispensing medicinal herbs in Traditional Korean Medicine are classification of medicinal herbs for general public and special medical uses, establishment of national medicinal herb distribution company of governmental base, restriction in purchase of medicinal herbs for special medical use, partnership between doctors and pharmacists of Traditional Korean Medicine, and coverage of herbal medicine-based medication in national health insurance, etc. The number of Traditional Korean Medicine Pharmacists which was born during 'the herbal medicine conflict' initiated in 1993, goes over 1,000 and will increase by 120 annually. The number of Traditional Korean Medical Doctors is over 17,000 and increases by 850 annually. So in order to engage partnership between two groups, the government have to arrange the number of outputs of each group. Standardization and classification of diagnosis and diseases in Traditional Korean Medicine is a matter of course in the separation of prescribing and dispensing medicinal herbs. Related societies and academies need to do researches with governmental fund first. After these works, we can launch a task force team for implementation of process for the separation of prescribing and dispensing medicinal herbs in Traditional Korean Medicine properly. Entering the national health insurance system for full coverage of Korean Medicine care service will be essential for the patients. Implementation the separation of prescribing and dispensing medicinal herbs in Traditional Korean Medicine would be the core of health insurance coverage for medication.

• Journal of Physiology & Pathology in Korean Medicine
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• v.25 no.3
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• pp.582-588
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• 2011

The objective of this study is to examine the difference about manner of utilization and satisfaction on western and oriental medical care. The data came from the National Health and Nutrition Examination Survey in 2001 and 2005. The Andersen model of health behavior was employed to make this analysis. The major statistical methods used in this analysis are chi-square test and logistic regression. The major findings are as follows; Medical care is totally increased in 2005 in comparison with 2001, but medical care in the oriental side is decreased. There is no significant variables in predisposing factors such as sex, age, education level and spouse. Of health behavior factors, the average persons in health state are more favorable in oriental care rather than western care. Oriental care is favorably taken in health insurance subscribers and residents in a large city of enabling factors. The patients with musculoskeletal disease are more dependent in oriental care than western medical care. In conclusion, the findings show that it is largely related to patients' health state, medical insurance, living area and disease types to take oriental medical care. These characteristics should be considered in establishing policies of the oriental medical care in the future.

• The Journal of Korean Medicine
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• v.29 no.3
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• pp.100-112
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• 2008

Objectives: The purpose of this survey is to monitor the changes that have occurred in the business environment surrounding Oriental medicine clinics, with the focus on their facilities, staff, patients, and service fee revenue. Method adopted: A questionnaire was sent in December 2006 to 1,000 Oriental medicine clinics nationwide, of which 122 (or 12 percent of them) replied. Previous questionnaires similar to this one in nature were checked for comparison. Results: As a result of analyzing the aforesaid replies, the average Oriental medicine clinic appears to have a floor size of 156 square meters (= 47.2 pyeong) and is equipped with 6.6 beds. The number of helpers and nurse's aids at each Oriental medicine clinics comes to 3.2 and 1.58, respectively. The number of patients coming to see a practitioner of Oriental medicine stands at 36.3 persons per day, of whom 32.06 come for acupuncture treatment. 50.2 percent of the Oriental medicine clinics' service fee revenue is paid from the health insurance. Each clinic spends on average 2.42 million won per month on the purchase of medicinal substances and so forth. The foregoing indicates a 27 percent increase from 1999 in terms of floor size, a 30 percent increase in the number of beds, a 47 percent increase in the number of helpers, a 45 percent increase in the number of nurse's aides, and an 11 percent increase in the number of patients who visit a practitioner of oriental medicine. As for the latter figure, there was an increase of 3.64 over a seven-year period. The number of patients coming for acupuncture treatment increased by 7.06 in the same period, whereas the number of those coming for medication treatment decreased by 4.28 percent. Health insurance payments as a proportion of Oriental medicine clinics' service fee revenues increased by 23.9 percentage points from 26.29 percent in 1997 to 50.2 percent in 2006. The amount that a clinic spends on the purchase of medicinal substances, etc, decreased by 250,000 won or by 9.3 percent from 1999. The estimated value of the domestic Oriental medical service market for 2006 stood at 2,422.2 billion won in total. Conclusion: Oriental medicine clinics in Korea appear to be getting larger, with an increase in the number of beds and helpers. Health insurance payments now account for a greater proportion of Oriental medicine clinics' service fee revenues, and management conditions at the clinics are deteriorating.

• Journal of Oriental Neuropsychiatry
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• v.25 no.4
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• pp.411-422
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• 2014

Objectives: A large number of patients require psychiatric therapy. We attempted to determine the present situation regarding psychotherapy and neuropsychological tests for dementia in Korean medicine for the benefit of the Health Insurance Review and Assessment Service (HIRAS). The aim of this study was to aware of the current status about psychotherapy and neuropsychological test for dementia in Korean medicine. Methods: We searched the medical practice records for psychotherapy and neuropsychological tests in oriental neuropsychiatry between 2009 and 2013 using the Health Insurance Review and Assessment Service (HIRAS) database. The search categories were: IJeongByunGi (Medical practice code:59001), JiUnGoRoen (59002), Kyungjapyungji (59003), OhJiSangSeung (59004), neuropsychological test for dementia (29005). Results: 1. The number of patients treated with Korean Medical Psychotherapy increased annually by 151%. The total number of patients treated with Korean Medical Psychotherapy was 4,289 in 2013. 2. The total cost for patients treated with Korean medical Psychotherapy in the public health medical insurance budget was 268,032,000 won in 2013. The average medical cost for one therapy was 17,000 won in 2013. 3. The number of patients in local clinics is increasing faster than the number in Korean medical hospitals. 4. The age group between 20~30 years of age, for both men and women, is the group with the greatest density in Korean Medical Psychotherapy. 5. Neuropsychological Testing for Dementia in Korean Medicine is slowly decreasing. Conclusions: The prevalence of mental illness in Korea is increasing, therefore, the demand for Korean Medical Psychotherapy has increased recently. Authorizing Korean Medical psychiatrists to utilize Korean mental Health resources is essential. This study could be helpful in understanding the current status for the purpose of expanding Korean Medical Psychotherapy.

• Korea Journal of Hospital Management
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• v.26 no.1
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• pp.71-82
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• 2021

Purpose: The purpose of this study is to estimate incomes and costs of the medical clinics by using secondary data. Methodology: The medical incomes and costs were estimated from 405 clinics operated by sole practitioner providing out-patient services among all clinics subject to the Medical Cost Survey on National Health Insurance Patients in 2017, excluding dental clinics and oriental medical clinics. The incomes and costs of the medical clinics were reflected with incomes and costs of health insurance benefits and were calculated by types of medical services (i.e., basic care, surgery, general treatment, functional test, specimen test and imaging test). The costs were classified as follows: labor costs, equipment costs, material costs and overhead costs. Secondary data was used to estimate the incomes and costs of the medical clinics. For allocation bases for costs for each type of the medical service, the ratio of revenue from health insurance benefits by types of medical services was applied. However, labor costs were calculated with the activity ratio by types of medical services and occupations, using clinical expert panel data. Finding: The percentage of health insurance income for all medical income was 73.1%. The health insurance cost per clinic was 401,864 thousand won. Labor cost accounted for the largest portion of the health insurance income was 191,229 thousand won (47.6%), followed by management cost was 170,018 thousand won (42.3%), materials cost was 35,434 thousand won (8.8%), and equipment costs was 5,183 thousand won (1.3%). Practical Implications: This study suggests a method of estimating incomes and costs of medical clinic services by using secondary data. It could efficiently provide incomes and costs to assess an appropriate level of the health insurance fee to the clinics.