• 농촌의학ㆍ지역보건
• /
• 제17권1호
• /
• pp.17-24
• /
• 1992

The medical care insurance system has been adopted in rural areas in 1988, since then, the utilization of medical care services has increased rapidly in rural areas. The government has restructured the 15 health centers, which are located in remoted rural areas and these 15 health centers were strengthend to provide the curative care to the residents in order to meet the curative can demand of the residents. Besides the reorganization of the health centers, the government has implemented the oriental medical care demonstration project at the health center in a designated rural areas. This study was aimed to analyze the utilization and expenses of medical and oriental medical care services in a designated rural areas. Number of annual visits of residents to health centers in 1991 showed slightly decreased compared with that in 1989. However number of annual visits to the hospitalized health centers was an increase of 49.3%~64.5%. Regarding the coverage of curative care for the residents in rural areas, the hospitalized health centers are functioning more effective than that of health center. Expenses per case of medical care rendered by health center was lower than that of oriental medical care, while the expenses of the medical care was quit higher than that of oriental medical care in the hospitalized health centers. According to the above mentioned study results, the hospitalized health centers were more effective and suitable to provide a curative care to the residents than the health centers, and also the oriental medical care could be needed to be provided by public health network in the near future.

• 대한한방부인과학회지
• /
• 제23권1호
• /
• pp.72-82
• /
• 2010

Purpose: This study was conducted to estimate the annual socioeconomic costs of menopausal syndrome treated with oriental medicine in Korea 2008. Methods: Study subjects selected were patients aged 40 years or older who had national health insurance(NHI) claims record with menopausal syndrome(KCDO codes: K04, K04.0, K04.2, K04.3, K04.4) for oriental medicine treatment in 2008. Direct medical cost of oriental medicine treatment for menopausal syndrome were measured from NHI claims records. Direct non-medical costs were estimated as transportation costs incurred when visiting hospitals. Indirect costs were defined as patients' productivity loss associated with office visits or hospitalization. Also, the costs of unpaid-household chores were calculated. Results: The total cost for the oriental medicine treatment of menopausal syndrome in the nation was estimated to be 743,091,219 Korean won(KRW) which included direct costs at 442,971,637 KRW and indirect costs at 300,119,583 KRW. Conclusion: This study provides an important perspective of socioecnomic influence due to menopausal syndrome treated with oriental medicine. And this results can be used as elementary data for menopausal syndrome-related health policy of oriental medicine.

• 보건행정학회지
• /
• 제1권1호
• /
• pp.116-135
• /
• 1991

Few studies have been conducted on the detailed routes of medical care utilization under the National Health Insurance. This study was undertaken to identify the utilization patte군 of health care facilities among industrial workers and their dependents. One of the largest health insurance association was purposively chosen for this objective. The association had 345, 757 members as of 31 December, 1990. The study sample of 297, 948 subjects have been drawn from the membership pool on the basis of their continuous membership status during 1 January through 31 December 1990. This study has tried to identify differential utilization patterns between acute and chronic conditions, and among standard income classes. All the diagnoses were recoded in a manner to achieve the objective of this study. As for acute diseases, most age group had used one medical facility as much as by 60% except the age group of 1-4, This young age group had used over three different health facilities as much as by 10.9-15.8%. The finding suggests that some policy measures by sought for remedying the excessive/inappropriate use of services. In addition, mid-income classes(between 17 and 48) were more likely to use multiple sources of care than lower income classes(between 1 and 16) and upper income classes(above 49). This study has revealed that chronic cases are more likely to pursue multiple sources of care, however those with chronic conditions tend to use single health facility more than those with acute conditions(67.9% versus 52.4%). As many as 12.2% have visited more than three health facilities in chronic conditions, but 5.9% for acute conditions. The most likely source of care was primary clinics for both acute and chronic conditions. Compared with the role of general hospital, small-size hospitals found to play a minimal role in the care and referral of patients. This indicates the need of strengthening the function of small-size hospitals. While a minor cross utilization of western medicine and pharmacy was noted, no significant boundary crossing was identified between western medicine and oriental medicine, or between pharmacy and oriental medicine. It is too early to confirm that whether there is substitutability or cross utilization among these alternative sources of care. A further study is needed to identify these relationship.

• 대한예방한의학회지
• /
• 제19권2호
• /
• pp.37-50
• /
• 2015

Objective : In order to understand the scale of medicinal expenditure in the Korean medicine, an analysis has been made of Korean National Health Account and statistic archives used to estimate the Korean National Health Account and also of such archives as are contributory to learn the scale of total health expenditures in the Korean medicine. Method : From the Korean National Health Account archives, an analysis has been made of National health insurance statistic annual reports, National health insurance non-payment items, Korean Economic Census (The Service Industy Survey), and Korea Health Panel data. Moreover, in order to know the sales of overall Korean medicine clinics, relevant data have been utilized and cited from investigations into National tax statistics, Korean medicine medical institutions and Korean medicines used, and current states of medicinal herbs and Korean medicine industry. Results : It is found that the average scale of each section of the medical expenditures archives in the Korean medicine in 2012 was KRW 3.5638 billion and that the average medical expenditures in the Korean medicine derived from Total Health Expenditure, The Service Industy Survey, National tax statistic, and Korean medicine industry are approximately KRW 3.3901, 3.4796, 3.7218 and 3.9634 billion. And the average expenditures derived from National health insurance patients and Korea Health Panel data are 2.5162 and 2.2292 billion won and those from the users and consumers of Korean medicines and herbs are 5.6,461 billion won. In order to verify the appropriateness of estimated medical expenditures in the Korean medicine included in the archives, an analysis has been made of uninsured costs which come from the aggregate sales amount surveyed minus health insurance treatment expenditures and it is found that the ratio of insured costs against total health expenditures in 2006 was 50.67% and 41.92% in 2012 and that the ratio based on National tax statistics and The Service Industy Survey was 52.19% and 49.28% in 2006 and 50.54% and 50.64% in 2012 and that the ratio of uninsured costs against Korean medicines and herbs and Korean medicine industry was 37.5% and 58.27% in 2013. Conclusion : It calls for the improvement of the accuracy of an investigation into Total Health Expenditure which comprise the actual conditions of health insurance and Korea Health Panel, the development of statistic schemes for understanding and classifying medical expenditures of all the Korean medicine medicinal institutions like medicinal clinics, and enhanced methods for independent panels to comprehensively collect and analyze the number of sampled Korean medicine medical institutions.

• 동의신경정신과학회지
• /
• 제29권3호
• /
• pp.135-144
• /
• 2018

Objectives: The purpose of this study was to analyze the medical cost for patients with vertigo and to examine associations between chronic vertigo and mental disorder using 2014 Health Insurance Review & Assessment Service-National Patients Sample (HIRA-NPS). Methods: We analyzed sociodemographic characteristics, medical cost and medical care use pattern for vertigo patients. We used hierarchical multiple logistic regression analysis to examine odds ratio between chronic vertigo and mental disorder. Results: A total of 46,502 people and 118,504 claims data were identified for vertigo cases. Characteristics of vertigo patients have significant differences on proportion of female patients (68.36%), patients' average age (54.98) and proportion of medical assistance (5.76%) compared with non-vertigo patients. Results revealed that Korean medicine are one of frequent methods among total treatments for vertigo patients. Total days of medical care and total costs are 2.78 days and 111,362 won, respectively, and days for outpatients in Korean medical care (mean: 2.26 days) are more than those (mean: 5.05 days) in Western medical care. There is significant difference relative to sex between acute vertigo and chronic vertigo. The odds ratio between chronic vertigo and mental disorder is estimated as 1.34, that means risk of becoming chronic is 34% higher for vertigo patients with mental disorder. Conclusions: This study assessed socio-demographic characteristics, medical care use and expenses related to vertigo, and estimated associations between chronic vertigo and mental disorder. Findings provide a basis for economic evaluation studies on vertigo patients and development of clinical practice guidelines for vertigo patients with mental disorder.

• 대한예방한의학회지
• /
• 제11권2호
• /
• pp.41-70
• /
• 2007

The purpose of this study was to identify a tendency in patients who seek oriental medical service and factors influencing patient satisfaction. The study was conducted with 1,520 residents of a community during the period from February 5, 2005 through June 30, 2005 using a questionnaire. This study results are summarized as follows : 1. Of subjects who sought oriental medical service, 66.2% had musculoskeletal disorder and connective tissue disease, 18.9% had digestive tract disease, 16.4% had respiratory disease, 8.2% had endocrinemetabolic disease, 7.5% had circulatory disease and the remaining subjects had other diseases(p<0.001). 2. Of subjects who sought oriental medical service for the treatment of musculoskeletal disorder, 84.9% preferred acupuncture. Of those who had digestive tract diseases, 47.0% preferred packaged herbal medicine. Of those who had respiratory disease, 63.0% preferred packaged herbal medicine. 3. Acupuncture was the most often sought by subjects with musculoskeletal disorder. Packaged herbal medicine was sought by subjects with respiratory disease, digestive tract disease, endocrine-metabolic disease or circulatory disease. Tablet-type herbal medicine was sought by subjects with musculoskeletal disorder or digestive tract disease. Combined therapy was sought by subjects with musculoskeletal disorder, digestive tract disease, hematopoietic disease or immune disorder. 4. The level of satisfaction with oriental medical service was higher in subjects with circulatory disease, subjects with digestive tract disease, subjects with neurological disorder and subjects with musculoskeletal disorder in descending order. Of total subjects, 39.4% experienced side effects of oriental medical care, 38.1% experienced side effects of herbal medicine. About 51.9% considered the price of herbal medicine costly while 23.2% considered it reasonable. 5. Subjects' knowledge of herbal medicine was measured as $29.2{\pm}3.83$ out of 42 scores or 69 out of 100 points, indicating a low knowledge level. Subjects' knowledge was influenced by occupation, religion, side effects, sex, age, residence area, the type of insurance. These variables explained 15.2% of the variance. 7. Of total subjects, 56.8% were satisfied with oriental medical service. Patient satisfaction varied with occupation, religion, the type of insurance, health state and treatment outcomes. These variables explained 37.3% of the variance. Conclusion : The majority of subjects were satisfied with oriental medical service. However, oriental medical care are not widely used to treat all kinds of diseases while its use skews to a small categories of diseases. It is therefore necessary for the government and oriental medical service providers to develop new therapy approaches for the treatment of a broader range of diseases.

• 대한예방한의학회지
• /
• 제7권1호
• /
• pp.17-28
• /
• 2003

We met results like the followings through the literatures and questionnaires about the tasks and solutions about the insurance fee of packed medical herbs. 1) It's turned out that 74.8% of herb doctors agrees to the insurance fee of packed medical herbs. However, in comparison with the same survey of the herb doctor association the percentage of general approval went somewhat lower, and especially the percentage of 'positive approval' became notably lower$(43.7%{\rightarrow}26.5%)$ and the percentage of 'active objection' raised about 2 times$(6.8%{\rightarrow}12.9%)$. Inquiring into the approval reasons on the insurance fee application of packed medical herbs some heads such as 'development toward treatment medical science' and 'decrease of publics burden' were higher than the one of 'management income and expenditure.' 2) As a result of the research, 36.0% of the patients and 42.8% of the residents recognized that the pay range of Chinese herb health insurance is narrow. They recognized that less people have the experiences of Chinese medical hospital use and internal application of the packed medical herbs as they are older, men rather than women. 85.4% of the patients and 74.9% of the residents agreed on the insurance pay of packed medical herbs. It's shown that they agree on the Chinese medical hospital use more as the economic standard is lower, on the insurance pay as they have ever taken the packed medical herbs. In the aspect of increase of insurance fee, 66.7% of the patients and 44.3% of the residents agreed on the insurance pay of packed medical herbs, and 18.1% and 36.1% disagreed on the insurance pay of packed medical herbs. The main objective reason why they disagree on the insurance pay of packed medical herbs was 'because the insurance fee goes up higher,' which answered 95.2% of the patients and 78.8% of the residents. 7.22% of the patients and 1.80% of the residents answered that they can pay more insurance fee in case of the insurance pay of packed medical herbs. However, in the priority order of the insurance pay, it hold the 5th position between 2 target research groups which was less than medical examination, charges for hospital accommodation and taking MRI. 3) According to the result of analysis about the cost of packed medical herbs, current practice price is 115,000 won and the average prime cost of a packed medical herb is 73,000 to 106,000 won. It's examined that the herb doctors regard that 95,000 won will be reasonable when the packed medical herb is payed in insurance. However, it was found out that the public generally thinks that the price would be appropriate on the level of 30,000 to 40,000 won and the percentage of the answers of 20,000 won to 30,000 was fairly high. 4) the central system of a prescription should be change into the central system of demonstration and the sick and wounded. 5) To solve this problem, the government should regulate it to pass by the circulation gradation of [importer, $peasantry{\rightarrow}manufacturer{\rightarrow}wholesaler{\rightarrow}distributor$(Chinese medical hospital, pharmacy dispensary of Chinese medicine)]And it should intervene into the quality and the circulation steps of Chinese medicine through 'the office or organization which is in charge of certification of Chinese medicine' and 'the office or organization which is in charge of the circulation of Chinese medicine.' And some actions such as simple severance, lavation, drying should be included into the conception of manufacture and the boundary between food and medical supplies should be made at a manufactory. And the regulation of standardized goods at one's own house should be improved so that, the peasantry can sell the materials of Chinese medicine only to the manufacturer. 6) In company with the insurance pay of packed medical herbs, the study about the separation of dispensary from medical practice in the Chinese medicine should be accomplished.

• 보건행정학회지
• /
• 제24권1호
• /
• pp.13-23
• /
• 2014

Background: A need arises to efficiently control health expenditure for medical aid due to a sharp increase in medical aid expenditure. This study experimently analyzes the impact of physician behavior on medical use for medical aid beneficiaries using supplier induced demand (SID) theory. Methods: This study looks into analyze SID effect using expenditure factor analysis of medical aid for the years between 2003 and 2010 in comparison with health insurance. Moreover, this study analyzes the existence and scale of SID using econometrics modeling with panel data on 16 cities and provinces's health expenditure data for medical aid from 2003 1/4 to 2010 4/4. Results: This study finds that the growth rate of visit days per capita and treatment amount per visit days for medical aid is higher than health insurance. Furthermore, the result of econometrics modeling analysis shows the existence of SID in general hospital, hospital, clinic, oriental clinic. Conclusion: In order to efficiently control expenditure for medical aid, it is required to reinforce macro polices such as the introduction of 'target management' and micro policies such as the strengthen of management on medical institutes in the perspective of suppliers as well as regulations of demanders.

• 대한예방한의학회지
• /
• 제3권2호
• /
• pp.1-23
• /
• 1999

The purpose of this paper is to survey the current status of service utilization in oriental medicine, to identify the determinants of consumers' decision in the service utilization, and then suggest policy implications for promoting the consumers' utilization. A multiple regression model was adopted to analyze the factors that influence consumer's decision in purchasing the oriental medical services. Data used in this research relied on National Survey Data conducted by Korea Institute of Health and Social Affairs, and sampling survey. The results could be summarized as follows.: 1. the number of visits to oriental medical institutions has shown an overall increase during the last decade since the inception of health insurance for oriental medical services. It still, however, revealed a relatively iow figure to western medical services. 2. the main factors, after controlling demographic variables, that determine consumers' selection between oriental medical services and western medical services are considered to be price, belief in effectiveness of services, waiting time for service. Implications for policy recommendation include 1. to reduce a barrier to service utilization by discounting dramatically the price of herb medicine, which is believed to be crucial in expanding market share, 2. to encourage consumer's belief in clinical effectiveness through a specialization in competitive services compared with wertern medicine, 3. to keep the affirmative image among consumers alive through an active participation of oriental medical doctors in community activities, 4 to change the health care system in favor of oriental medicine in the long run.

• 대한한의학회지
• /
• 제39권3호
• /
• pp.1-16
• /
• 2018

Objectives: The purpose of this study was to investigate the effects of 56 herbal formulae covered by the National Health Insurance Corporation (NHIC) on dementia-related biomarkers and neuronal cell changes. Methods: The 56 herbal formulae were extracted with 70% ethanol at $100^{\circ}C$ for 2 h. The antioxidant properties was measured by radical scavenging assay using ABTS+ radical. The acetylcholinesterase (AChE) activity was tested by Ellman's assay and $amyloid-{\beta}$ ($A{\beta}$) aggregation was determined using fluorescence method. To estimate the inhibitory effects of herbal formulae on neuronal cell death and inflammation using HT22 hippocampal cells and BV-2 microglia, respectively. Results: Among the 56 herbal formulae, Dangguiyukhwangtang, Banhasasimtang, Samhwangsasimtang, Cheongwiesan, Hwangryunhaedoktang, Banhabaekchulchunmatang, Jaeumganghwatang, Cheongseoikgitang, and Hoechunyanggyuksan has a significant inhibitory effects on acetylcholinesterase (AChE) activity. Doinseunggitang and Samhwangsasimtang exerted the effect on the inhibition of $amyloid-{\beta}$ ($A{\beta}$) aggregation. Additionally, 10 herbal formulae affected AChE and $A{\beta}$ aggregation revealed antioxidant activity as well as neuroprotective and anti-neuroinflammation effects in neuronal cell lines. Conclusions: 10 herbal formulae that have been shown to be effective against the major dementia markers have been shown to have antioxidant activity, neuronal cell protection and inhibition of brain inflammation. Further investigation of these herbal formulae will need to be validated in dementia animal models.