• 대한예방한의학회지
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• 제11권1호
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• pp.139-151
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• 2007

This paper evaluated the benefits of the National Health Insurance(NHI) and suggested the necessity of extending some oriental medical services into the benefits schedule in the NHI. Comparing the rate of public financing in national health expenditure in OECD countries and measuring out-of-pocket payments in total medical cost showed the level of insurance payments to total medical cost is approximately $50%{\sim}60%$ in Korea, which is quite insufficient to pay household medical expenses, although the NHI covers the whole population. A few of consumers' priority surveys for medical needs suggested herb medicine, muscle treatment, and manufactured herb medicine be included in the list of the NHI benefits, based on efficiency and equity criteria. It was estimated that the NHI can afford to cover these three items of oriental medical services.

• Journal of Preventive Medicine and Public Health
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• 제13권1호
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• pp.47-51
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• 1980

This study attempts to assess the effect of the 1st class health insurance program to the income redistribution among the participants in a unit health insurance cooperative. One health insurance cooperative, located in Seoul, with 1558 members and 768 households was selected for this purpose. The relationships between amount of premium payed and benefits from the cooperative were compared. Necessary data were obtained from the bills submitted to the health insurance cooperative by the contracted medical institutions from 1st January 1977 to 30th June 1979. Households and individuals were the unit of the assessment. The indicators measuring income redistribution effect were the ratios between the benefit and expected benefit and the ratios between the benefit and the mean benefit. The major findings were: 1. The ratios between the benefits and the expected benefits were lower than 1 in the high income group and greater than 1 in the middle and lower income groups. This fact imply that the income redistribution effect was shown in the studied groups. It was shown that the middle income group received the greatest benefit, and then the lower income group. 2. The ratios between the benefit ana the mean benefit of the households in the higher standard income grade, were found to be higher. This means that the equity of the benefits of households were not achieved by the policy of the health insurance plan. 3. The health insurance utilization rates of the higher standard income group, measured by the household unit, were higher, and by the individual unit, the same rates of the middle income group were higher than other groups.

• Journal of Preventive Medicine and Public Health
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• 제22권3호
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• pp.398-405
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• 1989

A change in the consumer's surplus was measured in order to evaluate the social benefit to be derived from expanding health insurance to the entire population. The most refined and correct way to measure a project's net benefit to society is to determine a change in the consumer's surplus. Benefits from introducing the health insurance program to the uninsured people can be classified into two elements. The first is the pricing-down effect(E1) which results from applying the insurance price system, which is lower than the actual price, to the uninsured patients. The second effect(E2) is a decrease in actual payment because an insured patient pays only a portion of the total medical bill(copayment). We collected medical price information from the data banks of 93 hospitals, and obtained information of medical utilization by referring to the results of other research and from data published by the Korean Medical Insurance Societies. The total net benefit was estimated as \214 billion, comprising the first effect(E1) of \57 billion and the second effect(E2) of \157 billion. The price elasticity of physician visits is less than that of hospital admissions: however, benefits from the increase in physician visits are greater than those from hospital admissions because there are considerably more of physician visits than hospital admissions. The sensitivity analysis also shows the conclusion that expansion of the health insurance program to the entire population would result in a positive net benefit. Therfore, we conclude that the National Health Insurance Program is socially desirable.

• 보건행정학회지
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• 제21권4호
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• pp.617-642
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• 2011

The purpose of our study is to analyze the determinants of the benefits of the long-term care insurance in Korea using 2008 and 2009 cross-sectional data. Per capita long-term care insurance benefits can be divided into home care services utilization rate, institutional care services utilization rate, per capita home care services benefits, and per capita institutional care services benefits, which are used as the dependent variables in our regression analysis. Admission rate and the ratio of the admitted to the applicant also used as the dependent variables. The results of our analysis show that the explanatory variables such as income level, needs for care, family type, access to the services, and regional characteristics are statistically significant to explain the dependent variables, the long-term care insurance benefits. The higher is the regional income and the more of the female residents, the more are the long-term care insurance benefits. The easier is the access to the services, the more are the insurance benefits. In the rural area, the level of the insurance benefits is relatively high. We propose that copayment rates of the long-term care insurance should be examined and monitoring on the over-use of the services should be done. Also preventive services and care by the family member should be expanded.

• 보건행정학회지
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• 제4권1호
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• pp.77-106
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• 1994

This study attempts to evaluate the beneficial equity and operational efficiency of the three Korean medical insurance programmes and thereby suggest directions for their policy improvement. Concepts of the equity and effciency were reviewed to develop indicators for comparative analysis. For the analysis, statistical and financial accounting data for 1991, issued by the National Federation of Medical Insurance and the Korea Medical Insurance Corporation, on the operational status and performances of the programmes, were collected and rearranged to be suited to the purpose of the study. The analysis reveals that beneficial inequity exists between self-employed and employee programs. and that operational inefficiency is prominent in both programms for self-employeds and for Government employees and private school teachers. In order to improve the beneficial inequity of the self-employed program, it is suggested that policies be formulated and implimented toward increasing the program revenue through increasing subsidies from the Government, and through inter- program finance adiustment. For the operational inefficiency of the two programs, it is judged that, toghether with the administrative support and control from the Government and the insurance society bodies, self- efforts be initiated to improve the internal mangement styles and systems of the insurance societies. Finally, from the viewpoint of the structural efficiency, expansion of the preventive insurance benefits by the insurance soceties is recommended both for beneficial equity and operational efficiency.

• Journal of Preventive Medicine and Public Health
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• 제28권1호
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• pp.153-174
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• 1995

This study was conducted to examine the determinant factors for expenditure of the medical insurance program for self-employeds based on the analysis of 1991 'The Medical Insurance Program for Self-Employeds Statistical Yearbook', and also similar yearbooks in the metropolitan and other provinces. The major findings are as follows : We have divided benefits into these four components such as the utilization rate for out-patients, expenses per claim for out-patients as paid by the insurer, utilization rate for in-patients, and the expenses per claim for in-patients as paid by the insurer, in order to examine the determinant factors for it. The results of the study revealed the following findings, in urban areas, the supply of medical care had more influence on the benefits than other demographic and economic variables, while, in county areas, both the supply of medical care and the rate of those aged over 65 affected the provision of benefits. The determinant factors for financial balance of the medical insurance program for self-employeds are, first, the determinant factor for administrative expenses was the number of households. The more the number of households, the less the administrative expenses per the insured. This shows that the economy of scale is being. And so, the administrative district must be taken into consideration in the incorporation of small regional medical societies and should be re-organized for more efficient management. Second, in urban areas, the supply of medical care had more influence on utilization rate and expenses per claim as paid by insurer, and therefore it is necessary to control it. In county areas, the supply of medical care and the rate of those aged over 65 raised the utilization rate and expenses per claim as paid by insurer. For the financial stability of county areas, a common fund for medical care for the aged and expansion of finance stabilization fund would be necessary. But, in county areas, it would be unnecessary to control the supply of medical care because it was much more insufficient than in urban areas. The vitalization of public health facilities must be carried out in county areas, for they reduced benefits. Sice the more insured in a single household, the less the utilization of the medical insurance program, benefits for habilitation at home should be given consideration. The law of majority and the economy of scale were applied here, and therefore the incorporation of regional medical societies must be taken into consideration. In integrating regional medical societies, it would be absolutely necessary to review the structural differences among all regional medical societies, the medical demand of each region, and also the local characteristics of each region.

• Journal of Preventive Medicine and Public Health
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• 제57권1호
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• pp.91-94
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• 2024

For nearly four decades, Ugandans have experienced a period marked by hope, conflict, and resilience across various aspects of healthcare reform. The health insurance system in Uganda lacks a legal framework and does not extend benefits to the entire population. In Uganda, community-based health insurance is common among those in the informal sector, while private medical insurance is typically provided to employees by their workplaces and agencies. The National Health Insurance Scheme Bill, introduced in 2019, was passed in 2021. If the President of Uganda gives his assent to the National Health Insurance Bill, it will become a significant policy driving health and universal health coverage. However, this bill is not without its shortcomings. In this perspective, we aim to explore the complex interplay of challenges and opportunities facing Uganda's health sector.

• Journal of Preventive Medicine and Public Health
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• 제53권4호
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• pp.285-288
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• 2020

The health insurance system in Korea is well-established and provides benefits for the entire national population. In Korea, when patients are treated at a hospital, the hospital receives a partial payment for the treatment from the patient, and the remaining amount is provided by the health insurance service. The Health Insurance Review and Assessment Service (HIRA) assesses whether the treatment was appropriate. If HIRA deems the treatment appropriate, the doctor can receive payment from the health insurance service. However, this system has several drawbacks. In this study, we aimed to provide examples of the problems that can occur in relation to HIRA assessments in Korea through actual clinical cases.

• 대한한의학회지
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• 제28권3호통권71호
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• pp.244-260
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• 2007

Objectives : The purpose of this study was to provide lawmakers with basic data for the purpose of establishing a policy on health insurance for packed herbal medicine. Methods : To properly execute an insurance system for packed herbal medicine, we surveyed the following questions from May 1st to June 15th, 2006: (1)the way to pay the insurance benefits (2)specific impression (disease) names as related to insurance (3)the range of insurance coverage. We obtained answers from 304 Korea traditional doctors. Results : 89.4% respondents were agreed on execution of health insurance for packed herbal medicine. 93.86% respondents answered that the way to pay insurance benefits and the range of insurance coverage have to be changed properly. Most respondents answered that the coverage should be based on a specific disease being treated, not the current symptoms method which relates to the prescription. The execution of health insurance for packed herbal medicine is expected to increase the number of patients and make the Korean medical system more popular. Conclusion : The findings are expected to make it easier for the general public to get treatment by providing basic data with policy makers that will cover packed herbal medicine in insurance. Also, a proper Korea traditional health insurance program should be set up as soon as possible to widen the choice of medicine for the general public.

• Journal of Preventive Medicine and Public Health
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• 제33권1호
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• pp.76-82
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• 2000

Objectives : We attempted to assess He accuracy of ICD codes for cerebrovascular diseases in medical insurance claims (ICMIC) and to investigate the reasons for error. This study was designed as a preliminary study to establish a nationwide surveillance system. Methods : A total of 626 patients with medical insurance claims who indicated a diagnosis of cerebrovascular diseases during the period from 1993 to 1997 was selected from the Korea Medical Insurance Corporation cohort (KMIC cohort: 115,600 persons). The KMIC cohort was 10% of those insured who had taken health examinations in 1990 and 1992 consecutively. The registered medical record administrators were trained in the survey technique and gathered data from March to May 1999. The definition of cerebrovascular diseases in this study included cases which met ore of two criteria (Minnesota, WHO) or 'definite stroke' in CT/MRI finding. We questioned the medical record administrators to explain the error if the final diagnoses were not coded as stroke. Results : The accuracy rate of the ICMIC was 83.0% (425 cases) Medical records were not available for 8.2% (51 cases) due to the closing of hospitals, the absence of a computer system or omission of medical record, etc. Sixty-three cases (10.0%) were classified as impossible to interpret due to insufficient records in 'major clinical symptoms' or 'neurological deficits'. The most common reason was 'to meet review criteria of medical insurance benefits (52.9%)'. The department where errors in the ICMIC occurred most frequently was the department for medical insurance claims in the hospital. Conclusion : The accuracy rate of the ICMIC was 83.0%.