• Journal of Society of Preventive Korean Medicine
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• v.22 no.3
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• pp.31-44
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• 2018

Objectives : The aim of this study was to investigate the Korean medicine doctor's perception of the extension and activation of herbal medicine preparations insurance benefits. Methods : The sample of Korean medicine doctors' panel pool which is extracted by examining the square root quota of city location of Korean medicine clinics was used. In case of a vacancy in some participants, the number of Korean medicine doctors were supplemented and placed for investigation. Results : It has 54.0% awareness of the separation of prescribing and dispensing herbal preparations, 87.0% agreed on the need to be insured, but the separation as a necessary condition for being insured was only 60.3% agreed. When a large number of herbal preparations are being insured, it was expected that 30% to 50% of patients(30.3%) will be prescribed herbal preparations and the number of new patients will increase by 5 to 15 for the purpose of prescriptions only(49.3%). Increase amount of medical expense(?3,000) as a result of the separation of prescribing and dispensing herbal preparations are insufficient(54.3%). Conclusions : From the results of this study, extension of national health insurance to cover herbal preparations must be needed to activate herbal medicine preparations and improve Korean medical services.

• Journal of Preventive Medicine and Public Health
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• v.22 no.2 s.26
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• pp.259-267
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• 1989

The objective of this study was to analyze the influence of the hospital and insurer in causing delayed reimbursement of medical insurance benefits. We analyzed major variables at three different sized hospitals to examine the effect of the hospital and insurer using the two-way ANOVA method. The results were as follows: 1. The time interval between claim by hospitals and payment of the benefit was statistically different according to hospital in both admission and outpatient care. 2. The time needed by the insurer for investigating the claims was statistically different according to hospital and insurer in both admission and outpatient care. There was interaction between the hospital and insurer factors in outpatient care. 3. Although there was interaction between the hospital and insurer factors in admission care, the time interval between claim and payment was statistically different. In outpatient care, the payment interval between claim and payment was also statistically different according to the hospital and insurer.

• Journal of Society of Preventive Korean Medicine
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• v.23 no.3
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• pp.109-119
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• 2019

Background : Germany is the first country in the world to introduce modern systems of public health insurance, and the country which most widely uses complementary alternative medicine(CAM) in Europe. In early 21^st century, a large evaluation studies were conducted to include acupuncture in health insurance payments, which were eventually decided. Objectives : This study is to investigate and analyze the process of public policy determination on insurance coverage for acupuncture in German health insurance system. Methods : We collected the data and information through the literature search and from the websites of German government departments and health insurance organizations. To obtain contextual information, German experts of health insurance and acupuncture clinical study were interviewed. Results : As use of acupuncture had been growing, German public health insurers wanted to evaluate the validity of acupuncture coverage and sponsored three evaluation projects for clinical effectiveness of acupuncture using randomized clinical trials, systematic reviews, and pragmatic trials from 2001 to 2005. For some pain condition, acupuncture was founded not to be effective than sham acupuncture, but more effective than standard care. The federal joint committee of health insurance decided to cover acupuncture for chronic pain of lumbar spine and chronic pain in at least one knee joint due to gonarthrosis. Conclusions : Considering the controversial subject matter in the process of acupuncture's health insurance coverage in Germany, expanding the benefits of Korean medicine in Korea needs to come up with ways to overcome the difficulties of placebo effect, standardization and lack of literature evidence.

• Journal of Preventive Medicine and Public Health
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• v.40 no.2
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• pp.150-154
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• 2007

Objectives : The aim of this study is to identify factors determining the purchase of private health insurance under the mandatory National Health Insurance(NHI) system in Korea. Methods : The data were collected by the National Cancer Center in Korea. It includes cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer. Data were gathered from the hospital Order Communication System (OCS), medical records, and face-to-face interviews, using a structured questionnaire. Clinical, socio-demographic and private health insurance related factors were also gathered. Results : Overall, 43.9% of patients had purchased one or more private health insurance schemes related to cancer, with an average monthly premium of \65,311 and an average benefit amount of \19million. Females, younger aged, high income earners, national health insurers and metropolitan citizens were more likely to purchase private health insurance than their counterparts. Conclusions : About half of Korean people have supple-mentary private health insurance and their benefits are sufficient to cover the out-of-pocket fees required for cancer treatment, but inequality remains in the purchase of private health insurance. Further studies are needed to investigate the impacts of private health insurance on NHI, and the relationship between cancer patients' burden and benefits.

• Journal of Preventive Medicine and Public Health
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• v.22 no.2 s.26
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• pp.248-258
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• 1989

As a result of cost-benefit analysis by making a macroscopic approach to the health screening projects conducted 4 times since 1950 for the insured people of the Korea Medical Insurance Corporation, the following conclusions were reached. 1. The direct costs put into the health screening project, and the time costs which were paid by examinees or calculated in terms of social costs have been estimated. The results is that the lowest estimation was 10,337 million won and the highest 15,141 million won when a minimum of 1.5 hours of time spent and a maximum 4 hours were applied. 2. In terms of the psychiatric benefits, the lowest estimation was 5,341 million won while the highest was 5,585 million won. 3. In terms of the benefits for each kind of diseases, the lowest estimation of 37,188 million won and highest estimation of 74,383 million won have been calculated for the liver diseases. And for the cardiovascular diseases, the minimum estimation was 14,475 million won while the maximum was 20,532 million won. In case of pulmonary tuberculosis, with external effect benefits being included, the estimation ranged from the minimum of 1,649 million won to the maximum of 1,832 million won. And the estimation of benefits for diabetes mellitus and renal diseases ranged from 89 million won to 92 million won and from 4,567 million won to 7,598 million won respectively. 4. In comparing costs and benefits, as a results of comparing each highest and lowet estimation a range of minimum 46,708 million won and maximum 98,071 million won of benefits has been gained.

• Journal of Society of Preventive Korean Medicine
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• v.24 no.2
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• pp.83-94
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• 2020

Backgrounds : To reduce the patients' economic burden of herbal decoctions use, in 2012, Korean government decided to implement the pilot project of herbal decoctions coverage in the National Health Insurance. Objectives : This study aimed to analyze the policy decision-making process for the pilot insurance project in 2012. Methods : Official documents, research papers, statistical reports, and news articles, etc. on the coverage of herbal decoctions were searched and collected. We used the Kingdon's Policy Stream Model to analyze how the policy of pilot project of herbal decoctions coverage was decided, and who were the main activists for the decision-making process. Results : Components to be included in the 'Problem stream' were the decline in the profits of Korean Medicine institutions, the contraction of the herbal decoctions use, and the fiscal surplus of National Health Insurance. In the 'Policy stream', there were several model studies for herbal decoctions coverage, and examples of herbal benefits in other social insurances. In the 'Political stream', there were the legislative initiatives by member of the National Assembly and the promotion of insurance coverage by the Association of Korean Medicine(AKOM), etc. Policy window for herbal decoctions coverage was opened by the combination of these three streams with the efforts of policy activists, such as the executives of AKOM, and policy researchers. Conclusions : The policy decision process for health insurance coverage of herbal decoctions was analyzed using Kingdon's model, and the analysis shows that the combination of political streams and entrepreneurs' competencies can be an important driving force in policy decision making.

• Journal of Society of Preventive Korean Medicine
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• v.21 no.3
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• pp.43-50
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• 2017

Objectives : This study was conducted to survey on uncovered services in National Health Insurance(NHI) of Traditional Korean Medicine(TKM) Institution. Methods : For TKM doctors working in hospital, it was surveyed to professors working in university-affiliated hospital. A total of 40 professors were participated online survey and all of them was included. For TKM doctors working in clinic, an e-mail survey was conducted for members of the association of Korean medicine. A total of 436 TKM doctors, 279 TKM doctors were included study and 157 were excluded because of duplication clinic or not working in clinic. It was conducted general status and uncovered services in NHI status. Results : The proportion of uncovered services in NHI was 54.7% for hospitals, 39.0% for clinics and there was a significant difference between hospital and clinic. Decoction and herbal(bee venom) acupuncture were most commonly used in both institutions. For decoction treated patients, It was commonly treated Sibjeondaebo-tang, Bojungykki-tang, Gwibi-Tang and patients chief complaints was thoraco-lumbar pain, functional dyspepsia, fatigue. Conclusions : It is necessary to expansion of benefits range of the NHI on TKM services.

• Korean Journal of Health Education and Promotion
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• v.16 no.2
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• pp.205-233
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• 1999

This study is an effort to make policy suggestions by analysing the current health examination program as a benefit service provided by the national health insurance system, including health screening for the insured, screening of cancer and chronic diseases for their dependents. Analyses found some issues being gave attention to; 1) The insured under the community health insurance system do not get the health examination benefit. A program for them should be set to have equity in benefit services. 2) Low rates of using screen services compromise purpose and the efficiency the services have first intended to. An immediate attention should be made to increase low rate of use of screen test to detect chronic diseases in particular. 3) Selection of diseases and test items covered by health examination program does not reflect the need of the insured, but to reflect financial resources of the national health insurance system. 4) Lack of health screening facilities and their geographical maldistribution is observed, which with preference of a general hospital as a screening post by the insured may lead to unreliable test. 5) A follow-up system should have been developed for the suspected classified by test results of carrying chronic diseases. They should be cared for within the health examination program. Public health care systems incorporate such a system, along with caring for those who are in need of having a health counselling on preventive care. In conclusion, the national health insurance system should be a medical insurance of giving a higher priority on preventive care benefits, health examination program in particular. That could be done by making rearrangements of test items, screening methods and system, rationalizing current reimbursement system of service fee, increasing accessibility to and utilization of the services, and making an establishment of follow-up system.

• Journal of the Korean Data and Information Science Society
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• v.22 no.3
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• pp.467-476
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• 2011

We developed the hybrid model coupled with predictive model and business rule model for administration of injury by utilizing medical data of the National Health Insurance in Korea. We performed decision tree analysis using data mining methodology and used SAS Enterprise Miner 4.1. We also investigated under several business rule for benefits (expense paid by insurer) and claims of injury in National Health Insurance Corporation. We can see that the proposed hybrid model provides a quite efficient plausible results.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.8
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• pp.3767-3772
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• 2012

Objective: We estimated the total medical costs incurred during the 5 years following a cancer diagnosis and annual medical use status for the six most prevalent cancers in Korea. Methods: From January 1 to December 31, 2006, new patients registered with the six most prevalent cancers (stomach, liver, lung, breast, colon, and thyroid) were randomly selected from the Korea Central Cancer Registry, with 30% of patients being drawn from each cancer group. For the selected patients, cost data were generated using National Health Insurance claims data from the time of cancer diagnosis in 2006 to December 31, 2010. The total number of patients selected was 28,509. Five-year total medical costs by tumor site and Surveillance, Epidemiology, and End Results (SEER) stage at the time of diagnosis, and annual total medical costs from diagnosis, were estimated. All costs were calculated as per-patient net costs. Results: Mean 5-year net costs per patient varied widely, from $5,647 for thyroid cancer to $20,217 for lung cancer. Advanced stage at diagnosis was associated with a 1.8-2.5-fold higher total cost, and the total medical cost was highest during the first year following diagnosis and decreased by the third or fourth year. Conclusions: The costs of cancer care were substantial and varied by tumor site, annual phase, and stage at diagnosis. This indicates the need for increased prevention, earlier diagnosis, and new therapies that may assist in reducing medical costs.