• Korea Journal of Hospital Management
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• v.23 no.4
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• pp.15-25
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• 2018

Purposes: The objectives of this study present the direction of the criteria for the separately reimbursement of therapeutic medical device. Methodology: We summarized experts' opinion using Delphi survey and Analytic Hierarchy Process(AHP). 48 experts were gathered from Medical Insurance Review Nurses Association, medical device industry, academy and association, Medical Device Expert Evaluation Committee. Descriptive statistics, consistency index, content validity ratio were analyzed. Findings: Clinical utility, patient safety, infection control, cost-homogeneity, cost-effectiveness showed high feasibility and importance, but market contribution and functional utility showed low feasibility and importance in a relative sense. The results of functional utility differed between clinical and non-clinical experts. Measurability was low across the whole area. Among the criteria for the separately reimbursement of therapeutic medical device. Patient safety/infection control and clinical utility showed the highest relative importance values, analyzed using AHP. Practical Implications: Patient safety and infection control are needed to be considered as one of Value Assessment Criteria. It is important to find out how to improve the measurability of therapeutic medical device.

• Journal of Korean Library and Information Science Society
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• v.39 no.2
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• pp.65-83
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• 2008

The National Library of Korea establishes an Act on Legal Deposit and Use for the Online Digital Products in 2007 and it is preparing an enforcement. The purpose of this study is to suggest rate base on legal deposit of digital products before enforcement of this bill. To reach the goal, this study reviewed the legal deposit acts on digital products in the world. Also the opinion of main stakeholders in this area was collected such as digital book publishers and music copyright association. In conclusion, this study proposed rate base of reimbursement for legal deposit of digital products.

• Korean Journal of Adult Nursing
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• v.24 no.4
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• pp.358-369
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• 2012

Purpose: This study was performed to compare the costs of nursing interventions implemented for the obstetrical and gynecological patients using Korean Reimbursement System and ABC codes system developed in the US for costing out interventions performed by health care professional. Methods: First, the narrative data on nursing interventions were extracted from electronic medical record system of a tertiary university and mapped with Nursing Intervention Classification (NIC) by two researchers until 100% consent was reached. Narrative nursing interventions mapped with NIC were then remapped with ABC codes system using the electronic program developed in the research. The mapping data were analyzed with real numbers, frequency, percentage, mean, and standard deviation. Results: More nursing interventions were mapped with ABC codes than Korean reimbursement system. Total of 97 different types of narrative interventions could be mapped with NIC, 43 NIC interventions could be reimbursed by ABC code but only 16 NIC interventions were reimbursed by Korea Reimbursement System. Conclusion: Korean medical insurance fee system needs amendment to include more comprehensively interventions performed by nurses which are very important to patient outcomes. Further study is needed to develop strategies to costing out nursing interventions.

• Health Policy and Management
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• v.15 no.4
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• pp.1-25
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• 2005

Legislation on pharmaceutical reimbursement decision using economic evaluation results was made in Korea in fm, but has yet to be fully implemented. We evaluated the quality of Korean economic evaluation studies of pharmaceuticals to understand gaps between legislation and implementation. From this evaluation, we propose policy options that might strengthen the research Infrastructure In order to support such studies. We reviewed 23 published studies for drugs conducted between 1996 and 2004. Evaluation criteria included methodological characteristics, healthcare system characteristics, population characteristics, and applicability of results. Large variation in study quality was observed, particularly with study design, outcome data, treatment patterns and interpretation. Korean clinical data used was mostly from observational studies of 1-2 hospitals. Foreign data was extracted from clinical trials that did not Include Asian population and their selection criterion was not clarified. With respect to treatment patterns, medical records and hospital bills were used without adjustment regarding area, hospital type, and others. And next frequent situation relied on expert opinion from academic physicians in specialty practice. preference measures, when used, were not elicited from the Korean population. $78.3\%$ of studies did not clarify the funding source. If the Korean economic evaluation policy is to provide meaningful data for decision makers, the quality of cost-effectiveness studies will need to improve dramatically. This may involve access to or creation of better data, more diverse funding, unproved training of researchers and evaluators, and partnerships with technology manufacturers.

• The Journal of the Korean dental association
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• v.48 no.6
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• pp.459-468
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• 2010

International Classification of Disease (ICD-10) is widely used as a crucial reference not only in the medical diagnosis of diseases but also within the health insurance system. It makes possible for medical personnel to make decisions systematically and for the people working in the health insurance or public health industries to better understand medical issues. However, this classification is often not enough or acceptable in a clinical setting. Many countries amend in their own way to make it more appropriate for their people. Korean Classification of Disease (KCD-5) was made by adding a 5 digit code for some diseases to clarify the conditions of the patients. The authors found problems of KCD-5 in temporomandibular disorders and several related medical problems. Medical treatment for these problems had not been covered even by public health insurance until 2000 in Korea. For the last decade, private insurance companies have introduced new items for reimbursement of the treatment fees the patients actually pay. The authors assumed that many patients with these medical problems encountered difficulties in the reimbursement from private insurance companies because KCD-5 did not classify these medical conditions appropriately. An overview of KCD-5 and suggestions for improvement are introduced in this study.

• Journal of Korean Critical Care Nursing
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• v.11 no.3
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• pp.95-107
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• 2018

Purpose : This study aimed to investigate the public's perception of reimbursement for the education and counseling services provided to advanced practice nurses in intensive care units. Method : This was a secondary data analysis study. The original data were collected utilizing an online panel. The sample comprised 615 individuals aged between 19 and 49 years nationwide. The study variables included the public's perception of reimbursement for education and counseling services, age, gender, education level, income, and health status. Variables such as past experience of being admitted to an intensive care unit by self, family, or relatives and the recognition of advanced practice nurses were also examined. Results : The mean of the perception score was 3.15 on a 4-point scale ranging from 1 (strongly disagree) to 4 (strongly agree). Among the participants, 89.2% answered "somewhat agreed" or "strongly agreed" to the question about the education and counseling services being covered by the National Health Insurance. Moreover, education level, past experience of being admitted to an intensive care unit by self, family, or relatives, and recognition of advanced practice nurses were significantly associated with the perception score. Conclusion : Efforts should be made to publicize the need for the education and counseling services that are provided to advanced practice nurses in intensive care units.

• Journal of health informatics and statistics
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• v.43 no.4
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• pp.318-328
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• 2018

Objectives: People are living longer, but often with diseases or chronic conditions. As a consequence, interest in resolving insurance blind spots is growing. This study provides substandard risk-relevant statistics to help substandard risks who are likely to fall in insurance blind spots obtain insurance coverage, such as the reimbursement of medical costs, as well as to stimulate insurance product development. Methods: This study uses National Health Insurance Service (NHIS) cohort data to determine the relevant statistics. The incidence rates of severe diseases are derived and compared against standard risks to establish a set of relative risk factors. These incidence rates of standard and substandard risks are then compared. Results: Currently, an individual's cancer history is used in the underwriting process for simplified issue insurance. However, underwriting focusing on hospitalization and procedures related to serious illnesses could lower premiums for substandard risks. Moreover, the statistical results could be used to expand the coverage of health insurance products. Conclusions: This study's relative risk factors can be used to derive simplified issue premium rates for substandard risks. They can also be used to implement discount and loading schemes for medical reimbursement insurance and help insurance companies implement proactive risk management.

• Korean Journal of Clinical Pharmacy
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• v.31 no.1
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• pp.1-11
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• 2021

Objective: This study aimed to overview and assess the effectiveness of the policies and regulations that have governed new drug access in Korea, and to propose policies to enhance patient access to drugs, particularly for new innovative medicines. Methods: We approached drug access issues in two perspectives: approval lag (or availability) and reimbursement lag (or affordability). The issues were identified and evaluated through the review of literature, public documents, reports published by the government agencies and private organizations, and news articles. Results: To shorten approval lag, it is recommended to hire and train more reviewers at the Ministry of Food and Drug Safety. Increasing user fees to a realistic level can facilitate this process. To reduce reimbursement lag, flexible incremental cost-effectiveness ratio threshold, alternative cost-effectiveness evaluation, and establishment of funding source other than the national health insurance are identified as the areas to be improved. Conclusion: The current policies and regulations had to be supplemented by new systems to drastically promote patient accessibility to new drugs, consequently in order to promote national public health.

• Clinics in Shoulder and Elbow
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• v.25 no.1
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• pp.42-48
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• 2022

Background: Total shoulder arthroplasty (TSA) has been demonstrated to be an effective treatment for multiple shoulder pathologies. The purpose of our study was to compare the relative value units (RVUs) per minute of surgical time for primary and revision TSA. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients that underwent primary TSA, one-component revision TSA, and two-component revision TSA between January 1, 2015 and December 31, 2017 using current procedure terminology codes. RVUs were divided by mean operative time for each procedure to determine the amount of revenue generated per minute. Rates were compared between the groups using a one-way analysis of variance with post-hoc Tukey test. Statistical significance was set at p<0.05. Results: When dividing compensation by surgical time, we found that two-component revision generated more compensation per minute compared to primary TSA (0.284±0.114 vs. 0.239±0.278 RVU per minute or $10.25±$4.11 vs. $8.64±$10.05 per minute, respectively; p=0.001). Conclusions: The relative value of revision TSA procedures is weighted to account for the increased technical challenges and time associated with these procedures. This study confirms that reimbursement is higher for revision TSA compared to primary TSA.

• The Journal of the Korea Contents Association
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• v.22 no.6
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• pp.712-728
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• 2022

World-widely, there has never been a greater need for people to access high-quality expertise about the effective and safe use of medications. Therefore, the profession of pharmacy should meet these needs of the times, as the demographic shifts have led to a situation where older adults now outnumber children, and polypharmacy is also a commonplace. However, the reimbursement system covered by the National Health Insurance (NHI) in Korea is still limited to the traditional dispensing and compounding role of pharmacist. To provide a take-home message to Korean pharmacy reimbursement system, we aimed to review and analyze the international trends in pharmacy remuneration systems. This is a comparative study between Korea, Japan, the United Kingdom, and the United States. Comparison was conducted by reviewing each country's policy and enforcement programs, as well as the related literature. Japan, the UK and the US systems remunerate diverse patient-centered pharmaceutical care services. The Korean pharmacy service fee is, however, narrowly focused on the traditional product-oriented pharmacy services. This study discussed the future direction of improving pharmacist reimbursement systems in Korea, by expanding professional pharmacy service coverage and diversifying fee schedule.