• Title/Summary/Keyword: reimbursement system

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A Study on Reimbursement for Legal Deposit of Digital Produce (디지털자료 납본에 대한 보상 체계 연구)

  • Kwak, Seung-Jin;Choi, Jae-Hwang;Cho, Young-Joo;Ryu, Hee-Kyeung
    • 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.

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Review of Economic Evaluation Studies for Drug Reimbursement Decision (의약품 보험급여 결정을 위한 경제성평가 연구의 평가)

  • Choi Sang-Eun;Sullivan Sean D.
    • 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.

Current Status of the Reimbursement for Pharmacist-provided Health Care Services in Japan, the United States, and the United Kingdom (국외 약사서비스 지불보상체계 현황 : 일본, 미국, 영국을 중심으로)

  • Park, Ji Hyun
    • 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.

Impact of the reform for separation between prescribing and dispensing of drugs upon financial situation of the National Health Insurance (의약분업이 건강보험 급여비에 미친 영향)

  • Jeong Hyoung-Sun
    • Health Policy and Management
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    • v.16 no.2
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    • pp.117-134
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    • 2006
  • Korean health care system introduced the reform for separation between prescribing and dispensing of drugs (SPD reform) in the latter part of the year 2000. The objective of this paper is to look at what change this reform has brought about in the financial situation of Korean public health insurance scheme, particularly in terms of insurance benefit outlay. Since the inception of the reform is a development of more than five years ago, its impact on the finance situation would now start to become apparent. Hypothesis is set in this study for each of three components of drug reimbursement in health insurance, i.e. average price level, composition of drugs and their overall volume. In terms of the classification of health care services by mode of production, the impact of the SPD reform is confined mainly to the last two among three drug reimbursement fields including inpatient department, out-patient department and pharmacy. Pure impact of the SPD reform was estimated to be more or less than 1.7 trillion won, 13.1% of the total outlay of the Nation Health Insurance in 2001, and more than 2.0 trillion won, 14.9% of the total outlay of the Nation Health Insurance in 2003. Both dispensing fees for the pharmacists, which had been newly introduced on occasion of the SPD reform, and larger share of expensive drugs in the medicines prescribed by doctors were confirmed to be main drivers of the augmentation of drug reimbursement.

The Effects of Patient and Facility Characteristics On the Resource Use by the Elderly in Long-term Care Services (환자 및 시설 특성이 장기요양서비스 이용 노인의 자원소모량에 미치는 영향)

  • 권순만;김홍수;김선민
    • Health Policy and Management
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    • v.12 no.1
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    • pp.21-53
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    • 2002
  • The purpose of this study is to measure the resource use of the elderly in long-term care services and to examine the effects of patient and facility characteristics on their use of resources. The data were collected from 510 old people over sixty years of age, residing in five long-term care hospitals and two skilled nursing homes during the period between December 1, 2000 and February 28, 2001. For a full sample, when the first level of RUG(Resource Use Group)-III categories were employed as the proxy of patient severity, facility characteristics, such as location, size and ownership, have large effects on the resource use measured by service intensity, whereas patient characteristics such as severity have little or no effect. The resource use is significantly high if the facility: (1) is located in rural areas (gun): (2) has mare than 200 beds; (3) is a long-term care hospital; (4) is private; and (5) has a low percentage of medical aid patients. The analysis of the resource use in each RUG-III categories, for which ADL(Ability of Daily Living) were employed as the prosy of patient severity, shows a similar result. The loose relationship between the needs of residents and the resource use seems to be closely associated with the ineffective reimbursement system for providers. The current reimbursement system has no provision for quality improvement and reimburses facilities simply according to their types: fee-for-service for long-term care hospitals, and monthly-flat-rate or full-coverage-national-aid for skilled nursing facilities. It will be necessary to develop a more reasonable reimbursement system that takes patient's severity into account and gives incentives for long-term care providers to offer cost-effective services.

A Study on the Variation in Meical Service Utilization of The Dead by Cerebrovascular Diseases Patients in Korea (뇌혈관질환 사망자 의료이용 변이의 분석)

  • Hong, Worl-Lan;Jung, Doo-Chae
    • Korea Journal of Hospital Management
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    • v.14 no.1
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    • pp.36-61
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    • 2009
  • This study focused on finding the variation of medical service utilization, paths of medical service utilization and medical payments of the patients died by cerebrovascular diseases. For this study, data of the one-year episodes of the health insurance subscribers died in 2004 were selected. The frequency of medical visits, the lengths of stays, the days of outpatient visits, the total period of medical services and the total medical payments were compared by the characteristics of the suppliers and utilizers. This study is useful in reviewing the equity of medical service utilization because it analyzed variance in utilization by episodes. In oder to collect accurate data of the patients died by cerebrovascular diseases in 2004 the 2004 reimbursement data of all medical institutions were matched to the data of funeral fee payment by the National Health Insurance Corporation from January 2004 to May 2005. The major results of the study are as follows. The variation of medical service utilization of cerebrovascular diseases was influenced by supplier factors suppliers, such as types and locations of medical institutions and user factors such as sex and age. It was suspected that the reimbursement by fee-for-service contributed to the variation quite a lot, but we could not compare the variation between the different reimbursement systems in Korea. On the basis of analyzing results this study suggests that the factors of suppliers and utilizers should be reviewed to reduce the under use and over use expressed by variations of medical service. The processes of care, effective communication and management system should be investigated for the equity of medical service utilization and also. alternative medical services would be recommended to reduce the high medical payment. Additionally to find other causes of variation further in depth study controling the severity of diseases, socio-economic status of the users and the system factors is required.

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Variation of the Medical Service Utilization of the Dead by Cancers (암 사망자의 의료이용 변이)

  • Hong, Worl-Lan;Lee, Won-Jae;Youn, Kyung-Il
    • Korea Journal of Hospital Management
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    • v.12 no.3
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    • pp.1-19
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    • 2007
  • This study focused on finding the variation of medical service utilization and medical payments of the patients died by three, cancers, stomach, breast, and colon cancer. For this study, data of the one-year episodes of the health insurance subscribers died in 2004 were selected. The frequency of medical visits, the lengths of slays, the days of outpatient visits, the total period of medical services and the total medical payments were compared by the characteristics of the suppliers and utilizers. The data of the patients died by cerebrovascular diseases and cancer in 2004 were selected. To select the dead by cerebrovascular diseases and cancer in 2004, were matched the 2004 reimbursement data of all medical institutions to the data of funeral fee payment by the National Health Insurance Corporation from January 2004 to May 2005 for the death in 2004. The results of the analysis were as follow. The variation of medical service utilization of the dead by cancers were not small in Korea. The current study found that the variation of medical care utilization was influenced by the factors of suppliers, such as types and locations of medical institutions and the factors of users, such as sex and age. It was suspected that the reimbursement by fee-for-service contributed to the variation quite a lot, but we could not compare the variation between the different reimbursement systems in Korea. The results of the study suggested that tile factors of suppliers and utilizers should he reviewed to reduce the under use and over use expressed by variations of medical service utilization. The processes of care, effective communication and management system should be investigated for the equity of medical service utilization. Additionally, prospective payment could he recommended to reduce the high variation of medical service Use. To find the variation caused by under use and over use, further study need to control the severity of diseases, socio-economic status of the users and the system factors.

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Study on Cost-shifting in Cost Reimbursement type of Defense Contracts (개산형 방산계약에서의 원가이전에 관한 실증연구)

  • Lee, Jeong-Dong;Lee, Chun-Ju;Jung, Kyeong-In
    • Journal of the military operations research society of Korea
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    • v.31 no.2
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    • pp.1-12
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    • 2005
  • Defense firms' excess profitability by shifting common overhead costs from non-defense sector to defense sector in the award of cost reimbursement type of defense contracts is a widespread conclusion in prior researches. In this paper, we reviewed cost-shifting incentives in defense-contracting firms and extended the analysis of McGowan and Vendrzyk(2002) by applying modified model to Korea Defense Contracts. We formulated six hypotheses to test the relation of cost-shifting and excess profitability regarding market openness, auditing system, ranking in defense contracts, and firm types(sole defense contractors, sole non-defense contractors, and defense and non-defense mixed contractors). But, we could not find any evidence that defense firms shifted costs from non-defense sector to defense sector for the period 1997-2002. The results suggest that the excess profitability of Korea defense firms may not be from the cost-shifting but from other reasons.

The Private Physicians' Opinions of Being Attending Physicians in Teaching Hospitals (개원의의 개방병원 참여에 대한 의견)

  • Kim, Seok-Beom Gib;Kwun, Koing-Bo;Kang, Pock-Soo;Kim, Ki-Hong
    • Quality Improvement in Health Care
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    • v.5 no.1
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    • pp.140-150
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    • 1998
  • A mailed survey with structured questionnaire was conducted to study the demand of private physicians who were operating their own clinics in the community to be a attending physician at the general hospital. The responding proportion was 21.6 percent of the 960 private physicians. A total of 207 responders; 65.2 percent wanted to be a attending physician. In particular, the physicians who were male, young, surgeon and teaching hospital careered after specialist were more highly motivated. The major activities what they wanted as a attending physician were medical care for the admission patients. They responded that the hospital charges for the medical services and the responsibility of malpractice issues should be fairly shared by attending physician and hospital according to their contributions. There is growing consensus that the need of attending physician at the general hospital will become wide spread, but little organizational preparation to assure the quality of medical care of attending physicians including training of resident physicians and students. In addition, the effective reimbursement system should be develop to compensate appropriately according to the medical achievement of the attending physicians.

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