• Korean Journal of Clinical Pharmacy
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• v.21 no.4
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• pp.347-352
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• 2011

Health insurance review & Assessment service (HIRA) has enforced cutting the drug costs when physicians prescribe split extended release drugs, starting from December, 2010. The objective of this study is to analyze extended release and enteric coated drugs on pharmaceutical reimbursement list in Korea, and to investigate the impact and barriers of the health insurance review on splitting extended-release formulation drugs. By using the ingredient code, extended release and enteric coated formulations make up 7.8% of all drugs in April, 2011. The most frequently used drugs are agent affecting circulatory and digestive system. From the extended release and enteric coated formulations (n=112), 34.8% (n=39) were not available in other dosage forms. According to questionnaire survey for 169 pharmacists (response rate: 73.8%), the rate of splitting and crushing of extended release and enteric coated drugs decreased. When pharmacists correct physician's prescription errors, the biggest problem was lack of other dosage forms. So it is necessary to develop variety of other dosage forms, and computerized checking system for splitting extended-release drugs. It is also important to inform physicians and patients in regard to the problems of split prescription of extended release and enteric coated drugs.

• Journal of Korean Academy of Nursing Administration
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• v.19 no.4
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• pp.449-461
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• 2013

Purpose: The purpose of this study was to explore the relationship between cost and revenue for inpatient nursing activities in general wards. Methods: Data were collected from 12 medical-surgical wards in one general hospital from January 1 to December 31, 2010. The nursing activities were categorized into 2 groups according to nursing service payment type in terms of the Korea health insurance system. Descriptive statistics were used to identify nursing activities and nursing activity costs. Results: Of 140 nursing activities identified as performed in general wards, payment for 69 items was included in nursing management fees. The percentage of each cost for the nursing units was 90% for labor, 4% for materials, and 6% for operating expenses. The cost for medical support nursing service accounted for 38% of costs and nursing management fees, 62%. The average profit and loss was -237,257,000 won. The cost recovery rate for nursing service was only 44%. Conclusion: The results indicate a need to measure the economic value of nursing activities performed in general wards and use it as a basis for establishing an adequate reimbursement system for nursing service.

• Health Policy and Management
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• v.28 no.4
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• pp.360-368
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• 2018

Background: The proportion of pharmaceutical expenditure out of total health-care expenditure in South Korea is high. In 2016, 25.7% of national health insurance (NHI) spending was for pharmaceuticals. Given the increasing demands for the access to newly introduced medicines and following increase in pharmaceutical spending, the management of NHI pharmaceutical expenditure is becoming more difficult. Methods: This study analyzed the data claimed to NHI for pharmaceutical reimbursement from 2010 to 2016. Results: The policy implications with respect to the trends and problems in spending by drug groups were elicited. First, the proportion of off-patent drugs spending which were treated to chronic disease was much higher than anti-cancer drug spending. Second, the spending to the newly introduced high-costed medicine increased, however, current price-reduction mechanism was not sufficient to manage their expenditure efficiently. Conclusion: Our system seems to need several revisions to improve the efficiency of pharmaceutical expenditure and to cope with high-costed medicines. This study suggested that the prices of off-patent drugs need to be regularly readjusted and the Price-Volume Agreement System should be operated more flexibly as well.

• Korea Journal of Hospital Management
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• v.13 no.2
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• pp.20-35
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• 2008

Though the attending system was first implemented in 2003 to facilitate the efficient utilization of medical resources and specialties, only a few hospitals and physicians are participated in that system. The purpose of this study was to investigate the actual facts which related to operation of attending system and propose a basic information to revitalized of the attending system in Korea. The data were collected between August 1 and October 30, 2005 from 25 hospitals and 42 attending physicians who were in part of the attending system. Medical institutions were unwilling to participate despite the advantages of the attending system with respect to the utilization of medical resources and improvement in the quality of medical services. The primary reason for this was the lack of understanding among physicians about the attending system and the difficulty(lack of time) encountered by the attending physicians in administering care to patients hospitalized in the attending hospitals. Moreover insufficient reimbursement for rendered medical services constituted another important reason. In conclusion, we can state that the establishment of a committee is required to discuss the issues surrounding the attending system and to control the growing disparity between the viewpoints of hospitals and physicians. Regardless, there is a need to develop economical incentives for medical institutes. The attending system served as a useful policy in promoting the medical service system and bringing about an improvement in the management of medical institutes.

• 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.

• Korea Journal of Hospital Management
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• v.7 no.1
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• pp.105-120
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• 2002

In the United States, the prospective payment system(PPS), under which diagnosis related groups (DRGs) are used to reimburse hospitals for the care of Medicare patients since 1983, Study results showed that the PPS is having a major impact on the quantity of services especially of hospital length of stay. The PPS has increased the likelihood that a patient will be discharged home in an unstable condition and the use of nursing homes or long term care facilities increased. Still, it is insufficient to conclude that the PPS has decreased the Medicare total expenditure, but relatively sufficient to conclude that the quality of care hasn't changed. The maintenance of the quality resulted from the systemic "check-and-balance" composed of three factors; (1) The doctors are reimbursed based on the fee-for-service system, (2) hospitals contact with doctors under the attending system, and (3) there are some public hospitals. In Korea, the reimbursement for hospitals and doctors are not divided, the hospitals have doctors as employees, and 90% of hospitals are private. These differences may weaken the "check-and-balance" existing in the U.S. system. And there are few long term care facilities and the diagnostic coding system using in pilot test are not suitable for Korean situation. In conclusion, for successful implementation of the DRG payment system in Korea, the government should establish the "check-and-balance" system in the health sector to make sure the quality of care before the implementation.

• Korea Journal of Hospital Management
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• v.1 no.1
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• pp.154-169
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• 1996

Some of the large sized companies have taken parts in a hospital business with a view or justification to improve medical care regadless of the disadvantageous fee-for-service medical insurance reimbursement system controlled by authorities related. This gradually brought about the financial difficulties to university hospitals as well as general hospitals that were less competitive. In this circumstance the hospital administrators are called for preparing and implementing proper financial strategies by analyzing external circumstances and internal abilities of their hospitals. In this aspect, an effective cost-analysis system in the hospital has been needed for years. K-University hospital developed the practical cost-analysis system and applied it to the hospital management. The effects of cost analysis system are as belows: first, the trend of the monthly revenue per medical specialist from March to July in 1996 showed increasing pattern which is different from that in past years. second, it turned out that the department of functional laboratory in relation to medical treatment enlarged the medical revenue very sharply. third, the intensive care units were being operated at the state of deficit, while other general wards were lucrative.

• Health Policy and Management
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• v.14 no.1
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• pp.44-64
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• 2004

As of 1 July 2000 a big reform was introduced into the Korean health care system: the separation between prescribing and dispensing of drugs (SPD reform). There was, however, a big financial stake associated with pharmaceuticals, particularly before the reform, because physicians as well as pharmacists were allowed to purchase drugs at much lower costs than the insurance reimbursement. In this respect, this study focuses on the change in income and profit of both doctor's clinics and pharmacies after the reform. Data from National Health and Nutritional Survey by the ministry of health and welfare were used to estimate the income or expenditure that are financed by out-of-pocket payment of the patients, while national health insurance data etc. were used for the estimation of the income or expenditure that is financed by insurers. Average annual income per doctor's clinic increased from 299 million won to 338 million won for the three years between 1998 and 2001, whereas average annual income per pharmacy increased enormously from 60 million won to 305 million won for the same period. Average annual 'profit' increase per each doctor's clinic caused by the reform itself was estimated to range from 50 to 83 million won, while that per each pharmacy, from 23 to 87 million won. In sum, while both doctor's clinics and pharmacies are beneficiaries of the SPD reform, its positive impact is particularly prominent on the latter.

• Journal of Preventive Medicine and Public Health
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• v.41 no.2
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• pp.74-79
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• 2008

Since the positive listing system for prescription drug reimbursement has been introduced in Korea, the number of pharmacoeconomic evaluation studies has increased. However it is not clear if the quality of pharmacoeconomic evaluation study has improved. Due to the lack of randomized clinical studies in Korean health care setting, Korean economic evaluation studies have typically integrated the local cost data and foreign clinical data. Therefore methodological issues can be raised in regard to data coherence and consistency. But the quality of data was not questiened and the potential bias has not been investigated yet. Even though changes in policy have encouraged the undertaking of pharmacoeconomic evaluations, there is few public-side funding for validation study of cost-effectiveness models and data. Several companies perform economic evaluation studies to be submitted on behalf of their own products, but do not want the study results to be disclosed to the academic community or public. To improve the present conduct of pharmacoeconomic evaluations in Korea, various funding sources need to be developed, and, like other multidisciplinary areas, the experts in different fields of study should collaborate to ensure the validity and credibility of pharmacoeconomic evaluations.

• Journal of Korean Academy of Nursing Administration
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• v.8 no.2
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• pp.283-293
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• 2002

Purpose: The purpose of this study was to define cost-countable perioperative nursing activities and to analyze the cost of each nursing activities based on the Resource-Based Relative Value Scale (RBRVS). Method: Researcher and 3 research assistants observed and documented the 83 operating patients in order to measure nursing time for each of the perioperative nursing activities. And then, 35 operating room nurses with at least one year of perioperative nursing experience were observed for the RBRVS of perioperative nursing activities. Finally, the direct and indirect nursing costs were estimated. Result: Nursing costs of 25 nursing activities were estimated using the RBRVS. Most expensive nursing activities were delivery of the instrument and implement for OP team (9,780 won per hour) and behavior of wash, pack, disinfect the instrument (6,770). Conclusion: Based on the relative values of each perioperative nursing activities estimated in this study, proper medical reimbursement system should be established in a near future.