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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
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Health Policy and Management
Journal Basic Information
Journal DOI :
The Korean Society of Health Policy and Administration
Editor in Chief :
Volume & Issues
Volume 14, Issue 4 - Dec 2004
Volume 14, Issue 3 - Sep 2004
Volume 14, Issue 2 - Jun 2004
Volume 14, Issue 1 - Mar 2004
Selecting the target year
Factors Influencing to Select Types of U.S. Hospital Network
Health Policy and Management, volume 14, issue 2, 2004, Pages 1~16
DOI : 10.4332/KJHPA.2004.14.2.001
The study purpose was to find which factors affect selection of hospital network types. This study used the 1998 American Hospital Association Annual Survey Database from Health Forum. Among these U.S. hospitals, the researcher selected hospitals located in Metropolitan Statistical Areas. Therefore the final observation cases for analysis are 1,971 Metropolitan Statistical Area hospitals in the United States. To identify significant variables influencing hospital network types, the study used proportional odds logistics regression model on population size, Health Maintenance Organization penetration rate, and market competition rate of area including a hospital, types of hospital ownership, hospital bed size, proportion of Medicare patients and Medicaid patients in total hospital patients, and occupancy rate. Contrary to conventional wisdom, selection of hospital network types was influenced by population size of area which a hospital located, types of ownership, hospital bed size, and proportion of medicare patients rather than Health Maintenance Organization penetration. Population size 1,000,000-2,499,999 had the highest probability of selecting type IV (clinical-vertical integration) from an independent hospital, and a religious group owned hospitals and for-profit owned hospitals had the highest probability of selecting Type IV (clinical-vertical integration) from an independent hospital. A bed size had positive relation on selecting Type IV (clinical-vertical integration) from an independent hospital. Unlikely general belief that the selecting types of hospital network was determined by the change of health insurance policy such as Health Maintenance Organizations and Preferred Provider Organizations, the types of hospital network were influenced by community characteristics such as population size, and hospital characteristics.
Fairness of Health care financing: Progressivity and Retstributive Effect
Health Policy and Management, volume 14, issue 2, 2004, Pages 17~33
DOI : 10.4332/KJHPA.2004.14.2.017
The present study attempts to examine the progressivity of health care financial sources based on the income approach, for which it decomposes redistributive effects into vertical, horizontal, and re-ranking components. The study data include Korean Household Expenditure Survey (2000) conducted every 5 year by Korea National Statistical Office. The data were sampled from the national population by the multistage probabilistic sampling method, and amounts to 23,270 households. For the better application of the income approach, the study employs household total expenditure in Korea instead of total income, because the former data source is more reliable and less fluctuated over time. Progressivity of health care financing was measured by Kakwani index. Aronson's decomposition equation was used in case of the analysis where differential treatment of health care expenditure needs to be considered. Despite the progressivity of Korea's governmental contributions, total expenditure of health care showed regressive pattern, which may largely be attributable to the higher regressivity in out-of-pocket money. With the result of negative Kakwani index, differential treatment increased income redistribution biased for better-off. It is worth to note that social insurance displays not only negative Kakwani index, but also horizontal inequality, suggesting that the first step of health care financing reform should be the revision of social insurance premium rates toward effective and equable way.
Priority-setting in Expanding the Basic Benefit Package in Korean Health Insurance Scheme
Health Policy and Management, volume 14, issue 2, 2004, Pages 34~57
DOI : 10.4332/KJHPA.2004.14.2.034
Universal health insurance normally requires a basic benefit package, whose design intersects with almost all other aspects of the health insurance debate. Despite its central importance, basic benefit package has not received the analysis it deserves in Korea. The issue of how to decide which health services should be delivered and to whom has been a matter for consistent policy debate. Many industrialized countries observed in this study have been dealing explicitly or implicitly with the basic benefit package. The methods vary from having a specific positive list of services (Bismarkian countries) to the use of guidelines (Beveridgian countries). The purpose of this paper is to form the underlying principles and process for determining what is included or left out by getting accurate and representative responses from health-related personnel. Mail survey is used. Economic burden for treatment, seriousness of disease and urgency of treatment are ranked at the first three priorities. Services that had been suspended because of financial crisis in health insurance scheme in 2001 were selected as items which should firstly be expanded into coverage. Diagnostic test against heart disease and vaccination were also selected as items which should additionally belong to the list of covered services.
Critical Review of health care economic evaluation methodology : With a special reference to study design and cost estimation
Health Policy and Management, volume 14, issue 2, 2004, Pages 58~77
DOI : 10.4332/KJHPA.2004.14.2.058
Cost containment has become high political issues since financial crisis of the Korean Health Insurance fund in 2000. Korean Government has developed and implemented several measures to reduce the pharmaceutical expenditures. Pharmaceutical economic evaluation can be a tool in decision to allocate scare resource efficiently. In order to increase the quality of economic evaluation for pharmaceuticals, the Korean Health Insurance Review Agency(HIRA) is considering the development of a guideline for economic evaluation. It mandates that pharmaceutical companies could submit the result of an economic evaluation when demanding reimbursement of new pharmaceutical drugs. The purpose of this study is to provide a critical review of the economic evaluations of health care technologies published in the Korean context whether they have been performed according to current guidelines and therefore whether their results are directly useful for decision making. We found there exist important problems and deviation from, good practice' both in the general features of the studies, like the study design and perspective, and in terms of cost measurement and valuation. There are needs to develop clear guidelines and to educate and train researchers in performing economic evaluations.
Categorized the Contribution evasion through Health Insurance contribution evasion expected model
Health Policy and Management, volume 14, issue 2, 2004, Pages 78~98
DOI : 10.4332/KJHPA.2004.14.2.078
The purpose of this study was to categorize the contribution evasion and develop the expected models for contribution arrears in National Health Care System. The modified logistic regression model in non-payments was used as logistic regression model based on the statistical method. By using this model, we arranged non-payment types and typical branches those are appeared by statistical technique. First fact, sex and age branches those are able to take a part in economy had effect mostly. Also they had difference in non-payment probability by existence of their incomes and property. Especially people who didn't have their own house and car were appeared in high non-payment probability, disease and reduction characteristic(rare diseases, reduction of seniors, handicaps, numbers of medical treatments) didn't effect much in probability. The reason for some characteristic of non-payment which is higher than the correct threshold value of Logistic Regression Model (a suggested model for predicting non-payment)'s distribution of probability was mostly moral hazard. Living difficulty was the bigger reason for non-payment, but moral slackening was the bigger reason for non-payment. But it is careless to decide that moral hazard is just the reason, there is a necessity to examine on the side of sociology based in family. By the reason, the member's non-payment reason can be classified by economy, population, and psychology, but there was a comprehension that losing of work desire could be one reason. So we analyzed informations for composition of family of members. In conclusion, we grasped that family conflict makes non-payment and conversion of member in the National Basic Livelihood Protection System difficult.
Determinants of the National Health Expenditures: Panel Study
Health Policy and Management, volume 14, issue 2, 2004, Pages 99~116
DOI : 10.4332/KJHPA.2004.14.2.099
This study estimates the determinants of national health expenditures of OECD countries using panel regression method. The data used are OECD Health Data(2003) covering 33 countries and from 1970 to 2001. This study shows several important different results compared to the previous studies. Further this study estimates the determinants of Korean case using data from 1m to 2000, and compare with the results of OECD panel. The main findings are as follows. The income elasticity of health expenditures is estimated below 1.0, but is shown above 1.0 when the different health systems of each country are controlled. The women's labor participation influences strongly positive effect on the health expenditures. The diffusion of new technologies is positively related with the increasing expense. The increasing government expenditures have a tendency not to contain health expenses, but to increase expenses. The expansion of public health insurance holders is containing the expenses, and the increasing number of doctors is pushing expenditures. This implies the health expenditures are influenced more by the induced demand of providers rather than the moral hazard of patients. However, the above result is opposite in Korean case. The existence of primary care doctors affects slightly up warding rather than containing expenditures. Finally the determinants are seriously depending upon which factors are included in the model and which statistical model is chosen. Therefore it must be cautious to interpret the results of statistical model.
Gender differences in Health Behaviors and Related Factors of the Urban Elderly
Health Policy and Management, volume 14, issue 2, 2004, Pages 117~137
DOI : 10.4332/KJHPA.2004.14.2.117
The purpose of the study is to examine gender differences in health behaviors and the related factors for the urban elderly population. This study utilized the data from the Suwon city health survey of the elderly in 2001. The data consisted of a random sample of 979 (388 males, 591 females) elderly people aged over 65. The results of the study were as follows. First, the elderly people's health behaviors were different by gender. Concerning health risk-taking behavior, the frequencies of smoking and drinking were higher in males than in females. In terms of health promotive behavior, the regular exercise rate was higher in males than in females. Second, there were different factors that influenced health behaviors by gender. The factors that influenced the health risk-taking behaviors were health status factors for male, and socioeconomic factors for female. The factors that significantly influenced the health promotive behaviors were social supports networks for both gender. Therefore, program priorities need to be modulated in accordance with these gender differences in health behaviors. Moreover, different program strategies are needed that reflect the gender differences in health behavior determinants.
Small Area Variation in Rates of Common Surgery in General Surgery Department
Health Policy and Management, volume 14, issue 2, 2004, Pages 138~162
DOI : 10.4332/KJHPA.2004.14.2.138
This study was performed to investigate small area variation in rates of three common surgeries in general surgery department across 156 small areas. Three surgery rates were analyzed; Anal and/or stomal procedures, inguinal and/or femoral hernia procedures, appendectomy. Methods: We used health insurance claims data and the number of patients were 13,845, 2,154 and 7,151 persons respectively. Surgery rates were directly standardized with age and sex and logistic regression was used to analyze surgery rates. Results: Mapping of the surgery rates, there was small area variation in anal and/or stomal procedures. The clinic which was located in more competitive market and chose DRG payment system tends to do more anal and/or stomal procedures. There was no factor except DRG bed rates had effect on rate of inguinal and/or femoral hernia procedures. Conclusions: Findings of this study will contribute to developing investigation method on small area variation and policy to reduce the variation such as developing evidence based medical practice guideline.