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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
> Journal Vol & Issue
Health Policy and Management
Journal Basic Information
Journal DOI :
The Korean Society of Health Policy and Administration
Editor in Chief :
Volume & Issues
Volume 17, Issue 4 - Dec 2007
Volume 17, Issue 3 - Sep 2007
Volume 17, Issue 2 - Jun 2007
Volume 17, Issue 1 - Mar 2007
Selecting the target year
The Refinement Project of Health Insurance Relative Value Scales: Results and Limits
Kang, Gil-Won ; Lee, Choong-Sup ;
Health Policy and Management, volume 17, issue 3, 2007, Pages 1~25
DOI : 10.4332/KJHPA.2007.17.3.001
Relative value scales introduced in 2001 remarkably improved health insurance fee schedule, but current relative value scales have many problems. In the beginning the government intended to introduce 'resource based relative value scales(RBRVSs)' like USA, but political adjustment of RBRVS studied in 19.17 weakened the relationship between relative value scale and resource consumption. So unbalance of health insurance fees are existing till now. Also relative value was not divided to physician work and practice expense, and malpractice fee was not divided separately. To correct the unbalance of current relative value scales, the refinement project of health insurance relative value scales started in 2003. The project team divided relative value scales into three components, which are physician work, practice expense, malpractice fee. Physician work was studied by professional organizations like Korean medical association. To develop the practice expense relative value, project team organized clinical practice expert panels(CPEPs) composed of physicians, nurses, and medical technicians. CPEPs constructed direct expense data like labor costs, material costs, equipment costs about each medical procedures. The practice expense relative values of medical procedures were developed by the allocation of the institution level direct & indirect costs according to CPEPs direct costs. Institution level direct & indirect costs were collected in 21 hospitals, 98 medical clinics, 53 dental clinics, 78 oriental clinics, and 46 pharmacies. The malpractice fee relative values were developed through the survey of malpractice related costs of hospitals, clinics, pharmacies. Putting together three components of relative values in one scale, the final relative values were made. The final relative values were calculated under budget neutrality by medical departments, that is, total relative value score of a department was same before and after the revision. but malpractice fee relative value scores were added to total scores of relative values. So total score of a department was increased by the malpractice fee relative value score of that department This project failed in making 'resource based' relative value scales in the true sense of the word, because the total relative value scores of medical departments were fixed. However the project team constructed the objective basis of relative value scale like physician's work, direct practice expense, malpractice fee. So step by step making process of the basis, the fixation of total scores by the departments will be resolved and the resource based relative value scale will be introduced in true sense.
Quantitative and Qualitative Difference in the Utilization of Health Care - Based on the Survey of Gwangju-Jeonnam Residents
Kim, Jeong-Ju ; Oh, Ju-Hwan ; Moon, Ok-Ryun ; Kwon, Soon-Man ;
Health Policy and Management, volume 17, issue 3, 2007, Pages 26~49
DOI : 10.4332/KJHPA.2007.17.3.026
The purpose of this study is to analyze the equity of health care utilization by income groups in terms of both quantity and quality of care, which is measured by expenditure, type of care, and type of health care institutions. Equity in health care utilization is measured by HIwv index, based on the survey of 1,480 Gwangju-Jeonnam residents. Health care utilization in terms of the probability and quantity of outpatient and inpatient care show equitable or pro-poor inequitable distribution, whereas the distribution of health care expenditure, which can account for the quality of care, is pro-rich inequitable, implying that the better off tend to use more expensive medical care. In terms of the types of care, simple visits for basic care show equitable distribution, whereas the distribution of the utilization of traditional tonic medicine, comprehensive health examination, CT, MRI, and ultrasound is pro-rich inequitable. Utilization of general hospitals and traditional health institutions show pro-rich inequitable distribution, hospitals and dental care institutions equitable, and physician clinics and public health centers pro-poor inequitable.
Income elasticity of household health expenditures and differences by income level
Huh, Soon-Im ; Choi, Sook-Ja ; Kim, Chang-Yup ;
Health Policy and Management, volume 17, issue 3, 2007, Pages 50~67
DOI : 10.4332/KJHPA.2007.17.3.050
This study investigated income elasticity of household health expenditures and differences by income level from 1998 through 2003. Data from Korean Labor and Income Panel Study was used for empirical analyses. To estimate the income effects on health expenditure, the two-part model was employed: a logistic regression for any health expenditure-first part-and a Ordinary Least Square regression for health expenditure conditional on any spending-second part. To estimate income elasticity, both health expenditure and income were log transformed in the second part. In addition, the random effects(RE) model was used for a longitudinal panel which was continuously followed from 1998 through 2003 to estimate income effects on health expenditures controlling for within and between unobservable household characteristics. Furthermore, difference in income effects on health expenditure across income level was investigated. Although income slightly increased odds of any health expenditure, there was not no table differences across income level. Income significantly increased health expenditures during study period(overall income elasticity: about 0.2) and the highest 20% income group presented higher income elasticity than the lowest 20% income group.
The Modifying Effect of Switching Barriers in Customer Loyalties in Medical Services
Lee, Sun-Hee ; Kim, Hyun-Mi ; Chae, Yoo-Mi ;
Health Policy and Management, volume 17, issue 3, 2007, Pages 68~86
DOI : 10.4332/KJHPA.2007.17.3.068
This study was performed to explore the effect of customer satisfaction and switching barriers on customer royalties in medical services. 900 households, 1% sample were randomly selected from K city located in Kangwon province. Interview survey was performed with structured questionnaire for the entire people, 923 persons who experienced medical service utilization during one year before survey on time, september, 2002. In comparison of switching barriers by sociodemographic characteristics, lower income group and lower educated group showed the higher level of recognition level on availability of changing the service provider significantly. In terms of economic loss as one of switching barriers, the group of over aged 61, the lower income group and the lower educated group felt higher than other groups. Also, the time loss of switching barrier was recognized in 41-60 aged group and employee in service industry highly. For the perceived risk factor as another switching barrier, the high educated group showed the higher recognition level in performance risk and felt higher social risk than other groups. In analysis of customer satisfaction and loyalty levels by switching barrier components, the lower level of availability of changing the service provider and the higher level of recognition for economic and time loss, they showed the higher satisfaction and loyalty levels. In final step, multiple regression analysis showed the positive relationship between customer satisfaction, switching barrier and customer loyalties. Besides, the moderating effect of switching barrier in relationship between customer satisfaction and loyalties was significant and this results suggests that the influence of customer satisfaction to customer loyalties might be weakened in high level of recognition for switching barrier. In conclusion, perceived risk of economic and time loss as switching barrier is an important factor and should be considered in planning of marketing strategy carefully in terms of defensive marketing.
Does performing high- or low-risk coronary artery bypass graft surgery bias the assessment of risk-adjusted mortality rates of hospitals?
Lee, Kwang-Soo ; Lee, Sang-Il ; Lee, Jung-Soo ;
Health Policy and Management, volume 17, issue 3, 2007, Pages 87~105
DOI : 10.4332/KJHPA.2007.17.3.087
The purpose of this study was to analyze whether nonemergency, isolated coronary artery bypass graft (CABG) surgery for high- or low-risk patients biases the assessment of the risk-adjusted mortality rates of hospitals. This study used 2002 National Health Insurance claims data for tertiary hospitals in Korea. The study sample consisted of 1,959 patients from 23 tertiary hospitals. The risk-adjustment model used the patients' biological, admission, and comorbidity data identified in the claims. The subjects were classified into high- and low-risk groups based on predicted surgical risk. The crude mortality rates and risk-adjusted mortality rates for low-risk, high-risk, and all patients in a hospital were compared based on the rank and the four intervals defined by quartile. Also, the crude mortality rates of the three groups were compared with their 95% confidence intervals of predicted mortality rates. The C-statistic (0.83) and Hosmer-Lemeshow test (
=11.47, p=0.18) indicated that the risk-adjustment model performed well. Presenting crude mortality rates with their 95% confidence intervals of predicted rates showed higher agreements among the three groups than using the rank or intervals of mortality rates defined by quartile in the hospital performance assessment. The crude mortality rates for the low-risk patients in 21 of the 23 hospitals were located on the same side of their 95% confidence intervals compared to that for all patients. High-risk patients and all patients differed at only one hospital. In conclusion, the impact of risk selection by hospital on the assessment results was the smallest when comparing the crude inpatient mortality rates of CABG patients with the 95% confidence intervals of predicted mortality rates. Given the increasing importance of quality improvements in Korean health policy, it will be necessary to use the appropriate method of releasing the hospital performance data to the public to minimize any unwanted impact such as risk-based hospital selection.
Ideology and Reality in Health Policy
Lee, Kyu-Sik ;
Health Policy and Management, volume 17, issue 3, 2007, Pages 106~128
DOI : 10.4332/KJHPA.2007.17.3.106
The Korean health care system is under great controversy. Over the last 30 years, main goal of health policies was to pursue equal access of health care services. However, another goal of health policies laid on efficiency and Quality of care, it had lower priorities. Superficially, controversy stems from priority setting among goals of health care system, equity, efficiency and quality. At a deeper level, arguments arise from disagreement and confusion about the values of Korean health care system. One of the value spectrums believes that health care is the basic right of human beings, therefore it should be produced and distributed on need approach, and needs are known to be decided by professionals. If we accept need approach, health care is a pubic good. Another value of spectrums considers that health care should be distributed on demand approach. Demand approach means that health care is a consumption good on the positive economics, while normative judgement believes that health care is a public good. In equity aspect, health care is considered as a public good. Over the last several years, some of scholars proposed health care reform based on the principle of competition which is based on demand approach. Others argue that the competition principle based on demand approach is not appropriate for the reform proposal, because health care has to be approached on need base. If we do not make explicit values we should adopt, consensus building for reform is nearly impossible. From this perspective, this article will review an ideology and reality in health policies in Korea.