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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
> Journal Vol & Issue
Health Policy and Management
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Journal DOI :
The Korean Society of Health Policy and Administration
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Volume & Issues
Volume 2, Issue 2 - Dec 1992
Volume 2, Issue 1 - Jul 1992
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Design and Management of Health Care Financing and Delivery System -What can We Learn from the Canadian Experience\ulcorner-
Health Policy and Management, volume 2, issue 2, 1992, Pages 1~32
The Canadian experience-universal government health insurance administeredby the ten provinces and two territories with some fiscal and policy variations-suggests the possibility of more effectve and efficient health care delivery system. The central purpose of the Canadian health in surance was to reduce and hopefully eliminate financial barriers to medical care. In this it succeeded. But it also produced varous kinds of unexpected side-effects on cost and quality. The Federal and Provincial Governments of Canada continue to exert theri efforts to ameliorate these problems. The lesson from Canada is that the health care revenue should be raised at the national level and managed at the regional level, and the regional healthcare financing organization has to take over the functions of the public health center. These alternatives is expected to make the Korean health care delivery system more efective and efficient, and to achieve health for all. This paper also discussed the policy agenda for implementing such alternatives in Korea.
Optimal Distribution of Public Health Administration between Local and Central Government
Health Policy and Management, volume 2, issue 2, 1992, Pages 33~56
The objectives of this research are (i) to review the functional and financial distribution of public health adminstration between central and local governments, (ii) to find out, based on economic criteria, optimal distribution required to fullfil local need for public health, and finally, (iii) to suggest policy implications in health area in face of the newly arising local autonomy system in Korea. Judging from data on government expenditures and tax revenues, public health administration in Korea is highly concentrated into central government, both functionlally and financially. High dependency of public health on central government has often been critisized that local residents can not participate in the decision making process for local health problems. This study, however, shows that localization of public health administration does not necessarily result in efficient and equitable allocation of resource to satisfy local demand for public health. From this point of view, two eccnomic criteria are suggested, i.e. external effect and economies of scle, as distributive criteria of roles in public health administration between local and central government. In addition, superiority of central concentration of public health administration to localization is emphasized in that public health in a wide sense contains the nature of public good and is part of compulsory socil security system. As a consequence, planned intervention by government is desirable.
A Study on the Organization, Function and Management of Health Subcenters in Korea
Health Policy and Management, volume 2, issue 2, 1992, Pages 57~89
This study is aimed both to reorient the Health net-works focused to Health Subcenters in times of development of local autonomy in Korea and to collect the fundamental data such as attitude and practice of the directors of Health Subcenter. The materials are collected from 134 out of 258 sampling directors of Health Subcenters with a questionaire by mailing(respond rate 51.9%). The major findings of this fundamental data are as follows. 1. Current average number of outpatients cared by a director of Health Subcenter is found to be 21.6. 2. The directors of Health Subcenter have little deducted hours for Public Health Programme. 3. Number of the Preventive Health Programme worked by a director of Health Subcenter is from 0 to 3. The most major group worked only 1 programme marked at 69.4%. 4. The directors of Health Subcenter express approval opinin marked at 80.2% that their qualification to appoint has to finish intern course. 5. The average diagnosis allowance a month is approximately twenty hundred thousand won. 6. Most of Health Subcenter(market at 94%) adopted a self-supporting account system. 7. The most complaining subject of directors of Health Subcenter is their working environment. The second complaining subject is governmental officier's interference. 8. The average number of outpatients cared by a director of Health Subcenter is found to be certain differentials by their marriage and the duration of employment. Some proposals of development on Health Subcenter based on the result of this research is as follows : 1. The reorganization on Health Subcenter under line of National Health Center Net-work 2. The psychological reorientation of directors of Health Sucenter and officers. 3. Autonomy management of Health Subcenter. 4. Reorientation of status on directors of Health Subcenter.
Definition and Strategy of Community Involvement in Health
Health Policy and Management, volume 2, issue 2, 1992, Pages 90~111
Community involvement is to be the keystone of primary health care, Unfortunately, efforts to promote it failed in many countries. Author inquired into the reasons why such efforts fail, and the alternative strategies for effectively promoting it in Korean situation today. In doing so, the concept of community involvement is clarified as an amalgamation of two different concepts; one is that of the community development, and the other is that of approaches for overcoming the alienation of the people from the health care process. Stategies of community involvement in Korea so far followed the line of the community development, e.g. village health worker. It loses, however, the feasibility as Korea has experinced so cial and economic developpment. The strategies of the second line of thought is now more feasible; empowering the people by providing more information and enhancing comitment to health, improving acceptabilty of community involvemt on the part of the health professionals and the bureaucrats, and building the mechanism of community involvement into the health policy-making process.
Quality Improvement in Patient Care Services : Obstacles and Approaches
Health Policy and Management, volume 2, issue 2, 1992, Pages 112~130
Patient care services are provided to individual patients in response to their health needs produced by illnesses or injuries. The services are often addressed to very serious conditions, and also they constitute the most expensive component of health care services. Therefore, the importance of quality is emphasized, but there are many indications that patient care quality is far from a satisfactory state in most of the countries. Based upon this observation, it is attempted to examine obstacles and approaches to quality improvement in patient care services. In doing so, following Taguchi's(1986) definition of product quality, quality of patient care services is conceived of as better when the less is the sociental loss attributalbe to variability of intended function and harmful side effects they emhibit after being delivered. Some distinguishing features of medical care sector pose difficulties in implementing effective quality improvement programs in patient care services. Nevertheless, newly proposed method of quality management, based on industrial quality management approach, seems to have a great deal of potential to effectively cope with such difficulties. This method, unlike the traditional approach to quality assurance, focuses on total organisational processes, not individuals, as the obproach to quality assurance, focuses on total organizational processes, not individuals, as the objects of quality improvement; variation, not comparison with standards, in quality measurement; and continuous improvement, not removing only bad quality care, as an ideal. Prerequisite to a successful use of any quality mangement method is motivating providers to improve quality. Conceivable approaches for such motivation are self-regulation, external controls and promotion of competition. Since these approaches are not mutually exclusive, they may be employed in an appropriate combination. In Korea, medical care providers are now functioning under the circumstances where they have little reason for making efforts to improve quality of their services. Once these circumstantial conditions are changed to exert pressures on providers to improve quality, the use of adequate quality management method becomes an issue. In this connection, much attention shoould be directed to the newly proposed method described above. In all these efforts for improving quality of patient care services, health insurance would be able to play a pivotal role. Poviders of medical care, buth indiciduals and organizations, are usually very responsive to the measures that affect their financing, and thus health insurance can be a strong instrument for motivationg providers to improve quality. Also, the insurance continuously acquires data on patient care, which could be processed to produce information required to effective quality control.
Difference of Prescription Services between the Health Center and the Private Clinic
Health Policy and Management, volume 2, issue 2, 1992, Pages 131~151
The contents of prescription service were comparatively analysed between health centers(HC) and private clinics(PC). Medical chart review was done for 330 otu-patients diagnosed with upper respiratory tract infection(UR) of 120 adults and 90 children, and gastritis or duodenitis of 120 adults. Emphasis on comparison was the prime cost of medication which used in prescription service. The results were as follows; 1. The prime costs fro the medication per visit of HC group were significantly higher than PC group in all three diseases, and the out of pocket payments of patients per visit were significantly lower in the HC group than PC group. 2. The reason for high prime costs of medication per visit of HC in adult case of URI were due to the idverse use of medication and long prescription period per visit. And high medication costs in children cases of URI in HC group were due to the longer prescription day. In cases of gastritis, the prime cost of medication was also higher because of longer prescription period and the higher prime cost of medication. The proportions of medications for injection in the HC and PC groups showed similar features. 3. In depth analysis of the prescription services showed the differences of the contents of medication. In adults cases of URI, the averaged cost of oral medication was significantly lower in HC group, but that of medication for injection was higher in HC group. In children cases of URI, the averaged cost of oral medication and medication for injection was lower in HC group than in PC group. But in the cases of gastritis it was was higher in HC group than in PC group. The prescription periods were longer in HC group than in PC group in all three diseases. As a conclusion prime medication cost and quality of prescription services of HC group were higher than PC group. In terms of health care the cost containment and quality assurance in physician visit for common disease, public sector utilization is good option for those perspectives. But it should not be generalized unless future study about structure and outcome research for quality assurance.
A Study on the Adopting Franchises System for the Improvement of Emergency Medical Services
Health Policy and Management, volume 2, issue 2, 1992, Pages 152~178
This study focuses on making recommendations for the improvement of poor emergency medical services or EMS in Korea. Problems of the current EMS system is widely reviewed. As an alternative of the current system, a franchises system is introduced to EMS. A feasibility study of the new system is carried out as follows. 1) The current EMS system shows such problem as; - Inadequacy of emergency medical fee schedule, - Shortage of emergency medical resources, - Concentration of emergency medical facilities in metropolitan area, - Unestablishment of training program for emergency personnel, - Inappropriateness of patients' behvaviro pattern in emergency care system. 2) Recommendations for the improvement of EMS are as follows: - Well organized communication and transportation system needs to be established by utilizing all the availabl EMS is to be devised for the provision of appropriate emergency care. - A franchises system can be widly adopted so that private organizations are willing to establish a free standing emergency center. - Emergency care fee schedule of the franchises system needs to be appropriate for the system to provide high standard medical services.
Why the Prescribing-Dispensing Services Are Not Separated in Korea\ulcorner -An Economic Approach-
Health Policy and Management, volume 2, issue 2, 1992, Pages 179~193
This paper attempts to explain why the prescribing-dispensing services are not seperated in Korea. The main reason why physicians and pharmacists do not compromise, even though the two parties support the seperation policy in public, is contended to be that both parties would lose their interests if the policy were implemented. Physicians' loss from giving up their vested rights to dispensing would be larger than their gain from an increase in the number of prescriptions. Pharmacists' loww from being forced not to to sell medicines without prescriptions would also be larger than their gain from prohibiting physicians from dispensing. The net ganier form the seperation policy would be the patients. Therefore, the seperation policy would not be implemented unless political pressure from general public surpasses that from physicians and pharmacists.
A Study on the Socio-economic Characteristics of Magnetic Resonance Image(MRI) Uses in Korea
Health Policy and Management, volume 2, issue 2, 1992, Pages 194~220
In recent years there has been a rapid influx of high cost MRI equipment into Korea. This diffusion has raised concerns about the changes it will bring for the health care utilization. Therefore, the purpose of this study is to identify socio-economic characteristics of MRI uses in Korea. A structured questionnaire was designed for this purpose, and 1, 091 users were surveyed at the 35 MRI units of 33 hospitals during a week, sometimes March 1992. The study reveals that high cost technology such as MRI, CT scanner is so prevalent in Korea. This is particularly the case in metropolitan areas. Among others, Seoul has the highest percentage of MRI equipment, 51.05%, Pusan 12.10% and Kwangju 11.9%. Unfortunately, most high cost technology equipments are foreign products. Thus, hospitals with such a high cost technology have difficulties in maintenance of the equipment. The average performance of MRI equipment has declined from 10.2 cases per day in 1988 to 7.16 cases in March 1992. Due to the rapid increase, the performance of MRI equipment seems to be deterioration. Male usere are dominant in the case of MRI use. The utilization rate has positively increased with the rise of educational level of users. The same is true for the level of income; the MRI utilization rate by income level shows that it is negatively proportional to income, which indicates that the poor have difficulties in the use of high cost technology. Particularly, the cost of MRI is so high that ordinary patients are unable to pay for it. For example, 86.3% of respondents have answered that the cost is too high even though they are insured by health insurance. This is the first empirical study on the use status of MRI. The information obtained in this study is sufficient to maintain that the Korean health insurance programme is urgently in need of improving the insurance benefit schemes. The easiest way to do this is to include provision of high cost technology service into the benefit package.
Analysis of Source of Increase in Medical Expenditure for Medical Insurance Demonstration Area before(1982-1987) and after(1988-1990) National Health Insurance
Health Policy and Management, volume 2, issue 2, 1992, Pages 221~237
The reasons for cost inflation in medical insurance expenditure are classified into demand pull inflation and cost push inflation. The former includes increase in the number of beneficiaries and utilization rate, while the latter includes increase in medical insurance fee and the charges per case. This study was conducted to analyze sources of increases of expenditure in medical insurance demonstration area by the period of 1982-1987 which was earlier than national health insurance and the period of national health insurance(1988-1990). The major findings were as follows: Medical expenditure in these areas increased by 9.4%(15.1%) annually between 1982 and 1990 on the basis of costant price(current price) and for this period, the yearly average increasing rate of expenses for outpatient care[10.5%(15.8%)] was higher than that of inpatient care [7.3%(12.6%)]. Medical expenditure increased by 6.3%(8.9%) annually between 1982 and 1987, the period of medical insurance demonstration, while it increased by 10.7%(18.9%) after implementing national health insurance(1988-1990). Medical expenditure increased by 35.9%(45.9%) between 1982 and 1987. Of this increase, 115.2%(92.1%) was attributable to the increase in the frequencies of utilization per beneficiary and 61.0%(68.1%) was due to the increase in the charges per case, but the expenditure decreased by 76.2%(60.2%) due to the reduction in the number of beneficiaries. Beteen 1988 and 1990, the period of national health insurance, medical expenditure increased by 21.2%(41.4%). Of this increase, 87.5%(46.4%) was attributable to the increase in the frequencies of utilization per beneficiary and 52.4%(73.4%) was due to the increase in the charges per case, and of the increase in the charges per case, 69.6%(40.8%) was attributable to the increase in the days of visit per case. Medical expenses per person in these areas increased by 78.2%(89.0%) between 1982 and 1987. Of this increase, 76.6%(69.1%) was attributable to the increase in the frequencies of utilization per beneficiary and 23.4%(30.9%) was due to the increase in the charges per case. For this period, demand-pull factor was the major cause of the increase in medical expenses and the expenses per treatment day was the major attributable factor in cost-push inflation. Betwee 1988 and 1990, medical expenditure per person increased by 31.2%(53.1%). Of this increase, 60.8%(37.2%) was attributable to the demand-pull factor and 39.2%(62.8%) was due to the increase in the charges per case which was one of cost-push factors. In current price, the attributalbe rate of the charges per case which was one of cost-push factors was higher than that of utilization rate in the period of national health insurance as compared to the period of medical insurance demonstration. In consideration of above findings, demand-pull factor led the increase in medical expenditure between 1982 and 1987, the period of medical insurance medel trial, but after implementing national health insurance, the attributable rate of cost-push factor was increasing gradually. Thus we may conclude that for medical cost containment, it is requested to examine the new reimbursement method to control cost-push factor and service-intensity factor.