• Title, Summary, Keyword: Korean medical expenses

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Management Strategies for Medical Expenses Depending on Type of Diseases for Patients of Seafarers Insurance - Focused on Busan - (선원보험 수진자의 상병유형에 따른 진료비 관리방안 - 부산지역을 중심으로 -)

  • Park, Eun-Ha;Hwang, Byung-Deog
    • The Korean Journal of Health Service Management
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    • v.10 no.4
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    • pp.1-11
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    • 2016
  • Objectives : The aim of this study is to investigate the actual condition of the occurrence and recovery of medical expenses through seafarers insurance and to provide basic data that will be helpful in the establishment of efficient hospital management strategies for medical expenses of insurance companies depending on the type of seafarers insurance. Methods : Three general hospitals located in Busan, Korea, were selected, and seafarers insurance claim data was collected from January 1, 2012 to December 31, 2013(24 months) and analyzed. There were 5,490 cases in total. Results : There was a significant difference in the distribution of disease incidence, accrued medical expenses, reimbursement of medical expenses, and the actual condition of medical receivables depending on the insurance company. Conclusions : Therefore, differentiated payback strategies for medical expenses are needed that consider the various seafarers insurance companies and their treatment characteristics.

The Legal Base and Validity of Reviewing Medical Expenses in the Health Insurance (건강보험 진료비심사의 법적 근거와 효력)

  • Kim, Un-Mook
    • The Korean Society of Law and Medicine
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    • v.8 no.1
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    • pp.137-177
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    • 2007
  • The medical expenses review system in Korea has developed under fee-for-service system with its own unique structure. The importance of reviewing medical expenses has been emphasized, as the size of medical expenditures moving through the health insurance legal context and its weight in the national economy have increased very rapidly. It is, however, analyzed that the feuds and arguments continue among the stakeholders for the lack of laws supporting the medical expenses review system. The medical expenses review is a series of administrative procedures, deciding whether claims from medical care institutions to the insurer are legal and valid or not. It mainly controls the increase of unnecessarily excessive health insurance claim and prevents fraudulent claim and abuse and checks the less use or unsuitable use of medical resources. It also works a function guarantees medical benefits for the appropriate treatment according to the object of health insurance system as a social insurance scheme. The dispute on legal base of the medical expenses review is about the source of law in the medical expenses review. There are the Health Insurance Act and administrative laws as jus scriptum and the guidelines of review as administrative orders. The medical expenses review should reflect various factors, such as the development of medical healthcare technologies, the health expenditures distribution, the financial situation of the health insurance, and the evaluation on the level of appropriate benefits. It is also likely to adapt to the traits of characters of medicine, and trends and transition, Besides it should judge the legality and the validity of medical benefits expenditures by synthesizing these all factors. And the evaluation system of appropriateness of medical benefits was administrative procedure which was consecutive with reviewing the medical expenses system and it was intended to make up for the result of reviewing the medical expenses in more comprehensive levels.

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An Analysis on the Health and the Medical Demand in Korea: Using the Grossman Model (우리나라의 건강수요 및 의료수요에 대한 분석: Grossman Model을 중심으로)

  • Hwang, Yongha;Sakong, Jin
    • Health Policy and Management
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    • v.29 no.3
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    • pp.332-341
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    • 2019
  • Background: This study analyzes the effects of the individual's health behavior on the health and the medical demand for the management of health and medical expenses. Methods: This study uses the Korea Health Panel Survey data from 2010 to 2015. We utilize the panel ordered logit model and the panel Tobit model with the subjective health status and the medical expenses as the dependent variables. Results: Chronic diseases would cause the deterioration of his or her health and the increase in medical expenses. Smoking and drinking alcohol would deteriorate one's health. The total amount of cigarettes increases medical expenses. Exercises could make people healthier, whereas excessive exercise might increase medical expenses. Private health insurance would increase medical expenses. Conclusion: Since health could reduce the medical expenses, people should promote one's health by changing one's behavior for health.

Study on Out-of-pocket Money among Medical Expenses of an Oriental Medical University Hospital (한방의료의 본인부담금 연구)

  • Shin Sang-Moon;Kang Sung-Wook
    • Journal of Society of Preventive Korean Medicine
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    • v.3 no.1
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    • pp.67-82
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    • 1999
  • This study was performed to investigate out-of-pocket money among medical expenses of an oriental medical university hospital by the use of internal data of an oriental hospital because medical insurance program data could not show us insuree's out-of-pocket money among medical expenses. The purpose of this study was to analyze out-of-pocket money among medical expenses of ambulatory and hospitalized patients. Under this purpose, We analyzed actual medical expenses data of 1389 out-patients and 858 in-patients of the oriental medical university hospital with 90 beds that could be approach to internal data from July 1, 1998 to March 31, 1999. The major findings are as follows : 1. In ambulatory patients, the cost share ratio of insuree & that of insurer was 90 : 10 respectly. 2. In hospitalized patients, the cost share ratio of insuree & that of insurer was 72 : 28 respectly.

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Analysis of Medical Expenses for patients by Automobile Accident (자동차사고에 의한 환자의 진료비 성향 분석)

  • Ko, Min-seok;Kim, Seung-Hee
    • Journal of the Korean Society of Mechanical Technology
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    • v.13 no.1
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    • pp.1-9
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    • 2011
  • The present study aimed to compare and analyze the particulars of and difference in medical expenses and their composition ratio for 2,026 patients hospitalized at 2 types of medical institutions (443 at a clinic and 1,583 at a hospital) in Jeonju-si, Jeollabuk-do under coverage of automobile insurance during 2009. From the analysis, it became evident that there were differences in individual characters of inpatients covered by automobile insurance, and details, composition and composition ratio of medical treatment for them depending on types of medical institutions. There was no difference, however, between the total and average medical expenses per capita even when markup rate was applied to the automobile insurance by types of hospitals. The ratio of radiotherapy and physical therapy in the composition of medical expenses was found to be extraordinarily high in clinics compared to that of hospitals. The composition ratio of the fixed cost including charge for hospitalization also turned out to be fairly high in all medical institutions.

An Analysis of Medical Expenses for In-patients in an Oriental Medical Hospital and Factors Affecting Them (한방병원 입원환자의 진료비와 이에 영향을 미치는 요인 분석)

  • Ko, Min-Seok;Choi, Joon-Young
    • Journal of Society of Preventive Korean Medicine
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    • v.15 no.1
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    • pp.71-87
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    • 2011
  • Objective : The present study is aimed at providing basic data to help oriental medical hospitals devise efficient operational plans by analyzing the medical expenses of in-patients in an oriental medical hospital and the factors affecting such expenses. Methods : PASW 18.0 was used to analyze the medical insurance program data of 929 patients who were discharged from a university oriental medical hospital(with 105 sick-beds) during the period from January 1 to December 31, 2010 after treatment under the coverage of health insurance and medical aid. Results : 1) Of all the patients hospitalized, 63.3% were females, their mean age was 52.73 years old, and 87.7% was covered by the health insurance program. The biggest number or 31.2% of the patients were treated by the department of acupuncture, 31.5% suffered mainly from the diseases of musculoskeletal system and connective tissues, and the average length of stay at the hospital was 19.49 days. 2) There were statistically significant differences in total medical expenses by age, clinical department in charge, principal diagnosis, and number of days hospitalized while daily average medical expenses differed depending on age, type of medical security, clinical department, principal diagnosis, and number of days staying at the hospital. 3) Total medical expenses were found significantly influenced by age, type of medical security, clinical department, principal diagnosis, and number of days hospitalized(explanatory power : 95.9%), whereas type of medical security, clinical department and principal diagnosis turned out to exercise significant influence on the daily average medical expenses(explanatory power : 26.9%). Conclusion : Oriental medical hospitals are suggested to make efforts to ensure geographical and economical accessibility for their main clients, the elderly and middle-aged, as well as to improve satisfaction of the clients with the medical service provided. They are also encouraged to work out systems to specialize in treatment with a focus on chronic degenerative and adult diseases. In addition, they are expected to try to enhance people's awareness of oriental medicine in an attempt to diversify the brackets of clients and increase frequency of their utilization.

A Study on The Determinants of the Medical Expenses in the Health Insurance System in Korea (의료보험 진료비의 결정요인에 대한 연구)

  • 사공진;김진영
    • Health Policy and Management
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    • v.11 no.2
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    • pp.29-57
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    • 2001
  • Since the inauguration of the medical insurance system in 1977, the increasing medical expenses which can be menace to tile finance of the medical insurance system, have become major concern in the medical insurance field In Korea. This study focuses on the determinants of the medical expenses in the health insurance in Korea and analyzes the impact of these factors on the increase in the medical expenses. The empirical work is done using the pooled cross-section and time-series data of the medical insurance for the self-employeds and the industrial workers from the year 1995 to 1997. The result of this study shows that the main determinants of the medical expenses in the health insurance are the ratio of the population of the aged to the total population, the frequency of the utilization, number of doctors per capita and the regime changes. Although the increasing trend in the medical expenses seems to be unavoidable, we probably need to add some efficiency to the medical expenses by suppressing the supply and the utilization of the unnecessary medical services. The fee-for-service reimbursement system of today can't suppress the supply of the unnecessary medical services effectively. So we need to convert the present fee-for-service system into DRG's which is known to reduce the medical costs. The increase in the medical expenses comes from a lot of factors. Therefore, we should develop more systematic and comprehensive measures to control the soaring medical expenses in consideration of the various factors such as demand, supply, and the organizational side of the medical system.

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Health Beliefs and Elderly Medical Expense Preparation for Baby Boomers (베이비부머의 건강에 대한 인식 및 노후의료비 준비에 관한 연구)

  • Cho, Hye-Jin
    • Korean Family Resource Management Association
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    • v.16 no.2
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    • pp.123-143
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    • 2012
  • This study, based on a health belief model, examines how baby boomers perceive health and how they are financially preparing for future medical expenses. In addition, the study analyzes which factors influence baby boomers' preparation behaviors for future medical expenses and their perceived sufficiency of the preparation for medical expenses. Through such activities, this study examines baby boomers' current preparation status for future medical expenses, and based on this outcome, will turn the attention of individuals and society toward becoming more concerned with health and increasing health expectancy. For this study, an online survey was conducted targeted at men and women who were born between 1955 and 1963 and live nationwide, and its resultant data were collected. After conducting a 15-day survey in November 2011, a total of 418 questionnaire responses were used for the final analysis. The major findings of this study and their implications are as follows: First, baby boomers' health beliefs and their perceptions of health identified by subjective health conditions were very positive. Second, while there were some partial differences in the influencing factors, health beliefs and perceived health influenced the sufficiency of future medical expenses in the three groups, which were segmented according to how they prepare for future medical expenses-insurance-based, pension-based, and insufficiently prepared groups. Third, the baby boomers selected the national health insurance as the primary means of preparing for post-retirement medical expenses, and backed it up with private health insurance or the national pension. In addition, when baby boomers' perceived sufficiency of future medical expenses were examined, 57.6% of the respondents expressed that their old-age medical expenses were not sufficient. Fourth, in terms of baby boomers' preparation behaviors for future medical expenses, it was revealed that as one recognizes old-age health more seriously, he/she has a higher chance of using insurance and lower chance of using a pension to prepare for medical expenses. Fifth, regarding baby boomers' sufficiency of preparations for future medical expenses, economic factors such as total assets, the sufficiency of retirement assets, and the number of insurance policies, as well as health perceptions, including health beliefs and subjective health conditions, were important influencing factors.

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Influence Factors on Health and Medical of Retirees Expense to Public Pension Recipients (공적연금유형에 따른 은퇴자들의 보건의료비지출 결정요인)

  • Choi, Ryoung;Hwang, Byung Deog
    • Health Policy and Management
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    • v.25 no.2
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    • pp.80-89
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    • 2015
  • Background: This study aims to identify the monthly average medical expenses of public pension recipients, and analyze the determinants of total health and medical expenses and Western and Oriental medicine expenses, medical service expenses, and medical supplies expenses. Methods: This study used the fifth year data of 2013 out of the raw data of the Korean Retirement and Income Study collected by the National Pension Research Institute. This study conducted t-test, analysis of variance, and linear regression to verify publicly the relevance between pension recipients' general characteristics and health and medical expenses status using IBM SPSS ver. 21.0 for data analysis. Results: It was analyzed that there is a difference in the spending of expenditure and health care costs according to public pension recipients. Medical expenses of the national pensioners was higher compared to the special corporate pensioners. The national pensioner is related expenditure size, education level, family members living together, residential areas, status of spouse, number of chronic illness, and status of limitation in daily life with psychological health status. Conclusion: Therefore, fairness does not occur fire to the medical use between the special corporate pensioners and national pensioners, aggressive of government such as health policy and financial support for the retiree pension policy that reflects the reality intervention would be required.

Medical Expenses Structure on Hospitalized Patients of an Oriental Medical University Hospital (한방병원 입원환자의 진료비 구조 분석)

  • 서미경;이석구
    • Health Policy and Management
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    • v.6 no.2
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    • pp.115-130
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    • 1996
  • This study was performed to investigate the practical oriental medical expenses by the use of internal data of an oriental hospital due to the bias of medical insurance program data. The purpose of this study was to describe prevalent diseases of clinical department in the studied hospital, to analyze medical expenses structure and to verify the each cost share ration of expenses on insurer to insuree. Under this purpose, we analyzed actual medical expenses data of 1,611 hospitalized patients of the oriental medical university hospital with 150 beds that can be approached to internal data from Jan. 1, 1994 to Dec. 31, 1994. The major findings are as follows : 1. Upper five of most frequent diseases of admitted patients were Joul-Jung-Pung(55.5%), Yoo-Kak-Tong(7.3%), Yoo-/Tong(7.1%), Gu-An-Wa-Sa(2.7%) and sequale of Joul- Jung-Pung(2.4%) 2. In medical expenses structure, hospital ward fee was 47.1%, medication fee 41.3%, fee for procedure(acupuncture, moxibustion, negative therapy, physical therapy, etc) 11.1% and consultation fee 0.5%. In addition to the cost share ration of insuree & that of insurer was 75:25 respectly.

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