• Health Policy and Management
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• v.27 no.2
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• pp.103-113
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• 2017

There have been many achievements for 40 years since the introduction of compulsory health insurance. Despite many achievements, it has many challenges in health insurance. Aging, non-communicable disease, and low growth economy are threatening the sustainability of health insurance, and it is time to reform the health insurance. A long-term reform plan will be an absolute necessity for reform of health insurance and health care system. Health insurance and health care reform should be an extremely revolutionary content that completely changes the framework. This reform should deal with the philosophy of health, approach of medical education and doctor training, changing supply of medical service, the innovation of primary medical care, reform of public health system, the management of medical utilization, the integration of medical cure and care services, enhancing the benefit coverage, prohibition of covered and non-covered services, etc. Therefore, it is urgent to form a consensus on the necessity of reform, to establish the health insurance plan on this consensus, and to make efforts to make health insurance sustainable.

• The Journal of the Korean life insurance medical association
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• v.33 no.2
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• pp.15-17
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• 2014

All Korean people are eligible for National Health Insurance(NHI). But large non-coverage of NHI is a big problem. The origin of this problem is from medical fee schedules. NHI calculate all hospital income including insurance medical practice, non-insurance medical practice and non-medical income(i.e. a funeral hall, a parking lot, stores in hospital).

• Korean Journal of Health Education and Promotion
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• v.10 no.2
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• pp.11-21
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• 1993

Recently the structure of disease is changing its form into chronic disease. Taking into consideration this, the health care system doesn't cope with this tendency. With the health care system for acute disease, it is difficult to decrease medical care cost. At this point, Health education like primary health care can reduce risk factors and possibilities of occurrence of disease. This can cut off the medical insurance finance further more cuts off the rates of insurance cost. This is why health education is the principle part of medical insurance service. Though the law shows health education must be executed in the field of Medical insurance, still it is not enough. In order to carry out health education in the medical insurance organization, the efforts we should make are as follows: 1. Recognize the importance of health education. 2. Set the clear goals in health education. 3. Organize health education system. 4. Train health workers. 5. Systematize health education service. 6. Reform the medical insurance system. 7. Evaluate the effect of health education and practice the model.

• Health Policy and Management
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• v.30 no.4
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• pp.460-466
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• 2020

Background: The purpose of this study is to analyze whether there is a change in patterns of medical use among those likely to be converted their health insurance qualifications when the family support rule is alleviated. There is no empirical analysis that converting health insurance qualification will affect the increase in medical use. Methods: For analysis, data were extracted from the national health insurance eligibility and medical care database. To identify analysis targets similar to that of medical aids' characteristics among health insurance coverage, we compared income, property level, and medical use patterns through basic statistical analysis and used a difference-in-difference (DID) analysis to estimate the net effect of changes in medical use following the change of qualifications. Results: The main results are as follows. The results show that those who are under the 5% income group (1st income group) of health insurance coverage are the most similar to the medical aids group. DID analysis shows that changes in the medical use of people who maintain their national insurance qualification and who are not. As a results, the number of hospitalized days of converting group was reduced by 3.5 days while outpatient days were increased by 1.8 days. Conclusion: As a result, there was not much difference in the patterns of medical use for the under 5% income group who are likely to be eligible for expanded medical aids when the family support rule is alleviated. In addition, more than 30% of them are in arrears with their health insurance premiums, causing inconvenience in using medical services. These findings suggest the need of abolishing the criteria obligated to support family, and great efforts should be made to contribute to non-paid poor and remove their medical blind spot.

• Health Policy and Management
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• v.31 no.4
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• pp.423-436
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• 2021

This article summarizes the structure of China's current social health insurance system and reviews the development status of China's private health insurance (PHI). China's medical security system is mainly composed of two parts: basic medical insurance (BMI) and PHI. Among them, the BMI provides reimbursement of basic medical expenses for the insured persons according to different proportions. PHI is a necessary supplement to the BMI and provides assistance to the insured persons in the event of illness or accident. By having PHI, people can obtain medical protection outside the coverage of BMI. In the development of PHI in China, the total medical cost is high and the insurance market size is large, but the proportion of PHI expenditure is low and the personal burden is high. Through this Chinese case, it will be helpful for mutual development between Korean PHI and national health insurance, for Korean insurance companies to enter the Chinese market, and for removing the medical burden on the people.

• The Journal of Korean Obstetrics and Gynecology
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• v.21 no.3
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• pp.218-230
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• 2008

Purpose: This study was performed to investigate the percentage of the oriental medical Ob & GY disease group in Korean Medical Health Insurance and to gain the basic data of enlargement and improvement of Acupuncture Benefits in the oriental medical Ob & Gy field. Methods: We requested data about the status of Insurance Benefits in 2005. 2006 to Health Insurance Review & Assessmenstatus Service(HIRA). And on the basis of this 2005. 2006 data, we analyzed the status of Insurance Benefits and Acupuncture Benefits in the oriental medical Ob & Gy disease group. Results: 1. Total health care benefit costs of Korean medical health insurance in 2005, 2006 took 4.38 percent and 4.25 percent of total health care benefit costs of Health insurance. 2. Total health care benefit costs of the oriental medical Ob & Gy disease group in 2005, 2006 took 0.38 percent and 0.40 percent of total health care benefit costs of Korean medical health insurance. 3. The percentage of Acupuncture benefits costs of the oriental medical Ob & Gy disease group in 2005, 2006 was merely 0.22 percent and 0.23 percent of total Acupuncture Benefits costs. 4. The main sick and wounded name of Ob & Gy diseases of Acupuncture Benefits was limited to Menstrual Disorder(K01)과- Uterus Abnormality(K13). Conclusion: The percentage of the oriental medical Ob & Gy disease group in Korean Medical Health Insurance was very low and the percentage of Acupuncture Benefits of he oriental medical Ob & Gy disease group was also very low. From now on, Searching ay of enlargement of Acupuncture Benefits in the oriental medical Ob & Gy field is required.

• The Korean Society of Law and Medicine
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• v.8 no.2
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• pp.9-35
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• 2007

The Health care program in Korea has now been systemized after 30 years of declaring the inauguration of the national health insurance system by the current government. The national health care covering all Korean citizens was achieved after 12 years of implementing the national health insurance and the health care program since 1977. Hundreds of multiple operational agencies managing the insured individually had undergone the amalgamation process from 1998 to 2000, and had been restructured as one agency, the National Health Insurance Corporation. In 2003, the community/area based financial management was also merged together with the employment based financial management. The National health care system of Korea offer various merits, compared with that of other countries, such as health care provision covering all Koreans, low insurance premium, accessibility of medical services/facilities etc. However, there are still some weak features which need to be addressed for improvement; below expectation insurance cover system, mistrust on the medical services, low medical charges resulted from excessive restrictions, and unstable financial status of the national health insurance etc. Therefore, the National health care system should continue to evolve to re-establish itself as more effective national health care system by further strengthening its merits, and by improving its weaknesses; with adopting the positive system to optimize the costs of prescribed medicines/drugs, applying simpler insurance coverage system to calculate the optimum medical charges, promoting private medical insurances, and increasing insurance premium etc.

• The Korean Society of Law and Medicine
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• v.8 no.2
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• pp.69-118
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• 2007

In providing general medical treatments, the medical service contract between the patient and the doctor is the mutually responsible onerous contract. However, the nature of the mutually assumed contract standings of the patient and the doctor has been changing since the implementation of the national health insurance program. For instance, besides the cases of beyond excessive medical charges and medical negligence, if the doctor charged for his/her medical treatments violating the post-treatment/nursing cover criteria, the overpaid medical charge, regardless of being collected with the patient's consent, has to be refunded back to the patient. Medically needed aspects, treatment results, and unfair benefits favoring the patient are not at all taken into consideration in the health insurance scheme. This makes it easier for patients to get refunds for their share of the medical payments by involving the Health Insurance Review & Assessment Service or the National Health Insurance Corporation, without engaging in civil law suits (for reimbursement claim) against doctors. In other words, the doctor's responsibility to provide medical treatments and the patient's responsibility to pay for the medical treatment provided within the contractual realm are being demolished by the administrational arbitration of the National Health Insurance system. The basic rights of medical service providers, and the patient's right to choose are as important constitutional rights, as the National Health Insurance program, which is essential in the social welfare system. Furthermore, the development of the medical fields should not be prevented by the National Health Insurance system. If the medical treatment services can be divided into necessary treatments, general treatments, and high quality treatments, the National Health Insurance is supposed to guarantee the necessary and general treatments to provide medical treatments equally to all the insured with limited financial resources. However, for the high quality treatments, it is recommended that they should not be interfered by the National Health Insurance system, and that they should be left to the private contract between the patient and the doctor.

• The Korean Journal of Health Service Management
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• v.5 no.2
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• pp.157-172
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• 2011

The purpose of this study is to provide basic information for improving medical security between the Korean National Health Insurance Corporation and the private health insurance in Pusan Metropolitan area by investigating of the recognition with the benefit groups. Questionnaires of 431 were taken between Feb. 11th and Feb. 25th 2008. The survey was carried out to gather information about SES and contents of insurance and recognition between the benefit group of the Korean National Health Insurance and the private health insurance on the financial conditions and the stability. The result of survey is as follows. First, there is a difference between the National Health Insurance and the private health insurance on the financial conditions and the stability of the Korean National Health Insurance. Second, there is a high score at the private health insurance on the financial conditions and the stability of the private health insurance. Third, privatizing of a National Health Insurance is high score at increase of the premium, medical payments of the National Health Insurance group and is high score at enhance of quality of medical service and decrease of loss of medical payment of the private health insurance group. Therefore, to provides more information and improved medical security with the benefit group. it is necessary for concerns to put more efforts in creating Conflicting vs. Complementing of systemic base.

• Korea Journal of Hospital Management
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• v.26 no.1
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• pp.71-82
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• 2021

Purpose: The purpose of this study is to estimate incomes and costs of the medical clinics by using secondary data. Methodology: The medical incomes and costs were estimated from 405 clinics operated by sole practitioner providing out-patient services among all clinics subject to the Medical Cost Survey on National Health Insurance Patients in 2017, excluding dental clinics and oriental medical clinics. The incomes and costs of the medical clinics were reflected with incomes and costs of health insurance benefits and were calculated by types of medical services (i.e., basic care, surgery, general treatment, functional test, specimen test and imaging test). The costs were classified as follows: labor costs, equipment costs, material costs and overhead costs. Secondary data was used to estimate the incomes and costs of the medical clinics. For allocation bases for costs for each type of the medical service, the ratio of revenue from health insurance benefits by types of medical services was applied. However, labor costs were calculated with the activity ratio by types of medical services and occupations, using clinical expert panel data. Finding: The percentage of health insurance income for all medical income was 73.1%. The health insurance cost per clinic was 401,864 thousand won. Labor cost accounted for the largest portion of the health insurance income was 191,229 thousand won (47.6%), followed by management cost was 170,018 thousand won (42.3%), materials cost was 35,434 thousand won (8.8%), and equipment costs was 5,183 thousand won (1.3%). Practical Implications: This study suggests a method of estimating incomes and costs of medical clinic services by using secondary data. It could efficiently provide incomes and costs to assess an appropriate level of the health insurance fee to the clinics.