• The Korean Journal of Health Service Management
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• v.11 no.1
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• pp.117-130
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• 2017

Objectives : In this study, 3,107 patients were used to evaluate the impact based on raw data of 2014 and the health status and medical expenses income quintile was collected and data was analyzed. Methods : Analysis method was the average comparison, ANOVA, subjected to a multiple logistic regression analysis, the statistical test was the t-test and the scheffe post verification. Results : Gender(p<.000), age(p<.000), marital status(p<.000) educational status (p<.000), easement(p<.000), medication(p<.000), subjective health status(p<.005) were analyzed. First quintile identified that the highest amount was spent in the Chungcheong region, the 2nd quintile showed that the highest output was in the Gyeongsang region. The 3rd and 4th quintiles indicated that the highest expenditure was in the Seoul metropolitan region. The 5th quintile showed that the Chungcheong was the highest once again and the Jeolla region was the lowest in terms of expediture. Conclusions : Future medical research on income will require the government's Big Data collection to create the primary basis for policy making in order to improve the efficiency, effectiveness and equity of medicine spending.

• Journal of Preventive Medicine and Public Health
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• v.28 no.1 s.49
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• pp.153-174
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• 1995

This study was conducted to examine the determinant factors for expenditure of the medical insurance program for self-employeds based on the analysis of 1991 'The Medical Insurance Program for Self-Employeds Statistical Yearbook', and also similar yearbooks in the metropolitan and other provinces. The major findings are as follows : We have divided benefits into these four components such as the utilization rate for out-patients, expenses per claim for out-patients as paid by the insurer, utilization rate for in-patients, and the expenses per claim for in-patients as paid by the insurer, in order to examine the determinant factors for it. The results of the study revealed the following findings, in urban areas, the supply of medical care had more influence on the benefits than other demographic and economic variables, while, in county areas, both the supply of medical care and the rate of those aged over 65 affected the provision of benefits. The determinant factors for financial balance of the medical insurance program for self-employeds are, first, the determinant factor for administrative expenses was the number of households. The more the number of households, the less the administrative expenses per the insured. This shows that the economy of scale is being. And so, the administrative district must be taken into consideration in the incorporation of small regional medical societies and should be re-organized for more efficient management. Second, in urban areas, the supply of medical care had more influence on utilization rate and expenses per claim as paid by insurer, and therefore it is necessary to control it. In county areas, the supply of medical care and the rate of those aged over 65 raised the utilization rate and expenses per claim as paid by insurer. For the financial stability of county areas, a common fund for medical care for the aged and expansion of finance stabilization fund would be necessary. But, in county areas, it would be unnecessary to control the supply of medical care because it was much more insufficient than in urban areas. The vitalization of public health facilities must be carried out in county areas, for they reduced benefits. Sice the more insured in a single household, the less the utilization of the medical insurance program, benefits for habilitation at home should be given consideration. The law of majority and the economy of scale were applied here, and therefore the incorporation of regional medical societies must be taken into consideration. In integrating regional medical societies, it would be absolutely necessary to review the structural differences among all regional medical societies, the medical demand of each region, and also the local characteristics of each region.

• Journal of Preventive Medicine and Public Health
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• v.25 no.4 s.40
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• pp.399-412
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• 1992

This study was designed to investigate factors relating to fiscal deficit for regional health insurance. The financial statements for the fiscal year 1990 of nationwide 254 regional medical insurance societies were analyzed. Important findings are summarized below: 1. There were differences in the main reason fur the financial deficit among regions when deficit and surplus societies were compared by regions. The total revenue per enrollee, especially revenue from the premium contribution of a deficit society was significantly smaller than that of a surplus society in large cities and counties. On the other hand, the total expenditure per enrollee of a deficit society was larger than that of a surplus society in small cities. 2. Both low premium rate at the beginning of health insurance program and less effort to increase the premium rate were main factors for the smaller revenue from the contribution of a deficit society in large cities and counties. 3. Larger expenditures per covered person of a deficit society in small cities were explained with larger medical expenditures especially for out-patients services rather than larger administrative expenses. 4. A regression analysis showed that utilization rates in out-patient services were significantly associated with income and numbers of total medical care institution per capita within a region where a health insurance society located. Also expenses paid by insurer per visit were associated with the proportion of utilization for tertiary care hospitals as well as the proportion of utilization of public health centers.

• The Korean Journal of Health Service Management
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• v.10 no.3
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• pp.1-12
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• 2016

Objectives : This study examined relations between investment efficiency and management performance as indexes related to productivity of Korean regional public hospitals. Methods : The analysis data are financial information of Korean regional public hospitals from 2011 to 2014. For the indicators, value added to total assets, value added to productive activity tangible fixed assets, and value added to personnel expenses, operating margin to revenues, net profit to total earnings, and ratio of value added. Results : Significant relevance was not shown among indicators of investment efficiency. However, Significant relevance was shown between value added to personnel expense and productivity per value added. Conclusions : It confirmed that outside support funds like subsidy did not have effect on improving the management performance. Also, it could be known that availability about input of capital and labor was not realized organically.

• International Journal of Advanced Culture Technology
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• v.9 no.1
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• pp.16-21
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• 2021

As the average age of national veterans has increased from 69 years old(2011) to 71 years old(since 2015) over the past five years, the overall medical service cost of veterans has increased by about 20%. The main cause of this phenomenon is 'ultra-aging', which accounts for 67% of veterans, while the proportion of health insurance patients aged 70 or older is 9%. Therefore, it is judged that the analysis of the trend of use of medical services at veterans hospitals in each region that is in charge of severe medical services of national veterans can serve as an opportunity to seek countermeasures for the severe medical system of national veterans. First of all, based on the details of major medical expenses (hospitalization, outpatient, pharmaceutical expenses) by region for the last 10 years(2010-2019), data significance was performed through a chi-square test, and the Central Veterans Hospital and Non-Central Veterans Hospital using EXCEL. 'Expected frequency' was calculated by year. By applying the CHITEST(observation frequency, expected frequency) function again, the p-value(p<0.05) was calculated, and the profit bias of each region's veterans hospital could be determined. The specific research method is for the last 10 years(2010-2019) for state-sponsored patients_outpatient treatment income, state-sponsored patients_hospitalization income, exempt patients_outpatients at the Central Veterans Hospital, Busan Veterans Hospital, Gwangju Veterans Hospital, Daegu Veterans Hospital, and Daejeon Veterans Hospital. A one-way analysis of variance was conducted to verify the significance of the difference between group averages on the status of 5 medical revenues of veterans hospitals in each of the 5 regions, including medical treatment income, reduced patients_hospitalization income, and reduced patients_medicine expenses. It was found to be significant(p<0.05) at all levels, including region and type. Finally, the bias in the profit structure of regional veterans hospitals was the highest in 2017(p=0.0004) and the lowest in 2013(p=0.0349). In addition, in the profit structure of the Veterans Hospital, the year in which the'regional' variable worked the most was 2019, and the year with the least affected was 2010. The order of the former is Jungang(=31,674,713), Busan(=12,314,614), Gwangju(=11,957,038), Daegu(=10,168,015), and Daejeon(=6,991,034), and the order of the latter is Jungang(=57,868,791), and Busan(=19,183,194). Gwangju(=17,904,712), Daegu(=15,656,034), and Daejeon(=14,377,395). In conclusion, the profit bias of veterans hospitals repeatedly raced the lowest(p=0.01986) and highest(p=0.03499) for the past five years(2010-2014) year by year, with the 'regional' variable being the most in the veterans hospital's profit structure It was identified as a major influence factor. On the other hand, for the last 5 years (2015-2019), the influence factors of the'regional' variable every year were in 2015(p=0.02015), 2016(p=0.01741), 2017(p=0.00045), and 2018(p=0.00394). in 2019(p=0.00227), a significant difference was confirmed at a very low level.

• The Korean Society of Law and Medicine
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• v.11 no.1
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• pp.91-116
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• 2010

As Complex Regional Pain Syndrome (CRPS) is a new and rare illness, medical cause for it has not yet been clearly found out. Nevertheless, the patients continue to file lawsuits for damage compensation against wrongdoers or their insurers, claiming that the cause of the illness is certain actions of the wrongdoers. Moreover, the claim amount reaches to hundreds of millions of won through billions of won unlike other illnesses. Therefore, CRPS has become an important legal issue in the damage compensation lawsuit. Even though the wound is slight, the development and result may be serious in the case of CRPS. As a result, a sharp conflict arises even regarding medical diagnosis of CRPS in the lawsuit. And, even if the medical diagnosis of CRPS is admitted, severe debates occurs with regard to many issues, which include the causation between accident and CRPS in connection with establishment of damage compensation liability and scope of liability like anamnesis, determination standard of aftereffect disability, and scope of admitted aftereffect medical expense in connection with scope of damage compensation. In this study, I will review fundamental medical research on CRPS up to now and discuss principal legal issues in the damage compensation lawsuit focusing on lower court rulings.

• Journal of The Korean Society of Integrative Medicine
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• v.9 no.1
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• pp.69-90
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• 2021

Purpose : This study explores unmet medical services within a region for patients admitted to a single medical institution in one region and was to analyze the importance and satisfaction of hospital selection attributes. Through this, we tried to solve the unmet medical needs of patients and provide useful basic data in terms of hospital management in the region. Methods : It were collected to a total of 250 questionnaires for patients admitted to the regional integrative medical hospital. However, 232 samples were used for the final analysis, excluding 18 copies not reported in good faith. For the analysis, first, demographic frequency analysis of inpatients and inpatients was performed, and second, characteristics of patients, including frequent disease receiving treatment, were analyzed. Next, descriptive statistics analysis was conducted on unmet medical service intentions. In terms of hospital selection attribute, the items of continuity maintenance (I quadrant), priority visibility (II quadrant), low priority (III quadrant), and excessive effort (IV quadrant) were derived using the IPA (importance-performance analysis) matrix technique. Results : The derived results were classified by item and area. In the priority administration area, it was the reputation and recognition of medical institutions and the service area of medical institutions. In the case of items, there were 6 items including the importance of surgery and medical expenses, and diet at hospitalization. 1) Conclusion : Thus a result of this study, resources are efficiently allocated to priority correction areas with high importance but low satisfaction and circulatory medical treatment is performed in the departments required by patients who use medical care and, various methods, such as preparing a policy to support medical expenses, should be sought.

• Journal of Preventive Medicine and Public Health
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• v.25 no.4 s.40
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• pp.333-342
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• 1992

The purpose of this study is to estimate the minimum optimal scale(MOS) of the self-employed health insurance associations. Considering the high proportion of operating expenses, the author have selected 254 regional health insurance associations eon the 1990 Finance Report of the self-employed health insurance programs. Both a quadratic function and a hyperbolic function were chosen for the analysis. The dependent variables are the average maintenance cost per insured person and per household, and the independent variables are the number of insured members and of household The minimum optimal scale was obtained from the differentiation of the quadratic function. Major findings are summarized as follows: 1. The M.O.S. was calculated as 166,174 members (27,442 households) for the rural self-employed health insurance associations and 258,462 members (75,446 households) for the urban. Providing that both the rural and urban health insurance associations would be integrated, the M.O.S. be found to become 231,687 members (68,101 households) 2. Compared with the optimal minimum scale, the magnitude of the current health insurance association found to be much smaller, less than half of the optimal scale. 3. In order to reduce the operating cost, it is necessary to enlarge the operational scale of self-employed health insurance associations.

• The Korean Journal of Pain
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• v.36 no.4
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• pp.458-464
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• 2023

Background: Fibromyalgia (FM) is a complex disorder characterized by widespread chronic pain and tenderness in the muscles, ligaments, and soft tissues. It is a chronic pain condition often accompanied by other symptoms and comorbidities. To effectively manage FM, it is crucial to obtain fundamental epidemiological data pertaining to the target population. Therefore, this study was conducted to elucidate the epidemiological characteristics of FM in the Korean population. Methods: Population-based medical data of 51,276,314 subscribers to the National Health Insurance Service of Korea from 2014 to 2018 were used in this study. Results: The overall incidence of FM ranged from 441 (2014) to 541 (2018) cases per 100,000 person-years, with a higher prevalence observed among female patients compared to male patients. The incidence gradually increased until middle age, followed by a decrease. The highest incidence rates were observed in the fifth decade of life for females and the sixth decade of life for males. When categorizing the affected parts of the body, the shoulder region was observed to be the most frequently affected. A comparison of the drug prescriptions based on medical specialty showed that antidepressants were the most commonly prescribed medications. The management of FM leads to consistent increases in medical expenses, regional disparities, and variations in prescription patterns across different medical specialties. Conclusions: The findings of this study will not only contribute to the understanding of FM characteristics but also provide a vital foundation for efficient management of FM in Korea.

• Journal of agricultural medicine and community health
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• v.16 no.2
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• pp.179-194
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• 1991

Despite its universal coverage of health insurance, the rural health insurance program(RHIP) stands at the crossroads in Korea. The RHIP has weaknesses in stability of financing, problems of inequities in the provision of health services and has suffered from high cost of running the program. The author has analyzed these problems from the perspective of health insurance policy and presented several options for improvement. First of all, this study urged the importance of a firm Governmental commitment of RHIP with the 50% subsidization of contributions as the Government had promised, instead of the current 40%. This can be justified from the 20% subsidization by the Government for the contributions of private school teachers and their dependents, who belong to richer segments of the population. Second, various cost containment measures ought to be sought curbing the rising demand for medical through strengthening health education and increasing individual responsibility, and tightening the claim review process. Third, this study requires the Government to run a demonstration project on the introduction of case payment system for primary health care. Fourth introducing an income-related cost sharing scheme is another possibility. Reforming the cost sharing formula for large medical expenditures is recommendable for a beginning. This measure can take the form of tax credit for medical expenditures of the poor. Fifth, the degree of financial adjustment among health insurance plans should be levelled up for enhancing stability of RHIP and social solidarity. Sixth, health policy should be redirected toward development of rural health resources and higher priority should be put on relieving difficulties in access to care. Seventh. the insurance plan owned-hospital needs to be developed or provision of health services in the medically underserved areas, and the need of such facilities is particularly acute for geriatric care, rehabilitation and renal dialysis, etc. Eighth, more generous insurance benefits are required of the elderly who are suffering the most : elimination of the maximum 180 days of benefit period and provision of glasses and artificial dentures, etc. Ninth. the economies of scale principle is working for the operating expenses of regional self-employed insurance plan. Thus, measures should be instituted to pursue an optimum size of health insurance plans. Lastly, excessive dependence on exclusion items is an evil so that some radical remedies are urgently required to cut them.