• 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 Korea Journal of Herbology
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• v.21 no.4
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• pp.1-10
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• 2006

Objectives : Recently, the total medical expenses of the korean oriental medical service in national health insurance is on the increase every year. Herbal medicines are one of the major methods of the medical treatment. But the expenses of these herbal preparations that can receive benefits from insurance system are decreasing. Methods : In this research, we obtained statistical data of the benefit states of herbal preparations in herbal heath insurance during year 2001-2003 from Health Insurance Review Agency. We analyzed top twenty main diseases in herbal health insurance and mainly used prescription in these diseases. Results : There were wide differences in the application of prescriptions among diseases. For example, musculoskeletal diseases occupied an important position and Ojucksan took more than 50 percentage. Conclusion : We hope that this study could be a basic data for improving the benefit system of herbal health insurance and further studies should be carried out subsequently.

• The Journal of Korean Medicine
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• v.34 no.1
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• pp.35-51
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• 2013

Objectives: The purpose on this study was to analyze medical health insurance to provide useful data to reestablish oriental medical insurance fees for long-term care hospitals. Methods: First, comparative analysis on medical health insurance was performed, calculating insurance fees of patients admitted to Mungyung Long-term Care Hospital. The oriental medical insurance fee of the patients was calculated as if the patients have been admitted to oriental long-term care hospitals, and the ratio of oriental medical insurance fee to western was calculated. Results: 1. The ratios of total medical expenses were 90% within 3 months and 82% over 3 months. 2. The ratios of co-pays were 86% within 3 months and 82% over 3 months. Conclusions: Oriental medical insurance fees need to be reevaluated.

• Journal of Society of Preventive Korean Medicine
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• v.13 no.3
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• pp.113-126
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• 2009

Objective : This research aimed to investigate and analyze the opinions of Oriental Medical Doctors (O.M.D.) on covering herbal medicines into National Health Insurance scheme. Methods : Structured questionnaires were e-mailed to the O.M.D.s listed on member's DB of the Association of Korean Oriental Medicine. Collected data were analyzed with the SPSS 12.0 program. Results : The insurance coverage for herbal decoctions was supported by 80.8% of the responders, the median reasonable price for daily herbal decoctions was \9,517, the minimum price median of daily herbal decoctions considering its costs was \8,080, and the daily technical fee median was \4,379. On health insurance coverage for herbal decoctions, O.M.D.s were specially considering the standardization of herbal medicines. Conclusion : In this study, majority of O.M.D.s assented to health insurance coverage for herbal decoctions, but considered standardization of herbal medicines and optional prescription fee. It needs to prepare plan for insurance coverage of herbal decoctions that reflect the character of oriental medicine and oriental medical institutions.

• Journal of Society of Preventive Korean Medicine
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• v.12 no.3
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• pp.21-34
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• 2008

Objectives : This paper analysed the alternative methods of calculating conversion factor for oriental medicine in the National Health Insurance and estimated the conversion factor(reimbursing price level) of the oriental medical services, based on health insurance claims data and macro economic data. Methods : Comparing cost accounting method, SGR model, and index model to estimate conversion factor in the national health insurance, six empirical models were derived depending on the scope of revenue considered in financial indicators. Classifications of data and sources used in the analysis were identified as officially released by the government. Results and Conclusion : Cost accounting analysis and SGR model showed a two digit decrease in the physician fee schedule of oriental medical services in the national health insurance, while index model indicated a positive increase in the fee reimbursed. As expected, SGR model measured an overall trend of health expenditures rather than an individual financial status of medical institutions, and index model properly estimated the level of payments to oriental medical doctors. Upon a declining share of health expenditures on oriental medicine, a global budget system fixed to a flat rate of total budget could be an opportunity as well as a challenge.

• Journal of Society of Preventive Korean Medicine
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• v.14 no.1
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• pp.77-96
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• 2010

Objectives : This paper recommends a global budget based payment system for reimbursing oriental medical services in the national health insurance. Methods : We analyzed previous research outcomes related to oriental medical services and payment system We reviewed the experiences of other countries' global budget system in terms of their strength and weakness. In addition, we developed a reimbursement method for oriental medical services based on global budget. Results : Our reviews focused on global budget system of Germany, the Netherlands, the United Kingdom, Canada, France, and Taiwan. The estimation of global budget in the national health insurance was described in two scenarios. First scenario was to allocate oriental medical services in scale after signing a contract for global budget. In this case, 4.16% of the national health insurance expenditure was allocated for the oriental medical services. Second scenario was to estimate the global budget in a historical context. As a result, the first scenario in total budget was higher than the second, and we proposed a retrospective adjustment method for the gap between the budget and the actual expenditure Conclusions : The payment system for oriental medical services is recommended to shift from fee-for-service to global budget.

• Health Policy and Management
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• v.31 no.3
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• pp.344-354
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• 2021

Background: The purpose of this study was to analyze the effect of national health insurance coverage of Chuna therapy in April 2019 on the costs and service uses in automobile insurance. Methods: This study used the claim data from Health Insurance Review and Assessment Service. A total of 189,912 inpatients and 1,550,497 outpatients who received Chuna therapy covered by automobile insurance in oriental medical institutions were included. The analysis period was from July 2018 to December 2019, and a total of 18 months before and after April 2019, when Chuna therapy was covered by national health insurance. Interrupted time series analysis was applied to analyze the impact on the costs and service uses of Chuna therapy in automobile insurance before and after April 2019. Results: From July 2018 to December 2019, for 189,912 inpatients the cost and the number of times for Chuna therapy per capita were increased by 22.0% and decreased by 7.3% respectively right after the implementation of the policy. In the case of 1,550,497 outpatients, the cost of Chuna therapy per capita tends to be increased by 0.4% in overall study periods and increased 28.4% immediately after the implementation of the policy. Meanwhile, the number of times and visits for Chuna therapy per capita tends to be increased by 0.4% in overall study periods but decreased by 0.4% after the implementation of the policy. Conclusion: Results suggest that if the national health insurance coverage of oriental medicine services increases according to the policy stance for benefit expansion in national health insurance, the criteria for providing national health insurance benefits should be considered with the comprehensive impacts on the costs and service uses of automobile insurance.

• Journal of Korean Medicine Rehabilitation
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• v.19 no.3
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• pp.101-109
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• 2009

Objectives : This study aimed to investigate the present status of physical therapies provided in the Korean medicine clinics, and to find out the priorities among and the estimated fees of physical therapies for the National Health Insurance plan. Methods : We administered nationwide survey to Korean medicine doctors using the on-line survey system. 16 physical therapies were listed in the Web-based questionnaires, and responders were asked to mark the therapies they used for their patients, and, for each therapy they marked, to fill in the form including the frequencies of service, service fees, target diseases, and priorities for health insurance coverage, etc. Results : Of 488 respondents, 93.7% provide more than one physical therapy for their patients, and each responder uses 5.9 physical therapies on average. 60-90% of physical therapies are being given to patients for free because they are not covered by the National Health Insurance. There is little evidence that the specialties of Korean medicine doctors are related with the use of physical therapies, but, in some therapies, the doctors with longer career years use the physical therapy more frequently. Most physical therapies are applied to the patients with musculoskeletal diseases, cardiovascular diseases, and nervous diseases, etc. Conclusions : Physical therapies are widely used among Korean medicine doctors without proper compensation. This could be the one of the main factors distorting the profit structure of Korean medicine clinics, and it encourages the National Health Insurance to cover physical therapies provided in the Korean medicine clinics.

• The Journal of Korean Medicine
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• v.26 no.2 s.62
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• pp.105-125
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• 2005

Objectives: The purpose of this study was to identify resources put into clinical. activities and identify a new RBRVS for oriental medical services in the Korean National Health Insurance. Methods: Based on a survey of physician's time, physical effort & technical skill, mental effort & judgment, and stress that were used for patient treatments, relative input values for the relevant clinical activities were estimated and rearranged in a way to be compared. with the current values in health insurance. Results: We found the actual resource-based relative values for oriental medical services statistically different from the current values, with a narrower variation in value distribution. Conclusions: The findings suggest the C\lrrent RBRVS should be revised to reflect the actual input resources into physicians activities and to avoid a distortion of physicians behavior.

• Journal of Society of Preventive Korean Medicine
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• v.14 no.2
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• pp.57-66
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• 2010

Backgrounds : Since December 1, 2009, National Health Insurance began to reimburse for three physical therapies of Korean medicine. The extension of insurance coverage is demanded by Korean medicine societies. Objectives : This study aimed to measure the resource-based relative value scale (RBRVS) scores for thirty four physical therapies of Korean medicine and to estimate the insurer's expenditure for them in National Health Insurance. Methods : To measure the physician's work and the practice expense, the 'magnitude estimation method (MEM)' and the 'fully distributed cost - attributable cost method (FDC-ACM)' were applied respectively. We collected the frequency data of physical therapies from Korean medicine hospitals and clinics to estimate the total expenditure. Results : The resource-based relative value scale scores of physical therapies were measured from 23.44 to 160.66. Total insurer's expenditure was calculated to be 95.5 billion won as of 2009. Conclusions : Based on the result that showed minor increase of total expenditure, most physical therapies of Korean medicine need to be reimbursed in the National Health Insurance.