Health Insurance System In Korea Research Articles

Secondary Malignancies in Multiple Myeloma in Korean Patients: A Nationwide Population-Based Study.

This study investigated the incidence of secondary malignancy in multiple myeloma (MM) patients compared with that in the general population using a population-based database covering all residents in Korea. Based on the national health insurance system in Korea, all people primarily diagnosed with MM between January 1, 2010 to December 31, 2018 were identified. A total of 9,985 MM patients aged ≥ 20 years in Korea were included. Among them, 237 (2.4%) developed secondary malignancies by 2018. The standardized incidence rates (SIRs) of all secondary malignancies in MM patients were 0.87 (95% confidence interval [CI], 0.76 to 0.98), with a higher incidence of hematologic malignancies than in the general population with an SIR of 3.80 (95% CI, 2.61 to 5.00). The incidence rates of both lymphoid malignancy (SIR, 3.56; 95% CI, 2.31 to 4.82) and myeloid malignancy (SIR, 3.78; 95% CI, 1.16 to 6.39) were higher in MM patients than in the general population. In contrast, a lower incidence of solid cancer was observed in MM patients than in the general population (SIR, 0.76, 95% CI, 0.65 to 0.86). There was no significant difference in survival in MM patients without secondary malignancies, with hematologic malignancy, and with solid cancer (p=0.413). MM patients had a greater risk of secondary malignancies, especially hematologic malignancies, than the general population. Future studies with a focus on analyzing patients' history, treatment details, and genetic information in various stages of MM patients are needed to better understand the mechanism behind this increased risk.

Issues Facing the National Health Insurance System in Korea and Their Solutions

South Korea is not a wasteland of publicly funded health care—instead, it has a good medical social security system known as the national health insurance (NHI). The NHI of Korea has three unique features; (1) low premiums, low insurance fees, and low coverage; (2) obligatory designation of medical institutions; (3) and allowance of non-benefit services. These features have made hospitals and doctors interested in profit-seeking. However, the commercialization of medical institutions has taken place in both private- and public-established sectors. A basic problem of commercialization is the co-existence of the obligatory designation of medical institutions and non-benefit services. The problem became worse in the Kim Dae-Jung government because it officially permitted non-benefit services. Since 2000, the Korean government has consistently pursued benefit extension policies, but the coverage rates of the NHI have stagnated. In addition, premiums and current medical expenses have markedly increased because policy-makers have emphasized accessibility to the NHI, while ignoring important principles of medical social security such as a needs-based approach and patient-referral system. In order to resolve the commercialization problem, the obligatory designation of medical institutions to the NHI should be changed to a contract system, and non-benefit services should be prohibited at NHI institutions. We must re-establish the patient-referral system via a needs-based approach. We also need to build a primary healthcare system and public health policies. We should make a long-term plan for healthcare reform.

Severe Hypoglycemia Increases Dementia Risk and Related Mortality: A Nationwide, Population-based Cohort Study.

There are few studies focused on the relationship between hypoglycemia and new-onset dementia in patients with type 2 diabetes and no study regarding mortality of dementia after hypoglycemia. We investigated the effect of severe hypoglycemia on dementia subtypes and its relation to overall mortality in patients with type 2 diabetes. We evaluated incident dementia, including Alzheimer disease and vascular dementia, among health checkup participants aged 40 years or older in the National Health Insurance System in Korea from January 2009 to December 2015. Episodes of severe hypoglycemia were examined for 3 years before the date of the health checkup. Among 2 032 689 participants (1 172 271 men, 860 418 women), 14 443 (0.7%) experienced severe hypoglycemia, during a mean follow-up period of 6.9 ± 1.7 years. Individuals in the severe hypoglycemia group were more likely to be diagnosed with dementia compared to individuals without severe hypoglycemia (23.3% vs 7.3%; P < .001) and the overall incidence of Alzheimer disease was higher than vascular dementia. Dementia risk rose with increasing number of severe hypoglycemic episodes (1 episode [hazard ratio (HR) = 1.54; 95% CI, 1.48-1.60], 2 or more episodes [HR = 1.80; 95% CI, 1.66-1.94]). Overall mortality was higher in participants with dementia, but without severe hypoglycemia (HR = 2.03; 95% CI, 1.96-2.10) and severe hypoglycemia, but without dementia (HR = 4.24; 95% CI, 4.29-4.40), and risk of death was highest in those with both severe hypoglycemia and dementia (HR = 5.08; 95% CI, 4.83-5.35). Severe hypoglycemia is associated with dementia, especially Alzheimer disease and mortality; together, they have an additive effect on overall mortality.

Dilemmas Within the Korean Health Insurance System.

The health insurance system in Korea is well-established and provides benefits for the entire national population. In Korea, when patients are treated at a hospital, the hospital receives a partial payment for the treatment from the patient, and the remaining amount is provided by the health insurance service. The Health Insurance Review and Assessment Service (HIRA) assesses whether the treatment was appropriate. If HIRA deems the treatment appropriate, the doctor can receive payment from the health insurance service. However, this system has several drawbacks. In this study, we aimed to provide examples of the problems that can occur in relation to HIRA assessments in Korea through actual clinical cases.

Metabolic and Bariatric Surgery Accreditation Program and National Health Insurance System in Korea.

Since the first laparoscopic bariatric surgery in Korea introduced in January 2003, the number of metabolic and bariatric surgery has been steadily increasing. According to the report from National Health Insurance big data analysis, the prevalence of morbid and super obesity has greatly increased and metabolic and bariatric surgery also increased in the last 10 years. As the incidence of morbid obesity is more frequent in people of poor socioeconomic status, the need for a reimbursement by the government seemed to be necessary. Finally, the national health insurance system decided to financially cover metabolic and bariatric surgery from January 2019. In order to improve the safety and qualify of metabolic and bariatric surgery, the Korean Society for Bariatric and Metabolic Surgery (KSMBS) introduced surgeon’s and institution’s accreditation system. The authors intend to introduce comprehensive overview of accreditation system of bariatric surgery and discuss the contents of national health insurance for metabolic and bariatric surgery.

Ethical Consideration of National Health Insurance Reform for Universal Health Coverage in the Republic of Korea.

In the current era of the Sustainable Development Goals (SDGs), many countries are attempting to strengthen their health system and achieving Universal Health Coverage (UHC). The Korean National Health Insurance (NHI) system functions as a core element of health financing, contributing to achieving UHC by promoting public health and social security through insurance benefits for prevention, diagnosis, treatment, rehabilitation, childbirth, and health promotion. The Republic of Korea achieved 100% NHI coverage of the target population in 1989, 12years after the introduction of the social insurance system. However, poor coverage of health services and lack of financial protection are major obstacles to achieving UHC. Therefore, the Korean government announced and implemented 'Moon Jae-in Care' in August 2017 to enhance the coverage rate of NHI by 70%. First, this study reviews the existing health insurance system in Korea from the perspective of health financing and UHC. Second, it analyses 'Moon Jae-in Care', based on the main framework of UHC. Third, it considers the ethical implications of these developments, with focus on the principles of equity, fairness, autonomy, and solidarity. Although the NHI reform is expected to propel Korean health care closer to UHC, many ethical, social, and political issues remain.

Routine chromosomal microarray analysis is necessary in Korean patients with unexplained developmental delay/mental retardation/autism spectrum disorder.

BackgroundAll over the world, chromosomal microarray (CMA) is now the first tier diagnostic assay for genetic testing to evaluate developmental delay (DD), mental retardation (MR), and autism spectrum disorder (ASD) with unknown etiology. The average diagnostic yield of the CMA test is known to be about 12.2%, while that of conventional G-banding karyotype is below 3%. This study aimed to assess the usefulness of CMA for the purpose of clinical diagnostic testing in the Korean population.MethodsWe performed CMA and multiplex ligation-dependent probe amplification (MLPA) tests in 96 patients with normal karyotype and unexplained DD, MR, or ASD. The CMA was conducted with CytoScan 750K array (Affymetrix, USA) with an average resolution of 100 kb.ResultsPathogenic copy number variations (CNVs) were detected in 15 patients by CMA and in two patients by MLPA for four known microdeletion syndromes (Prader-Willi/Angelman syndrome, DiGeorge syndrome, Miller-Dieker syndrome and Williams syndrome) designated by National Health Insurance system in Korea. The diagnostic yield was 15.6% and 2.1%, respectively. Thirteen (13.5%) patients (excluding cases with pathogenic CNVs) had variants of uncertain clinical significance. There was one patient with a 17.1-megabase (Mb) region of homozygosity on chromosome 4q.ConclusionsOur findings suggest the necessity of CMA as a routine diagnostic test for unexplained DD, MR, and ASD in Korea.

Diabetes burden and prevention in Korea and the Western Pacific Region

Diabetes burden in the Western Pacific Region (WPR) is more problematic than in any other part of the world. In 2013, the International Diabetes Federation reported >382 million people are living with diabetes around the world. About 36%, approximately 138 million people with diabetes, are living in the WPR. In addition, in the WPR, from 2012 to 2013, 6 million diabetes mellitus cases were newly diagnosed, accounting for 54.5% of all type 2 diabetes mellitus (T2DM) cases diagnosed in the world during the same period. South Korea is no exception, and the prevalence of diabetes is estimated to be as high as 5 million people. The prevalence of T2DM in Korea increased from <1% in 1960 to >10% by early 2000. According to the Ansung–Ansan Cohort study, from 2001 to 2011, T2DM increased 54% and 60% in the 50th and 60th age groups, respectively. The main reason for the rapid increase in the prevalence of diabetes in Korea was the sudden growth in the economy, resulting in rapid urbanization. Moreover, scientific evidence suggests the dramatic increase in T2DM incidence and prevalence in Korea is related to the influence of economic development, health policy, urbanization, westernized diet, decreased physical activity, as well as an individual's health behavior changes. However, diabetes management response rate was low in the newly onset groups with <20%, but gradually increased up to around 90%, then declined to <80% after 16–20 year of developing T2DM, showing an “M” management pattern. The study results revealed that despite the successful implementation of the universal health insurance system in Korea beginning in 1987, people diagnosed with T2DM were not properly managing T2DM. Most developing countries in the WPR are emulating the Korean experiences. There is clear evidence that utilization of BED (Behavioral change, Exercise, and proper Diet) could be the best vector to fight against the diabetes tsunami in the WPR. From the Korean experiences the WPR, at high risk for T2DM, could learn to prevent, intervene, and properly manage T2DM in order to reduce diabetes-related morbidity and mortality.

주요국의 제네릭 의약품 활성화 정책 고찰과 시사점

Backgrounds: Escalating pharmaceutical expenditure has threatened the sustainability of National Health Insurance system in Korea. Generic medicines allow patients to access safe, effective, high-quality medicines at low cost, thus insurers could achieve significant financial savings by promotion of generics, if they are priced much lower than the originator. The purpose of this study was to review generic pricing as well as promotion policies in other countries and assess the implication of those policies. Methods: We reviewed the main measures adopted by the developed countries such as Austria, Belgium, Denmark, Finland, France, Germany, Italy, Japan, Netherlands, Norway, Sweden, United Kingdom, especially in countries where governments are the largest third-party payers or insurance finance resource is the national health insurance. Results: The foreign countries’s experience with generic medicine policy shows that demand-side policies such as physician budgets, international nonproprietary name prescribing, generics substitution, patients co-payment as well as supply-side policies relating to pricing and reimbursement seems to play a critical role in developing the generic medicines market.Conclusion: Various strategy should be implemented to promote generic drug use.Keywords: Generic drugs; Drug policy; Costs and cost analysis; Generic use

Ethical Assessment of National Health Insurance System of Korea

The current adverse effects of the health insurance system in Korea are considered to be problems that arise from an insufficient reflection of the notion of respecting human rights. The ethical principles most commonly suggested and used in public health are the 4 principles suggested by Beauchamp and Childress in 1994. From the perspective of the community, these 4 principles of medical ethics can be expanded to resolve problems surrounding existing social systems from a socialistic standpoint. This article describes a flexible, easy-to-use model for incorporating the 4 medical ethics principles into the National Health Insurance System (NHIS). First, the principle of respect for autonomy involves respecting the decision-making capacities of autonomous medical consumers and providers and enabling individuals to make reasoned and informed choices. Second is the principle of good practice. The government and medical institutions should act in a way that benefits the health care consumers. The principle of prohibiting bad practice involves avoiding causing health problems. The National Health Insurance Corporation and health care providers should not harm the health care consumers. Finally, the principle of justice is concerned with distributing benefits, risks, and costs fairly-that is, the notion that patients in similar positions should be treated in a similar manner. If these problems are solved, health system quality could be better and more accessible and sustainable. The ethical assessment of the NHIS could be a trial to match the 4 medical ethics principles and the NHIS. It can be applied internationally to relevant policy makers in different settings.

서울시 가구의 과부담의료비 지출 발생 및 반복적 발생의 영향요인

Graduate School of Public Health, Seoul National University The national health insurance system in Korea is characterized as relatively high out-of-pocket payments, which are the principal source of catastrophic health expenditure (CHE). The objectives of this study are to estimate the incidence of household CHE and to clarify the characteristics that affect the occurrence and recurrence of household CHE using the Seoul Welfare Panel Survey database for 2008 and 2010. Thresholds to estimate CHE were 10% and 20% of the total household income (T/X), and 25% and 40% of the income excluding food share (T/Y). Determinants of the occurrence and recurrence of CHE at the threshold of T/X=10% were analysed using multiple logistic regression models. Out of the 3,665 households that responded in 2008 survey, households with CHE were 12.07% (T/X<TEX>${\geq}$</TEX>10%), 5.34% (T/X<TEX>${\geq}$</TEX>20%), 6.84% (T/Y<TEX>${\geq}$</TEX>25%), and 4.44% (T/Y<TEX>${\geq}$</TEX>40%). Risk factors associated with household CHE included living with a spouse, non-Medicaid beneficiary, householder unemployment, low household income, the number of disabled members, poor subjective health, and the number of chronic diseases. A total of 41.78% of households with CHE in 2008 repeatedly experienced CHE in 2010. Risk factors of CHE recurrence included decreased household income and an increase in chronic diseases over the two time periods, the number of members with disability or chronic diseases, and the presence of cancer patients in 2008. Households with lower socioeconomic and health status had a higher financial burden on health care than do their counterpart households. There is a need to enhance society-wide financial protection from health spending among vulnerable citizens in Seoul, particularly, households with low income, disabled members or cancer patients.

The Gap Between Physicians and the Public in Satisfaction with the National Health Insurance System in Korea

The Korean National Health Insurance (NHI) system was an unprecedented accomplishment that was achieved in a short period of time. In this study, we sought to identify gaps between physicians and the public with respect to attitudes toward the NHI system in Korea. The study population was derived from the 2008 Korean Medical Association Survey, which was conducted to investigate satisfaction with and perceptions of the NHI system among physicians (n = 961) and the public (n = 935). Only 6.5% of the physicians were satisfied with NHI system, and 71.5% were dissatisfied with it. In contrast, 28.3% of the public were satisfied with the NHI system, and 21.4% were dissatisfied. The level of dissatisfaction expressed by physicians (2.03 ± 0.91 on a five-point scale) was also higher than that expressed by the public (3.06 ± 0.84). Despite rapid growth of NHI system, a large gap in satisfaction exists between physicians and the public.

History of reimbursement system for routine histopathology services by the National Health Insurance in Korea

ABSTRACTIn January 2009, a new classification of pathology services was been launched for the reimbursement by the National Health Insurance system in Korea. Five basic types of surgical pathology services are reclassified into 13 types and their resource based relative value scores are adjusted. In this report, we summarize the history of the classification system for the reimbursement on pathology services and report the impact of the change in January 2009 on the distribution of cases and contribution on the income of the department of pathology from each class at the Seoul National University Hospital.

The weather watch/warning system for stroke and asthma in South Korea

Weather watch/warning systems have been established for human health outcomes. Our study aims to develop and demonstrate a weather watch/warning system for asthma and stroke within the whole of South Korea, using a stratified regression approach. We converted claim-based health insurance data covering almost all medical claims for the only health insurance system in Korea for asthma and stroke from 1996–2003 into personalized disease episode data, and combined them with meteorological data. We utilized a step-wise regression method using factors extracted from the meteorological data to develop stratified models for six (stroke) and nine (asthma) regional and day-of-week strata. Validation studies showed that the actual number of hospitalizations in 2003 increased according to the three-leveled predictions (levels I, II, and III) from the model based on the 1996–2002 data. This system is accessible via the internet (http://industry.kma.go.kr/APP/sub_APP15_H01.htm) at the Korean Meteorological Administration website.

민간의료보험의 선택에 영향을 미치는 요인 : 민간의료보험 활성화에 대한 함의

Since the introduction of mandatory health insurance in In, the Korean national health insurance(KNHI) has grown rapidly. In 2004, about <TEX>$96.9\%$</TEX> of the total population are covered by the KNHI and the remaining <TEX>$3.1\%$</TEX> by the Medical Aid program. Despite national health insurance system in Korea, private health insurance market has grown rapidly. In 2004, the size of the private health insurance market was estimated at 6,568 billion won. The purpose of this study Is to identify the factors that determine the purchasing decisions of supplementary private health insurance under mandatory national health insurance system in Korea. The data from n04 Busan Health Survey were analysed for the Purpose. The variables in this study are demographic factors, health status and health behavioral factors, health care systemic factors, and socioeconomic factors. For statistical analyse, we used logistic regression. The Findings show that female, economically active age group(especially 35-49 years), persons with better health status or experience of health screening test are more likely to purchase private health insurance. And higher household income and expenditure, higher education level are more associated with the increased probabilities of private health insurance purchases. This results imply that the expanding of private health insurance market could widen the gap between the have and have-not in terms of equal health care accessibility.

Progress and Problems of Health Insurance System in Korea

Progress and Problems of Health Insurance System in Korea

Current status of Parkinson's disease treatment in Korea

The health insurance system in Korea has been under governmental control, and has covered whole population since 1989. About 97% of Korean people have benefits from this system, while 3% are covered by a Medical Aid system for poor people. According to the statistical yearbook of Health Insurance Review in Korea, the number of claims under Parkinson's Disease, in whole country increased steeply from 44,619 in 1995 to 96,229 in 2000. If each patient were to take medication for the full duration of their insurance coverage, the average number of visits per year would be 11 in 2000. Thus the number of PD patients calculated using these statistics is about 8600. The prevalence is 19/100,000, which is much lower than that in Japan. Considering the significant increase in the number of claims in last few years, however, there are still many PD patients who do not receive an accurate diagnosis and appropriate treatment. The other factor influencing these statistics is the fact that patients were able to buy their medications in drug stores without prescription, i.e. without visiting a hospital (since 2001 this has no longer been allowed). Almost all PD medications are available in Korea. There are several forms of levodopa drugs. Dopamine agonists include bromocriptine, pergolide, dihydroergocriptine, ropinirol, and pramipexole. Other parkinsonian medications are amantadine, benztropin, trihexyphenydil, deprenyl, and entacapone. Recently multicentre clinical trials were performed using ropinirol and entacapone, which showed reliable results. Currently deep brain stimulation is available in a number of medical institutes.

The Future of Health Insurance System in Korea

The Future of Health Insurance System in Korea