BACKGROUND: Identification of blood use characteristics in medical facilities is essential for predicting blood demand and maintaining an efficient blood programme. We investigated the use of blood components and discard rate of blood in hospitals. METHOD: Blood component utilization of hospitals in 1998 and 1999 was analyzed by mail survey and co-work with eight university hospitals. RESULTS: A total of 1,510,862 blood component units in 1998 and 1,646,346 units in 1999 meaning an increase of 8.97 % percent were used by 59 hospitals investigated. Use of irradiated blood and single-donor platelets increased. Blood discard rate was less than five percent in most hospitals and many hospitals experienced improper cut in health insurance reimbursement. CONCLUSION: Use of blood components in hospitals is increasing and national guideline for transfusion is needed. A successive investigation on National wide blood utilization like this study is required for estimation of blood demand.
Hospitals, University ; Insurance, Health, Reimbursement ; Korea* ; Postal Service

BACKGROUNDMedical consortium is a specific vertical integration model of regional medical resources. To improve medical resources utilization and control the health insurance costs by fee-for-service plans (FFS), capitation fee and diagnosis-related groups (DRGs), it is important to explore the attitudes of doctors towards the different health insurance payment in the medical consortium in Shanghai.

METHODSA questionnaire survey was carried out randomly on 50 doctors respectively in 3 different levels medical institutes.

RESULTSThe statistical results showed that 90% of doctors in tertiary hospitals had the tendency towards FFS, whereas 78% in secondary hospitals towards DRGs and 84% in community health centers towards capitation fee.

CONCLUSIONSThere are some obvious differences on doctors' attitudes towards health insurance payment in 3 different levels hospitals. Thus, it is feasible that health insurance payment should be supposed to the doctors' attitudes using the bundled payments along with the third-party payment as a supervisor within consortium.

This study was focused on developing a computerized decision support program for physician order entry of 20% albumin infusion and perineal care procedures in order to minimize inpatients'insurance claims rejects. The frequency of inpatients health insurance reimbursement claims rejects of a 800-bed tertiary care teaching university hospital in Seoul area was reviewed and the most common two orders of the reject were chosen for the study. The order decision support program was designed on the basis of Korean Health Insurance Reimbursement Guidelines. The server system used for the study was ProLiant 7000 and Pentium III was used for the program development. Windows 2000 was used as the operating system, MS SQL v7.o was used for the database. The software development languages were Visual basic V6.0 and Spread v3.0. This Decision Support Program was proven to be very useful when doctors and nurses wanted to reflect the Health Insurance Reimbursement Guidelines in their ordering practices.
Humans ; Inpatients ; Insurance, Health* ; Insurance, Health, Reimbursement ; Program Development ; Seoul ; Tertiary Healthcare

Colorectal endoscopic submucosal dissection (ESD) is not yet fully popularized in Korea, but is increasing steadily. The outcomes of colorectal ESD in Korea are comparable to those in Japan and other countries. ESD-related complication rates are decreasing as experiences accumulate. Particularly for rectal laterally spreading tumors, ESD is becoming more prevalent than transanal endoscopic microsurgery. Standard indication, qualified training system, and full medical insurance coverage should be established for the procedure to become popular in the long run.
Colonic Neoplasms ; Endoscopy ; Insurance Coverage ; Insurance, Health, Reimbursement ; Japan ; Korea ; Microsurgery

In the last few moments of life before death, a more adequate health care system must be established in order for suffering patients to have their dignity respected. To this point, Korea's health care system does not possess additional health insurance reimbursement covering hospice care. Until recently, the existing fee for service system consists of an informal hospice care service that has been developed and supplied. Due to society's increasing expectation of hospice reimbursement in regard to development and in reality, progression is currently being undertaken which we have welcomed. However, there has been a tendency for over expectation in financial reduction by hospice reimbursement introduction in which there were evidence from cases in other nations. In practice, supplementation of per diem type of hospice coverage will be the mainstream and fee for service in some areas must be explored in order to compensate for the negative aspects of per diem type of hospice coverage.
Delivery of Health Care ; Fee-for-Service Plans ; Hospice Care ; Hospices ; Humans ; Insurance, Health, Reimbursement ; Stress, Psychological

Background: The Universal Health Care Law seeks to optimize financing of personnel costs without compromising quality and equitable health care among the health care facilities. This position statement aimed to identify strategies and policy recommendations for the cost-effective financing of health personnel in public healthcare facilities. Methods: A systematic review of literature was done to generate policy brief and key points for roundtable discussion in collaboration with the Department of Health (DOH). The discussion was guided by the three health financing options of DOH: (a) retain Personnel Services (PS) as DOH budget but shift Maintenance and Other Operating Expenses (MOOE) to PhilHealth; (b) shift PS and MOOE to PhilHealth, and (c) rationalize part-time status in government hospitals. Results: The pros and cons of financing options were cross-examined. In Option 1, physicians in government hospitals would receive fixed salaries from DOH / Local Government Units. In Option 2, there would be a monopsony between PhilHealth and provincial power. Payment will be performance-driven, and balance billing will be eliminated. Option 3 would be a set up of retaining part-time positions for physicians. Conclusion and Recommendation Participants deduced that for Option 1, provision of salary augmentation sources and ensuring adequate plantilla items and level of remuneration in government hospitals should be considered, in order to sufficiently compete with physicians’ income from private practice. For Option 2, the PhilHealth reimbursement system should ensure timely reimbursement so as not to subject care providers to financial instabilities. For Option 3, rationalizing part-time status should be flexible and can be applied regardless of how physicians are paid, as this would incentivize caregivers to work harder and smarter.
Universal Health Insurance ; Healthcare Financing ; Physicians ; Universal Health Care ; Reimbursement Mechanisms

Lack of awareness, the stigma of carrying a genetic mutation, and economic factors are barriers to acceptance of BRCA genetic testing or appropriate risk management. We aimed to investigate the influence of Angelina Jolie's announcement of her medical experience and also health insurance reimbursement for BRCA gene testing on practice patterns for hereditary breast and ovarian cancer (HBOC). A survey regarding changes in practice patterns for HBOC before and after the announcement was conducted online. The rate of BRCA gene testing was obtained from the National Health Insurance Review and Assessment Service database. From May to August 2016, 70 physicians responded to the survey. Genetic testing recommendations and prophylactic management were increased after the announcement. Risk-reducing salpingo-oophorectomy and contralateral prophylactic mastectomy was significantly increased in BRCA carriers with breast cancer. The BRCA testing rate increased annually. Health insurance and a celebrity announcement were associated with increased genetic testing.
Breast Neoplasms* ; Breast* ; Genetic Testing ; Insurance Coverage ; Insurance* ; Insurance, Health ; Insurance, Health, Reimbursement ; Mastectomy ; National Health Programs ; Ovarian Neoplasms ; Risk Management

The resource-based relative value scale (RBRVS) was introduced in Korea as a payment system in 2001. However, the health insurance fee schedule had many problems. Unbalanced insurance fee schedules still occur, and the relative value was not divided between physicians' work and practice expenses. Furthermore, malpractice fees were not included in the total RBRVS. The first refinement project of the health insurance relative value scales was conducted in 2003 and the second project started in 2010. In the first project, final relative values were calculated under budget neutrality by medical departments, and imbalances within the departments were resolved. However, imbalances still existed between departments. In the second project, final relative values were classified and computed by the type of medical treatment. The final RBRVS has been applied step by step since 2017 and the imbalance problem of the insurance fee schedule has been partially resolved. The government recently announced strengthening the plan for health insurance coverage. The current coverage rate for total medical costs by national health insurance is 63%. The purpose of this plan was to increase the coverage rate by up to 70%. The government has suggested detailed plans but there remain many controversial issues and limitations with regard to the practical aspects. Thus, further research and suggestions are needed.
Budgets ; Fee Schedules* ; Fees and Charges* ; Insurance ; Insurance Benefits ; Insurance, Health* ; Insurance, Health, Reimbursement ; Korea ; Malpractice ; National Health Programs ; Relative Value Scales

PURPOSE: To know the current trend of the annual number of AAA patients in Korea and treatment modality, we attempted to investigate the numbers of patients diagnosed with AAA and the number of patients who underwent open or endovascular treatment of AAA in Korea during the last 6 years. METHODS: To investigate the number of AAA patients, we searched for ruptured AAA and AAA without description of rupture disease from the database of Health Insurance Reimbursement Association (HIRA) by searching the disease code of HIRA I71.3 (ruptured AAA) and I71.4 (AAA without description of rupture) during the period between 2003 and 2009. To investigate the number of patients who underwent treatment for AAA, we searched for code O 2036, O 2034, O 0223, O 0224 (open surgical repair) and M 6612 (endovascular aneurysm repair, EVAR). To discern the number of AAA-related deaths in Korea during the same period, we depended on the database of the Statistics Korea. RESULTS: We found that the number of AAA patients and treatment of AAA were rapidly increasing recently after the inception of the reimbursement for EVAR by the HIRA. But the number of AAA-related deaths did not significantly change during the same period in Korea. CONCLUSION: After observing that the number of patients with AAA and its treatment rapidly increased while the number of AAA-related death did not increase, we can assume that it is the result of increase of patients detection rather than that of prevalence of AAA and also think that many AAA patients are still under-detected in Korea. To cope with the increasing number of AAA patients and to facilitate detection of hidden AAA patients, we would like to propose a nationwide screening program of AAA for a selected group of the population.
Aneurysm ; Aortic Aneurysm, Abdominal ; Humans ; Insurance, Health, Reimbursement ; Korea ; Mass Screening ; Phosphatidylethanolamines ; Prevalence ; Rupture

In Korea, implementation of nutrition support guidelines has been limited due to strict health insurance reimbursement policies as well as the lack of consensus on the best approach to TPN management. We examined the impact of TPN provision to hospitalized patients where NST (nutrition support team ) consultations were not requested by their primary physicians. The study showed the followings : 1. The median dutation of TPN provision was 8 days, but many patients were on TPN for less than 1 week. 2. The intake of energy and protein were less than the patient's requirements 3. Lipid emulsion was not provided to the most TPN patients. In conclusion, the role of NST should be expanded and studies are needed not only on TPN formulations which are suitable to Koreans but also on the cost-effectiveness of NST activities. TPN policies and protocols should be established based on the needs of each hospital.
Consensus ; Humans ; Insurance, Health, Reimbursement ; Korea ; Protein-Energy Malnutrition ; Referral and Consultation