This study was conducted to determine how the regional health insurance program, put into effect nation- wide, might affect paterns and extent of medical care utilization in rural areas. The study employed a "onegroup, before-after design" and the data were collected from two sampling surveys conducted in Kangwha County, based on "multi-stage, stratified cluster sampling. "Changes in ambulatory care utilization, as measured in terms of the number of visits per 100 persons during the two-week survey period, varied with the type of facility. Out-of-pocket expenses for medical care connected with all forms of facilities were found to have decreased during the time interval due to insurance coverage. Before insurance, when a person sought medical help at a drugstore, it was more often because it was conveniently close and he or she was old and believed himself or herself to not be seriously ill; when a person sought medical help at a clinic or hospital, it was because he or she believed himself or herself to be seriously ill(i.e. only morbidity condition was a significant factor). After insuranc, when a person sought help at a drugstore, it was mainly because he or she was old and the drugstore was conveniently located. when a person sought help at a clinic or hospital, it was because he or she believed himself or herself to be seriously ill and, in addition, because the facility was conveniently located (i.e. geographical accessibility became an added factor of significance). Furthermore, knowledge of benefit coverage increased as residents gained more experience with the program during the interval between surveys.
Health Expenditures ; Health Services/utilization* ; Human ; Insurance, Health* ; Korea ; Rural Population*

OBJECTIVE: This study analyzed the national claims data of veterans to generate scientific evidence of the trends and appropriateness of their drug utilization in an outpatient setting. METHODS: The claims data were provided by the Health Insurance Review & Assessment (HIRA). Through sampling and matching data, we selected two comparable groups; Veterans vs. National Health Insurance (NHI) patients and Veterans vs. Medical Aid (MAID) patients. Drug use and costs were compared between groups by using multivariate gamma regression models to account for the skewed distribution, and therapeutic duplication was analyzed by using multivariate logistic regression models. RESULTS: In equivalent conditions, veteran patients made fewer visits to medical institutions (0.88 vs. 1), had 1.86 times more drug use, and paid 1.4 times more drug costs than NHI patients (p < 0.05); similarly, veteran patients made fewer visits to medical institutions (0.96 vs. 1), had 1.11 times more drug use, and paid 0.95 times less drug costs than MAID patients (p < 0.05). The risk of therapeutic duplication was 1.7 times higher (OR=1.657) in veteran patients than in NHI patients and 1.3 times higher (OR=1.311) than in MAID patients (p < 0.0001). CONCLUSION: Similar patterns of drug use were found in veteran patients and MAID patients. There were greater concerns about the drug use behavior in veteran patients, with longer prescribing days and a higher rate of therapeutic duplication, than in MAID patients. Efforts should be made to measure if any inefficiency exists in veterans' drug use behavior.
Drug Costs ; Drug Utilization ; Humans ; Insurance, Health ; Logistic Models ; National Health Programs ; Outpatients* ; Prescriptions* ; Veterans*

BACKGROUND: To evaluate oral anticoagulant (OAC) utilization in patients with atrial fibrillation after the changes in the health insurance coverage policy in July 2015. METHODS: We used the Health Insurance Review and Assessment Service-National Patient Samples (HIRA-NPS) between 2014 and 2016. The HIRA-NPS, including approximately 1.4 million individuals, is a stratified random sample of 3% of the entire Korean population using 16 age groups and 2 sex groups. The HIRA-NPS comprises personal and medical information such as surgical or medical treatment provided, diagnoses, age, sex, region of medical institution, and clinician characteristics. The studied drugs included non-vitamin K antagonist OACs (NOACs) such as apixaban, dabigatran, edoxaban, and rivaroxaban, and were compared with warfarin. We analyzed drug utilization pattern under three aspects: person, time, and place. RESULTS: The number of patients with atrial fibrillation who were prescribed OACs was 3,114, 3,954, and 4,828; and the proportions of prescribed NOACs to total OACs were 5.1%, 36.2%, and 60.8% in 2014, 2015, and 2016, respectively. The growth rate of OACs prescription increased from 61.4 patients/quarter before June 2015 to 147.7 patients/quarter thereafter. These changes were predominantly in elderly individuals aged more than 70 years. The proportion of NOACs to OACs showed significant regional difference. CONCLUSION: The change of health insurance coverage policy substantially influenced OACs prescription pattern in whole Korean region. But the impact has been significantly different among regions and age groups, which provides the evidence for developing standard clinical practice guideline on OACs use.
Aged ; Anticoagulants ; Atrial Fibrillation* ; Dabigatran ; Drug Utilization ; Drug Utilization Review ; Humans ; Insurance, Health* ; Korea* ; Prescriptions* ; Rivaroxaban ; Warfarin

BACKGROUND: Blood utilization review in medical facilities is necessary for predicting blood demand and maintaining an efficient blood program. We investigated the use of blood components and discard rate of blood components in eight university hospitals in Korea. METHODS: Blood component utilization including autologous blood collection in eight university hospitals on 1999 was analyzed with the co-work of its department of laboratory medicine. RESULTS: 700,686 blood component units were used at eight university hospitals investigated. Among a total of 601,262 units analyzed, the department of internal medicine used 303,843(50.5%) units and ranked first among clinical department for blood use, followed by general surgery 91,450 units, thoracic surgery 45,038 units. The cumulative number of autologous blood collected until 1999 was 6,232 units. Seven hospitals experienced rejection of reimbursement for health insurance payments and the rejection rate ranged from one to 28%. CONCLUSIONS: This survey provides information on blood component usage in eight Korean university hospitals. A successive nationwide survey on blood utilization like this study is required for estimation of blood demand.
Hospitals, University* ; Insurance, Health ; Internal Medicine ; Korea* ; Thoracic Surgery ; Utilization Review

BACKGROUNDNational Breast and Cervical Cancer Early Detection Program (NBCCEDP) has provided free or low-cost mammograms to low-income or no health insurance women in all of the states of the United States (US) since 1997. The objective of this study was to understand whether health insurance and annual household income impacted the mammography utilization since the implementation of NBCCEDP, in order to evaluate how the implementation of NBCCEDP impacted mammography utilization among American women.

METHODSData were from the database of Behavioral Risk Factor Surveillance System (BRFSS) of the CDC in US. Mammography utilization was measured by whether the American woman aged 40 to 64 years had the mammography within the last two years. The chi square test and multivariate Logistic regression were used to evaluate the associations between mammography utilization and health insurance, annual household income, and other factors for any given year.

RESULTSFrom 2000 to 2008, the rate of mammography utilization among participants had a steady decrease on the whole from 86.7% to 83.8%. The results showed that the mammography utilization correlated significantly with health insurance and annual household income for any given year. The results also showed that compared with participants who were uninsured, those who were insured had a greater times higher rate of mammography in 2008 than any other year from 2000 to 2008, and compared with participants whose annual household income was below $15 000, those whose annual household income was above $50 000 had a greater times higher rate of mammography in 2008 than in 2004 and 2006.

CONCLUSIONSHealth insurance and annual household income impacted the mammography utilization for any given year from 2000 to 2008, and the implementation of NBCCEDP has not achieved its original goal on breast cancer screening.

Adult ; Female ; Humans ; Income ; Insurance, Health ; Mammography ; utilization ; Middle Aged ; United States

OBJECTIVETo investigate workers' willingness to participate and wiliness to pay for a hypothetical industrial injury insurance scheme, to analyze the influential factors, and to provide information for policy making of the government.

METHODSMultistage cluster sampling was used to select subjects: In the first stage, 9 small, medium, orlarge enterprises were selected fromthree cities (counties) in Zhejiang province, China, according to the level of economic development, transportation convenience, and cooperation of government agencies; in the second stage, several workshops were randomly selected from each of the 9 enterprises. Face-to-face interviews among all workers in the workshops were conducted by trained interviewers using a pre-designed questionnaire.

RESULTSIt was found that 73.87% (2095) of all workers were willing to participate in the hypothetical work injury insurance scheme and to pay 2.21% of monthly wage (51.77 yuan) on average, and more than half of the workers were willing to pay less than 1%of monthly wage (35 yuan). Of the 741 workers who were not willing to participate, 327 thought that the premium should be borne by the state or enterprises, instead of individuals, and others were not willing to participate because of low income, unstable job, or poor understanding of the hypothetical industrial injury insurance scheme. Logistic regression analysis showed that workers with higher education levels, longer length of services, longer weekly working time, or more knowledge of occupational diseases showed higher willingness to participate in the scheme; workers who were exposed to physical hazards, had health records, or had participated in the existing medical insurance or industrial injury insurance were more willing to participate. Multiple linear regression analysis showed that with increasing average monthly wage, weekly working time, and self?health evaluation, the proportion of workers with willingness to pay increased; however, with increasing work intensity and awareness of occupational disease, the proportion of workers with willingness to pay decreased. The workers who were not covered by the industrial injury insurance paid more than those covered by the industrial injury insurance.

CONCLUSIONThe hypothetical industrial injury insurance scheme increased the applicability and advantage of independent third-party running and lifetime insurance, which significantly increased the workers' willingness to participate in or to pay for the insurance scheme. Therefore, the industrial injury insurance can be improved in these aspects to promote workers' willingness to participate in and to pay for the insurance scheme. This conclusion provided a reference for the solution of delayed or shirking corporate responsibility for paying the premium.

Accidents, Occupational ; economics ; Attitude to Health ; China ; Cluster Analysis ; Financing, Personal ; Health Policy ; Humans ; Insurance ; Insurance, Health ; economics ; utilization ; Models, Theoretical ; Occupational Diseases ; economics ; Surveys and Questionnaires

OBJECTIVES: The Korean government in January 2006 instigated an exemption policy for hospitalized children under the age of six years old. This study examines how this policy affected the utilization of medical care in Korea. METHODS: A total of 1,513,797 claim records from the Health Insurance Review Agency were analyzed by complete enumeration methods. The changes of medical utilization were compared from 2005 to 2006. In addition, the changes of medical utilization between 2004 and 2005 were compared as a pseudocontrol group. RESULTS: The admission rate increased 1.14-fold from 15.20% in 2004 to 17.32% in 2005, and this further increased 1.08-fold to 18.65% in 2006. The increase of patients with a common cold (1.2-fold) was higher than that of both the general patients (1.08-fold) and the patients with the top 10 fatal diseases (0.91-fold). The average length of stay per case for clinics showed the highest increase rates (1.06-fold). The rates of patients with the common cold showed a higher increase (1.05-fold) than that of the general patients. The average medical expense per case was increased by 1.10-fold from 2005 to 2006, which was higher than that from 2004 to 2005 (1.04-fold). The increase rate for patients with the common cold was higher at 1.18-fold than that of the general patients. CONCLUSIONS: The cost exemption policy has especially led to an increase in the utilization of clinics and the utilization by patients with a common cold.
Child, Preschool ; Cost Sharing/*legislation & jurisprudence ; *Health Policy ; Health Services/*utilization ; Hospitalization ; Humans ; Insurance Claim Review ; Korea ; Length of Stay

The purpose of this study are to find useful knowledge through discovering relations and patterns of unknown facts from large data using data mining technique and to introduce a scheme of knowledge management concept in medical field. The application areas of data mining in medical fields include the medical utilization review analysis, disease pattern analysis, analysis related with health promotion and hospital management analysis. Among those areas, we selected the disease pattern analysis and studied on prediction of the diagnosis of hypertension patients. Three data mining techniques of the statistical analysis, decision tree analysis and C4.5 were performed on the health examination data from Korea Medical Insurance Corporation. From the experiments, the levels of importance of factors to hypertension were inferred and the specifications between hypertensive group and normotensive group was classified and identified. These results can be applied not only to the prediction of the diagnosis of hypertension patients but also to the medical decision support system for the management of hypertension. From now on, the data mining techniques that reproduce valuable information to help decision support will provide and be applied to various areas; clinical epidemiological study, useful information of health promotion project, health care policy support information. And the technique will also give the additional efficiency of national projects related health and the realization of scientific health social management resulting the much more national welfare service.
Data Mining* ; Decision Support Techniques ; Delivery of Health Care ; Diagnosis ; Health Promotion ; Humans ; Hypertension ; Insurance ; Knowledge Management* ; Korea ; Utilization Review

OBJECTIVES: The aim of this study is to identify factors determining the purchase of private health insurance under the mandatory National Health Insurance(NHI) system in Korea. METHODS: The data were collected by the National Cancer Center in Korea. It includes cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer. Data were gathered from the hospital Order Communication System (OCS), medical records, and face-to-face interviews, using a structured questionnaire. Clinical, socio-demographic and private health insurance related factors were also gathered. RESULTS: Overall, 43.9% of patients had purchased one or more private health insurance schemes related to cancer, with an average monthly premium of won 65,311 and an average benefit amount of won 19 million. Females, younger aged, high income earners, national health insurers and metropolitan citizens were more likely to purchase private health insurance than their counterparts. CONCLUSIONS: About half of Korean people have supplementary private health insurance and their benefits are sufficient to cover the out-of-pocket fees required for cancer treatment, but inequality remains in the purchase of private health insurance. Further studies are needed to investigate the impacts of private health insurance on NHI, and the relationship between cancer patients' burden and benefits.
Questionnaires ; *Private Sector ; *Neoplasms ; National Health Programs ; Middle Aged ; Male ; Korea ; Insurance, Health/*utilization ; Humans ; Female ; *Decision Making ; Aged ; Adult

OBJECTIVES: This paper proposes new alert override reason codes that are improvements on existing Drug Utilization Review (DUR) codes based on an analysis of DUR alert override cases in a tertiary medical institution. METHODS: Data were obtained from a tertiary teaching hospital covering the period from April 1, 2012 to January 15, 2013. We analyzed cases in which doctors had used the 11 overlapping prescription codes provided by the Health Insurance Review and Assessment Service (HIRA) or had provided free-text reasons. RESULTS: We identified 27,955 alert override cases. Among these, 7,772 (27.8%) utilized the HIRA codes, and 20,183 (72.2%) utilized free-text reasons. According to the free-text content analysis, 8,646 cases (42.8%) could be classified using the 11 HIRA codes, and 11,537 (57.2%) could not. In the unclassifiable cases, we identified the need for codes for "prescription relating to operation" and "emergency situations." Two overlapping prescription codes required removal because they were not used. Codes A, C, F, H, I, and J (for drug non-administration cases) explained surrounding situations in too much detail, making differentiation between them difficult. These 6 codes were merged into code J4: "patient was not taking/will not take the medications involved in the DDI." Of the 11 HIRA codes, 6 were merged into a single code, 2 were removed, and 2 were added, yielding 6 alert override codes. We could codify 23,550 (84.2%) alert override cases using these codes. CONCLUSIONS: These new codes will facilitate the use of the drug-drug interactions alert override in the current DUR system. For further study, an appropriate evaluation should be conducted with prescribing clinicians.
Ambulatory Care ; Decision Support Systems, Clinical ; Drug Interactions ; Drug Utilization Review* ; Drug Utilization* ; Hospitals, Teaching* ; Humans ; Insurance, Health ; Korea* ; Outpatients* ; Prescriptions*