A change in the consumer's surplus was measured in order to evaluate the social benefit to be derived from expanding health insurance to the entire population. The most refined and correct way to measure a project's net benefit to society is to determine a change in the consumer's surplus. Benefits from introducing the health insurance program to the uninsured people can be classified into two elements. The first is the pricing-down effect(E1) which results from applying the insurance price system, which is lower than the actual price, to the uninsured patients. The second effect(E2) is a decrease in actual payment because an insured patient pays only a portion of the total medical bill(copayment). We collected medical price information from the data banks of 93 hospitals, and obtained information of medical utilization by referring to the results of other research and from data published by the Korean Medical Insurance Societies. The total net benefit was estimated as won214 billion, comprising the first effect(E1) of won57 billion and the second effect(E2) of won157 billion. The price elasticity of physician visits is less than that of hospital admissions; however, benefits from the increase in physician visits are greater than those from hospital admissions because there are considerably more of physician visits than hospital admissions. The sensitivity analysis also shows the conclusion that expansion of the health insurance program to the entire population would result in a positive net benefit. Therefore, we conclude that the National Health Insurance Program is socially desirable.
Elasticity ; Humans ; Insurance ; Insurance, Health ; Medically Uninsured ; National Health Programs*

The effects of regional medical insurance on utilization of medical care in urban population was examined in this study. The data was collected in a 2-year follow-up household survey conducted at Taegu city before and after implementation of the regional medical insurance. The study population was divided into 2 groups. Cohort I was the uninsured in 1989 and cohort II was the insured in 1989. After the coverage of medical insurance, physician visit rate per 1,000 population, use-disability ratio and use-restricted activity ratio in cohort I were increased compared to cohort II in both of acute and chronically ill people. The use-disability ratio and use-restricted activity ratio of the insured poor were lower than those of the insured nonpoor in both of cohort I and cohort II. The major reasons for pharmacy use were accessibility and affordability before the coverage of medical insurance in cohort I, however, after the coverage of medical insurance, the important reason was accessibility rather than affordabifity. In logistic regression analysis of physician visit, the significant independent variables were acute illness episode(+), chronic illness episode(+) and income(+) in both of cohort I and cohort II. In cohort I, after the coverage of medical insurance, more people replied that the medical cost of hospital and clinic was reasonable. The people who covered by the regional medical insurance were more dissatisfied with the imposed premium than those who covered by other types of medical insurance in both of cohort I and cohort II. More people in cohort II than cohort I were dissatisfied with the services from hospitals and clinics after implementation of the regional medical insurance. In conclusion. after the coverage of medical insurance, the gap between the poor and the nonpoor still exists in terms of medical care utilization.
Chronic Disease ; Cohort Studies ; Daegu ; Family Characteristics ; Follow-Up Studies ; Humans ; Insurance* ; Logistic Models ; Medically Uninsured ; Pharmacy ; Urban Population*

The current national health-insurance system of the Republic of Korea uses the negative-list method to determine benefit coverage, which includes most medical services. However, financial limitations have led to frequent conflicts between medical-service providers and the Health Insurance Review and Assessment Service (HIRA) about the inclusion of specific service-providers' practices within benefit coverage. The role of HIRA is to determine whether payments claimed by service providers are clinically valid and formulated in a cost-efficient manner. This article describes the present state and structure of the benefit system in the Korean national health-insurance system. We focus on issues of arbitrary uninsured benefits that may arise when service providers request patients to pay in full (with their approval) for a service that is not included in the benefits, according to the National Health Insurance Act. We also consider the legal treatment of arbitrary uninsured benefits in Korea and other countries. We suggest measures to improve the payment system for arbitrary uninsured benefits in Korea. Laws and regulations should be revised to cover these arbitrary uninsured benefits in a manner that can be agreed upon by HIRA, service providers, and patients.
Consensus ; Humans ; Insurance, Health ; Jurisprudence ; Korea ; Medically Uninsured ; National Health Programs ; Republic of Korea ; Social Control, Formal ; Social Security

PURPOSE: The medical student-run Einstein Community Health Outreach Clinic provides free healthcare to the uninsured adult population of New York, the United States. During the summer, prehealth student volunteers are recruited to assist with clinic operations. METHODS: We designed a survey study to identify the baseline characteristics of the volunteers between June and August of 2013 and 2014 in order to evaluate the influence of working in a medical student-run free clinic on their education, impressions, and career goals. RESULTS: A total of 38 volunteers (response rate, 83%) participated in the study. The volunteers were demographically diverse and interested in primary care specialties and community service. CONCLUSION: After the Einstein Community Health Outreach program, the volunteers showed an improved understanding of the healthcare process and issues relevant to uninsured patients. They also developed favorable attitudes towards primary care medicine and an increased level of interest in pursuing careers in primary care.
Adult ; Ambulatory Care Facilities ; Delivery of Health Care ; Education ; Humans ; Medically Uninsured ; Primary Health Care ; Social Welfare ; United States* ; Volunteers*

OBJECTIVES: To determine the relationships between physical activity (PA), the neighborhood environment support for PA, and social support for PA among Mexican-American women living in South Texas. The Enlace study was a randomized controlled trial that tested the effectiveness of a promotora-led PA intervention among low-income Mexican origin women (n=614) living in colonias. METHODS: The dependent measures included accelerometer-measured average moderate to vigorous physical activity (MVPA) and sedentary breaks and the Community Health Activities Model Program for Seniors PA 41-item questionnaire. The independent measures included the Physical Activity and Neighborhood Environment Scale (PANES) and the 13-item Physical Activity Social Support (PASS) scale. RESULTS: Enlace participants were on average 40.4 (standard deviation, 10.3) years old, born in Mexico (86.1%), and uninsured (83.1%). Adjusted linear regression results indicated that each 1-point increment in the PANES overall score was associated with 0.050 (p < 0.001) unit increase in sedentary break and a −0.043 (p=0.001) unit decrease in sedentary break duration. Both PANES (β=0.296; p=0.002) and PASS scores (β=0.076; p < 0.001) were associated with weekly average self-reported MVPA. Interaction effects were observed between PASS scores and accelerometer-measured frequency of sedentary breaks and sedentary time duration. CONCLUSIONS: The findings of this study indicate that the relationships between PA and built environment and social support are measure-dependent and suggest that reducing sedentary time in this population may require a closer assessment of social support for PA.
Community-Based Participatory Research ; Female ; Health Equity ; Humans ; Linear Models ; Medically Uninsured ; Mexico ; Motor Activity* ; Residence Characteristics* ; Texas*

BACKGROUND: The “Tuberculosis Relief Belt Supporting Project (Tuberculosis Patient Management Project for Poverty Groups)” is a national program for socioeconomically vulnerable tuberculosis (TB) patients. We sought to evaluate the clinical and socioeconomic characteristics of poverty-stricken TB patients, and determined the need for relief. METHODS: We examined in-patients with TB, who were supported by this project at the National Medical Center from 2014 to 2015. We retrospectively investigated the patients' socioeconomic status, clinical characteristics, and project expenditures. RESULTS: Fifty-eight patients were enrolled. Among 55 patients with known income status, 24 (43.6%) had no income. Most patients (80%) lived alone. A total of 48 patients (82.8%) had more than one underlying disease. More than half of the enrolled patients (30 patients, 51.7%) had smear-positive TB. Cavitary disease was found in 38 patients (65.5%). Among the 38 patients with known resistance status, 19 (50%) had drug-resistant TB. In terms of disease severity, 96.6% of the cases had moderate-to-severe disease. A total of 14 patients (26.4%) died during treatment. Nursing expenses were supported for 12 patients (20.7%), with patient transportation costs reimbursed for 35 patients (60%). In terms of treatment expenses for 31 people (53.4%), 93.5% of them were supported by uninsured benefits. CONCLUSION: Underlying disease, infectivity, drug resistance, severity, and death occurred frequently in socioeconomically vulnerable patients with TB. Many uninsured treatment costs were not supported by the current government TB programs, and the “Tuberculosis Relief Belt Supporting Project” compensated for these limitations.
Drug Resistance ; Health Care Costs ; Health Expenditures ; Humans ; Medically Uninsured ; Nursing ; Poverty* ; Retrospective Studies ; Social Class ; Transportation ; Tuberculosis*

PURPOSE: Two-stage management with Hartmann's procedure is the most common procedure used for the treatment of obstructive left colon cancer with or without perforation. However, single-stage procedures have gained popularity recently with reports that show little difference in safety compared to the conventional multi-stage procedures. To evaluate the economic advantage of single stage procedure compare with two stage procedure in emergent left colonic pathology. METHODS: Eleven patients (SP; single stage procedure) without other accompanying diseases among 15 patients who entered the emergency room and treated by the single stage procedure using the intraoperative irrigation for the left colon obstructions with or without perforation during the period from July of 1999 to November of 2000, were compared in their costs retrospectively with 11 patients (MP; multiple stage procedure) without other accompanying diseases and had final reduction of stoma out of 28 patients treated by Hartman's procedures including the resections of lesions during the period from September 1996 to May 1999 with the same diagnosis. The costs were compared using Mann-Whitney U tests, with data on the costs of overall treatments, operations, anesthesia, admission room, medications, test/evaluations, and managements as well as days of hospital stay, all on the record of accounting department. The relationships of the factors to the total cost of treatment were evaluated using Multi-variant regression analysis, and the pre-operative physiologic status were compared using APACHE III scoring system. The total treatment cost did not include optional treatment costs, uninsured admission room costs, and the costs of colonic irrigator used in the operations for the SP. RESULTS: There were no significant difference in the age and gender of the two groups as 67 +/-15 years with 6 males for the SP and 6+/-19 years with 7 males for the MP. The preoperative physiologic status of patients, in APACHE III scoring system, were 29.1+/-10.6 in the SP and 26.1+/-8.2 in the MP without any significant difference between the two groups. The average of hospital stay showed a significant difference between two groups as 17.1+/-6.2 (range: 13-25) days for the SP and 31.3 (range: 24-43) days for the MP (p<0.01). The average of total costs showed also a significant difference in two groups as 3,938 687 (range: 3,017-4,974) thousand won for the SP and 7,543 1,851 (range: 5,314-9925) thousand won for the MP (p<0.01). It showed that the SP had roughly 50, 53, 76, 79, and 72% reductions of costs over operations, anesthesia, admission room, medications, tests/evaluations, and managements. The analysis of the overall costs of treatments showed 3,540 thousand won reduction in SP. CONCLUSIONS: Single stage procedure using intraoperative colonic irrigation technique showed no difference in safety but has an economical advantage over the conventional multiple stage in the management of emergent left colonic obstruction or perforation patients.
Anesthesia ; APACHE ; Colon* ; Colonic Neoplasms* ; Diagnosis ; Emergency Service, Hospital ; Health Care Costs ; Humans ; Length of Stay ; Male ; Medically Uninsured ; Pathology ; Rectal Neoplasms ; Retrospective Studies

BACKGROUND AND PURPOSE: There has been no systematic analysis of emergency department (ED) utilization in the multiple sclerosis (MS) population. We investigated the acute-care needs of MS patients using ED as a route for entry into healthcare services. METHODS: ED visits made by MS patients were identified. Data extracted included demographics, medical/neurological history, and workup/management in the ED. RESULTS: The Mount Sinai ED received 569 visits from 224 MS patients during a 3-year period, of whom 33.5% were covered by Medicaid and 12.9% were uninsured. Patients with an Expanded Disability Status Scale score of > or =6 accounted for 54%, 50.5% of relapsing remitting MS patients were being treated with disease-modifying therapies, and 74.5% of the ED visits were non-neurological. Patients with mild-to-moderate MS were more likely to present to the ED for issues directly related to MS such as acute exacerbations, while those with severe MS presented more often due to medical issues indirectly related to MS, such as urinary tract infections (p<0.0001). CONCLUSIONS: Most MS patients seeking ED care suffer from acute non-neurological problems. The MS patients presenting to the ED tended to be underinsured, had high levels of disability, and were undertreated with disease-modifying therapies. The acute-care needs of MS patients evolve over the disease course, as do the resources that must be utilized in providing emergency care across the spectrum of MS severity. Understanding the characteristics, problems, and needs of MS patients utilizing the ED is an important step in improving care in this population from both clinical and public health perspectives.
Delivery of Health Care ; Demography ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital ; Humans ; Medicaid ; Medically Uninsured ; Multiple Sclerosis* ; Public Health ; Urinary Tract Infections

OBJECTIVES: The purposes of this study were to examine the status of children and adolescents with regard to enrollment in private medical insurance (PMI) and to investigate its influence on their utilization of medical services. METHODS: The present study assessed 2973 subjects younger than 19 years of age who participated in five consecutive Korea Health Panel surveys from 2009 to 2012. RESULTS: At the initial assessment, less than 20% of the study population had not enrolled in any PMI program, but this proportion decreased over time. Additionally, the number of subjects with more than two policies increased, the proportions of holders of indemnity-type only ('I'-only) and of fixed amount+indemnity-type ('F+I') increased, whereas the proportion of holders with fixed amount-type only ('F'-only) decreased. Compared with subjects without private insurance, PMI policyholders were more likely to use outpatient and emergency services, and the number of policies was proportionately related to inpatient service utilization. Regarding out-patient care, subjects with 'F'-only PMI used these services more often than did uninsured subjects (odds ratio [OR], 1.69), whereas subjects with 'I'-only PMI or 'F+I' PMI utilized a broad range of inpatient, outpatient, and emergency services relative to uninsured subjects (ORs for 'I'-only: 1.39, 1.63, and 1.38, respectively; ORs for 'F+I': 1.67, 2.09, and 1.37, respectively). CONCLUSIONS: The findings suggest public policy approaches to standardizing PMI contracts, reform in calculation of premiums in PMI, re-examination regarding indemnity insurance products, and mutual control mechanisms to mediate between national health insurance services and private insurers are required.
Adolescent ; Ambulatory Care/*utilization ; Child ; Child, Preschool ; Female ; Health Surveys ; Humans ; Income ; Infant ; Infant, Newborn ; Insurance, Health/economics/*statistics & numerical data ; Male ; Medically Uninsured ; Odds Ratio ; Republic of Korea

PURPOSE: The purpose of this study was to investigate health management state during pregnancy, childbirth, and postpartum of immigrant women. METHODS: A descriptive research design was employed. Data were collected from 182 immigrant women who lived in four provinces and D city. Subjects were completed the following questionnaires: demographic, medical service use, pregnancy and childbirth, and health management during the ante-postpartum. RESULTS: The average age of subjects was 28.96 and 83 subjects (45.6%) were coming from Vietnam. 55 Subjects (30.2%) were within the low-income group with less than 4 million won per month. So, 62 subjects were uninsured women because of the expensive costs. Subjects mainly visited a health care center with their husband. On the using a health care center, subjects complained about communication difficulties and transportation problems. 42 Subjects were pregnant but 21.4% of pregnant subjects did not receive antenatal care. Subjects got information about pregnancy and childbirth through their husbands and husband's family. CONCLUSION: Nursing intervention to manage the pregnancy, childbirth, and the postpartum of immigrant women need to be developed and should include strategies to take care of themselves after delivery and provide knowledge and information about ante-postpartum.
Cultural Diversity ; Delivery of Health Care ; Delivery, Obstetric ; Emigrants and Immigrants ; Female ; Humans ; Medically Uninsured ; Parturition ; Postpartum Period ; Pregnancy ; Research Design ; Spouses ; Transportation ; Vietnam