The objective of this study is to provide basic information and policy implications needed to balance the supply and demand for dietitian by projecting supply and demand for dietitian. The data from the Ministry of Health Welfare and Family on the number of licensed nutritionist, resident registration data of the Ministry of Public Administration and Security, and health insurance qualification data of the National Health Insurance Corporation were used to examine the current status of supply. To project the supply of nutritionist workforce, the in-out moves method and demographic method were used. The ratios of nutritionist to population and GDP, and that of other countries were applied as the demand projection method. According to the study results, the projection on the imbalance of supply and demand for dietitian by year 2021 differs depending on the method used. First, according to the results based on age-adjusted population ratio, there is an oversupply of 1,643 dietitians in year 2010, and 2,076 dietitians in year 2020. Second, although the projection on the imbalance of the supply and demand for dietitian differs depending on whether the GDD is calculated in won(won) or dollar($). it is expected that there will be an oversupply in general. Third, as to the scenario using the nutritionist ratio in foreign countries, the oversupply of dietitian is likely in Korea, under any scenario, when comparing the nutritionist supply projection with the demand projection based on the nutritionist ratio in the United States. However, the projection of the supply and demand varies in each scenario when the European nutritionist ratio is applied. Under European 'scenario 1', an oversupply is expected, whereas under 'scenario 2', a shortage of supply is expected. A careful approach is required in interpreting the supply and demand projection using criteria of other countries, because dietitian assumes different roles and functions in each country. Although a slight oversupply of nutritionist workforce is projected, it does not cause a major problem as the demand for diet therapy is expected to rise due to aging and the increase of chronic diseases, and as the demand for clinical dietitians in hospitals increases. Accordingly, the demand for dietitians will rise and, in this context, the oversupply of nutritionist will not incur much problem. However, the nutritionist qualification is much too open in Korea, and this has a negative effect on the quality of the nutritionist workforce. Therefore, it is important that the nutritionist qualifications and requirements are reinforced in the future, enhance the quality level of the nutritionist supply, and maintain the balance between the supply and demand.
Aging ; Chronic Disease ; Guanosine Diphosphate ; Humans ; Insurance, Health ; Korea ; National Health Programs ; United States

BACKGROUND: Mupirocin, a topical antimicrobial agent has been used for patients with methicillin-resistant Staphylococcus aureus and recently mupirocin resistance was issued in some studies. The objective of this study was to analyze prescription patterns of topical mupirocin, to evaluate appropriateness of prescriptions in the ambulatory setting, and to compare frequency of mupirocin usage in South Korea with that in United States. METHODS: Topical mupirocin prescription patterns (the number of prescription and a prescription period), and appropriateness of prescription (including a prescription rate over 10 days, a repeat prescription rate within 30 days and a prescription rate within labeled indications) were analyzed using the 2012 Health Insurance and Review and Assessment service-National Patient Sample dataset of South Korea. The National Ambulatory Medical Care Survey dataset was used to quantify topical mupirocin prescription in United States for comparison. RESULTS: In South Korea, the prescriptions rate for use over 10 days was 3%, the repeat prescription rate within 30 days was 8.87% and the prescription proportion within labeled indications was 33.84%. The most frequent diagnostic code was nonbacterial infection. The prescription rate per 1000 population of topical mupirocin in South Korea was calculated to be 46.07, whereas in United States was calculated to be 13.10. CONCLUSION: Topical mupirocin has been used frequently and inappropriately, so further studies are required to investigate the rationale behind such prescribing mupirocin patterns.
Ambulatory Care* ; Dataset ; Health Care Surveys ; Humans ; Insurance, Health ; Korea ; Methicillin-Resistant Staphylococcus aureus ; Mupirocin* ; National Health Programs* ; Prescriptions* ; United States

Health technology assessment was first introduced to the Republic of Korea in 2006 by amending the Medical Services Act. The Committee of New Health Technology Assessment (CNHTA) is the ministerial committee that has the responsibility of reviewing the safety and effectiveness of new health technology. CNHTA review plays a gatekeeping role for new health technology in Korea, which can increase the burden on patients in Korea, either by out-of pocket payments or co-pays for National Health Insurance covered service. This kind of gatekeeping is a function of the healthcare system in many countries where no financial cap such as a fixed budget or diagnosis-related group payment is applied. However, it has been argued that gatekeeping works against industrial promotion policy. The one-stop service introduced in 2014 is a system similar to US parallel review between the US Food and Drug Administration and Centers for Medicare and Medicaid Services. This service provides a simultaneous process of regulatory review by the Ministry of Food and Drug Safety, identification of existing technology by the Health Insurance Review and Assessment Services, and new health technology assessment by the National Evidence-based Healthcare Collaborating Agency and the Ministry of Health and Welfare. This service is expected to reduce the total review process by 3 to12 months. A limited health technology appointment service was introduced in April 2014. This service designates orphan health technologies and health technologies for rare and incurable diseases and supports evidence development at designated hospitals. Several countries have similar systems: US Coverage with Evidence Development, Canadian Conditionally Funded Field Evaluation, UK Only in Research, and many others. The future direction of Health technology assessment should focus on the life cycle management of health technology. A consistent, continuous, and transformative mechanism to manage from the research and development of health technology to delisting obsolete technology to make room for new innovative technology is warranted.
Biomedical Technology* ; Budgets ; Centers for Medicare and Medicaid Services (U.S.) ; Child ; Child, Orphaned ; Delivery of Health Care ; Diagnosis-Related Groups ; Financial Management ; Gatekeeping ; Humans ; Insurance, Health ; Korea ; Life Cycle Stages ; National Health Programs ; Republic of Korea ; United States Food and Drug Administration

PURPOSE: Pancreaticoduodenectomy (PD) is a complex surgery associated with high morbidity, mortality, and cost. Municipal hospitals have their important role in the public health and welfare system. The purpose of this study was to identify the feasibility as well as the cost-effectiveness of performing PD in a mid-volume municipal hospital based on 13 years of experience with PD. METHODS: From March 2003 to November 2015, 183 patients underwent PD at Seoul Metropolitan Government - Seoul National University Boramae Medical Center.. Retrospectively collected data were analyzed, with a particular focus on complications. Hospital costs were analyzed and compared with a national database, with patients divided into 2 groups on the basis of medical insurance status. RESULTS: The percentage of medical aid was significantly higher than the average in Korean hospitals. (19.1% vs. 5.8%, P = 0.002). Complications occurred in 88 patients (44.3%). Postoperative pancreatic fistula (POPF) occurred in 113 cases (61.7%), but the clinically relevant POPF was 24.6% (grade B: 23.5% and grade C: 1.1%). The median hospital stay after surgery was 20 days (range, 6–137 days). In-hospital mortality was 3.8% (n = 7), with pulmonary complications being the leading cause. During the study period, improvements were observed in POPF rate, operation time, and hospital stay. The mean total hospital cost was 13,819 United States dollar (USD) per patient, and the mean reimbursement from the National Health Insurance Service (NHIS) to health care providers was 10,341 USD (74.8%). The patient copayment portion of the NHIS payment was 5%. CONCLUSION: Performing PD in a mid-volume municipal hospital is feasible, with comparable results and cost-effectiveness.
Health Personnel ; Hospital Costs ; Hospital Mortality ; Hospitals, Municipal* ; Humans ; Insurance Coverage ; Length of Stay ; Local Government ; Mortality ; National Health Programs ; Pancreatic Fistula ; Pancreaticoduodenectomy* ; Postoperative Complications ; Public Health ; Retrospective Studies ; Seoul ; United States

Objective: This study aims to explore and analyze the modern contraceptive use of National Health Insurance (NHI) participants before and during the COVID-19 pandemic in South Kalimantan, Indonesia. Methods: This research is an ecological study using aggregated data from 13 Districts/Cities in South Kalimantan. This study used secondary data in 2018-2020 from the official website of the National Population and Family Planning Agency. Spatial analysis and paired T-test were used. Results: There were 30.7% of Districts/Cities in stagnation and 30.7% in the decline of modern contraception use during the pandemic (2019-2020). In addition, the study showed that there were differences in the use of modern contraception before (2019) and during the COVID-19 pandemic (2020) among active family planning acceptors of NHI participants (p=0.048). Conclusion The existence of NHI, especially recipients of contribution assistance, can increase the use of modern contraception in South Kalimantan. There are differences in the use of modern contraception before and during the COVID-19 pandemic among NHI participants.
National Health Programs ; National Health Insurance ; COVID-19

OBJECTIVE: This study examined the Risk Sharing Agreement (RSA) on pharmaceutical pricing system in Korean national health insurance. Through RSA, the insurer was able to maintain the principles in the price listing process while managing the budget effectively and improving patient access to new drugs. Despite these positive effects, there are still issues raised by some stakeholders, such as lack of transparency in the listing process and doubts about its effectiveness. Therefore, we investigated the impacts of RSA on national health insurance financing and patient access to analyze the effects of RSA. METHODS: The impact of RSA was investigated by analyzing the health insurance claims data for 2014~2016. The degree of improvement in patient access was determined by the decreased amount of patients' payment. RESULTS: Results showed that the financial impact of RSA was not significant and patients' access to the new drug greatly improved. CONCLUSION: These results show that RSA is a good system for improving patient access to new drugs without additional expense on insurance.
Budgets ; Humans ; Insurance Carriers ; Insurance* ; Insurance, Health ; National Health Programs*

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*

PURPOSE: This study was done to investigate factors affecting perceived financial burden of medical expenditures. METHOD: The participants were 2,024 inpatients who were enrolled in a survey on the benefit coverage rate of the National Health Insurance in 2006. The collected data were analyzed using t-test, ANOVA-test, Mann-Whitney-test, Kruskal-Wallis-test, Chi-square test and logistic regression. RESULTS: The crucial factors for perceived financial burden were age, job, equivalence scale, ratio of annual family income vs medical expenditure, and private health insurance. Perceived financial burden was higher for people who were older, who were unemployed, whose medical expenditures were high compared to annual family income, whose index of family equalization was low and for those who had no private health insurance. CONCLUSION: The results of the study indicate a demand for system reform that will enable management of no-pay hospital bills in the National Health Insurance to decrease the medical expense of people in the low-income bracket.
Health Expenditures ; Humans ; Inpatients ; Insurance, Health ; National Health Programs

The aim of article is to introduce the current status of diabetes care and characteristics in diabetic patients in Korea, which is a joint report by Korean Diabetes Association (KDA) and Health Insurance Review Agency (HIRA) ("Diabetes in Korea 2007") and to review the recent published data about the current status of diabetes mellitus in Korea.
Diabetes Mellitus ; Humans ; Insurance, Health ; Joints ; Korea ; National Health Programs

This paper introduces the major issues related to the Health Insurance Act and the core content of recent precedents, in order to prevent health insurance arguments and to contribute to health insurance-related administrative litigation. The basis of Korea's health insurance system is the National Health Insurance Act. After providing medical services, the medical cost is covered by the National Health Insurance Corporation (NHIC). If the doctor was paid deceptively or improperly, then the NHIC will seize the entire payment, and the Minister of Health and Welfare will order the doctor to suspension practice or, similarly, fine the doctor for five times the original payment. In addition, doctors who have used deception will have their license suspended. If the doctor has any objection against this administrative measure, he or she can file an administrative lawsuit. So far, if the action was illegal, the court has generally made principle-based judgments, regardless of whether the behavior was intentional or negligent; however, recently, especially in cases related to the court of first instance (only a few cases), the court has made a judgment clearly cancelling the measure under the condition that the measure was beyond the level by analyzing the reason why the practitioner committed an offense. From the practitioners' point of view, it is encouraging that the judges have started to understand the reality of the medical field. Further, this paper argues that judges should increase their understanding the medical field and specific validity. This article reviews the litigation process related to the National Health Insurance Act and recent trends in its precedents. From now on, these judgments should support the arguments of practitioners. Con-clusively, these judgments were the result of legal actions; therefore, doctors should avoid taking an attitude of annoyance toward lawsuits or being intimidated by the organization, and as a result, respond passively by simply paying out the lawsuit settlements.
Deception ; Insurance, Health ; Judgment ; Jurisprudence ; Licensure ; National Health Programs