This study is to analyze the change of the health insurance policy in the 1970s in relation to social welfare discourse. The public health care in Korea was in very poor condition around the first amendment of the National Health Insurance Act in 1970. Furthermore, due to the introduction of new medical technology, increasing number of big hospitals participating in the medical market, inflation, and other factors, medical expenses skyrocketed and made it hard for ordinary people to enjoy medical services. Accordingly, the social solution to the problem of medical expenses which an individual found hard to deal with became of demand. And as the way to the solution, it was inevitable to consider the introduction of health insurance as social insurance. In this condition, Park regime began to stress the social development from the 1960s. It was to aim to settle various social problems triggered by the rapid industrialization in the 1960s through social development as well as economic development. As the social development was emphasized, the matter of social welfare appeared of importance and led to the first amendment of the National Health Insurance Act in 1970. However, it was impossible for Korean government to enforce a nationwide health insurance. The key issue was how to fund it. Park regime was reluctant to use government fund; it was also hard to burden private companies. Even while the health insurance policy was not determined yet for this reason, the social demand for health insurance became large and large. In particular, in the midst of the first "Oil Shock" which gave a big blow to people's living condition from the late 1973, some reported issues in relation to health service, such as hospitals' rejection of the poor, became a big problem. Coupled with the social demand for a health insurance system, the changes occurred within the medical community was also important. Most of all, hospitals was facing the decrease of the effectiveness of their medical facilities. Therefore, they began to see health insurance as a means of developing potential demand for medical service. In addition, the business world, which already expanded their own corporate welfare for employees from the early 1970s, sharing the idea that it was impossible to keep the issue of public health insurance unsolved, showed an enthusiastic attitude. These factors finally enabled Park regime to adopt the public health insurance system. Likewise, it is critical to understand the establishment of the public health insurance system in Korea through pursuing the process to it. What matters is the discoursive changes as well as the changes in social condition around the establishment, not merely the policy changes per se. Then most people, including decision makers in Park regime, thought of social welfare as a privilege developed countries. Thus, in the 1970s when unbalanced industrialization brought about widening gap between social classes, the employment of a social welfare policy could be recognized as a symbol of an escape from backwardness. In fact, with the introduction of the national health insurance in the 1970s, Park regime could fortify the material fundamental of a social welfare discourse which would be mobilized to strengthen the dichotomous discourse of developedness and backwardness and to dump the social crisis caused by Park regime's industrialization drive on the next generation.
Health Policy/economics/*history ; History, 20th Century ; Humans ; National Health Programs/*history ; Public Health/economics/history ; Social Welfare/economics/*history

Due to technological advances and the establishment of evidence-based medicine, radiological examinations are playing a crucial role in modern medicine, as a result of which they have been steadily increasing, and the rate of increase has intensified in the 2000s. Although this is a global phenomenon, the increase of radiological examinations in Korea is also high due to the introduction of the National Health Insurance Coverage Expansion Policy, so-called Moon Jae-in Care, for ultrasonography and magnetic resonance imaging. For accurate and rapid diagnosis of diseases, it is necessary for doctors to order appropriate radiological studies. However, the increase in radiological examination has created many problems, such as increased medical costs, decreased diagnostic accuracy due to radiologist burnout, and increased patient exposure to radiation. To reduce unnecessary imaging studies, a number of measures could be deployed including the development of clinical guidelines to select appropriate radiological examinations for each clinical situation.
Diagnosis ; Evidence-Based Medicine ; History, Modern 1601- ; Humans ; Insurance, Health ; Korea ; Magnetic Resonance Imaging ; Moon ; National Health Programs ; Ultrasonography

Free medical care is currently a highly debated issue in Korea. However, from a practical point of view, 'completely free' medical care is impossible. Last year the National Health Insurance Corporation (NHIC) reported a huge deficit of up to 1.3 trillion in Korean won, which is the largest deficit in the past 10 years. NHIC expenditures are skyrocketing for many reasons: drug overuse, very expensive new drugs or devices increasing geriatric population and survivors of cancer or chronic illnesses, expanding insurance coverage for new diagnostic tests, drugs, neonates, rare diseases, disabilities, and cancer, occurrence of new diseases, increasing number of doctors, moral hazard, and wasting of resources due to the duplication and counteraction between modern medicine and Oriental medicine. What, then, should we do to provide partially free medical care? We need to reduce expenditures for drugs and increase health insurance premiums. Korean health insurance premium currently low compared to that of other countries in Organization for Economic Co-operation and Development. It is also necessary to introduce the concept of a health tax, in which healthy individuals with a high income pay higher premiums while sick or low-income individuals pay lower premiums. Expanding public health coverage such as vaccinations, regular health surveillance programs, and education on health promotion should be implemented. Private health care insurance can be introduced carefully with close monitoring. The last and most important recommendation is that society must become more ethical and transparent. Korea is entering a new era as a developed country and as a result a welfare system, including medical care is notoptional but is mandatory in some part. However, even a partially free medical care is going to be possible only if the entire health care system is operated in an ethical and efficient way for maximal utilization of limited resources while avoiding moral hazard and waste.
Chronic Disease ; Delivery of Health Care ; Developed Countries ; Diagnostic Tests, Routine ; Health Expenditures ; Health Promotion ; History, Modern 1601- ; Humans ; Infant, Newborn ; Insurance ; Insurance Coverage ; Insurance, Health ; Korea ; Medicine, East Asian Traditional ; National Health Programs ; Public Health ; Rare Diseases ; Survivors ; Taxes ; Vaccination

OBJECTIVES: Since 2000, the National Health Service (NHS) in the United Kingdom (UK) has challenged for a large-scale reforms. This study aims to review those reforms to reflect in the dental care system in Korea. METHODS: Reports and papers that were published from 2000 to 2015 and were related to the NHS dental care system and reforms were searched. Among them, official reports from the government or organization were prioritized. RESULTS: In 2002, the “NHS Dentistry: Options for Change” report suggested rebuilding the structure to meet the standard of care, improving the remuneration system, and modernizing the workforce. Eight years later, the government proposed the “NHS Dental Contract: Proposals for Pilots” to improve accessibility to oral health and dental care. The pilot was based on three elements: registration, capitation, and quality. In 2015, the Department of Health announced the “Dental Contract Reform: Prototypes.” These prototypes include the clinical pathway, measurement and remuneration by quality of care, and a weighted capitation and quality model reimbursement system. CONCLUSIONS: The changes to the UK dental care system has implications. First, national coverage should be extended to improve accessibility to dental care. Second, the dental care system is necessary to reform focused on patient-centered and prevention. Third, registration and remuneration by quality of care needs to be introduced. Fourth, change should start from the basic steps, such as forming consensus or preparing manuals, to strengthening personnel and conducting a pilot study. Most of all, the new system will center on clinical leadership.
Consensus ; Critical Pathways ; Delivery of Health Care* ; Dental Care ; Dentistry ; Great Britain ; Health Care Reform* ; Health Manpower ; History of Dentistry ; Korea ; Leadership ; Legislation, Dental ; National Health Programs ; Oral Health ; Pilot Projects ; Remuneration ; Standard of Care

BACKGROUND: The purpose of this study was to investigate the distribution of systemic diseases and medications in patients older than 65 years of age who visited the hospital for implant treatment, as well as to investigate basic information about surgical complications that may occur after insured implant treatment. METHODS: A total of 126 patients over 65 years of age were treated for implant surgery from October 1, 2013 to October 30, 2016. Electronic chart review was conducted to obtain medical records, which included sex, age, systemic diseases, medication(s) being taken, and control of the medications. Five patients were excluded due to lack of medical records giving information about systemic disease. RESULTS: Of the 126 patients, 112 (88.9%) were taking medication due to systemic disease and 9 patients (7.1%) were not. The sex distribution was 71 women and 55 men and the highest proportion of patients were between 65 and 69 years old. The most common diseases were, from most to least frequent, hypertension, cardiovascular disease, diabetes, and osteoporosis. The drug groups that can cause major complications after dental treatment were classified as hemorrhagic, osteoporotic, and immunosuppressive agents, and were taken by 45 (35.7%), 22 (17.5%) and 4 (3.2%) patients, respectively. CONCLUSION: Given that 88.9% of the elderly patients who were eligible for insurance implant treatment had systemic disease, it is necessary to carefully evaluate patients' medical histories and their general conditions in order to prevent emergencies during implant surgery.
Aged* ; Cardiovascular Diseases ; Delivery of Health Care* ; Dental Implants* ; Emergencies ; Female ; Humans ; Hypertension ; Immunosuppressive Agents ; Insurance* ; Korea* ; Male ; Medical History Taking ; Medical Records ; National Health Programs ; Osteoporosis ; Postoperative Complications ; Sex Distribution