According to Organization of Economic Co-operation and Development health statistics data, out-of-pocket expenditures account for 36.8% of current health expenditures in Korea, in contrast to the Organization of Economic Co-operation and Development average of 20.3%. The government has announced the implementation of a new healthcare policy to reduce out-of-pocket expenditures. Korea already has a universal coverage system for most essential health care services. Even though health services based on out-of-pocket expenditures are usually optional, and are supported by lower levels of evidence, the National Health Insurance program has promised to cover all medical services except for cosmetic plastic surgery. This will drive more demand for optional health services and drain healthcare resources. Korea needs improvement of its quality care system instead of high-cost optional services, because of the rapid transition to an aging society.
Aging ; Delivery of Health Care* ; Fantasy* ; Health Expenditures ; Health Services ; Insurance Coverage ; Korea* ; National Health Programs ; Surgery, Plastic ; Universal Coverage

A gap in the number of physicians caring for inpatients is expected in 2014 based on the restricted working hours for Korean medical residents. One potential solution is the use of hospitalists. The US hospitalist movement has proliferated due to high-quality care and economics. This movement has brought positive changes including a shorter length of hospital stay, increased quality of care, and greater patient satisfaction. Because the Korean government controls all suppliers and maintains a low financial compensation level for universal coverage, hospitals do not have the financial resources to introduce hospitalists. Therefore, in contrast to the US, the use of hospitalists must be developed as a cost-compensated system in Korea. Institutional strategies must be introduced to develop a hospitalist system in Korea. A hospitalist system in Korea would be distinct from that in the US. Further studies and specific strategies are needed that consider Korea's circumstances to effectively introduce a hospitalist system.
Compensation and Redress ; Hospital Medicine ; Hospitalists* ; Humans ; Inpatients ; Korea ; Length of Stay ; Patient Satisfaction ; Universal Coverage

OBJECTIVES: This study examined the validity of the principal diagnoses on discharge summaries and coding assessments. METHODS: Data were collected from the National Health Security Office (NHSO) of Thailand in 2015. In total, 118,971 medical records were audited. The sample was drawn from government hospitals and private hospitals covered by the Universal Coverage Scheme in Thailand. Hospitals and cases were selected using NHSO criteria. The validity of the principal diagnoses listed in the “Summary and Coding Assessment” forms was established by comparing data from the discharge summaries with data obtained from medical record reviews, and additionally, by comparing data from the coding assessments with data in the computerized ICD (the data base used for reimbursement-purposes). RESULTS: The summary assessments had low sensitivities (7.3%–37.9%), high specificities (97.2%–99.8%), low positive predictive values (9.2%–60.7%), and high negative predictive values (95.9%–99.3%). The coding assessments had low sensitivities (31.1%–69.4%), high specificities (99.0%–99.9%), moderate positive predictive values (43.8%–89.0%), and high negative predictive values (97.3%–99.5%). The discharge summaries and codings often contained mistakes, particularly the categories “Endocrine, nutritional, and metabolic diseases”, “Symptoms, signs, and abnormal clinical and laboratory findings not elsewhere classified”, “Factors influencing health status and contact with health services”, and “Injury, poisoning, and certain other consequences of external causes”. CONCLUSIONS: The validity of the principal diagnoses on the summary and coding assessment forms was found to be low. The training of physicians and coders must be strengthened to improve the validity of discharge summaries and codings.
Clinical Coding* ; Diagnosis* ; Hospitals, Private ; International Classification of Diseases* ; Medical Records ; Poisoning ; Sensitivity and Specificity ; Thailand* ; Universal Coverage

Vietnam has pursued universal health insurance coverage for two decades but has yet to fully achieve this goal. This paper investigates the barriers to achieve universal coverage and examines the validity of facilitating factors to shorten the transitional period in Vietnam. A comparative study of facilitating factors toward universal coverage of Vietnam and Korea reveals significant internal forces for Vietnam to further develop the National Health Insurance Program. Korea in 1977 and Vietnam in 2009 have common characteristics to be favorable of achieving universal coverage with similarities of level of income, highly qualified administrative ability, tradition of solidarity, and strong political leadership although there are differences in distribution of population and structure of the economy. From a comparative perspective, Vietnam can consider the experience of Korea in implementing the mandatory enrollment approach, household unit of eligibility, design of contribution and benefit scheme, and resource allocation to health insurance for sustainable government subsidy to achieve and sustain the universal coverage of health insurance.
Eligibility Determination ; Humans ; Income ; National Health Programs/*economics ; Republic of Korea ; Socioeconomic Factors ; Universal Coverage/*economics ; Vietnam

How much the Government should provide for its people in sickness and in health, till death do us part, is open to different interpretation in different societies. One of the great paradoxes is that welfare states with high taxation can be globally competitive, innovative, successful market economies, and still provide quality universal healthcare. The Nordic countries, classical welfare states, have achieved top global ranking in economic competitiveness. Denmark's people are the most satisfied with their healthcare in the world, and the world's fourth most responsive healthcare system. This paper examines some of the factors that have made Denmark a successful, open and civil society that provides free-access healthcare to all of its people.
Culture ; Denmark ; Humans ; National Health Programs ; Quality of Health Care ; Singapore ; Social Security ; Social Welfare ; Universal Coverage

This year marks the 40th anniversary of the introduction of National Health Insurance (NHI) which has contributed to improving public health and accessibility. This article aims to show the trends of main indicators during the last 40 years. NHI has achieved rapid expansion of target population (1977–1989). The percentage of population covered increased from 8.8% in 1977 to 94% in 1990. The average number of visit days per person was 0.75 in 1977 but significantly increased to 31.11 in 2015. In 2015, NHI revenues were 52.4 trillion won and expenditures were 48.2 trillion won which is 9.5 times and 9.6 times higher than in 1995. NHI achieved universal coverage in short period of time and has contributed to improving the healthcare status. However, there still remain problems including low-benefit coverage and high out of pocket money. Therefore, the effort to reform these problems is needed.
Anniversaries and Special Events ; Delivery of Health Care ; Health Expenditures ; Health Services Needs and Demand ; Humans ; National Health Programs* ; Public Health ; Universal Coverage

This year marks the 40th anniversary of the introduction of National Health Insurance (NHI) which has contributed to improving public health and accessibility. This article aims to show the trends of main indicators during the last 40 years. NHI has achieved rapid expansion of target population (1977–1989). The percentage of population covered increased from 8.8% in 1977 to 94% in 1990. The average number of visit days per person was 0.75 in 1977 but significantly increased to 31.11 in 2015. In 2015, NHI revenues were 52.4 trillion won and expenditures were 48.2 trillion won which is 9.5 times and 9.6 times higher than in 1995. NHI achieved universal coverage in short period of time and has contributed to improving the healthcare status. However, there still remain problems including low-benefit coverage and high out of pocket money. Therefore, the effort to reform these problems is needed.
Anniversaries and Special Events ; Delivery of Health Care ; Health Expenditures ; Health Services Needs and Demand ; Humans ; National Health Programs* ; Public Health ; Universal Coverage

Korean National Health Insurance (NHI) was established during only 12 yr from its inception (1977-1989), providing universal medical coverage to the entire nation and making a huge contribution to medical security. However, the program now faces many challenges in terms of sustainability. The low birth rates, aging population, low economic growth, and escalating demands for welfare, as well as unification issues, all add pressure to the sustainability of NHI. The old paradigm of low contribution - low benefits coverage - low NHI's fee schedule needs to be replaced by a new paradigm of proper contribution - adequate benefit coverage - fair NHI's fee schedule. This new paradigm will require reform of NHI's operating system, funding, and spending.
Health Care Reform ; Humans ; National Health Programs/*economics ; Program Evaluation ; Republic of Korea ; Risk Factors ; Universal Coverage/economics

Health Insurance and Review Assessment (HIRA) in South Korea, also called National Health Insurance (NHI) data, is a repository of claims data collected in the process of reimbursing healthcare providers. Under the universal coverage system, having fee-for-services covering all citizens in South Korea, HIRA contains comprehensive and rich information pertaining to healthcare services such as treatments, pharmaceuticals, procedures, and diagnoses for almost 50 million beneficiaries. This corpus of HIRA data, which constitutes a large repository of data in the healthcare sector, has enormous potential to create value in several ways: enhancing the efficiency of the healthcare delivery system without compromising quality of care; adding supporting evidence for a given intervention; and providing the information needed to prevent (or monitor) adverse events. In order to actualize this potential, HIRA data need to actively be utilized for research. Thus understanding this data would greatly enhance this potential. We introduce HIRA data as an important source for health research and provide guidelines for researchers who are currently utilizing HIRA, or interested in doing so, to answer their research questions. We present the characteristics and structure of HIRA data. We discuss strengths and limitations that should be considered in conducting research with HIRA data and suggest strategies for optimal utilization of HIRA data by reviewing published research using HIRA data.
Delivery of Health Care ; Diagnosis ; Health Care Sector ; Health Personnel ; Humans ; Insurance, Health* ; Korea* ; National Health Programs ; Universal Coverage

On May 1, 2019, the Minister of Health and Welfare announced publicly the first Comprehensive Plan of National Health Insurance (NHI). The Comprehensive Plan which is the 5-year plan including expenditure and revenue aspect of NHI, is desirable in 42 years of introduction of NHI and 30 years of universal coverage of NHI, though the Plan was late and had some conflict process. The Comprehensive Plan was established without evaluation of Moon's Care Plan, did not included to relationship with NHI and other health security systems, and did not have the blue print of NHI. The Plan was not sufficient in content of adequate health care utilization and relationship with service benefit and cash benefit. The Comprehensive Plan should be modified in considering the blue print of NHI and national healthcare system with participating stakeholder in turbulent environment-low fertility, rapid ageing, low economic growth rate, era of non-communicable diseases, unification of the Korean Peninsula, and 4th industrial revolution. Therefore, I suggest to establish the President's Committee of Improving Healthcare System for the blue print of health care and NHI.
Clergy ; Delivery of Health Care ; Economic Development ; Fertility ; Health Expenditures ; Humans ; National Health Programs ; Patient Acceptance of Health Care ; Universal Coverage