A survey on the appropriate level of premiums for National Health Insurance

As the National Health Insurance Law was established in 2000, the finances of workplace health insurance and regional health insurance were integrated. However, since employee health insurance (workplace insurance) and self-employed health insurance (community insurance) still use different contribution rating systems, the problem of inequity of premiums has caused ongoing controversy. Therefore, to examine the public's satisfaction with premiums calculation methods, and collect opinions on solving the problem of inequity of premiums, this survey was performed. A computer-assisted telephone interview with multi-stage stratified sampling of the population in Korea was performed. Responses were obtained from 1,016 people aged 25 to 64 years. The analyses showed that, to the question about the premiums calculation methods, more respondents answered that they were unsatisfied (41.4%) than satisfied (36.6%). The responses differed depending on the type of health insurance. The proportion of those who were satisfied with their insurance was relatively higher among those with employee health insurance. On the other hand, among those with self-employed health insurance, the proportion of those who were dissatisfied with insurance was 3 times more common than satisfaction with it, showing that those who belong to the self-employed health insurance group are less satisfied with the premiums calculation methods. It was also found that the majority people perceive that the current single payer health insurance system should be divided into mutually separate employee and self-employed health insurance systems or a multiple payer health insurance system (60.3%). To achieve premium equity in the future, the Health Insurance Corporation should make a greater effort to determine income levels correctly. In the institutional improvement process of the premiums contribution rating system in the future, it seems necessary to carry out further research on a multiple payer insurance system reflecting the attitudes and demands of the people.

A survey of the medical practitioners' offices in Korea 2011

Because of various current problems and issues which are low health insurance medical fee of National Health Insurance Corporation, extreme competition with very large general hospitals, new supply of more than of 3,000 new doctors, many medical practitioner's offices who are suffering management difficulties are increasing. In order to investigate their current overall management situations, we made this study through statistical extraction procedures with the sample population of the medical practitioners which are registered in Korean Medical Association and subsequently we made the study with 1,031 selected cases. The average number of patients is 53.6 patients per day. 44.4% of the medical practitioners' offices are working at night and legal holidays and 8.5% are working at Sunday. Average working hours is 50.1 hours per week, which greatly exceeds 40 hours per week that is regulated in the Labor Standards Act. According to the management performance analysis of those medical clinics through profit and loss statements, average total annual sales revenue in 2010 fiscal year was 444,167,867 KRW, the expenses were 314,217,081 KRW and the earnings before taxes was 129,940,786 KRW. The average net profit (earnings before taxes) of the director of the medical practitioners' offices was 122,337,868 KRW per year and 10,194,822 KRW per month. According to the study results, we have found that we need to increase doctor's bill for outpatient, and establishment and its improvement of medical service delivery systems and classification standards of medical services for first and succeeding outpatients. Considering overall results of the study, readjustment of outpatients' treatment fees and reestablishment of more efficient medical service delivery systems which require the first medical service is to be provided properly should be realized in order to improve the management performance of the medical practitioners' offices.

Financial state of primary care physicians under the Korean insurance system

Greater than its influence on the medical practitioner's individual ability is the National Health Insurance System's influence on the management of medical practitioners' offices in Korea. However, despite the important effect health insurance exerts on the income of medical clinics, recently, the financial difficulties of medical clinics have often become an issue, and financial difficulty has been aggravated as much as a solution has been sought. The current state of the overall management of medical clinics was investigated to understand the factors influencing the sales and expenses in their management. A questionnaire was completed by 1,009 physicians registered in the Korean Medical Association who were participating in a statistical extraction course. As a result of the study, the factors influencing the total revenue and total expenditures of medical clinics, such as increases in the total number of doctors, increasing numbers of outpatients, the size of the medical office, medical disputes, and clinical specialties (based on the first medical treatment) showed statistical significance. In conclusion, in order to improve medical clinic management, a health insurance medical fee should be more reasonably fixed, a medical transfer system should be reestablished, and a cooperative strategy should be created for medical clinics and general hospitals in order to attract patients. As a result, low cost and highly efficient medical services could be provided and the satisfaction of patients improved.

Pros and Cons of For-profit Hospitals and Policy Alternatives

Currently, the Korean government is actively advocating the need to allow for-profit medical institutions. According to the government, the establishment of for-profit medical institutions would further improve the quality of medical services and create new employment. However, the issue has triggered a social controversy between the two major parties of interest; some claim that for-profit hospitals would only cause negative effects while the others emphasize the advantages of such institutions. Proponents of for-profit hospitals argue that this new type of medical institution would enable patients to receive more diverse and advanced medical services. In addition, they also believe that hospitals would experience more efficient and transparent management, raise capital with greater ease, and in turn, use the additional funds for more sophisticated medical research. On the other hand, opponents claim that they would only increase medical expenses while decreasing access to medical care. The goals that the government seeks to achieve with for-profit medical institutions can be accomplished by eliminating or easing regulations on existing hospitals and clinics. The introduction of for-profit medical institution is expected to deliver the projected benefits not solely because the current medical institutions are non-profit but because they are banned from pursuing commercial activities by law and regulation. Before considering plans to establish for-profit medical institutions, priority should be on easing or eliminating regulations that interfere with market principles such as compulsory participation of medical institutions in national medical insurance should be eliminated or eased

Reorganization of the Medical Delivery System: A Cause for the Patients

There is a growing concern regarding the overly biased patient flow toward large hospitals. The seriousness of the current situation is clearly shown by the fact that the top five causes for visitation to such full-sized hospitals include common cold, primary hypertension, and diabetes; as a result, local medical offices does little more than merely referring patients to the large hospitals. n other words, the specific functions of different kinds of medical facilities are unable to be carried out in a definitive fashion. If such trend continues to dominate the medical delivery system, the sustainability of national health insurance might be compromised. In order to prevent destabilization of the national health insurance, the rigid regulation of medical delivery system must be put into practice through reorganization of the various medical providers in terms of their functions.