Estimation of the Number of HIV Infections and Time to Diagnosis in the Korea

BACKGROUND: Statistical data of undiagnosed people living with human immunodeficiency virus (PLHIV) are of great importance to human immunodeficiency virus (HIV) infection control. This study estimated the total number of PLHIV using nationwide claims data.METHODS: This study used data of the incident HIV cases identified by the National Health Insurance System between 2009 and 2015. The number of patients with acquired immune deficiency syndrome (AIDS) was identified by diagnoses or prescription records. The estimated number of PLHIV and the time to diagnosis were calculated from the incident numbers of HIV and AIDS cases using the HIV Modeling Tool of the European Center for Disease Prevention and Control.RESULTS: Between 2009 and 2015, a total of 7,033 PLHIV and 2,899 AIDS patients were diagnosed. In 2009, the number of incident HIV cases was 873 (460 AIDS patients), increasing to 995 (337 AIDS patients) in 2015. Besides, the estimated number of prevalent cases was 10,753 in 2009, compared to 14,880 in 2015. Patients visiting health facilities accounted for 42.9% (4,616/10,753) in 2009 and 64.1% (9,544/14,880) in 2015. In 2009, there were 8,363 (77.8%) undiagnosed HIV cases, experiencing a decline to 6,215 (41.8%) in 2015. It took a mean of 6.96 years to diagnose after HIV infection.CONCLUSION: This study estimates the total burden of HIV infection in Korea for the first time using an internationally recognized HIV modeling tool. Claims data can be used to estimate the number of undiagnosed cases by identifying the total number of PLHIV and AIDS patients visiting health facilities.

Descriptive analysis of prevalence and medical expenses of cancer, cardio-cerebrovascular disease, psychiatric disease, and musculoskeletal disease in Korean firefighters

Implementation of Korean Clinical Imaging Guidelines: A Mobile App-Based Decision Support System

OBJECTIVE: The aims of this study were to develop a mobile app-based clinical decision support system (CDSS) for implementation of Korean clinical imaging guidelines (K-CIGs) and to assess future developments therein. MATERIALS AND METHODS: K-CIGs were implemented in the form of a web-based application (http://cdss.or.kr/). The app containing K-CIGs consists of 53 information databases, including 10 medical subspecialties and 119 guidelines, developed by the Korean Society of Radiology (KSR) between 2015 and 2017. An email survey consisting of 18 questions on the implementation of K-CIGs and the mobile app-based CDSS was distributed to 43 members of the guideline working group (expert members of the KSR and Korean Academy of Oral and Maxillofacial Radiology) and 23 members of the consultant group (clinical experts belonging to related medical societies) to gauge opinion on the future developmental direction of K-CIGs. RESULTS: The web-based mobile app can be downloaded from the Google Play Store. Detailed information on the grade of recommendation, evidence level, and radiation dose for each imaging modality in the K-CIGs can be accessed via the home page and side menus. In total, 32 of the 66 experts contacted completed the survey (response rate, 45%). Twenty-four of the 32 respondents were from the working group and eight were from the consulting group. Most (93.8%) of the respondents agreed on the need for ongoing development and implementation of K-CIGs. CONCLUSION: This study describes the mobile app-based CDSS designed for implementation of K-CIGs in Korea. The results will allow physicians to have easy access to the K-CIGs and encourage appropriate use of imaging modalities.

Determinants on aged population’s health expenditures in China / 中国卫生政策研究

Objective:To provide references for policy-making on the establishment of a sound healthcare sys-tem for China’s aged population. Methods:Based on the framework of The Behavioral Model of Health Services Use and data from China Health and Retirement Longitudinal Study in 2011 , the Tobit model of aged population’s health expenditures is built. Results: Self-rated health conditions, chronic disease, medical insurance, endowment insur-ance, self-rated living standard, age, gender, marital status and urban-rural character are the significant determi-nants. Conclusions:The healthcare system for China’s aged population should be built through simultaneously apply-ing disease prevention and access facilitation policies and the characteristic differences of different groups of aged pop-ulation should be taken into consideration.

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.

Current Status of Health Insurance in the Treatment of Helicobacter Pylori Infection / 한양의대학술지

Since medical insurance has been applied from 1977 in Korea, it finally launched itself as a current nationwide health insurance system. Because medical science is ever changing, various novel methods of diagnosis and treatment are now clinically used after basic and clinical research. Therefore, the health insurance system should be covered by novel or updated methods of evidence-based treatment, if possible. Guidelines for the treatment of H. pylori infection are different according to its prevalence and regional H. pylori associated disease pattern. FDA approved the 2 weeks PPI-based triple therapy for indications of treatment with H. pylori infection, however, only 1 week triple therapy for H. pylori positive peptic ulcer disease is covered by the Korean health insurance system. The insurance coverage should be expanded to provide for good quality of life of patients after endoscopic mucosal resection of early gastric cancer, longtime H. pylori positive NSAID user, and with a family history of gastric cancer from evidence based medicine. In the future, if we get positive results of H. pylori treatment for chronic atrophic gastritis, functional dyspepsia, and prevention of gastric cancer, it can be added as accepted indications of H. pylori therapy.

The study on the development of relative value in medical treatment of the oral and maxillofacial surgery

The aim of this study is to evaluate the reasonableness of the medical fee on oral and maxillofacial surgery field according to surgeon's opinions and actual conditions. The medical fee has significant influence on hospital income, the supply and distribution of medical manpower, quality and facilities of medical services. Questionnaire survey was sent to 86 oral and maxillofacial surgeons who worked more than 3 years in general hospital. Among them, 25 doctors replied the 109 answers survey and the average of treatment time and physician work relative value on each category was calculated. And the health insurance cost (that has been applied since 2003) was compared with the questionnaire results. And finally we investigated items that health insurance system did not include in oral and maxillofacial field but actually performed in oral and maxillofacial surgery clinic. The result was that the medical fee did not properly reflect physician work relative value of actual treatments. In case of complicated extraction, work relative value needed 3.5 times enhancement of present value. For simple impacted tooth extraction 1.8 times, for impacted tooth extraction including odontomy 1.7 times, and for fully impacted tooth more than 2/3 of it located into the alveolar bone, 1.8 times enhancement needed. In respect of the present physician work relative value, hemimandibulectomy with neck lymph node dissection for the malignancy is appropriated as 3.3 times of open reduction and internal fixation for the mandibular fracture, but the questionnaire result showed 25 times discrepancy. In conclusion, this research shows the need for intervention that health insurance included items and legal relative medical value must act in union with treatment in clinic to reduce the imbalance between them.

Design and realization of the interface between "No.1 Military" Project and health insurance system of Xinqiao Hospital / 医疗卫生装备

With the wide spread of social health insurance system,Xinqiao hospital,a health insurance unit,interfaces HIS with health insurance system.With the application to Xinqiao Hospital and key features of health insurance system presented,this paper introduces the method for interfacing HIS of ″No.1 Military″ Project with health insurance system,thus can be referenced by other hospitals.

Direction of Health Care and Health Insurance System Reform to Strengthen Primary Care: Comparative Analysis of Korea, Japan and Taiwan

BACKGROUND: This study aims to find the direction of health care and health insurance system reform to strengthen primary care in Korea. METHODS: A comparative analysis was performed on health care system and health insurance system between Korea, Japan, and Taiwan. RESULTS: (1) Functional differentiation between the hospital and the clinic is unclear and many clinics run beds for in-patient care. However, Japan and Taiwan have clear rule on the function of the hospital and the clinic, and only temporary observation beds are allowed for the clinic. (2) Health service delivery system is not defined in the Korean Health care Act. However, Japan and Taiwan have rules on health service delivery system in their health care act. (3) The system of co-payment ceiling is operated in Japan and Taiwan, but not in Korea. And Taiwan has various co-payment system including exemption of co-payment to fulfill the mission of health security. (4) Japan and Taiwan have many fee schedules for enforcing primary care, while Korea has little. CONCLUSION: Health care and health insurance system should be reformed in order to strengthen primary care. Most of all, the role of the hospital and the clinic should be classified. Fee schedule for primary care should be changed to encourage coordinated management of chronic diseases. Reform of co-payment system is also required.

Development of Health Insurance Rate-Setting System Utilizing Data Mining Technique / 대한의료정보학회지

The objective of this study is to present a new approach to the development of national health insurance rate-setting system using data mining technique. In particular, this paper examines the feasibility of applying the rate-setting system for the regional insurance program to the insureds of the workman' s insurance program, so that the unified rate-setting system can be developed. The subjects of the study were the beneficiaries(sample size = 234,224) of the workman' s insurance program(excluding government officials and teachers) residing in Goyang City. 1998 data from Korean Medical Insurance Corporation were analyzed through various data mining techniques such as Decision Tree, Regression, Assessment and SCORE. Major results and conclusions are as follows: 1) On average, the insured' s property element of insurance fee, automobile element of insurance fee, property score of income assessment, and automobile score of income assessment together accounted for only 16% of the actual income, which implies that we need more precise data in order to develop an equitable rate-setting system. 2) To do so, it is necessary to gather all the income-related data(property income, financial income, earnings, ...) in a timely manner. Since current computer and information system would not allow efficient maintenance and utilization of such data, it would also be necessary to establish data warehouse for this purpose. 3) In developing the rate-setting system on the basis of data warehouse, various data mining techniques should be employed to ensure the equity of insurance rates among different classes of insureds.

Opinions of Obstetricians and Gynecologists in Kagoshima Prefecture about the Rules of Medical Services Based on the Health Insurance System in Japan and Learning about them in University Departments / 医学教育

The shortage of financial resources for medical services is an important social issue in Japan. To examine what obstetricians and gynecologists think about the rules of medical services based on the Japanese national health insurance system, questionnaires were sent in August 1999 to obstetricians and gynecologists in Kagoshima prefecture. Valid responses were obtained from 63% of questionnaire recipients, including 17 obstetricians and gynecologists of the Department of Obstetrics and Gynecology, Kagoshima University, 25 working at public hospitals, and 56 working at private hospitals. These physicians thought that medical services should be performed according to the rules based on the health insurance system. However, physicians at Kagoshima University or at public hospitals knew little about the rules as they had not been adequately instructed by senior doctors. Physicians working at private hospitals also reported that they had not been taught the rules during their postgraduate training at university hospitals. All respondents thought that the rules of medical services based on the health insurance system must be included in the postgraduate education system.

A Study of the allocation of health resources under the health insurance program / 中华医院管理杂志

To set up a health insurance program to facilitate a rational allocation of health re- sources,a scientific theory of health economics must be founded as a guidance and the percentage of the supply of health resources must be fixed in the GNP Consideration should be given to the ways in which the limited health resources are to be well allocated with the financial performance of the service units guaranteed at the same time.The current allocation of China's health resources indicates that the insuf- ficiency of national input go hand in hand with the false appearance of the ouersupply of such resources, which is called the"False Appearance Demand relationship"or"Nonensuring Line Demand Relationship".The divergence between the ensuring line and the nonensuring line shows the irrational waste-causing allocation of health resources.To help the establishment and improvement of China's health security system and make full and rational use of the health resouces,a social insuring line show- ing the regular total input of health resources muse be plotted;the macro—control function of the gov- ernment given full play;the reimbursement mechanism of medical cost improved;and the application of the law of value to the allocation of health resources instituted under the principle of fairness.