State Effects of Health Insurance Platforms

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	In conclusion, the article provides a robust overview of the Korean Health Security system, particularly the National Health Insurance program. It offers a detailed examination of its historical evolution, structure, and operational mechanisms. The research methodology, centred on a comprehensive analysis of various databases, ensures a thorough exploration of patient demographics, medical utilization, and insurance coverage. This article would greatly benefit audiences such as healthcare policymakers, researchers in health economics, and those interested in comparative healthcare systems. Policymakers can gain insights into the evolution of the Korean Health Security system, aiding in the development of effective health policies. Researchers in health economics can leverage detailed data assessment methodologies for comparative studies, while healthcare professionals can benefit from understanding the intricacies of the healthcare delivery system in Korea.		In conclusion, the article provides a robust overview of the Korean Health Security system, particularly the National Health Insurance program. It offers a detailed examination of its historical evolution, structure, and operational mechanisms. The research methodology, centred on a comprehensive analysis of various databases, ensures a thorough exploration of patient demographics, medical utilization, and insurance coverage. This article would greatly benefit audiences such as healthcare policymakers, researchers in health economics, and those interested in comparative healthcare systems. Policymakers can gain insights into the evolution of the Korean Health Security system, aiding in the development of effective health policies. Researchers in health economics can leverage detailed data assessment methodologies for comparative studies, while healthcare professionals can benefit from understanding the intricacies of the healthcare delivery system in Korea.
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		+	--[[User:Hn20mi|Hn20mi]] 02:38, 2 December 2023 (UTC)

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Revision as of 22:38, 1 December 2023

Background and Data Configuration Process of a Nationwide Population-Based Study Using the Korean National Health Insurance System

Song, S. O., Jung, C. H., Song, Y. D., Park, C.-Y., Kwon, H.-S., Cha, B. S., Park, J.-Y., Lee, K.-U., Ko, K. S., & Lee, B.-W. (2014). Background and data configuration process of a nationwide population-based study using the Korean national health insurance system. Diabetes & Metabolism Journal, 38(5), 395–403.

https://e-dmj.org/journal/view.php?doi=10.4093/dmj.2014.38.5.395 D.O.I: https://doi.org/10.4093/dmj.2014.38.5.395

Context

This article contributes to the broader landscape of health research, specifically focusing on diabetes in the Korean population. The National Health Insurance Service (NHIS) in Korea has entered into an agreement to provide limited open access to the databases within the Korean Diabetes Association. The NHIS, being a single-payer program mandatory for all residents, encompasses three main healthcare programs, offering comprehensive coverage. The databases in question contain crucial information on health insurance claims, health check-ups, and long-term care insurance. The research highlights the increasing prevalence of metabolic diseases, particularly in an aging society, and emphasizes the significance of NHIS data in understanding the time course of these chronic diseases. The article suggests that the serial population data available in the NHIS databases can be instrumental in predicting disease progress and facilitating primary and secondary prevention through data mining. In summary, this contribution underscores the importance of NHIS as a population-based database, offering a comprehensive view of the entire Korean population. The integrated information technology of the NHIS database positions it as a leading platform for population-based epidemiology and disease research globally. This article thus aligns with broader concerns in public health, epidemiology, and healthcare management, offering valuable insights and tools for researchers in addressing health issues, particularly in the context of metabolic diseases like diabetes.

Overview

The introduction of the article provides a comprehensive understanding of the historical development, structural components, and operational aspects of the Korean National Health Insurance System, shedding light on its multifaceted programs and the collaborative framework that underpins its functioning. The article delves into the historical development of the Korean health security system, highlighting key legislative milestones and the consolidation of medical insurance societies into the National Health Insurance Corporation (NHIC) in 2000. It outlines the three main healthcare programs - National Health Insurance (NHI), Medical Aid (MA), and Long-Term Care Insurance (LTCI) - and their roles in providing universal coverage to the Korean population. The NHI structure is detailed, involving regulatory bodies such as the Ministry of Health and Welfare (MOHW), NHIS, and the Health Insurance Review Agency (HIRA). The authors extensively describe the NHI program's medical coverage, the types of insurance benefits provided, and the reimbursement flow within the system.

Research design and Hypothesis

The key hypothesis of the study is to present descriptive information on the evolution of the Korean health security system, the structure and functioning of the NHI program, and the potential applications of its databases in disease research, with a specific emphasis on metabolic diseases like diabetes. They emphasize the compulsory nature of the NHI program, covering the entire Korean population, and provide insights into the benefits package, including in-kind and cash benefits. The reimbursement process, involving collaboration between insured individuals, healthcare providers, and regulatory bodies, is elucidated. The methodology involves studying the entire insured Korean population. This population is categorized into three groups: participants in the National Health Insurance (NHI) program belonging to employee and self-employed segments and recipients of medical aid. Subjects for the study were identified from databases maintained by the National Health Insurance Service (NHIS) and the Health Insurance Review Agency (HIRA). The HIRA database contains medical claims data covering the entire Korean population resulting from the NHI system, which functions as the quality control department of the study. The authors discuss the quality of the NHIS database, its protection of personal information, and the types of data collected, including qualification and contribution data, health check-up data, and long-term insurance data. In essence, the research method involves a meticulous analysis of diverse datasets, encompassing patient details, medical transactions, and insurance coverage, enabling a comprehensive exploration of healthcare utilization and demographic patterns. The detailed breakdown of databases ensures a thorough examination of broader health assessment programs facilitated by the NHI system.

Strengths and weaknesses

The study leverages a comprehensive dataset from the NHIS and HIRA databases, ensuring broad coverage of the Korean population for increased representativeness. Quality control through HIRA's review of health insurance claims reports enhances data accuracy. The discussion interprets findings within healthcare system types, emphasizing the compulsory nature and universal coverage of the Korean NHI system. Despite highlighting the NHIS database's national significance and collaborations for research, the study lacks specificity in research questions and outcomes, making it challenging to discern its focus. The acknowledgment of potential data gaps in uninsured events underscores the need for a more comprehensive analysis of healthcare utilization, while limitations in data validation suggest a necessity for cross-validation with other sources to ensure accuracy. utilization needs validation against other sources.

Assessment

In conclusion, the article provides a robust overview of the Korean Health Security system, particularly the National Health Insurance program. It offers a detailed examination of its historical evolution, structure, and operational mechanisms. The research methodology, centred on a comprehensive analysis of various databases, ensures a thorough exploration of patient demographics, medical utilization, and insurance coverage. This article would greatly benefit audiences such as healthcare policymakers, researchers in health economics, and those interested in comparative healthcare systems. Policymakers can gain insights into the evolution of the Korean Health Security system, aiding in the development of effective health policies. Researchers in health economics can leverage detailed data assessment methodologies for comparative studies, while healthcare professionals can benefit from understanding the intricacies of the healthcare delivery system in Korea.

--Hn20mi 02:38, 2 December 2023 (UTC)