scholarly journals Health Expenditure Difference according to Individual Copayment in National Health Insurance System

2021 ◽  
Vol 14 (1) ◽  
pp. 225-232
Author(s):  
Ki C. Kim ◽  
Soon C. Kwon
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
South Korea ◽  
National Health Insurance ◽  
National Health ◽  
Low Ses ◽  
Health Insurance System ◽  
National Health Insurance System ◽  
Medical Expenses ◽  
The Government

Background: South Korea adopt a mandatory national health care system covering all citizens and consisting of the National Health Insurance System (NHIS) and Medical Aid Program (MAP), which cover individuals of non-low and low Socioeconomic Status (SES), respectively. Objective: We investigated and compared the medical expenses per claim in South Korea for SES individuals, to predict health care expenditure and provide fundamental data regarding care for individuals with limited finances. Methods: The inpatient data on NHIS and MAP beneficiaries were derived from the National Health Insurance Statistical Annual Report of South Korea from 2011 to 2015. Medical expenses per claim for the NHIS and MAP were investigated by gender and age, and the ratio of expenses per claim under MAP to that under NHIS was calculated. Results: The ratio from 2011 to 2015 was consistently larger than 1 and increased at an inconsistent rate with each consecutive age group until 30-39 years, and decreased thereafter (Males: 1.09-3.47, Females: 1.07-1.95). Conclusion: The results of this study indicated that higher medical expenditures and longer durations of claim in the low SES group may become obstacles to developing a sustainable health care system. The government should induce social activities of working-age low-SES people to reduce the burden on the government and help them lead a healthy life.

scholarly journals Strategy for reduction of medical costs and growth of the healthcare industry after establishment of the national health insurance system in Japan: lessons for the Indonesian health care reform system -II-

2014 ◽  
Vol 23 (3) ◽  
pp. 182-4 ◽  
Author(s):  
Tokihiko Sawada ◽  
Hirohisa Kawahara
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Health Care Expenditure ◽  
Medical Expenditure ◽  
Health Insurance System ◽  
National Health Insurance System ◽  
National Health Care ◽  
Insurance System

Japan has long operated a government-based health insurance system covering the entire population, and has been focusing on strategies for balancing viable national health care services with the need to minimize national health care expenditure. Hemodialysis (HD) is a representative form of medical treatment that is expected to expand in Indonesia in the near future, and which will require sustained financial support from the national health insurance system. In this report, consecutive to our previous one, we describe how the Japanese government has attempted to minimize medical expenditure in the past, focusing especially on HD.

Exploring the Application of Cost-Effectiveness Evaluation in the Japanese National Health Insurance System

2019 ◽  
Vol 35 (6) ◽  
pp. 452-460 ◽  
Author(s):  
Hisayuki Ogura ◽  
Shigekazu Komoto ◽  
Takeru Shiroiwa ◽  
Takashi Fukuda
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Cost Effectiveness ◽  
National Health Insurance ◽  
National Health ◽  
Medical Devices ◽  
Effectiveness Evaluation ◽  
Health Insurance System ◽  
National Health Insurance System ◽  
Technical Requirements

AbstractObjectivesAdvances in health care due to the development and introduction of new drugs and medical devices have brought considerable benefits to people and patients in terms of upgraded quality of life and extended years of survival. However, some are concerned that the very advancement of health care would increase further the inflation of national healthcare costs. In response to these concerns, Japan's Central Social Insurance Medical Council (“Chuikyo”) began in 2012 to examine how cost-effectiveness evaluation might be applied to the national health insurance system, and has been working toward establishing a system for its usage.MethodsCost-effectiveness evaluation was adopted on a trial basis in fiscal year (FY) 2016, targeting seven drugs and six medical devices. Analyses and re-analyses were performed by manufacturers and a public expert organization, respectively. Based on these analyses, a cost-effectiveness evaluation expert organization conducted an overall assessment (“appraisal”). Results of the evaluation were used to adjust the prices of the target items.ResultsFollowing the trial adoption of cost-effectiveness evaluation, price adjustments were performed for three items in April 2018. Meanwhile, a decision was also made to examine seven items for which technical requirements were identified due to differences in the understanding of analysis methods between involved parties.ConclusionsThe Chuikyo will examine how to meet the newly identified technical requirements and discuss specific details with regard to establishing a system that incorporates cost-effectiveness evaluation. The Chuikyo plans to reach a conclusion by the end of FY 2018.

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