OCPIP SNU 2 기 김진란 (Western Pharmacy) 윤소아 (Caremax Pharmacy) Korea & USA

1. INTRODUCTION 2. PUBLIC HEALTH CARE - MEDICARE - MEDICAID 3. PRIVATE HEALTH INSURANCE 4. CONCLUSION

Deductible = the amount of expenses that a patient must pay before the health insurance company will pay any expenses Co-Insurance/ Co-pay = the percentage/ the amount of the cost of care for which the patient is responsible for after deductible is met Premium Out-of-pocket Maximum Formulary 1. ᅟ INTRODUCTION

Korea 전국민 건강보험 의료급여 노인장기요양보험 America Medicare Medicaid Military health benefits Indian health service 2. PUBLIC HEALTH CARE

Korea Korea has national health insurance programs” that : 1)Mandatory 2) Different cost for the same coverage America All Americans are not entitled to universal health care services : 1)Not guarantee access to health care for all populations 2)The same cost for the same coverage 2. PUBLIC HEALTH CARE

What is Medicare? Federal health insurance program Part A – Inpatient Part B – Outpatient Part C – Medicare Advantage Plans Part D – Prescription Drug Plans Who is eligible? persons age 65 or older those with certain disabilities or diseases are eligible for Medicare Parts A and B 2. PUBLIC HEALTH CARE

1. Medicare Advantage Plans Part A and Part B coverage, and prescription drug coverage (Part D) 2. Medicare Prescription Drug Plans (Part D) Add drug coverage to Original Medicare (Part A or Part B) Two types of plans offer Medicare prescription drug coverage 2. PUBLIC HEALTH CARE

at least as good as the coverage outlined in the 2003 Medicare Act at least two drugs in each drug class all drugs in these six categories: antidepressants, antipsychotics, anticonvulsants, antiretrovirals (AIDS treatments), anticancer drugs, and immunosuppressants 2. PUBLIC HEALTH CARE

OTC Drugs that treat symptoms of the common cold (e.g., coughs, congestion) Most vitamins and minerals Certain anti-anxiety and anti-seizure drugs Fertility drugs Drugs for weight loss or gain, and anorexia Cosmetic and hair growth drugs 2. PUBLIC HEALTH CARE

What is Medicaid? Joint federal- state health insurance program Medi-CAL Who is eligible? low-income individuals and their families. children, pregnant, seniors other disease(HIV, AIDS) details vary by states 2. PUBLIC HEALTH CARE

a Medi-Cal program for immediate, temporary coverage for prenatal care to low-income pregnant women pending a formal Medi-Cal application temporary Medi-Cal card for up to 2 months 2. PUBLIC HEALTH CARE

2013 년 결산자료 2. PUBLIC HEALTH CARE KOREA

2. PUBLIC HEALTH CARE AMERICA

2. PUBLIC HEALTH CARE KOREA

Claim real-time -Can know profit -Can know whether its covered or not Reimburse every week - PSAO(ex. Cardinal) - Individual contract 2. PUBLIC HEALTH CARE AMERICA

Korea Sickness insurance Long-term care insurance Accident insurance demand payment before treatment America Employer-sponsored coverage Individual coverage

HMO (Health maintenance organization) PPO (Preferred provider organization) POS (Point of service) PCPMust selectDon’t needMust select ReferralNeededNot neededNeeded Pay out-of- network No Yes (lot more copay) Yes (require referral) 3. PRIVATE HEALTH INSURANCE

Korea Brand Name Prescription No refill No Injections No diagnostic performance America Generic Name Prescription Refill Injections Measurement 4. CONCLUSION

미국의 의료개혁 동향과 의료체계의 변화 ( ) by Sung Yoon Bae, Professor of Healthcare Management at Inje University, Busan, Korea on Jan 07, 2014 Sung Yoon Bae agedcare/a/HMOs_vs_PPOs.htmhttp://healthinsurance.about.com/od/understandingman agedcare/a/HMOs_vs_PPOs.htm sics/a/Hmo-Ppo-Epo-and-Pos-whats-The-Difference- and-Which-Is-Best.htmhttp://healthinsurance.about.com/od/healthinsuranceba sics/a/Hmo-Ppo-Epo-and-Pos-whats-The-Difference- and-Which-Is-Best.htm part-d.htmlhttp:// part-d.html cal/eligibility/Pages/PE_Info_women.aspx