• Journal of the Korea Convergence Society
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• v.9 no.2
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• pp.125-136
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• 2018

The purpose of the study is to investigate dental health insurance coverage the awareness and dental health insurance coverage extension to scaling in service consumers. There were significant differences according to education level, age on the appropriateness of the age of yearly scaling benefit, and to married, regions, self-oral health of the frequency of yearly scaling benefit, who their teeth brushed frequence a day on the appropriateness of the fee of yearly scaling benefit. It implies that should be added to the coverage list national health insurance every age group after increasing periodontal disease. It is to be more extension as to age, frequency and fee health insurance coverage of scaling, the effort to improve dental health insurance coverage policy must be continue for oral health in the future.

• Journal of dental hygiene science
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• v.15 no.1
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• pp.46-53
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• 2015

The purpose of this study is to identify the awareness of oral health workforce and the attitude concerning the health insurance benefit on topical fluoride application. The subjects are 173 dentists and 288 dental hygienists. The data were collected using a self-administered questionnaire and analyzed using SPSS 12.0 statistical program. The findings of the study were as follows: Agree's (including strongly agree) ratios regarding to the health insurance benefit of topical fluoride application was 92.5% for dentists and 90.8% for dental hygienists. Appropriate age of health insurance benefit about the topical fluoride application was elementary, middle and high school students (8~19 years). This response ratio was high 45.7% for dentists and 43.2% for dental hygienists. Appropriate copayment (mean value) of health insurance about topical fluoride application coverage showed that NaF, $SnF_2$ solution and acidulated phosphate fluoride gel were 25,782 Korean Won (KRW) for dentist and 14,282 KRW for dental hygienist. Fluoride varnish copayment was 31,705 KRW for dentist and 17,979 KRW for dental hygienist. Fluoride iontophoresis copayment was 40,156 KRW for dentist, and 21,210 KRW for dental hygienist. The frequency of health insurance benefits about topical fluoride application was high in 'unlimited (37.5%)' for the dentists and 'two times (31.3%)' for dental hygienists. In conclusion, topical fluoride application should be included as one of the health insurance benefit items for oral health.

• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.4
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• pp.654-666
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• 2009

우식활성이 높은 어린이와 청소년 전체를 수용할 수 있는 치면열구전색(치아홈메우기) 사업의 확대 재생산을 위한 방안으로 건강보험 급여에 포함하는 정책이 2009년 12월부터 실시됨에 따라 본 연구는 급여화 기준 설정, 상대가치지수 개발 및 수가산정, 소요 재정추계 등, 급여화 운용을 위한 제반사항을 연구, 개발하는데 그 목적이 있다. 본 연구에서는 치면열구전색술의 적응증, 실시연령, 대상치아등에 대해 문헌고찰과 함께 상기 항목에 대한 정책적인 면에서의 검토를 시행하였으며, 치과의사를 대상으로 전국규모의 설문조사를 실시하여 치면열구전색술의 상대가치지수(RBRVS)와 연계한 의사업무량을 산출하고, 행위 기술서를 작성하였으며, 직접 및 간접비용의 세부내역 산출하였다. 도출된 상대가치지수를 바탕으로 예상수가를 산정하였으며 이를 근거로 대상 연령 및 대상치아, 의료 이용율 대비 재정추계 시행하였다. 이와함께 치면열구전색술의 급여화 순조로운 정착을 위한 외국사례 연구, 보험적용추진을 위해 치면열구전색의 유지율 및 비용효과, 예방적 레진수복과의 차등화문제, 재료적 고찰, 대국민 및 시술기관 대상 홍보 사항 등 급여화에 관련된 제반 사항을 검토, 제안하였다.

• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.131-157
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• 2015

NHIS claimed for damages to doctors that by doing the treatment breaching medical insurance criteria caused by doctors, NHIS paid for medicine cost to pharmacy; as a result, the doctors caused the tort to NHIS. Following consecutive rulings afterwards, NHIS also argued that the medicine cost violating medical law or medical treatment expense paid to medical organizations are both the tort in civil law. NHIS claimed for all the damages, and the Supreme Court confirmed this judgment. However, within our national health insurance system, the subject of insurance payment is NHIS and the subject of medical treatment expense are also NHIS since the treatment expense is also insurance payment by asking the treatment to medical organizations. Further, national health insurance law is not made to control the violation of medical treatment cases; therefore, the breach of medical law cannot be covered by illegality of tort in civil law regarding NHIS. If that is the case, in the case that if the patients are treated according to treatment criteria via the doctors delegated the doctors' permission by Health and Welfare minister, NHIS acquired the benefits to remove the duty to give treatment payment to doctors in civil law; thus, even though the doctors have breached the medical law, NHIS does not have any damages. The fact that supreme court confirmed the ruling that the treatment is the tort in civil law towards NHIS is the judgment not counting the benefits of insurance payment as the subject but only considering the fact that NHIS paid to the doctors and this ruling have gone against the principle under civil code section 750. If the doctors have breached the medical law, the case should be sanctioned by medical law not national health insurance law, and the ruling of supreme court is assumed that they have confused both with the principle of national health insurance law and civil law.

• The Korean Journal of Applied Statistics
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• v.31 no.6
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• pp.693-706
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• 2018

It is very important to support the elderly with disability ageing in place. Assisting devices can help them to live independently in their community; however, they have to be used appropriately to meet care needs. This study develops an assisting device recommendation system for the beneficiaries of long-term care insurance that include algorithms to decide the most appropriate type of assisting device for beneficiaries. We used long-term care (LTC) insurance data for grade assessment including 8,084 beneficiaries from July 2015 to June 2016. In addition, we collected standard care plans for assisting devices, that power-assessors made, considering their performance and ability that could subsequently be matched with grade assessment data. We used a decision-tree model in data-mining to develop the model. Finally, we developed 15 algorithms for recommending assisting devices. The findings might be useful in evidence-based care planning for assisting devices and can contribute to enhancing independence and safety in LTC.

• Journal of the Korean Society of Radiology
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• v.12 no.7
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• pp.869-877
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• 2018

This study analyzed the current status of MRI (frequency, amount of treatment) based on the history of application of the MRI health insurance benefit standard and health insurance claim data. MRI examinations began as a health insurance benefit in 2005. In 2005, the indications were restricted for some diseases, but coverage for benefits in 2010, 2013, 2016, and 2018 was expanded. In 2021, the Ministry of Health and Welfare decided to apply health insurance for all MRI examinations. From 2010 to 2017, the number of MRI examinations increased by 86.7% in 2017 compared to 2010, and the amount of treatment increased by 53.5%. According to general characteristics, the number of MRI examinations was higher in women than in men. By age, the number of examinations was the highest among ages 70-79. Outpatient examinations were more frequent than inpatient examinations, and the number of examinations in the tertiary hospitals was the highest among the types of hospitals. The number of brain MRI examinations was the highest in each exam site. In December 2013, the standard of MRI was expanded for heart disease and Crohn's disease, the number of cardiac MRI and abdominal MRI examinations increased in 2014 compared to 2013. However, the number of examinations is small and not associate with the disease, it would be difficult to say that it affected the increase in the total number of MRI examinations. To assess health insurance sustainability and policy effectiveness, monitoring will be necessary.

• 건강소식
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• v.11 no.8 s.105
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• pp.48-49
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• 1987

어떠한 상황, 어떠한 위치에서선 자신이 아닌 남을 위한 일을 해보겠다고 마음먹기란 쉬운 일이 아니다. 그러나 그보다 훨씬 어려운 것은, 주어진 기득권을 마다하고 봉사의 장을 찾아가는 것이다. 경기 제 6지구 의료보험조합 급여과장 설동룡씨(41세). 그는 그 쉽지 않은 길을 선택한 사람 중의 하나다.

• Journal of dental hygiene science
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• v.15 no.6
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• pp.815-824
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• 2015

This study aims to figure out the current state of health insurance education provided to dentists and personnel in charge of insurance claim as well as the effects of experiences in education on their knowledge of health insurance standard and actual application. As a result of analysis on 100 data sheets related to dentistry and 100 data sheets related to personnel in charge of insurance claim (a total of 200 data sheets), following results were generated. Insurance claim personnels showed higher score than dentist in knowledge of health insurance standard and it was significant statistically. Knowledge of insurance claim personnel showed significant differences in educational experiences, in health insurance for the latest three years and average hours of education per session whereas that of dentists did not indicate any significant differences. The level of practical application of dentists was significantly different (p<0.05) according to experiences in insurance claim, and that of insurance claim personnel significantly varied (p<0.05) depending on age, experiences of insurance education and average hours of education. The longer average hours of education, the higher level of practical application. Experiences of insurance education turned out to affect on the knowledge of health insurance standard significantly (p<0.05) on the part of dentists and insurance claim personnel, and the level of experiences in insurance claim and knowledge of health insurance standard on the part of dentists and insurance claim personnel turned out to affect on practical application significantly (p<0.001). Judging from the result, continuous education needs to be conducted in order to enable dentists and insurance claim personnel to maintain the level of knowledge about health insurance and practical application.

• Journal of Convergence for Information Technology
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• v.8 no.1
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• pp.15-25
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• 2018

This study aimed to investigate recognition of dental scaling and recognition of and satisfaction with health insurance coverage of dental scaling and make an efficient healthcare policy for dental health insurance; to do this, a survey was conducted in 389 residents in North Jeolla Province, drawing the following conclusion: First, the respondents were most likely to suggest that it was desirable to get dental scaling 'twice a year' and to start it 'in their twenties'. Second, those who were female and who were more concerned about periodontal health were more likely to recognize coverage of dental scaling. Third, those who were female and who were more concerned about periodontal health were also more satisfied with the coverage. It is therefore necessary to make PRs by using teaching media positively as well as by giving correct information with the objective of improving recognition of dental scaling on a continuous basis.

• 한국노년학
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• v.32 no.2
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• pp.593-609
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• 2012

The study was performed to identify the functional status change of beneficiaries of Long-Term Care Insurance and its related factors. We conducted the logistic regression with 17,652 beneficiaries during August and September in 2008. As a result, activities of daily living(ADL), behavioral changes, rehab, instrumental activities of daily living(IADL) and cognitive function, followed by nursing care area were improved in a greater degree. For the institutional service, level-1 beneficiaries was significantly improved in rehab area and level-2 beneficiaries was improved in ADL. For the home-visit care service of in-home services, level-1 beneficiaries was improved in ADL, level-2 beneficiaries was improved in ADL and rehab area, level-3 beneficiaries was improved in ADL, cognitive function and behavioral changes. For the day-and-night care service, level-1 beneficiaries was improved in ADL, IADL, behavioral changes and rehab area, level-2 beneficiaries was improved in behavioral changes, level-3 beneficiaries was improved in cognitive function and behavioral changes. For the short-stay service, level-3 beneficiaries was improved in behavioral changes. By the above results, there was a difference in a functional improvement by level and used services. Therefore, government need to provide the personalized service system based on the objective and comprehensive understanding for health and functional status of beneficiaries.