• Title/Summary/Keyword: 건강보험제도

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Denture wearers' recognition for their oral health status, denture cleansing methods, and insurance health system (의치사용자의 구강건강, 의치관리 및 의치건강보험 인식에 대한 실태 조사)

  • Kim, Sunjai;Kim, Seong-Kyun;Noh, Kwantae;Ahn, Su-Jin;Baik, Sang-Hyun;Kim, Jee-Hwan;Yoo, Dong-Ki;Kim, Kyoung-Rok;Kwon, Kung-Rock
    • The Journal of Korean Academy of Prosthodontics
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    • v.56 no.4
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    • pp.287-294
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    • 2018
  • Purpose: The aim of the present investigation was to understand the incidence, prevalence of denture stomatitis in denture wearers, who were over 60 years old, and use the results for a fundamental data to promote public awareness about denture stomatitis and its education tools. Materials and methods: From August 21 to September 8 2017, 500 denture wearers, who were more than 60 years old in Seoul and 4 other metropolitan cities (Busan, Daegu, Gwangju, and Daejeon), received questionnaires. The questionnaires included denture wearers' demographic distributions, specific dental treatment experiences, discomforts with current dentures, their oral health conditions, and the method of denture cleansing. Results: Thirty-two percent of 500 denture wearers responded that they have healthy oral conditions. Two hundred and eight respondents (41.6%) were aware of denture stomatitis. Only 131 (26.2%) were informed about the removable denture covered by national health insurance and 327 (65.4%) of denture wearers were using the improper denture cleansing methods. Conclusion: A large number of denture wearers still do not recognize the importance of proper treatment for denture stomatitis, insurance covered denture treatments, and adequate denture cleansing methods.

A Study on the Development and Implementation of a Data-mining Based Prototype for Hospital Bill Claim Reduction System (데이터마이닝 기법을 활용한 의료보험 진료비청구 삭감분석시스템 개발 및 구현에 관한 연구)

  • Yoo, Sang-Jin;Park, Mun-Ro
    • Information Systems Review
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    • v.7 no.1
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    • pp.275-295
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    • 2005
  • Changes in business environment caused by globalization of the world economy and the beginning of the knowledge society forced hospitals to equip with tools for the enhanced competitiveness. In other words, hospitals must aim three targets such as acquisition of advanced medical skills and equipments, improvement of service level for patients, and achievement of superior managerial performance simultaneously. This study has been done to suggest a way to reduce the possibility of hospital bill claim reduction as an alternative for the achievement of superior managerial performance. If the reduction rate of hospital bill claim is high, it will put negative impact on the hospital's revenue stream and hospital's reliability. Thus, if they want to stay competitive, hospitals need to device ways to cut the reduction rate as much as possible. In this study, a prototype system has been developed and implemented to check the possibility to cut the reduction rate through deep analysis of causes of reduction. The prototype first developed utilizing data mining techniques and the relation rules algorithm. Then the prototype was tested its performance using the D hospital's live data.

Analysis on the Constitutional Judicial Precedents concerning the Social Welfare Law (사회복지법 관련 헌법재판소 판례 분석 : $1987{\sim}2004$년 헌법판례 현황과 내용을 중심으로)

  • Jung, Jin-Kyung
    • Korean Journal of Social Welfare
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    • v.58 no.1
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    • pp.395-423
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    • 2006
  • The purpose of this study was to investigate the various contents of legal life's conflicts and constitutional applications by analysing on the constitutional judicial precedents regarding to social welfare law. The total cases of constitutional precedents are 62 totally, and 22 precedents among 62 are analysed through content analysis. These 22 constitutional precedents consist of nine cases of concerning Social Insurance Act, six cases in National Pension Act, two cases in National Basic Livelihood Protection Act and one cases in Social Welfare and Service Act. The major contents of these precedents are regarding to operational principles of social insurance system, rule of entitlements, benefits, social welfare organizations and the constitutional right such as property right, equal right, right of happiness. And also there are precedents to review how the rule of Act is interpreted or how the process of right protection is. Findings in this study show that Korean Constitutional Law has characteristics of welfare nationalism and social capital economics orientations, and sanctions legislation and administration discretion.

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Comparative study on the role of the public sector in the health care system -Comparison of the United States and Korea in social risk situations- (의료보장 체계에서의 공공 부분의 역할 비교연구 -사회적 위험 상황 속의 미국과 한국의 비교-)

  • Kim Jong Hwi;Hyun-Seung Park
    • Industry Promotion Research
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    • v.9 no.2
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    • pp.95-102
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    • 2024
  • This study aims to compare the role of the public sector in the U.S. and Korean medical security systems and study response measures in the social risk situation of the COVID-19 virus. The COVID-19 pandemic was a typical case of a 'disaster' that spread across the world across borders in a short period of time and caused serious social welfare losses by increasing the annual number of deaths by approximately 4% in 2020. Threats to health security, such as changes in social order, unpredictable endings, prolonged control of daily life, and deepening inequality, affected the economy, politics, and environment as a whole, and people had to experience anxiety and confusion due to mental and physical stress. Furthermore, developed countries failed to provide help to low-income countries in the face of global disasters. In this situation, the country's disaster management capacity to minimize harm and secure resilience, especially disaster response capacity in the health and medical field, is inevitably very important. Therefore, this study compares how the health insurance system, which is a system to guarantee citizens' right to life, differs from the United States, a liberal health care country, and raises the need to strengthen the role of the public sector.

An Improvement Plan of Ex-post Settling up System on the Social Insurance of Construction Project - Focused on the National Pension and National Health Insurance - (건설공사 사회보험료 사후정산제도의 문제점 및 개선방안 - 국민연금 및 국민건강보험을 중심으로 -)

  • Oh, Chi-Don
    • Journal of the Architectural Institute of Korea Structure & Construction
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    • v.35 no.1
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    • pp.29-36
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    • 2019
  • In the past, social insurance premiums, such as national pension and national health insurance, is contained within the costs of construction projects, have been lowered due to price competition of companies participating in the bidding. The government is implementing the "Ex-post settlement system" to improve the problem. Therefore, the purpose of this study is to examine the concept of an Ex-post settlement system and background of its introduction and to identify problems in the management of the system. The problems of the Ex-post settlement system are: 1) avoiding the participation of construction workers, 2) the rigidity of the insurance premium settlement method in construction field, and 3) the cause of direct construction cost reduction. The ways to improve these problems are: 1) excluding social insurance premiums from construction project cost, 2) securing flexibility of the settlement method of insurance premiums in construction field, and 3) expanding the scope of persons eligible to participate in social insurance.

Comparative Study on Setting-up the Civil Welfare Standard through Public-Private Partnership in Local Governments (민관협력방식의 지자체 시민복지기준 제정 비교연구)

  • Ko, Eun-Ju;Kyoung, Seung-Ku;Lee, Yong-Gab
    • The Journal of the Korea Contents Association
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    • v.19 no.2
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    • pp.605-618
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    • 2019
  • The study proposes some principles that enable local governments to set-up their own civil welfare standard through the public-private partnership in the context of the participation of residents. First, the study analyzes the concept of the civil welfare standard in comparison with the national minimum. In sequence, the study tries to compare various conception, set-up process, fields and contents of the civil welfare standard in 10 local government. And the study suggests a series of some principles for setting-up the civil welfare standard, budget securing, developing core businesses, and reflecting regional characteristics. At last, the study would remind that the process of setting-up and realization of a civil welfare standard could be long-term project through the public-private partnership with civil society organizations, research institutions, local governments and local councils in region.

Determinants of Intention to Take Korean Medicine: Focusing on the recognition of korean medicine treatment effects by disease (한약 복용 의향 결정요인 연구 : 질환별 한방 치료효과 인식을 중심으로)

  • Kim, Jae-Woo;Kim, Sung-Ho;Kang, Jung-Kyu
    • Journal of Digital Convergence
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    • v.20 no.1
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    • pp.327-334
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    • 2022
  • The purpose of this study was to analyze the impact on people's willingness to take korean medicine based on the perception of korean medicine treatment effects by disease, and provide basic data when the herbal medicine (pharmacology) health insurance pilot project is carried out. The survey 'Usage and Consumption of Korean Medicine Report in 2017' was used, and frequency analysis, chi-square test, and logistic regression analysis were conducted on 3,032 people. Logistic regression results showed that the perception of herbal treatment effects on digestive diseases and arthritis was a significant factor in the future intention to take korean medicine. As the herbal medicine health insurance pilot project aims to popularize herbal medicine treatment through the management of the quality of korean medicine by incorporating it within the system, it is necessary to consider highly acceptable digestive diseases and arthritis when expanding target diseases.

Bundled Discounting of Healthcare Services and Restraint of Competition (의료서비스의 결합판매와 경쟁제한성의 판단 - Cascade Health 사건을 중심으로 -)

  • Jeong, Jae Hun
    • The Korean Society of Law and Medicine
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    • v.20 no.3
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    • pp.175-209
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    • 2019
  • The bundled discounting which the dominant undertakings engage in is problematic in terms of competition restraint. Bundled discounts generally benefit not only buyers but also sellers. Specifically, bundled discounts usually costs a firm less to sell multiple products. In addition, Bundled discounts always provide some immediate consumer benefit in the form of lower prices. Therefore, competition authorities and courts should not be too quick to condemn bundled discounts and apply the neutral and objective standard in bundled discounting cases. Cascade Health v. Peacehealth decision starts ruling from this prerequisite. This decision pointed out that the dominant undertaking can exclude rivals through bundled discounting without pricing its products below its cost when rivals do not sell as great a number of product lines. So bundled discounting may have the anticompetitive impact by excluding less diversified but more efficient producers. This decision did not adopt Lepage case's standard which does not require the court to consider whether the competitor was at least as efficient of a producer as the bundled discounter. Instead of that, based on cost based approach, this decision said that the exclusionary element can not be satisfied unless the discounts result in prices that are below an appropriate measures of the defendant's costs. By adopting a discount attribution standard, this decision said that the full amount of the discounts should be allocated to the competitive products. As the seller can easily ascertain its own prices and costs of production and calculate whether its discounting practices exclude competitors, not the competitor's costs but the dominant undertaking's costs should be considered in applying discount attribution standard. This case deals with bundled discounting practice of multiple healthcare services by the dominant undertaking in healthcare market. Under the Korean healthcare system and public health insurance system, the price competition primarily exists in non-medical care benefits because public healthcare insurance in Korea is in combination with the compulsory medical care institution system. The cases that Monopoly Regulation and Fair Trade Law deals with, such as cartel and the abuse of monopoly power, also mainly exist in non-medical care benefits. The dominant undertaking's exclusionary bundled discounting in Korean healthcare markets may be practiced in the contracts between the dominant undertaking and private insurance companies with regards to non-medical care benefits.

사학연금 가입자들을 위한 점진적 퇴직제도의 도입방안에 관한 연구

  • Lee, Jeong-U
    • Journal of Teachers' Pension
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    • v.2
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    • pp.47-102
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    • 2017
  • 오늘날 대다수의 선진 국가들은 고령화 사회에 대비하여 자국의 노후소득보장 제도를 대대적으로 개혁해 오고 있다. 우리나라의 경우에서도 지난 2015년 사학연금제도의 개혁이 이러한 취지에 해당될 수 있을 것이다. 본 연구에서는 고령화 사회의 문제가 단순히 노인부양비용의 증가 그 자체가 아니라, 평균수명의 증가에도 불구하고 늘어나게 된 노후의 삶에 대한 시간적 배분이 근로와 여가에 걸쳐 균형적으로 이루어지지 않고, 사회적 부양을 필요로 하는 노후의 여가만 일방적으로 늘어나고 있다는 점을 문제점으로 지적하였다. 따라서 이러한 차원에서 볼 때 고령화 사회의 문제는 생애근로기간의 연장을 통해서만 효과적으로 극복할 수 있을 것으로 생각된다, 하지만 이와는 반대로 개인별로 건강상태나 가족상황 등의 이유로 생애근로주기의 연장이 불가능한 사람들을 위하여 별도의 제도적 장치가 추가적으로 마련되어야 할 것이다. 종합해 보면, 고령화 사회의 노동시장 문제는 개인별로 다양한 욕구나 능력을 반영하여 각자에게 다양한 선택권을 보장해 줄 수 있는 방향으로 개선되어야 할 필요가 있다. 본 연구에서는 고령화 사회에 대비하여 연금수급연령 상향조정의 필요성을 사학연금제도를 중심으로 살펴보고, 대신 그로 인해 발생할 수 있는 소득공백문제와 연금가입경력 공백문제 등 제반의 충격을 흡수할 수 있는 제도적 장치로서 점진적 퇴직제도의 도입방안을 제안하였다. 개략적으로 사학연금제도에 있어서 점진적 퇴직모형은 법정연금수급연령의 인상 일정에 따라 다음과 같이 운영하는 방안을 제안하였다. 먼저 법정연금수급연령이 60세로 유지되는 2022년까지의 단기적 대책으로서 여기서 점진적 퇴직의 자격연령은 모든 가입자에게 60세로 적용하도록 한다. 이 경우 가입자들의 신분구분에 따라 각각 교수 5년, 교원 2년(문제해결에 대한 정책적 의지에 따라 이행구간을 확장할 수도 있음) 그리고 교직원 0년의 조기의 점진적 퇴직이 허용되므로, 현재 교원이나 교수의 임용대란문제에 효과적으로 대응을 할 수 있는 장점이 있다. 다음으로는 2023년 이후 2033년 사이 법정연금수급연령의 인상단계에 해당되는 기간 동안의 대책으로서 여기서는 교수, 교원, 교직원에게 적용되는 정년연령과 매년도 법정연금수급연령 사이의 기간을 조기의 점진적 퇴직 이행구간으로 정하도록 한다. 그리고 이러한 이행구간에 상당하는 기간만큼 후기의 점진적 퇴직 이행구간을 별도로 설정하여 그에 적절한 혜택이 주어질 수 있도록 한다. 마지막으로 2033년 이후부터는 교수, 교사, 교직원의 신분구분 없이 모두에게 적용되는 사항으로서 65세를 기준으로 그 이전의 5년은 사학연금의 적용을 받는 조기의 점진적 퇴직 그리고 그 이후의 5년은 국민연금의 적용을 받는 후기의 점진적 퇴직이 이루어질 수 있도록 한다. 그리고 전체 10년의 점진적 퇴직 이행구간 동안 개인별로 퇴직시점이나 퇴직형태의 선택이 자유롭게 이루어질 수 있도록 하기 위하여 보험수리의 원칙에 입각한 감액률 또는 가산율의 엄격한 적용을 제안하였다. 그리고 고령계층이 자신의 근로시간을 단계적으로 단축할 수 있도록 하고, 그 과정에서 발생하게 되는 소득의 감소부분은 별도의 제도적 방법(가교연금, 시간가치적립계정 등)으로 충당하도록 하는 방안을 제안하였다. 나아가 점진적 퇴직제도의 운영방식은 근로시간의 단축뿐만 아니라 작업부담의 경감 등에 대해서도 인정을 해주도록 해줌으로써 임금피크제도의 기능과 연계가 가능할 수 있도록 할 것을 제안하였다.

성인병 뉴스 제303호

  • The Korea Association of Chronic Disease
    • The Korean Chronic Disease News
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    • no.303
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    • pp.1-18
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    • 2006
  • 한국만성질환관리협회 신준식 부회장/국가 심.뇌혈관 질환 예방위 설치/약제비 절감‘포지티브’제도 강행/6월부터 환자 식대 보험 적용 확정/말기암 환자 호스피스기관 선정/“농촌지역 암.만성질환 관리 시급”/의료법인, 세제개선 헌법소원 추진/‘신약인프라 구축’5개년 계획 추진/화장품에 인태반 원료 사용 금지/약국 간판.광고 규제 대폭 완화/‘한방의학으로 수술 않고, 척추질환 치료’/“건강의 비결은 걷는데 있다”/식이섬유 1일 평균 19.8g 섭취/식도암, 내시경 수술 효과 좋았다/만성질환 관리의 현황과 발전방향/“40~50대 파킨슨병 발생 많다”/전립선비대증 치료‘시알리스’효과 있다/위암 수술 후‘젤로다+ 엘록사틴’투여 평가/

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