• The Journal of the Korea Contents Association
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• v.17 no.6
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• pp.63-70
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• 2017

Although the National Health Insurance, many people sign up for private health insurance to alleviate their financial burden. In this study, we analyzed the relationship between private health insurance and subjective financial burden about cost sharing. To confirm the effect we conducted the binary logistic regression by utilizing the Health Care Policy related to public survey. The private health insurance have a significantly association with the subjective financial burden about cost sharing. People who uninsured to purchase private health insurance were more likely to have the burden. Therefore, given the low participation rate of private medical insurance for high age and low income group, we suggest the need for redefining the role of private insurance to enhance the function and resolve equity issues to prepare for the burden.

• The Journal of the Convergence on Culture Technology
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• v.10 no.3
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• pp.667-673
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• 2024

This study aims to diagnose the issues arising from the relationship between the out-of-pocket maximum in health insurance and private indemnity health insurance and propose policy tasks for institutional improvement. Through literature research, the study analyzed the damage to consumers caused by the non-payment of refunds exceeding the out-of-pocket maximum and the changing role of indemnity insurance due to the strengthening of health insurance coverage. The results confirmed that unilateral interpretation of insurance clauses and incomplete sales practices infringe upon consumer rights, and that insurance premiums do not decrease despite the reduction in coverage of indemnity insurance. Therefore, the study emphasized the urgency of institutional improvements such as rationalization of product structure, transparency of risk rate calculation, and reinforcement of consumer information provision, as well as the need for social consensus on the rational division of roles between health insurance and private insurance. This study is significant in that it provides policy implications for the developmental reorganization of the healthcare system.

• The Korean Society of Law and Medicine
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• v.12 no.2
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• pp.189-217
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• 2011

According to the current law of national health insurance, the Minister of Health and Welfare can impose a suspension of business or license, and a fine with medical institutions who violate the law. In case that medical institutions raise an action for ity with each penalty, they ask for replacing the suspension of business with a fine during the pendency of the action. But there is a long gap of time between an offense and administrative measures. One violation cause several types of administrative measures (suspension of business or fine, suspension of license etc.) and different government departments impose these penalties. It takes a lot of time to organize their opinions and they are liable to impose penalties after considerable space of time because of overwhelming tasks. Then the medical institutions can sustain a loss by getting unexpected administrative measures after their offense against the law. Thus, this article review whether extinctive prescription apply to the right of imposing fine on the law of national health insurance or not. Meanwhile, we have no regulations imposing a same fine to co-representatives of medical institution who infringe the law of national health insurance. On this point, this study review whether they have equal duty on that or not.

• The Korean Journal of Applied Statistics
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• v.26 no.6
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• pp.857-871
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• 2013

Export credit insurance is a policy tool for export growth. In the era of free trade under the governance of WTO, export credit insurance is still allowed as one of the few instruments to increase exports. This paper, using data on short-term export insurance contracts issued to foreign subsidiaries of Korean companies, calculates the expected loss per exposure by combining the effect of risk factors (credit rate of foreign importers, size of mother company, and payment period) on loss frequency and loss severity in different levels. We, applying generalized linear models (GLM), first fit loss frequency and loss severity to negative binomial and lognormal distribution, respectively, and then estimate the loss frequency rate per contract and the ratio of loss severity to coverage amount. Finally, we calculate the expected loss per exposure for each level of risk factors by combining these two rates. Based on the result of statistical analysis, we present the implication for the current premium rate of export insurance.

• The Journal of the Korea Contents Association
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• v.21 no.8
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• pp.305-314
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• 2021

According to the recent judgment of Supreme Court, in case when the National Health Insurance Service pays the insurance to a victim of torts, and then subrogate the victim's claim for damages, the scope of institution's subrogation should be limited to the amount of the assailant's responsibility rate of the institution charge, and the amount of compensation claimed by the victim to the assailant should be calculated in the method of contributory negligence after deduction. The court has judged that the institution could subrogate the whole amount of institution charge in the limit of assailant's damages, and the method of deduction after contributory negligence should be applied when calculating the assailant's damages to the victim. Supreme Court decision is greatly significant in the aspect of harmonizing the nature of health insurance as property right and social insurance as the beneficiaries could get additional supplement, and also seeking the balance between insurer and beneficiary. With the changed legal principles of Supreme Court in the scope of institution subrogation like this, the necessities to complement the litigation relation, legislation, and institution were suggested.

• Journal of Internet of Things and Convergence
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• v.8 no.2
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• pp.13-24
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• 2022

In order to explore the context of fraudulent claims and the measures for preventing them targeting the long-term care institutions for the elderly, which is increasing every year in Korea, this study conducted the text mining analysis using the media report articles. The media report articles were collected from the news big data analysis system called 'BIG KINDS' for about 15 years from July 2008 when the Long-Term Care Insurance for the Elderly took effect, to February 28^th 2022. During this period of time, total 2,627 articles were collected under keywords like 'elderly care+fraudulent claims' and 'long-term care+fraudulent claims', and among them, total 946 articles were selected after excluding overlapped articles. In the results of the text mining analysis in this study, first, the top 10 keywords mentioned in the highest frequency in every section(July 1^st 2008-February 28^th 2022) were shown in the order of long-term care institution for the elderly, fraudulent claims, National Health Insurance Service, Long-Term Care Insurance for the Elderly, long-term care benefits(expenses), elderly care facilities, The Ministry of Health & Welfare, the elderly, report, and reward(payment). Second, in the results of the N-gram analysis, they were shown in the order of long-term care benefits(expenses) and fraudulent claims, fraudulent claims and long-care institution for the elderly, falsehood and fraudulent claims, report and reward(payment), and long-term care institution for the elderly and report. Third, the analysis of TF-IDF was similar to the results of the frequency analysis while the rankings of report, reward(payment), and increase moved up. Based on such results of the analysis above, this study presented the future direction for the prevention of fraudulent claims of long-term care institutions for the elderly.

• Korean Security Journal
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• no.32
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• pp.151-176
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• 2012

Government organizations (including police, prosecutor, and Financial Supervisory Service) and programs to uncover or prevent from insurance crime are not well developed. However, insurance crime are increasing among not only private insurances such as life insurance, indemnity insurance, and auto insurance but also public insurances including national health insurance and industrial accident compensation insurance. The damages of crimes are serious in both economical and ethical perspectives. Insurance crime deteriorates a current account of insurance companies and the leakages due to insurance fraud worsen loss ratio. Consequently, insurance crime increases customers' costs of insurance. For this reason, insurance companies stated to establish Special Investigation Unit(SIU) to detect insurance crime and fraud by themselves. However, organizational and operational efficiencies are limited. The purpose of this study is to examine the relationship between work environment factors, perception of insurance crime and job satisfaction among Special Investigation Units. Therefore, this study investigated the perception of work environments of Special Investigation Units. In addition, this study examined how their work environments and general perception of insurance crime influence their job satisfaction. In order test the purpose of this study, reliability test, exploratory factor analysis(EFA), multiple regression were employed. The results of this study suggested that clarity of insurance company, distress/difficulty of resolve, compensation, perception of work pressure are statistically significant on jab satisfaction among Special Investigation Unit in South Korea. This exploratory study expected to contribute to understanding of Special Investigation Unit, and their insurance crime prevention system. The results from this analysis will be examined in light of previous findings and policy implications discussed.

• Fire Science and Engineering
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• v.31 no.4
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• pp.119-127
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• 2017

This study analyzed the cause of car explosion that occurred in the riverside park. The car carrying a male driver and a female passenger was parked in the park and explosion occurred inside the car. After the explosion, the driver and the passenger got burned. When they went to the hospital by the 119 Rescue Service, they stated that the car was sprayed with thinner before they had a quarrel and the explosion occurred during their quarrel. However, after several days, they changed their statement. They said that gasoline in the plastic bottle was poured and ran into the cigarette lighter. They tried to pull the cigarette lighter but pushed it by mistake. Then explosion occurred. Because only the explosion by mistake could receive car insurance, whether the cause of explosion was intentional or not became an issue. The car exploded was carefully investigated and analyzed. The statement of the driver and passenger was analyzed in the aspect of fire science. As a result, it was demonstrated that this car explosion occurred by driver's intention.

• Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology
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• v.8 no.3
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• pp.531-541
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• 2018

This study researched text mining and text network analysis to analyze the images of Nonghyup Insurance for consumers. With the recent development of social media, many texts are being produced and reproduced, and texts of social media provide important information to companies. Text mining and text network analysis are used in many studies to identify image of company and product. As a result of the text analysis, the positive image of the Nonghyup Insurance is safety and stability. Negative images of the Nonghyup Insurance is concern and anxiety. As a result of the textual network analysis, Centered mage of Nonghyup Insurance is safety and concern. This paper allows researchers to extract several lessons learned that are important for the text mining and text network analysis.

• Journal of Korea Port Economic Association
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• v.31 no.2
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• pp.41-53
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• 2015

In Paracomon Inc. v. Telus Communication, Realice's anchor became entangled with a working fiber-optic submarine cable during its voyage and are presentative of the shipowner(the captain) cut the cable. The owner of the cable brought a claim for the repair cost against the shipowner. The shipowner then advanced a third party claim against a liability insurance underwriter. The Supreme Court of Canada (SCC) held that the shipowner was entitled to limit its liability under the 1976 Convention on the Limitation of Liability for Maritime Claims. The SCC also ruled that even though the misdeed of the shipowner was insufficient to break its right to limitation of liability, its wrongdoing constituted willful misconduct under the 1993 Canada Marine Insurance Act, allowing the underwriter to deny coverage for the incident. Thecasewasthefirsttoaddresstheinterrelationship between the shipowner's right to limit liability under the international convention regime and the availability of liability insurance with respect to such limited liability. This study analyzes the reasoning behind the SCC's judgment and evaluates the appropriateness of this court's decision based on the current maritime industry as well as prevailing maritime law. It concludes that the SCC's decision to declare that the shipowner retained the right to limit its liability is appropriate under the Limitation Convention (1976). However, its declaration that the liability insurer was discharged from liability is not correct in due consideration of the common recognition in the maritime industry, the intended purpose of a third party's right against the liability insurer, and the adoption process of the conduct barring limitation. Based on the SCC's decision, this study finally reviews the issue of the shipowner's right to limit and the coverage of the liability insurer in the Sewol case (2014).