• Title/Summary/Keyword: 보험수가

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Legislative Study on the Mitigation of the Burden of Proof in Hospital Infection Cases - Focusing on the revised Bürgerliches Gesetzbuch - (병원감염 사건에서 증명책임 완화에 관한 입법적 고찰 - 개정 독일민법을 중심으로 -)

  • Yoo, Hyun Jung
    • The Korean Society of Law and Medicine
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    • v.16 no.2
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    • pp.159-193
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    • 2015
  • Owing to causes such as population aging, increased use of various medical devices, long-term hospitalization of various patients with reduced immune function such as cancer, diabetes, and organ transplant patients, and the growing size of hospitals, hospital infections are continuing to increase. As seen in the MERS crisis of 2015, hospital infections have become a social and national problem. In order to prevent damage due to such hospital infections, it is necessary to first strictly implement measures to prevent hospital infections, while, on the other hand, providing proper relief of damage suffered due to hospital infections. However, the mainstream attitude of judicial precedents relating to hospital infection cases has been judged to in fact shift responsibility over damages due to hospital infections on the patient. In light of the philosophy of the damage compensation system, whose guiding principle if the fair and proper apportionment of damages, there is a need to seek means of drastically relaxing the burden of proof on the patient's side relative to conventional legal principles for relaxing the burden of proof, or the theory of de facto estimation. In relation to such need, the German civil code (Burgerliches Gesetzbuch), which defines contracts of medical treatment as typical contracts under the civil code, and has presumption of negligence provisions stipulating that, in cases such as hospital infections which were completely under the control of the medical care providers, if risks in general medical treatment have been realized which cause violations of the life, body, or health of patients, error on the part of the person providing medical care is presumed, was examined. Contracts of medical treatment are entered into very frequently and broadly in the everyday lives of the general public, with various disputes owing thereto arising. Therefore, it is necessary to, by defining contracts of medical treatment as typical contracts under the civil code, regulate the content of said contracts, as well as the proof of burden when disputes arise. If stipulations in the civil code are premature as of yet, an option may be to regulate through a special act, as is the case with France. In the case of hospital infection cases, it is thought that 'legal presumption of negligence' relating to 'negligence in the occurrence of hospital infections,' which will create a state close to equality of arms, will aid the resolution of the realistic issue of the de facto impossibility of remedying damages occurring due to negligence in the process of occurrence of hospital infections. Also, even if negligence is presumed by law, as the patient side is burdened with proving the causal relationships, such drastic confusion as would occur if the medical care provider side is found fully liable if a hospital infection occurs may be avoided. It is thought that, alongside such efforts, social insurance policy must be improved so as to cover the expenses of medical institutions having strictly implemented efforts to prevent hospital infections in the event that they have suffered damages due to a hospital infection accident, and that close future research and examination into this matter will be required.

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Effect of the Mixing Ratio of Pot Media on the Germination and Early Growth in Vegetable crops (배양토 조성비율이 채소작물의 발아 및 초기 생장에 미치는 영향)

  • Oh, Tae-Seok;Kim, Chang-Ho
    • Korean Journal of Organic Agriculture
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    • v.15 no.3
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    • pp.319-330
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    • 2007
  • This study analyzed physical and chemical characteristics of peat soil to use peat soil as the materials fur pot media and investigated seedling quality of horticultural plants in order to use peat soil as the raw materials fur pot media. The summary of the results is as follows; The chemical characteristics of peat soil, which is main ingredient of pot media are as follows; pH was 4.9, EC was less than $2.0ds{\cdot}m^{-1}$, which interferes the growth of the plant and organic ingredient was 33%. When looking into the germination characteristics of plants according to the mixture of pot media, red pepper showed 54.2% speed of germination and 97% germination rate in peat soil single treatment. Therefore the peatsoil was appropriate for the pot media for red pepper. In case of cucumbers, in the 50 : 50 treatment of main ingredient (peat soil) and auxiliary ingredients (vermiculite, peat moss and perlite) they showed 100% speed of germination and 100% germination rate. Therefore 50 : 50 treatment was appropriate fur the pot media for cucumbers. In case of chinese cabbage, peat soil, perlite and peat moss mixture (50 : 25 : 25) treatment showed the highest speed of germination (77.5%), while the germination rate was a little lower (92.15%) than comparative soil. However, it was appropriate for the pot media for chinese cabbage. In case of watermelon, germination was bad because of the influence of EC when the teat soil ingredient is over 80%. However, in the mixture of peat soil and vermiculite (50:50) treatment, they showed 91.6% speed of germination and 100% germination rate. Therefore it was appropriate for the pot media for watermelon. When looking into the growth of the plants according to the mixture of ingredients, peat soil and perlite (50:50) mixture showed excellent seedling quality for cucumbers, peat soil and perlite (50:50) mixture showed excellent seedling quality and it was proven to be appropriate for the pot media for cucumbers. In case of watermelon, peat soil, peat moss and perlite (80 : 10 : 10) mixture showed excellent seedling quality and it was proven to be appropriate for the pot media for watermelon.

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A Study on the Development of Assessment Index for Catastrophic Incident Warning Sign at Refinery and Pertrochemical Plants (정유 및 석유화학플랜트 중대사고 전조신호 평가지표 개발에 관한 연구)

  • Yun, Yong Jin;Park, Dal Jae
    • Korean Chemical Engineering Research
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    • v.57 no.5
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    • pp.637-651
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    • 2019
  • In the event of a major accident such as an explosion in a refinery or a petrochemical plant, it has caused a serious loss of life and property and has had a great impact on the insurance market. In the case of catastrophic incidents occurring in process industries such as refinery and petrochemical plants, only the proximate causes of loss have been drawn and studied from inspectors or claims adjustors responsible for claims of property insurers, incident cause investigators, and national forensic service workers. However, it has not been done well for conducting root cause analysis (RCA) and identifying the factors that contributed to the failure and establishing preventive measures before leading to chemical plant's catastrophic incidents. In this study, the criteria of warning signs on CCPS catastrophic incident waning sign self-assessment tool which was derived through the RCA method and the contribution factor analysis method using the swiss cheese model principle has been reviewed first. Secondly, in order to determine the major incident warning signs in an actual chemical plant, 614 recommendations which have been issued during last the 17 years by loss control engineers of global reinsurers were analyzed. Finally, in order to facilitate the assessment index for catastrophic incident warning signs, the criteria for the catastrophic incident warning sign index at chemical plants were grouped by type and classified into upper category and lower category. Then, a catastrophic incident warning sign index for a chemical plant was developed using the weighted values of each category derived by applying the analytic hierarchy process (pairwise comparison method) through a questionnaire answered by relevant experts of the chemical plant. It is expected that the final 'assessment index for catastrophic incident warning signs' can be utilized by the refinery and petrochemical plant's internal as well as external auditors to assess vulnerability levels related to incident warning signs, and identify the elements of incident warning signs that need to be tracked and managed to prevent the occurrence of serious incidents in the future.

Changes in the Behavior of Healthcare Organizations Following the Introduction of Drug Utilization Review Evaluation Indicators in the Healthcare Quality Evaluation Grant Initiative (의료질평가지원금 제도의 의약품안전사용서비스 평가지표 도입에 따른 의료기관의 행태 변화)

  • Hyeon-Jeong Kim;Ki-Bong Yoo;Young-Joo Won;Han-Sol Jang;Kwang-Soo Lee
    • Health Policy and Management
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    • v.34 no.2
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    • pp.178-184
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    • 2024
  • Background: This study aimed to determine the effectiveness of drug utilization review (DUR) evaluation indicators on safe drug use by comparing the changes in DUR inspection rates and drug duplication prescription prevention rates between the pre- and post-implementation of the DUR evaluation indicators of the Healthcare Quality Evaluation Grant Initiative. Methods: This study used DUR data from the Health Insurance Review and Assessment Service in 2018 (pre-implementation) and the evaluation results of the Healthcare Quality Evaluation Grant Initiative in 2023 (post-implementation). The dependent variables were the DUR evaluation indicators, including DUR inspection rate and drug duplicate prescription prevention rate. The independent variable was the implementation of the DUR evaluation indicators, and the control variables included medical institution characteristics such as type, establishment classification, location, DUR billing software company, and number of beds. Results: The results of the analysis of the difference in the prevention rate of drug duplicate prescriptions between the pre- and post-implementation of the DUR evaluation indicators of the Healthcare Quality Evaluation Grant Initiative showed that the prevention rate of drug duplicate prescriptions increased statistically significantly after the implementation of the DUR evaluation indicators. Conclusion: The policy implications of this study are as follows: First, ongoing evaluation of DUR systems is needed. Second, it is necessary to establish a collaborative partnership between healthcare organizations that utilize DUR system information and the organizations that manage it.

An Exploratory Study on Marketing of Financial Services Companies in Korea (한국 금융회사 마케팅 현황에 대한 탐색 연구)

  • Chun, Sung Yong
    • Asia Marketing Journal
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    • v.12 no.2
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    • pp.111-133
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    • 2010
  • Marketing financial services used to be easier. Today, the competition in financial services is fierce. Not only has the competition become more intense, financial services have also changed structurally. In an environment with various customer needs and severe competitions, the marketing in financial services industry is getting more difficult and more important than before. However, there are still not enough studies on financial services marketing in Korea whereas lots of research papers have been published frequently in some international journals. The purpose of this paper is (1)to review the literature on financial services marketing, (2)to investigate current marketing activities based on in-depth interview with financial marketing managers in Korea, and (3)to suggest some implications for future research on the financial services marketing. Financial products are not consumer products. In fact, they are not products at all in the way product marketing is usually described. Nor are they altogether like services. The financial industry operates in a unique way, and its marketing tasks are correspondingly complex. However, the literature review shows that there has been a lack of basic studies which dealt with inherent characteristics of financial services marketing compared to the research on marketing in other industries. Many studies in domestic marketing journals have so far focused only on the general customer behaviors and the special issues in some financial industries. However, for more effective financial services marketing, we have to answer following questions. Is there any difference between financial service marketing and consumer packaged goods marketing? What are the differences between the financial services marketing and other services marketing such as education and health services? Are there different ways of marketing among banks, securities firms, insurance firms, and credit card companies? In other words, we need more detailed research as well as basic studies about the financial services marketing. For example, we need concrete definitions of financial services marketing, bank marketing, securities firm marketing, and etc. It is also required to compare the characteristics of each marketing within the financial services industry. The products sold in each market have different characteristics such as duration and degree of risk-taking. It means that there are sub-categories in financial services marketing. We have to consider them in the future research on the financial services marketing. It is also necessary to study customer decision making process in the financial markets. There have been little research on how customers search and process information, compare alternatives, make final decision, and repeat their choices. Because financial services have some unique characteristics, we need different understandings in the customer behaviors compared to the behaviors in other service markets. And also considering the rapid growth in financial markets and upcoming severe competition between domestic and global financial companies, it is time to start more systematic and detailed research on financial services marketing in Korea. In the second part of this paper, I analyzed the results of in-depth interview with 20 marketing managers of financial services companies in Korea. As a result, I found that the role of marketing departments in Korean financial companies are mainly focused on the short-term activities such as sales support, promotion, and CRM data analysis although the size and history of marketing departments to some extent show a sign of maturity. Most companies established official marketing departments before 2001. Average number of employees in a marketing department is about 58. However, marketing managers in eight companies(40% of the sample) still think that the purpose of marketing is only to support and manage general sales activities. It shows that some companies have sales-oriented concept rather than marketing-oriented concept. I also found three key words which marketing managers think importantly in financial services markets. They are (1)Trust in customer relationship, (2)Brand differentiation, and (3)Rapid response to customer needs. 50% of the sample support that "Trust" is the most important key word in the financial services marketing. It is interesting that 80% of banks and securities companies think that "Trust" is the most important thing, whereas managers in credit card companies consider "Rapid response to customer needs" as the most important key word in their market. In addition, there are different problems recognition of marketing managers depending on the types of financial industries they belong to. For example, in the case of banks and insurance companies, marketing managers consider "a lack of communication with other departments" as the most serious problem. On the other hand, in the case of securities firms, "a lack of utilization of customer data" is the most serious problem. These results imply that there are different important factors for the customer satisfaction depending on the types of financial industries, and managers have to consider them when marketing financial products in more effective ways. For example, It will be necessary for marketing managers to study different important factors which affect customer satisfaction, repeat purchase, degree of risk-taking, and possibility of cross-selling according to the types of financial industries. I also suggested six hypothetical propositions for the future research.

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Evolution of the National Pension Scheme in Korea: Uniqueness and Sustainability of the Korean Model (국민연금제도 전개의 한국적 특징과 지속가능성)

  • Kim, Yong-Hha;Seok, Jae-Eun
    • Korean Journal of Social Welfare
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    • v.37
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    • pp.89-118
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    • 1999
  • The goal of this paper is to define the distinguishing characteristics of Korea's National Pension Scheme compared to the National Pension types of other countries and sees if those characteristics are significant enough in order to warrant calling these the "Korean Model". Also, another point to consider is, if this "Korean Model" does indeed exist, whether it is a 'sustainable' model or not. The National Pension Scheme, which was implemented in 1988, is similar to the public pension system formerly used in Japan. The National Pension Scheme broke away from this 'Japanese Model' in 1995 with implementation of the Farmers and Fishermen Pension, and the unique "Korean Model National Pension" was completed in 1998 with revision of the National Pension Law. The characteristics of the Korean National Pension can be defined as being balanced equally on ability and equality, possessing strong intergenerational income redistribution, having a nationally integrated structure, an incomplete funded method financial neutralism of the government and also as being a Monroe-oriented pension system. There are several limits to the sustainable development of this Korean Model National Pension, though. Even though the precondition of "the income determination problem of self-employed persons", which has strong intra-generational income redistribution. in actuality there are still many policy issues to be confronted such as the structure which 'transfers the burden to the future generation', the 'inter-generational inequity' of the incomplete funded system, persons excluded from coverage under the national integrated structure, 'compulsory loaning of the public sector by the National Pension Fund' under the government's principle of finance neutralism, the separate existence of the 'Monroe-oriented National Pension' from other pensions, etc.,. Therefore, it need to reform of NPS once again to sustainable development of KMNP.

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The Effect of the Degree of Competition of the Hospital Market Regions on Clinic's Rate of Antibiotics Prescription (병원시장지역 내 경쟁 정도가 의원급 의료기관의 항생제 처방률에 미치는 영향)

  • Jo, Changik;Lim, Jae-Young;Lee, Soo Yeon
    • KDI Journal of Economic Policy
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    • v.30 no.2
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    • pp.129-155
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    • 2008
  • The rate of antibiotics prescription for an acute airway infection significantly varies depending upon the diagnosis type, specialty, and the location of the hospital along with many other related factors. The objective of this study is to empirically investigate the possible relationship between the antibiotics prescription rates for an acute airway infection and the degree of competition in the hospital market regions of mainly the providers of primary medical care services such as clinics, internal medicines, pediatrics and otorhinolaryngology department. Using the data from Health Insurance Review and Assessment Service (HIRA) regarding the hospitals' antibiotics prescription rates for the acute airway infection and controlling for selected variables of demand and supply sectors, this study tries to figure out that the degree of competition in the hospital market, regardless of what type of competition indexes we employed, has a statistically significant effect on the variations of antibiotics prescription rate of the clinics in local areas. This result implies that as an economic consideration itself, the change in the degree of competition in the hospital market can play a crucial role influencing the treatment behaviors of the medical doctors. More specifically, this study reveals that as the degree of competition increases the antibiotics prescription rate goes up. This result means that if the market becomes more competitive in a specific region so that it might cause a reduction in doctor's income, doctors with rational decision-making process, recognize that the benefit created from inducing patients' seemingly unnecessary demand for medical care (income effect) would be higher than the costs associated with sustaining their targeted income (substitution effect). It is because that the doctors are more likely to prescribe antibiotics which create relatively higher margins than other medical care services in order to sustain their targeted income when the hospital market competition becomes tighter. Even though this study empirically confirms that antibiotics prescription can be affected by the economic incentives, it still raises following issues as limitations of the study: first issue is about the representativeness of the hospital regions segregated for this study, which might be weak in explaining whether these regions are mutually exclusive in reality. Patients actually consider the quality of services, transportation cost, time costs, and any other related factors choosing the doctors or hospitals, and in that sense, this study rules out 'border-crossing' in using the medical care services. Second issue arises in capturing the data of antibiotics prescription rate. Since we use the average rate for each medical institution, we cannot figure out the average rate for each patient so that we are not able to control for the variation of patients' medical conditions. It is because of the unavailability of data regarding each patient's medical condition from HIRA. Thirdly, since this study mainly analyzes the medical institutions providing primary care such as clinics, internal medicines, pediatrics, and otorhinolaryngology department, it is skeptical of whether those institutions can represent the hospital market in respective regions and truly reflect the degree of competition. It needs to extend the study areas and disease types as well as any micro data for future studies.

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Influence of the Food Intake Ability and the Number of Remaining Teeth on Oral Health Related Quality of Life in Some Elderly People (일부 노인의 저작강도별 음식섭취능력과 잔존치아수가 구강건강관련 삶의 질에 미치는 영향)

  • Kim, Da-Hye;Hwang, Soo-Jeong
    • Journal of dental hygiene science
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    • v.16 no.1
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    • pp.53-61
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    • 2016
  • Eating supports to gain energy and nutrition and improves quality of life. Ageing affects the food intake ability due to loss of natural teeth and the progressive muscle degeneration. Our objective was to investigate how the food intake ability (FIA) and the remaining teeth could influence on oral health related quality of life in the elderly. This study was performed with 503 elderly subjects living in Daejeon, Korea. The questionnaire with the FIA with 30 Korean food and Oral Health Impact Profile 14 (OHIP-14) and oral examination were surveyed. The five groups according to cluster analysis of FIA had the different numbers of remaining teeth and functional posterior teeth with opposing teeth or prosthesis significantly: group 1, $21.78{\pm}8.27$ and $2.80{\pm}2.63$; group 2, $16.75{\pm}7.87$ and $2.16{\pm}2.44$; group 3, $14.68{\pm}9.77$ and $1.73{\pm}2.30$; group 4, $9.93{\pm}8.13$ and $0.78{\pm}1.68$; group 5, $10.18{\pm}8.37$ and $0.51{\pm}1.22$. The more foods the subjects could masticate, the better oral health related quality of life they had. The medium FIA, soft FIA and the number of remaining teeth could explain 46% of OHIP-14, but hard FIA could not in the multiple regression model. We suggested to develop the oral health program for the elderly to be able to eat the food with medium physical property at least be helpful to improve oral health related quality of life.

Development of Questionnaire Measuring Quality of Life in Pneumoconioses (진폐증 환자의 삶의 질 설문지 개발)

  • Baak, Young-Mann;Ahn, Byoung-Yong;Mun, Je-Hyeok;Jeong, Jin-Sook;Kim, Ji-Hong;Kim, Kyoung-Ah;Lim, Young
    • Tuberculosis and Respiratory Diseases
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    • v.48 no.1
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    • pp.54-66
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    • 2000
  • Background: Pneumoconiosis, like other chronic respiratory diseases, is essentially incurable and, for many, progressive. While improved survival time is an important aim of treatment, there is growing recognition that for some people, improving the quality of life is more important than extending the length of life. Currently the measurement of the quality of life is used to assess the efficacy of therapeutic agents. Methods: Sixty-three pnemoconiotics who were admitted to St. Mary's Hospital between April and August 1999 were interviewed using COOP charts, Chronic Respiratory Questionnaire(CRQ) and Pneumoconiotic Respiratory Questionnaire(PRQ), a newly developed questionnaire concerning clinical and socioeconomic features of pneumoconiotics. Also, ILO classification of the chest film, pulmonary function test, and arterial blood gas analysis of the patients were evaluated. The scores between Industrial Accident Compensation Insurance(IACI) covered and uncovered patients and between clinically stable and unstable patients were compared. Results: Domains of CRQ and PRQ showed a high internal consistency reliability($\alpha$=0.86-0.89, 0.77-0.81) except the dyspnea domain($\alpha$=0.63) of CRQ. The scores on the CRQ and PRQ showed statistically significant correlations with the results of COOP charts, pulmonary function test and arterial blood gas analysis. The dyspnea domain and social activity domain of the PRQ showed significant difference between IACI covered and uncovered patients and between clinically stable and unstable patients. Conclusion : Korean translation of the Chronic Respiratory Questionnaire and the newly developed Pneumoconiotic Respiratory Questionnaire are reliable and valid methods and are likely to be useful in measuring the quality of life in patients with the chronic respiratory disease including pneumoconiosis.

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The Demand and Supply of Nutritionist Workforce in Korea and Policy Recommendations (국민영양관리를 위한 영양사 인력의 적정수급에 관한 연구)

  • Oh, Young-Ho
    • Journal of Nutrition and Health
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    • v.43 no.5
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    • pp.533-542
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    • 2010
  • The objective of this study is to provide basic information and policy implications needed to balance the supply and demand for dietitian by projecting supply and demand for dietitian. The data from the Ministry of Health Welfare and Family on the number of licensed nutritionist, resident registration data of the Ministry of Public Administration and Security, and health insurance qualification data of the National Health Insurance Corporation were used to examine the current status of supply. To project the supply of nutritionist workforce, the in-out moves method and demographic method were used. The ratios of nutritionist to population and GDP, and that of other countries were applied as the demand projection method. According to the study results, the projection on the imbalance of supply and demand for dietitian by year 2021 differs depending on the method used. First, according to the results based on age-adjusted population ratio, there is an oversupply of 1,643 dietitians in year 2010, and 2,076 dietitians in year 2020. Second, although the projection on the imbalance of the supply and demand for dietitian differs depending on whether the GDD is calculated in won(₩) or dollar($). it is expected that there will be an oversupply in general. Third, as to the scenario using the nutritionist ratio in foreign countries, the oversupply of dietitian is likely in Korea, under any scenario, when comparing the nutritionist supply projection with the demand projection based on the nutritionist ratio in the United States. However, the projection of the supply and demand varies in each scenario when the European nutritionist ratio is applied. Under European 'scenario 1', an oversupply is expected, whereas under 'scenario 2', a shortage of supply is expected. A careful approach is required in interpreting the supply and demand projection using criteria of other countries, because dietitian assumes different roles and functions in each country. Although a slight oversupply of nutritionist workforce is projected, it does not cause a major problem as the demand for diet therapy is expected to rise due to aging and the increase of chronic diseases, and as the demand for clinical dietitians in hospitals increases. Accordingly, the demand for dietitians will rise and, in this context, the oversupply of nutritionist will not incur much problem. However, the nutritionist qualification is much too open in Korea, and this has a negative effect on the quality of the nutritionist workforce. Therefore, it is important that the nutritionist qualifications and requirements are reinforced in the future, enhance the quality level of the nutritionist supply, and maintain the balance between the supply and demand.