• Title/Summary/Keyword: 보험수가

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A Study on the Analysis of Factors for the Increase of Oriental Medicine Expenditure in the Automobile Insurance (자동차보험 한방진료비 증가요인 분석)

  • Lee, ChangSoo;Lee, Hyeon Ju;Chae, JungMi
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.20 no.1
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    • pp.121-130
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    • 2019
  • Automobile insurance medical expenses increased by 12% in year 2015 compared to year 2014. But the oriental medical service expenses in automobile insurance increased by 36% during the same period. In this paper the reason for the rapid increase of expenses for oriental medical service was analyzed using the method of decomposing medical expenses. As a result of analyzing 34,351,120 cases that were examined and completed during the period of 2014~2015, the number of oriental medicine patients increased by 27% and the medical expense per patient increased by 7%. The result of analysis showed that there was no significant change in service period per patient but medical expense per day increased by 7%. The increase in the number of patients receiving only oriental medical services was 32%. Increase in the number of patients receiving medical treatment and oriental medical services was 24% and the number of patients receiving medical treatment only decreased by 4%. There was significant increase in non standardized cost of oriental physical therapy which was one reason of the increase of the expenses. However, the most influential factor of the increase in the expenses of oriental medical services was the increase of the number of patients.

Necessity of Standardization and Standardized Method for Substances Accounting of Environmental Liability Insurance (환경책임보험 배출 물질 정산의 표준화 필요성 및 산출방법 표준화)

  • Park, Myeongnam;Kim, Chang-wan;Shin, Dongil
    • Journal of the Korean Institute of Gas
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    • v.22 no.5
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    • pp.1-17
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    • 2018
  • Related incidents and accidents are frequent after 2000 years, such as the outbreak of the Taian peninsula crude oil spillage and Gumi hydrofluoric acid leakage accident. In the wake of such environmental pollution accidents, Consensus has been formed to enact legislation on liability for the compensation of environmental pollution in 2014 and the rescue, and has been in force since January 2016. Therefore, in the domestic insurance industry, the introduced environmental liability insurance system needs to be managed through the standardization formula of a new insurance model for managing the environmental risk. This study has been carried out by the emergence of a safe insurance model with a risky nature of the risk type, which is one of the services of the knowledge base. The verification of the six assurance media on the occurrence of environmental pollution such as chemical, waste, marine, soil, etc. is expressed through semantic interoperability through this possible ontology. The insurance model was designed and presented by deducing the relationship between the amount of money and the amount of money that was written in the area of existing expertise, In order to exclude the possible consequences, the concept of abstract is conceptualized in the form of a customer, and a plan for the future development of an ontology-based decision support system is proposed to reduce the cost and resources consumed every year. It is expected that standardization of the verification standard of the mass of mass will minimize errors and reduce the time and resources required for verification.

Convergence study of long-term care insurance system for elderly of awareness of middle-aged people and demand for dental services in the system (한국 중년층의 노인장기요양보험제도에 대한 인식과 구강보건진료에 대한 요구의 융합 연구)

  • Park, Jeong-Ran;Youn, Mi-Sun;Choi, Yu-Ri
    • Journal of the Korea Convergence Society
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    • v.9 no.7
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    • pp.95-103
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    • 2018
  • The purpose of this study was to awareness of dental care services in the elderly long-term care insurance system and retirement preparation of middle-aged people. The survey respondents had a 56.1% saving for old age life, And showed a tendency to they don't like depend on one's family(41.8%), elderly care was intended to use facility services and nursing care. 36.7% of respondents answered "I know a little" about the system. Also, the need for dental care services within the system was high (98.5%), If the service is provided, 92.3% of the respondents said that they would participate, otherwise unrecognized rate of dental care services in long-term care insurance was 85.2%. Therefore, it is necessary to expand the awareness of the part of dental care service in the system. The results of this study can be used as basic data for the improvement of the system of dental care services in long-term care insurance for elderly.

The Self-regulating Fire Prevention System in Korea: with the Focus on the Role of Insurance System (자율예방체계의 구축 -규제개혁의 차원에서 보험의 역할을 중심으로-)

  • 김태윤
    • Fire Science and Engineering
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    • v.15 no.1
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    • pp.55-65
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    • 2001
  • This paper's purpose is three-folded: modeling the self-regulating fire prevention system, developing a packet of practical fire prevention measures and regulations, and reviewing the applicability of fire insurance system in Korea as a main components of the self-regulating fore prevention system. The so called self-regulating fire prevention system is defined as a grand national fire prevention framework based on and promoted by the vitality and creativeness of the market (or private sector). This drastically contrasts with the existing government-led fire prevention system in Korea. The self-regulating fire prevention system has three grounds: the principle of self-responsibility, the redefinition of the fire service as a public goods, and the principle of self-selection. It seems natural that the self-regulating fire prevention system requires the function of fire insurance institution as a pivoting mechanism providing individual decision makers with a system of incentives, resulting in rational behaviors in the part of each individuals and in the well-balanced fire prevention network in the part of the overall public. In this regard, this pilfer examines the institutions and performance of the fire insurance industry in Korea and reviews the limitation of the industry as an instant replacement mechanism of the current government-led fire prevention system in Korea.

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Effects of Dysfunctional Customer Behavior, Job Stress and Stress Copying on Job Satisfaction in Insurance Solicitors (고객공격행동, 직무스트레스, 스트레스 대처가 보험설계사의 직무만족도에 미치는 영향)

  • Lee, Sang-Hoon;Park, Seul-Ki
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.17 no.9
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    • pp.578-588
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    • 2016
  • Job satisfaction is the primary factor in determining happiness, so people change jobs when they aren't satisfied. In the case of insurance solicitors, high turnover rates imply low job satisfaction. Job stress impacts job satisfaction, and job stress is particularly prominent for insurance solicitors whose job involves working with customers face- to- face. The purpose of this study is to investigate factors influencing job satisfaction for insurance solicitors. Participants in this study consisted of 245 insurance solicitors from 3 insurance company located in Seoul, Kyonggi province and Kyongsang province. Data was collected from self-administrated questionnaires and analyzed using independent t-test, ANOVA, Pearson's Correlation Coefficient, and multiple regression. Job satisfaction showed a significant correlation with dysfunctional customer behavior, job stress, and ability to cope with stress. The main factors of job stress, stress coping ability, and income level had significant influence on job satisfaction for insurance solicitors. The explained variance for job satisfaction was 34%. These findings provide empirical evidence for the importance of job stress and stress coping variables in job satisfaction for insurance solicitors. This study aims to assist in predicting insurance solicitor's job satisfaction.

An Analysis of Relationships among Quality, Satisfaction and Utilization Perceived by Family Caregivers in Standard LTC Utilization Plan (가족수발자가 인지하는 표준장기요양이용계획서의 질과 만족도, 활용도 간의 관계분석)

  • Lee, Jung-Suk;Han, Eun-Jeong;Kwon, Jinhee
    • 한국노년학
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    • v.31 no.4
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    • pp.871-884
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    • 2011
  • Standard Long-term care(LTC) Utilization Plan is a kind of care plan, which aims to help beneficiaries and their family choose services to meet their care needs. The objective of this study is to determine the relationships among family caregivers' perceived quality, overall satisfaction and utilization in Standard LTC Utilization Plan. Data were gathered from family caregivers with beneficiaries who have used community service in long-term care insurance system. A national cross-sectional descriptive survey was conducted in December 2008, using proportionate quota sampling. Finally, 351 family caregivers completed questionnaires which included demographic characteristics, perceived quality(9 items), overall satisfaction(1 item) and utilization(2 items). Path analysis was conducted to find a causal relationship. This study shows firstly, the quality of Standard LTC Utilization Plan was categorized into three dimensions, that is, assessment of care needs, recommended care plan, and management of monthly benefits. Secondly, reliability and validity of quality items were satisfied. Finally, in the effect of perceived quality and satisfaction for utilization, assessment of care needs(indirect effect, path coefficients=0.077) and overall satisfaction(total effect, path coefficients=0.324) were statistically significant. The findings of this study would be helpful in developing the strategies, which is needed to improve the role of Standard LTC Utilization Plan.

Policy Implications of the Long-term Care Insurance System Revitalization Process for Establishing Integrated Care System in Japan (일본의 지역포괄케어시스템 구축과 개호보험제도 개정과정의 정책적 시사점)

  • Yoo, Ae Jung
    • 한국노년학
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    • v.39 no.1
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    • pp.1-20
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    • 2019
  • Recently, the Ministry of Health and Welfare has emphasized the necessity to build community care, and the interest of health care- long-term care-social welfare system continues. In order to examine the future vision of long-term care for elderly people, which can be a core system in establishing community models for elderly people in the future, we will implement aging in place as a national policy project. It is meaningful to analyze in depth the case of Japan's policy implementation through the amendment process of long-term care insurance system. The purpose of this study is to examine the concept definition, operating system, and major promotion process of the Integrated Care System in Japan and to suggest policy implications for the future Korea long-term care insurance system. As a result of reviewing the operation status and revision process of the long-term care insurance system for establishing the Integrated care system in Japan, it is necessary to clarify the basic principles and construction of community care system, diversification of residence type and upgrading work, establishment of linkage network of health care-long term care-social welfare, expansion of support for family and self-mind.

Dentists' Opinions in The Dental Field of Present Health Insurance Claim and Review (건강보험중 구강요양급여의 청구 및 심사에 관한 치과의사의 견해)

  • Chang, Yong-Seog;Ahn, Yong-Woo;Park, June-Sang;Ko, Myung-Yun
    • Journal of Oral Medicine and Pain
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    • v.30 no.2
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    • pp.215-230
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    • 2005
  • The study was intended to investigate how dentists in private dental clinic thought on the present claim and review of dental insurance to reflect it in future establishing dental insurance policies. 1,465 dentists who were running own dental clinic in Pusan Metropolitan City and the south part of Kyungsang province were surveyed in February, 2004. A total of 406 copies of finished questionnaire were finally retrieved and analyzed. The findings are as follows. 1. About insurance claim affairs : Most of the subject of insurance claim was by dentist himself or dental hygienist(nurse). Agency claiming was carried under 20% of total insurance claim. 2. The degree of attendance on insurance lecture : The degree of attendance on insurance lecture was relatively low. 3. Filing a protest against insurance claim : Filing a protest against insurance claim was reavealed about half-and-half for "have been" or "have not been". 4. Private clinic dentist,s opinion about the regulations affecting review of dental insurance : Private clinic dentists opinion about current guide for insurance review of dental fee was“the guidance is difficult and unfair cutback of claim fee may be carried”. 5. The affairs about health insurance review agency : About 70% of private clinic dentists have dissatisfaction on health insurance review agency. 6. Standpoint of private clinic dentists about issuance of receipt for dental fee : About 70% of private clinic dentist have an difficulty in issuance of receipt for dental fee. 7. The affairs about change insurance noncoverage treatment to insurance coverage treatment : Most of private clinic dentists hoped that insurance coverage about full mouth scaling, pit and fissure sealant, fluoride application. But they do not hoped that insurance coverage about geriatric denture, prothodontic treatment except precious metal, photopolymerization resin treatment.

Development of Driving Evaluation model of a truck for UBI (화물자동차 UBI 도입을 위한 운행 평가 모델 구축)

  • Yoo, GeonGeun;Won, Jong-Un;Lee, Suk;Kwon, YongJang
    • Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology
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    • v.6 no.12
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    • pp.469-481
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    • 2016
  • Freight car accidents occur frequently and have a high mortality. In this reason, freight can insurance fee has been raised drastically. But speeding and overloading of trucks are still not decreased. We need to consider a measure about voluntary safe driving of truck drivers. We select UBI(Usage-Based insurance) as a measure for safe driving of truck drivers. UBI is a car insurance system and insurance fee is flexible. If vehicle drivers drive safely, insurance fee is discounted. The other way, if vehicle drivers drive dangerously, insurance fee is increased. In now, very high insurance fee for truck drivers, UBI is a effective way for leading a truck driver to safe driving. The most important thing in UBI is to evaluate truck driver rationally and accurately. In this paper, we select the reasons of truck accidents and develop driving evaluation model from multiple regression analysis and correlation analysis with accident reasons and truck accidents.

재일 코리안 1세에 있어서 개호보험 서비스 이용을 소외하는 요인에 관한 연구

  • Ham, Ryeo-Jin
    • 한국사회복지학회:학술대회논문집
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    • 2007.04a
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    • pp.661-667
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    • 2007
  • 현재 일본 내에 거주하고 있는 외국인 중 재일 한국인/조선인(이하, 재일코리안)이 제일 많은 부분을 차지하고 있다. 재일 코리안 중 65세 이상이 13%가 넘는다(재일고령자 조사위원회, 2003). 이런 재일한국인/조선인의 고령자(이하, 재일코리안 1세라고 말함)는 대부분 식민지시대에 조국에서의 생활기반을 잃어버리고 일본에 건너오게 되거나 혹은 강제연행으로 인해 일본에 거주하게 되었다. 재일코리안 1세는 연령적으로는 후기 고령자이며, 문화의 차이, 언어적 문제 그리고 경제적인 문제 등의 어려움이 있다. 이런 많은 어려운 점 중에서도 특히 개호의 문제(노인수발 문제)는 가장 심각하다. 이런 문제들 중 먼저 역사적인 경위에 대해 선행연구 등을 통해 논해 보고자 한다. 또한 문화적 차이와 언어적 문제가 개호보험 서비스 이용에 있어서 장애가 될 가능성도 있을 수 있으며, 대다수가 무연금자인 점(길영(吉永), 2004), 개호보험과 재일코리안 1세의 경제적인 요인이 심각한 문제인 점인것(북촌(北村), 2004)을 말하고 있다. 이를 배경으로, 후꾸오까/나가사키 지역의 재일동포 1세에게 직접 설문조사를 실시했다. 조사 결과 재일코리안 1세는 일본의 고령자보다 훨씬 개호보험 서비스 이용에 소외될 가능성을 가지고 있었다. 재일코리안 1세의 개호의 문제는 한국에서가 아니라, 거주하고 있는 일본에서 해결되어 져야만 하는 문제이며 그 개선책 또한 논하였으며 향후의 방향성에 대해서도 고찰해 보았다.

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