• Title/Summary/Keyword: 의료보험

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The current status of the combination therapy of frequently used herbal extracts and anti-platelet drug, anti-coagulant drug in ischemic stroke patients hospitalized in oriental medical hospital (한방병원 입원 허혈성 뇌경색 환자에서 한방 의료보험용 엑스산제와 항혈소판제 및 항응고제의 병용투여 현황)

  • Han, Su-Ryun;Park, Sung-Hwan;Ahn, Young-Min;Ahn, Se-Young;Lee, Byung-Cheol
    • The Journal of Korean Medicine
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    • v.32 no.2
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    • pp.14-22
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    • 2011
  • Objective: Nowadays the combined use of herbal extracts and western medicines has been prevalent, but concern about its risk is also increasing. Even though the importance of clinical trials is well recognized, there have been only a few studies on the combined use of herbal extracts and western medicines. This study was aimed to examine which herbal extracts and antiplatelets or anticoagulants are most commonly prescribed together to inpatient ischemicstroke patients and investigate the combined prescription rate. Methods: We investigated the most frequently prescribed herbal extracts from two different sources. First, we chose herbal medicine extracts from 2008 Traditional Korean Medicine Utilization Status. Then, among patients who were admitted to Kyung-Hee Oriental Medical Center diagnosed with ischemic stroke, we found patients who were administered with these herbal medicine extracts and among these patients, we investigated how many were concomitantly administered with antiplatelets or anticoagulants. Second, we chose other herbal medicine extracts that were most often prescribed within Kyung-Hee Oriental Medical Center and found patients who were administered with these herbal medicine extracts, then investigated how many of them were concomitantly administered with specific antiplatelets or anticoagulants. Results: The most commonly prescribed herbal medicine extracts among ischemic stroke patients were Ojeok-san, Bojungikgi-tang, Sochungryong-tang and Samsoeum. About 46 to 69 percent were concomitantly administered with either specific antiplatelets or anticoagulants. Conclusions: The most often prescribed herbal medicine extracts in inpatient ischemic stroke patients are Ojeok-san, Bojungikgi-tang, Sochungryong-tang, and Samsoeum. Among patients who were prescribed with Ojeok-san, Bojungikgi-tang, Sochungryong-tang, Samsoeum, patients who were concomitantly administered with either antiplatelets or anticoagulants were about 46% to 69%.

The Accuracy of ICD codes for Cerebrovascular Diseases in Medical Insurance Claims (의료보험청구자료중 뇌혈관질환 상병기호의 정확도에 관한 연구)

  • Park, Jong-Ku;Kim, Ki-Soon;Lee, Tae-Yong;Lee, Kang-Sook;Lee, Duk-Hee;Lee, Sun-Hee;Jee, Sun-Ha;Suh, Il;Koh, Kwang-Wook;Ryu, So-Yeon;Park, Kee-Ho;Park, Woon-Je;Kim, Chun-Bae
    • Journal of Preventive Medicine and Public Health
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    • v.33 no.1
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    • pp.76-82
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    • 2000
  • Objectives : We attempted to assess He accuracy of ICD codes for cerebrovascular diseases in medical insurance claims (ICMIC) and to investigate the reasons for error. This study was designed as a preliminary study to establish a nationwide surveillance system. Methods : A total of 626 patients with medical insurance claims who indicated a diagnosis of cerebrovascular diseases during the period from 1993 to 1997 was selected from the Korea Medical Insurance Corporation cohort (KMIC cohort: 115,600 persons). The KMIC cohort was 10% of those insured who had taken health examinations in 1990 and 1992 consecutively. The registered medical record administrators were trained in the survey technique and gathered data from March to May 1999. The definition of cerebrovascular diseases in this study included cases which met ore of two criteria (Minnesota, WHO) or 'definite stroke' in CT/MRI finding. We questioned the medical record administrators to explain the error if the final diagnoses were not coded as stroke. Results : The accuracy rate of the ICMIC was 83.0% (425 cases) Medical records were not available for 8.2% (51 cases) due to the closing of hospitals, the absence of a computer system or omission of medical record, etc. Sixty-three cases (10.0%) were classified as impossible to interpret due to insufficient records in 'major clinical symptoms' or 'neurological deficits'. The most common reason was 'to meet review criteria of medical insurance benefits (52.9%)'. The department where errors in the ICMIC occurred most frequently was the department for medical insurance claims in the hospital. Conclusion : The accuracy rate of the ICMIC was 83.0%.

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Revenue and Expenditure by Alternative Integration Proposals of the Medical Insurance Society for Self-Employed (지역의료보험조합의 통합대안별 재정수지 비교)

  • Park, Jae-Yong;Beh, Sung-Kweun;Kam, Sin
    • Health Policy and Management
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    • v.5 no.1
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    • pp.80-105
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    • 1995
  • Assuming that we introduced integration of medical insurance society for self-employed, this study was conducted to examine effects and results after the integration and to research more effective method for integration. To assess effects and results of the finacial status of 266 insurance societies after intergration, the data were obtained from "The Medical Insurance Program for Self-Employeds Statistical Yearbook in 1992". The major finding are as follows : 1. Three alternative integration proposals were made. First alternative proposal was consisted of 232 medical insurance societies, second was 187, and third was 115. 2. As the results of average number of the insured per insurance societies of medical insurance program for self-employed every alternative proposal, first was 88, 119 persons, second was 108, 576, and third was 178, 967 from 76, 576 persons of present socienties. 3. It was true that the more average size of societies increased, the more average administration expenditure per 1, 000 insured reduced. 4. The average size of societies grew bigger, the rate of general expenditure to general revenue more improved. Also, the rate of benefits to contributions was changed for better. But if not to have had correct analysis and precise preparation for integration, effects and results of integration were always not optiized. 5. According to results of simple regression formulas, it was proved that the more the average size of societies was increased, the more result was advantaged. 6. The law of majority and the economy of scale were applied in this study, and it was necessary to analyze and assess effectiveness and efficiency of integration. Therefore, when the integration of medical insurance societies for self-employeds will be performed, it must be taken into consideration. Among three alternative proposals, third was showed more effective alternative than anothe, second was presented more ineffective result than present system. To achieve more effective and efficient integration of regional medical insurance societies throughout the result of the regression formula on present cost curve, it is necessary to operate well-integrated societies and to know appropriative countermeasures of present situation of each societies. Also, for integrating regional medical insurance societies, it is necessary to continue more deep research through practical model activity and to investigate the effective size and managed method of the societies.societies.

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Determinant Factors for Expenditure of the Medical Insurance Program for Self-Employeds (지역의료보험(地域醫療保險) 재정지출(財政支出)의 결정요인(決定要因))

  • Kam, Sin;Park, Jae-Yong;Yeh, Min-Hae
    • Journal of Preventive Medicine and Public Health
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    • v.28 no.1 s.49
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    • pp.153-174
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    • 1995
  • This study was conducted to examine the determinant factors for expenditure of the medical insurance program for self-employeds based on the analysis of 1991 'The Medical Insurance Program for Self-Employeds Statistical Yearbook', and also similar yearbooks in the metropolitan and other provinces. The major findings are as follows : We have divided benefits into these four components such as the utilization rate for out-patients, expenses per claim for out-patients as paid by the insurer, utilization rate for in-patients, and the expenses per claim for in-patients as paid by the insurer, in order to examine the determinant factors for it. The results of the study revealed the following findings, in urban areas, the supply of medical care had more influence on the benefits than other demographic and economic variables, while, in county areas, both the supply of medical care and the rate of those aged over 65 affected the provision of benefits. The determinant factors for financial balance of the medical insurance program for self-employeds are, first, the determinant factor for administrative expenses was the number of households. The more the number of households, the less the administrative expenses per the insured. This shows that the economy of scale is being. And so, the administrative district must be taken into consideration in the incorporation of small regional medical societies and should be re-organized for more efficient management. Second, in urban areas, the supply of medical care had more influence on utilization rate and expenses per claim as paid by insurer, and therefore it is necessary to control it. In county areas, the supply of medical care and the rate of those aged over 65 raised the utilization rate and expenses per claim as paid by insurer. For the financial stability of county areas, a common fund for medical care for the aged and expansion of finance stabilization fund would be necessary. But, in county areas, it would be unnecessary to control the supply of medical care because it was much more insufficient than in urban areas. The vitalization of public health facilities must be carried out in county areas, for they reduced benefits. Sice the more insured in a single household, the less the utilization of the medical insurance program, benefits for habilitation at home should be given consideration. The law of majority and the economy of scale were applied here, and therefore the incorporation of regional medical societies must be taken into consideration. In integrating regional medical societies, it would be absolutely necessary to review the structural differences among all regional medical societies, the medical demand of each region, and also the local characteristics of each region.

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A Study on the Introduction Direction of Private Investigation Law (민간조사업법의 도입방향에 관한 연구)

  • Lee, Seung-Chal
    • Korean Security Journal
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    • no.17
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    • pp.255-276
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    • 2008
  • The important items, which should be considered in Private Investigation Law, can include subjects, licenses, the scope of business, qualifying examinations, and supervisory and penal provisions. The subjects of Private Investigation Law should be permitted to be both natural persons and juridical persons in terms of providing various services, but should be permitted to be juridical persons and should be administered on a license system, even in order to ensure public interests. Concretely, the introduction scope of Private Investigation Law can be regulated to include the followings: that is, investigating the whereabouts identification of runaways and missing children, investigating the personal identification, habit, way of action, motivation, whereabouts identification, real child confirmation, association, transaction, reputation, and personality of specific persons or specific groups, investigating the whereabouts identification of missing persons, owners of government-vested properties or renounced properties, investigating the whereabouts of lost properties or stolen properties, investigating the causes of fire, character defamation, slander, damage, accident, physical disability, infringement on real estate or movable property, and investigating all sorts of accidents including traffic accidents, insurance accidents, and medical malpractices. In the qualifying examination, examinees' age should be restricted to be over age 25. The person, who is exempted from its primary examination, should be restricted to be the person, who has the career of over 20 years in related fields, in consideration of its equity with other certificates of qualification. In the supervisory institution, as the policy institution is the supervisory institution in many countries including France (the police) and Japan (public security committee), so the National Policy Agency should be the supervisory institution in consideration of management aspects. In the penal regulations, especially, we should clarify the management of personal information (personal information protection, personal information management), and so should prevent the infringement of people's basic rights, and then should ensure the public interest.

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Convergence Research on Periodic Changes in the Quality Assessment of Surgical Prophylactic Antibiotics (수술 예방항생제 적정성 평가의 주기별 융합 변화 연구)

  • Yang, Sae-Yie;Kim, Kwang-Hwan
    • Journal of Digital Convergence
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    • v.14 no.6
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    • pp.325-333
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    • 2016
  • This study was conducted to provide the base line for the use of prophylactic antibiotics and the standard of antibiotic use and the evaluation based on analysis of current use, quality assessment and periodic changes of prophylactic antibiotics in a university hospital. We chose the year 2008, 2009, 2010, 2012, and 2014 as the study periods since the primary evaluation on the first year of implementation in 2007. For this study, healthcare benefit quality assessment data from the Health Insurance Review and Assessment Service was used. We analyzed the differences each year of treatment period; one category for initial treatment timing, three categories for selecting antibiotics, and two categories for the length of treatment from multiple evaluation indices of gastric surgeries, colorectal surgeries, and cholecystectomy. The analysis revealed the followings: Regarding length of antibiotics treatment, total days of treatment decreased down to 1.5, 1.5, and 0.6 days in the year 2014, from 13.5, 12.8, and 6.9 days in the year 2007, for gastric surgeries, colorectal surgeries, and cholecystectomy. Based on these outcomes, the efforts to devise efficient delivery and distribution of the recommendations or indices which medical staff could adhere for quality improvement of the prophylactic antibiotics would be necessary. Also implementing monitoring system to help the hospitals to acknowledge their own faults may be helpful.

Exploration of relationship between confirmation measures and association thresholds (기준 확인 측도와 연관성 평가기준과의 관계 탐색)

  • Park, Hee Chang
    • Journal of the Korean Data and Information Science Society
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    • v.24 no.4
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    • pp.835-845
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    • 2013
  • Association rule of data mining techniques is the method to quantify the relevance between a set of items in a big database, andhas been applied in various fields like manufacturing industry, shopping mall, healthcare, insurance, and education. Philosophers of science have proposed interestingness measures for various kinds of patterns, analyzed their theoretical properties, evaluated them empirically, and suggested strategies to select appropriate measures for particular domains and requirements. Such interestingness measures are divided into objective, subjective, and semantic measures. Objective measures are based on data used in the discovery process and are typically motivated by statistical considerations. Subjective measures take into account not only the data but also the knowledge and interests of users who examine the pattern, while semantic measures additionally take into account utility and actionability. In a very different context, researchers have devoted a lot of attention to measures of confirmation or evidential support. The focus in this paper was on asymmetric confirmation measures, and we compared confirmation measures with basic association thresholds using some simulation data. As the result, we could distinguish the direction of association rule by confirmation measures, and interpret degree of association operationally by them. Futhermore, the result showed that the measure by Rips and that by Kemeny and Oppenheim were better than other confirmation measures.

Relationship between Oral Health Care Behaviors and Perceived Periodontal Disease on Hypertension Patients (고혈압 환자의 구강건강관리 행태와 주관적 치주건강수준의 상관관계 연구)

  • An, Eunsuk;Kim, Min-Young
    • Journal of dental hygiene science
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    • v.16 no.1
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    • pp.101-109
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    • 2016
  • The purpose of this study was to examine the impact of the oral health behaviors and lifestyle of hypertension patients on their perceived periodontal diseases. The data of the 2013 community health survey were used, and the data of 55,632 patients who suffered from hypertension and who were at the ages of 19 and over was analyzed. The analying methods used in this study were chi-square test and multiple logistic regression analysis. Gender, age, marital status, education, economic activity, income level and subscription to private medical insurance were identified as the factors to affect the perceived periodontal disease of the hypertension patients, and lifestyle and oral health behaviors were found to have exerted a significant influence on perceived periodontal disease. As this study found that not only the socioeconomic characteristics of the hypertension patients but their oral health care and lifestyle were all correlated with perceived periodontal disease, how to promote the oral health of those who are susceptible to periodontal diseases should carefully be considered.

Factors Affecting the Depression of the Elderly Women in Poverty (빈곤층 여성 노인의 우울에 미치는 영향요인)

  • Park, Eun-A;Lee, In-Sook
    • Journal of agricultural medicine and community health
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    • v.34 no.2
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    • pp.256-266
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    • 2009
  • Objectives: This study was to investigate the factors affecting the depression of the elderly women in poverty in community. Methods: The subjects were 1,208 elderly women over 65 years who were enrolled in the Public Health Care Center from Apr. 2008 to Jun. 2008. Data were collected using questionnaires including general characteristics, health related behaviors and health status by nurses at the time of enrollment. The collected data were analyzed by descriptive statistics, $x^2$-test, Pearson correlation coefficients and multivariate logistic regression. Results: The major findings of this study are as follows : The elderly women in poverty show a tendency to have lower level in income, education, self-rated health, cognitive function compared with ordinary women in old age. The predictors of depression of the elderly women in poverty were spouse's existence or nonexistence, type of insurance, cognitive function, and self-rated health. Conclusion: These findings suggest the need to develop nursing strategies for decreasing depression in the elderly women in poverty. To decrease the depression of the elderly women, the above-mentioned major influencing factors should be considered.

A Study of the Influence of 'the Separation of Prescribing and Dispensing Roles' Policy on Medical Institutions (의약분업실시에 따른 의료기관의 건강보험외래부문 순이익변화 추계)

  • Chung, Woo-Jin;Shin, Seung-Ho;Lee, Sun-Mi;Jung, Sang-Hyuk;Koh, Kwang-Wook;Park, Si-Woon;Shin, Eui-Chul;Lee, Sun-Hee;Hwang, Jin-Mee
    • Korea Journal of Hospital Management
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    • v.7 no.4
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    • pp.1-23
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    • 2002
  • This study examined the influence of the separation of prescribing and dispensing roles(SPD) policy implemented in Korea in July 2000, especially on the change in the net profit of medical institutions. Using the data set from the Korea's National Health Insurance and the previous research, this study elicited the following main results. First, tertiary care institutions was estimated to lose about 631 billion won after the SPD policy. Second, general hospitals and hospitals gained about 557 billion and 564 billion won, respectively. Third, it is shown that clinics also gained 389-659 billion won. Finally, however, the change in net profit of medical institutions after the SPD policy largely depends on different estimation models. Moreover, it also varies from the assumptions on the price differential of a reimbursable drug which worked as cross-subsidy to insufficient physician's fee before the SPD policy. Despite such limitations as lack of data outside of the National Health Insurance's coverage, this study differs from others. This is the first research to explore the effect of the SPD policy on different types of medical institutions and to attempt to purely focus on the SPD policy. In this study, we can draw the policy implication that preparing for a policy change, the government should set up the policy evaluation system to collect the concerned data and develop the methodologies in advance to the policy implementation.

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