• The Journal of the Korea Contents Association
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• v.22 no.1
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• pp.601-610
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• 2022

Although the number of people insured by private health insurance in Korea is steadily increasing, the household burden or the status of multiple purchasing for private health insurance has not been addressed. In this study, data of the 2011-2018 Korea Health Panel Survey was used to examine the purchasing trend of Korean households' private health insurance. Households with more than three private health insurance per household member were defined as the 'poly-purchases'. The logit model was applied to analyze factors associated with poly-purchase of private health insurance using 2018 cross-sectional data. From 2011 to 2018, the number of insurances purchased by Korean households increased (4.0 to 4.6), the number of insurances per capita increased (1.3 to 1.6), and the proportion of the poly-purchasing households increased (5.2% to 10.8%). As a result of logit analysis, the probability of poly-purchasing was increased when the household head was a woman, with a high level of education and income, and when the job of the household head was a service or sales. Poly-purchasing was less likely when the family was subsidized with Medical Aids and suffered with more chronic diseases. The results of this study serve basic evidence for establishing policies regarding private health insurance, such as establishing the relationship between public and private insurance.

• Korean Journal of Social Welfare
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• v.37
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• pp.119-141
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• 1999

Korea paid attention to the work injury insurance in the early economic development stage as other developed countries did. Thus "The industrial Accident Compensation Insurance Law" was legislated in 1963 and it is now expanded to apply to the workplace with five or more employees. Beside the low coverage of the number of employees, the scope of benefits are the problem of work injury insurance. The work injury insurance's main benefits are for the loss of income and the medical cost caused by occupational accidents. On the other hand, the investment on the prevention accident and the medical, social and employment rehabilitation is very low, even though the occupational accident pension is higher than that in other OECD countries. Practically lay-off benefits and survivor' benefit for some special workers are paid more than they need, therefore they want to remain under the benefit condition and the medical care days are longer. This paper indicates the problems of work injury insurance and suggest how to improve the functions of it.

• 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.

• Proceedings of the Korea Inteligent Information System Society Conference
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• 2007.11a
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• pp.362-366
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• 2007

최근 기업 경영활동의 의사결정시 사용되는 비즈니스 룰(Business Rule)을 정형화하고 하나의 시스템으로 구축하여 효과적으로 기업의 경쟁력을 제고하기 위한 노력이 다양하게 시도되고 있다. 비즈니스 룰 시스템 구축 작업의 경우 기업 내부에 비정형적으로 존재하는 비즈니스 룰을 체계적으로 관리하기 위해 BRMS(Business Rule Management System)와 같은 전문 관리 도구를 도입하나, 대부분의 경우 비즈니스 룰 리포지토리(Repository)를 단순히 기능별 혹은 업무별로 구성함으로 인해 동일한 내용의 룰이 서로 다른 룰 리포지토리에 중복 존재하게 되는 등 구조상의 문제점을 발생시킨다. 이로 인해 각 어플리케이션 간의 룰 또는 룰 세트(Rule Set) 공유 관계가 수동 관리되거나 중복 룰의 수정으로 인한 룰 세트별 버전 관리 문제 등 비즈니스 룰 리포지토리 운영의 어려움에 봉착하게 된다. 본 연구에서는 금융보험사의 룰웨어하우스 구축 사례를 통해 다양한 어플리케이션에서 참조되는 전사 수준의 비즈니스 룰 관리 아키텍처 구성 방법 및 각 방법이 지닌 장단점에 대해 분석한다. 본 연구의 결과를 토대로 다양한 어플리케이션에서 참조되고 수시로 변경되는 전사 수준의 통합 비즈니스 룰 관리 시스템 구축 방안에 대한 연구가 활성화되기를 기대한다.

• Journal of Preventive Medicine and Public Health
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• v.26 no.3 s.43
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• pp.457-468
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• 1993

This study was conducted to investigate the repeat test rate for diagnosis at a tertiary hospital for the outpatients who were referred themselves to the hospital by the clinics and other medical facilities. The study population consisted of 498 patients who visited outpatient department of internal medicine, general surgery, orthopedic surgery and neurosurgery in the hospital between March 16 and April 11, 1992. This study was surveyed by the questionnaire about the tests for diagnosis at first level medical facilities, and then, was investigated by the medical record about the tests for diagnosis at a tertiary hospital. The proportion of test among the patients who utilized the first level medical facilities was 20.9% for the X-ray test, 10.6% for the urinalysis, 9.0% for the electrocardiogram, 3.4% for the computer tomogram and 6.4% for the ultrasonogram. At the tertiary hospital, the X-ray test was 45.2%, the liver function test was 24.1%, the urinalysis was 19.1%, and the electrocardiogram was 15.7%. The proportion of patients who possessed results of test for diagnosis at the first level medical facilities was 76.5% for the computer tomogram, and 31.3% for the ultrasonogram. As the repeat test rate between the first level medical facilities and the tertiary hospital, the thyroid function test was the first rank as 71.4%, the second rank was the routine CBC as 67.9%, and the third rank was the X-ray test as 64.4%. But among the patients that brought the result for tests at the first level medical facilities, the repeat test rate was as follow : the routine CBC was 75.0%, the liver function test was 72.1%, and the computer tomogram was 15.4%.

• The Journal of the Korea Contents Association
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• v.13 no.4
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• pp.170-186
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• 2013

As the population is getting older, medical expenses amount of the whole is keep increasing. So, the pressure of the finances, Health Insurance, Medical Care Assistance Act and etc, is getting higher. The share of healthcare-expense is increasing due to elderly illness. And it became a social problem; we analysed present state of senior healthcare in South Korea-looked into current laws and policies, and found problems. We tried to suggest improvements that drew from the current state of foreign country senior healthcare of those problems. For the result, we found the problem in relevant-law system of senior healthcare guarantee. In this study, we proposed the ways to qualitatively upgrade of medical standard that considered on elderly' features: the strengthened guarantee for healthcare, financial secure for long-term convalescence benefit, linking and functional reinforcement for elderly welfare and long-term convalescence insurance, the solution for overlapped laws about convalescence in long-term convalescence insurance and elderly welfare, a betterment of grading, and a home service consolidation. We need to secure right amount of emergency medical service budget, and effective management system for the improved level of senior severely emergency medical service. Furthermore, we suggested that South Korea needs to legislate [The Law for Senior Medical Secure] to respond to rapidly increasing senior healthcare fee.

• 보건세계
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• v.46 no.8 s.516
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• pp.28-29
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• 1999

최근 한국보건사회연구원이 국민의 의약품 사용실태를 조사한 결과에 의하면 1천명중 33명이 매일 항생제를 복용한다. 이는 OECD 회원국가의 평균치 21명보다 월등히 높은 비율로, 약물남용이 우려할 만한 수준임을 보여준다. 이 조사는 또 97년도 의료보험 환자중 병$\cdot$의원에서 58.9$\%$가 항생제를 처방받았다고 밝혔다. 폐렴구균의 70$\~$80$\%$가 항생제 남용으로 페니실린에 내성을 보였는데 이는 아시아 최고수준이다. 약물남용은 항생제 뿐 아니다. 많은 사람들이 의사처방 없이 자가처방으로 약을 구입하며, 자가처방의 절반은 감기약을 구입하는데 이 경우 부적절한 처방이 문제된다. 더구나 감기약은 1가지만으로도 남용할 경우 부작용이 많은데 `판피린과 콘택 600을 주세요` 라는 식으로 물약과 알약을 동시에 주문한다. 이와 같은 약의 중복사용은 약물의 남용효과를 더욱 크게 한다.

• The Journal of the Korea Contents Association
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• v.12 no.12
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• pp.282-290
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• 2012

Today, home health care services needs a linkage plan of the customized home visiting health service in public health center, the medical institute home health care service, and home visiting nursing service based on long term care insurance for the elderly program which acknowledges the independence and professionalism of the home health care services while minimizing overlap through linking the projects. So, this study was performed by applying the Delphi technique, which draws agreement from professional opinion, to determine a method to link home health care services in Korea. The results of this study are as follows. Specialists agreed on 24 important items within the two domains of institutional linkage and medical linkage. And the significance of this study is as follows. The 24 items deduced for the approved nursing service linkage plan are expected to improve the home health care service business system, enhance the quality of home health care service, and bring increased satisfaction for service recipients. Also, seeking ways to minimize overlap in service can increase the effectiveness of health care and public health management at a national level. In addition, it is considered that this will ultimately reduce public medical costs as well as improve home health care service.

• 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.

• The Korean Journal of Financial Management
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• v.14 no.3
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• pp.113-135
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• 1997

본 논문의 목적은 미국 손해보험회사간의 합병을 대상으로 하여 합병전과 후 기업의 X-효율성을 실증분석과 모의분석 방법을 이용해서 검증하고 합병의 잠재적인 X-효율성 효과를 분석하고자 하였다. X-효율성의 증진정도를 파악하기 위해서 횡단면적인 비용함수를 먼저 추정하였는데 비용함수 추정시 생산물이 제로(0)인 경우를 포함하기 위하여 혼용초월 로그비용함수(hybrid translog cost function)를 사용하였다. 그리고 Berger(1992)의 비분포방법(distribution free approach)를 사용하여 기업의 합병전,후 X-효율성을 추정하였다. 1986년부터 1990년 사이에 수평합병한 미국 손보사를 대상으로 피합병기업(merged firms)과 합병기업(merging firms)간의 X-효율성 차이를 검증하였으나 합병전 합병기업이 더 효율적이라는 통계적 증거는 없었다. 두 번째로 합병기업은 합병후 효율성이 증진하였느냐는 가설도 검증하였으나 이 가설을 지지할 만한 통계적 증거는 미약하였다. 가상합병을 통한 모의분석에서는 합병후 상당한 X-효율성 증진이 있을 것이라는 통계적으로 유의한 결과를 얻었으나 합병후 규모효율성의 중진에 대해서는 통계적 유의성이 없었다. 이는 합병의 최대 효익이 규모효율성 증대가 아닌 X-효율성 증대라는 Shaffer(1993)나 Berger and Humphrey(1993)의 연구결과와 일치한다. 실증분석 결과와 모의분석 결과를 비교하면 전자에서는 합병후 X-효율성의 증가효과가 거의 없었으나 후자에서는 합병후 상당한 X-효율성 증가가 있을 것으로 나타났다. 이는 실제 미국 손보사의 합병에서 과도한 합병프리미엄 지급, 규제에 의한 중복비용 둥으로 단기적으로 볼 때 합병사가 부담하는 합병비용이 합병에 의한 효익보다 컸을 것이라는 것을 시사한다.