• Title/Summary/Keyword: 지수보험

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Development of Natural Hazard Risk Map using Insured Claim Payouts and Its Application (보험 손실액을 활용한 자연재해 위험 지도 개발 및 적용방안 연구)

  • Kim, Ji-Myong;Park, Young Jun
    • Proceedings of the Korean Institute of Building Construction Conference
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    • 2015.05a
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    • pp.257-258
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    • 2015
  • The amount of damages caused by natural hazards is consistently growing due to the unusual weather and extreme events. At the same time, property damage by natural hazards is rapidly increasing as well. Hence, we need systematic anti-disaster activities and consulting that can react to such a situation. To address these needs, we investigated and analyzed insured claim payouts from natural hazards by administrative area, and calculate the risk index utilizing GIS. According to the index, this map is identifying the areas of greatest natural hazard risk. The ranking of natural disaster vulnerability based on the risk index, and risk grades were divided into five based on the ranking. This map integrates the natural hazard losses to assist in comprehensive and effective loss prevention activities using analysis of regional loss claims from natural hazards. Moreover, this map can be as utilized as loss mitigation and prevention activities to verify the distribution of exposure and hazards.

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Financial Projection for National Health Insurance using NHIS Sample Cohort Data Base (국민건강보험 표본코호트 DB를 이용한 건강보험 재정추계)

  • Park, Yousung;Park, Haemin;Kwon, Tae Yeon
    • The Korean Journal of Applied Statistics
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    • v.28 no.4
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    • pp.663-683
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    • 2015
  • The change of the population pyramid due to low fertility and rapid aging threatens the financial sustainability of National Health Insurance. We construct statistical models for prevalence rates and medical expenses using National Health Insurance Service (NHIS) sample cohort data from 2002-2013. We then project yearly expenditures and income of national health insurance until 2060 that considers various assumptions in regards to future population structure and economic conditions. We adopt a VECM-LC model for prevalence rates and the double exponentially smoothing method for the per capita co-payment of healthcare expense (in which the two models are institution-disease-sex-age specific) to project of national health insurance expenditures. We accommodate various assumptions of economic situations provided by the national assembly and government to produce a financial projection for national health insurance. Two assumptions of dependents ratios are used for the projection of national health insurance income to conduct two future population structures by the two assumptions of aging progresses and various assumptions on economic circumstances as in the expenditure projection. The health care deficit is projected to be 20-30 trillion won by 2030 and 40-70 trillion won by 2060 in 2015 constant price.

A Study on the introduction of the outpatient and inpatient conversion factors in the 2020 Physician Fee Contract (외래⦁입원 환산지수에 기초한 2020년도 환산지수 산출 연구)

  • O, Dongil
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.22 no.4
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    • pp.183-194
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    • 2021
  • In this study, the conversion factor for 2020 is estimated based on an outpatient and inpatient conversion factor separation model developed from SGR and AR by using actual medical expense data. In addition, a policy plan is proposed to calculate the values of single and multiple conversion factors for each type of medical expense, and to effectively use the conversion factor separation model as one of the means to establish a medical delivery system. The major results are as follows. First, at r=0.1, the rate of adjustment in the hospital single conversion index in 2020 was 2.0%, and the outpatient and hospitalization conversion rates for hospitals were 2.2% and 2.3%, respectively. In addition, a combination of outpatient and inpatient conversion factors can be used for the adjustment. Second, as a measure to establish a medical delivery system, instead of adjusting the addition rate, a method of interlocking the addition rate and the conversion factor is proposed. Third, it is necessary to develop a model that enables target management of volumes, in addition to the outpatient conversion factor, the inpatient conversion factor, and the adjustment coefficient.

An Improvement of the Approximation of the Ruin Probability in a Risk Process (보험 상품 파산 확률 근사 방법의 개선 연구)

  • Lee, Hye-Sun;Choi, Seung-Kyoung;Lee, Eui-Yong
    • The Korean Journal of Applied Statistics
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    • v.22 no.5
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    • pp.937-942
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    • 2009
  • In this paper, a continuous-time risk process in an insurance business is considered, where the premium rate is constant and the claim process forms a compound Poisson process. We say that a ruin occurs if the surplus of the risk process becomes negative. It is practically impossible to calculate analytically the ruin probability because the theoretical formula of the ruin probability contains the recursive convolutions and infinite sum. Hence, many authors have suggested approximation formulas of the ruin probability. We introduce a new approximation formula of the ruin probability which extends the well-known De Vylder's and exponential approximation formulas. We compare our approximation formula with the existing ones and show numerically that our approximation formula gives closer values to the true ruin probability in most cases.

A Modeling of an efficiency analysis based on DEA_AR and AHP for the improvement of usefulness of the Accreditation of Hospitals (의료기관평가의 유용성 증대를 위한 AHP와 DEA_AR 기반의 효율성 분석 모델 구축)

  • O, Dong-Il
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.11 no.7
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    • pp.2406-2419
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    • 2010
  • This study aims to elevate the usefulness of the current annual Accreditation of Hospitals. To achieve this purpose, A modeling of an efficiency analysis based on DEA and AHP to the Accreditation of Hospitals Data from 2004 to 2008. By applying to AHP and DEA_AR to the scores derived from the various domains in data, An adequate prediction model about conversion factor in fee contract is made. By summarizing information derived from DEA, factor analysis and Generalized Linear Model, The linear functions combining conversion factor and efficiency index is successfully established. The factor analysis with AHP was used to merge diverse scores from the domains of evaluation. Not only the input and output initially introduced, AHP scores, dummy variables of hospital classification, geographical location are effective variables to forecast a conversion factor. If a predicted conversion factors from efficiency is used, It will be a great contributions to the annul doctor's fee contract.

Factors Affecting Basilar Artery Pulsatility Index on Transcranial Doppler (뇌혈류 초음파 검사에서 기저동맥 박동지수에 영향을 미치는 인자)

  • Jeong, Ho Tae;Kim, Dae Sik;Kang, Kun Woo;Nam, Yun Teak;Oh, Ji Eun;Cho, Eun Kyung
    • Korean Journal of Clinical Laboratory Science
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    • v.50 no.4
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    • pp.477-483
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    • 2018
  • Transcranial doppler is a non-invasive method that measures the blood flow velocity and the direction of cerebral blood vessels through the doppler principle. The pulsatility index is an index for measuring the transcranial doppler that reflects the distal vascular resistance and is used as an index for the presence and diffusion of cerebral small vessel diseases. The purpose of this study was to evaluate the risk factors affecting the basilar artery pulsatility index in ischemic stroke patients. From January 2014 to May 2015, 422 patients were selected by measuring the transcranial doppler pulsatility index, considering their basilar artery pulsatility index. Univariate analysis was performed using the basilar artery pulsatility index as a dependent variable. Multiple regression analysis was performed considering the factors affecting the pulsatility index as variables. Univariate analysis revealed age, presence of hypertension, presence of diabetes mellitus, presence of hyperlipidemia, and hematocrit (P<0.1) as factors. Multiple regression analysis showed statistically significant results with age (P<0.001), presence of diabetes (P=0.004), and presence of hyperlipidemia (P=0.041). The risk factors affecting the basilar artery pulsatility index of transcranial doppler were age, diabetes, and hyperlipidemia. Further research will be needed to increase the cerebral pulsatility index as a surrogate marker of the elderly, diabetes, and hyperlipidemia.

Utilization Rate of Medical Facility and Its Related Factors in Taegu (대구시민의 의료기관 이용률과 연관요인)

  • Kim, Seok-Beom;Kang, Pock-Soo
    • Journal of Preventive Medicine and Public Health
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    • v.22 no.1 s.25
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    • pp.29-44
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    • 1989
  • A household survey was conducted to determine the utilization rate of medical facilities and to identify the factors related with the utilization in the South District of Taegu from July 3 to July 15, 1988. Study population included 1,723 family members of 431 households which were selected by one-stage simple cluster random sampling. Well trained medical college students interviewed mainly housewives with a structurized questionnaire. Morbidity rate of acute illness during the 2-week period was 101 per 1,000 persons and it was highest in the age group of 9 years below. The rate for chronic illness was 77 per 1,000 persons, increasing with age, low income and medicaid benefit. During the 2-week period, 689 of 1,000 persons utilized the medical facilities. Of the facilities, most number, 294, used hospital and clinic, and the order ran as pharmacy, health center, and herb medical clinic. The utilization rate was higher in the female, 70-year and older group, medicaid group, the lowest income class and self-employed group than other groups. The average number of visits among users of medical facilities during the 2-week period was 3.25. those who visited medical facilities most frequently were females, the 70-year and older group, the lowest income class and blue collar worker group. During one-year period, admission rate of 1,000 persons was 27.6 and that of female was 38.9, higher than that of male. the eldest group had the highest admission rate. Admission rate of medical insurance beneficiaries was twice or higher than non-beneficiaries. The higher the family monthly income, the more frequently they admitted. During one-year period, average admission days of the persons hospitalized were 22.5 days and males were hospitalized longer than females. The groups which were hospitalized longest were those between the ages of 40 and 49, medical insurance beneficiaries, the lowest income group and unemployed group. During one-year period, average admission days of 1,000 persons were 560 days and those of female were 661 days, more than those of male. The guoups which had the longest admission days were those above 70 years of age, the lowest income and unemployed groups. The medical insurance beneficiaries were three times or longer than non-beneficiaries. In logistic regression analysis of utilization of physician significant independent variables were the 9-year and younger group(+), the 70-year and older group(+), acute illness episode(+), chronic illness episode(+), medical insurance beneficiary(+) and white collar workers(-). Acute and chronic illness episode(+), and medical insurance for government employees and private school teacher(-) were significant variables in analysis of utilization of pharmacy. In multiple regression analysis of the number of physician visits, siginificant variables were acute illnes episode(+), chronic illness episode(+), industrial, occupational and regional medical insurance beneficiary(+), white collar workers(-). Acute and chronic illness episode(+), and medical insurance beneficiary(-) were significant variables in analysis of the number of pharmacy visits. In logistic regression analysis of admission event, significant independent variables were the 9-year and younger group(+), the 70-year and older group(+) , chronic illness episode(+), and medical insurance beneficiary(+).

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Methods and Applications to estimate the Conversion Factor of Resource-based Relative Value Scale for Nurse-Midwife's Delivery Service in the National Health Insurance (조산원(助産院)의 분만간호서비스에 대한 건강보험수가 산출방법과 적용방안)

  • Kim, Jin-Hyun;Jung, Yoo-Mi
    • Journal of Korean Academy of Nursing
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    • v.39 no.4
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    • pp.574-583
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    • 2009
  • Purpose: This paper analyzed alternative methods of calculating the conversion factor for nurse-midwife's delivery services in the national health insurance and estimated the optimal reimbursement level for the services. Methods: A cost accounting model and Sustainable Growth Rate (SGR) model were developed to estimate the conversion factor of Resource-Based Relative Value Scale (RBRVS) for nurse-midwife's services, depending on the scope of revenue considered in financial analysis. The data and sources from the government and the financial statements from nurse-midwife clinics were used in analysis. Results: The cost accounting model and SGR model showed a 17.6-37.9% increase and 19.0-23.6% increase, respectively, in nurse-midwife fee for delivery services in the national health insurance. The SGR model measured an overall trend of medical expenditures rather than an individual financial status of nurse-midwife clinics, and the cost analysis properly estimated the level of reimbursement for nurse-midwife's services. Conclusion: Normal vaginal delivery in nurse-midwife clinics is considered cost-effective in terms of insurance financing. Upon a declining share of health expenditures on midwife clinics, designing a reimbursement strategy for midwife's services could be an opportunity as well as a challenge when it comes to efficient resource allocation.

Methods and Estimates of the Reimbursement for the Nurse Midwifery Center in the National Health Insurance (조산원의 건강보험수가 산출방법과 추계)

  • Im, Hyo-Min;Kim, Jin-Hyun
    • Women's Health Nursing
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    • v.17 no.4
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    • pp.328-336
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    • 2011
  • Purpose: The purpose of this study is to develop the optimal nursing fee for nurse-midwifery center (MC) in the national health insurance system. Methods: The three methodologies used to calculate the conversion factors for the MCs in the national health insurance include cost accounting method, sustainable growth rate (SGR) model, and index model. In this study, the macro-economic indicators and the national statistics were used to estimate the conversion factors for the MCs. Results: The optimal nursing fee for the MCs in 2011 was estimated to be an increase of 57.7% by cost accounting analysis, a decrease of 17.1% by SGR model, and a decrease of 16.1% by index model. The results from SGR model and index model could had been biased due to the upswing of medical spendings in the short-term period (2008~2009). A sensitivity analysis of pre-delivery subsidy program for OB & GYN hospitals and clinics showed that the program has substantially diminished the demand for the MC services. Conclusion: More reliable methodologies to estimate nursing fees precisely are required to prove the value of nurses' services and a government subsidy program for the MC services should be followed from a social perspective.