• The Korean Society of Law and Medicine
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• v.13 no.2
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• pp.11-38
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• 2012

The Supreme Court stand in the position in specific lawsuit that it doesn't allow the discretionary not covered service, but recently in revocation suit of fine disposal that is imposed on medical fee of leukemia patient, it altered the existing adjudgement and admitted the discretionary not covered service exceptionally. It put forward the allowable condition roughly in that case. According as this alteration, it has become more important to embody the allowance conditions of exceptions. The Supreme Court presented three things, which are procedural condition, medical condition and subscriber's agreement. Concerning procedural condition, several present conciliation procedures are as follows: medical care benefit arret request, relative value conciliation etc, prior request on anti-cancer drug among chemicals which exceed acceptance criteria, request of non benefit object on common drugs. To be granted the existence of those system, there should be no obstacle to use that. Even if it were so, we should take circumstances into consideration; individual situation is unescapable concerning substance and urgency of the discretionary not covered service, process of the procedure, time required etc. Regarding medical condition, safety and effectiveness will be verified through evaluation procedures of new medical skill. About the necessity, the Supreme Court made clear through a sentence that it allow the discretionary not covered service, in case that needs to treat a patient out of the standard of medical benefit. Strict interpretation is right and it answer the purpose of the sentence that the supreme court permit the discretionary not covered service, exceptionally. We need to differentiate medical necessity and medical validity. Subscriber's agreement should holds true if it entails full explanation, and if it is preliminary, explicit and individual. On this account, it should be difficult to admit that someone agree effectively when he call for the affirmation that he is recipient of medical care. Reasonable expense needs to be a part of review whether the agreement is valid. Meanwhile If we adjust system of medical expense and eventually reorganize a fee for consultation payment system (Fee-for-service controlled by item to DRG (Diagnosis Related Groups)), controversial area of the discretionary not covered service will be decreased and that will guarantee the discretion of the doctor.

• 한국사회정책
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• v.25 no.2
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• pp.165-189
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• 2018

Under the principle of subsidiarity, the German family policy formed in the 1950s and 1960s minimized the role of the state while maximizing the role of the parents. The German Constitutional Court, however, ruled that the level of compensation for the financial burden of child support costs must follow the basic rights, not the principle of subsidiarity. The Federal Constitutional Court has taken the duty of protecting the human dignity of the state under Article 1 of the Constitution as the starting point of the judgment. The Federal Constitutional Court held that the dignity of a child is guaranteed only if the level of the child's allowance or deduction is equal to or higher than the level of the child standard benefit under the Social Assistance Act established by Congress. The Federal Constitutional Court also regarded the state to compensate parents for child support costs as much as the level of child standard benefit under the Social Assistance Act as a family protection obligation of the state under Article 6, Section 1 of the Constitution. In addition, the Federal Constitutional Court ruled that the right to equality declared by Article 3 of the Constitution can be realized by compensating all parents for child support costs at the level of child standard benefit under the Social Assistance Act.

• KSCE Journal of Civil and Environmental Engineering Research
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• v.35 no.1
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• pp.165-172
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• 2015

The appropriateness of railway route design is generally evaluated by the future value corresponding to the travel demand or benefit-cost analysis. These methods may have the limitation for the reasons that all the design alternatives cannot be considered, and the differentiation between the alternatives may not be significant because the alternatives are based on the strict basic scheme such as the design criteria. In addition, the cost varies by the design elements. In this study, all the design alternatives are considered with the automatized tool and the design criteria, and evaluated with the multi-criterion decision making method. The weight for each design element with the analytic hierarchical process may be helpful to derive more efficient railway alignment.

• Journal of the Korean Society of Safety
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• v.14 no.2
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• pp.62-69
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• 1999

The quantitative risk assessment and consequence analysis by accident scenario in the process of EPS(Expendable Poly Stylene) reaction process are conducted. And the decision making process is studied followed by selecting various alternatives to safety management and facility improvement. The result are as follows; 1) The object of decision making through comprehensive risk assessment are the scenario which can cause four major accident, which are made by process analysis, work analysis and hazard identification. 2) Frequency analysis of ETA, FTA, HRA and consequence analysis of accident to each have been conducted. The each frequency values are yielded $9.2{\times}10_{-5}/yr$ to scenarios $1, 8.2{\times}10^{-4}/yr$ to scenario 2, $4.5{\times}10^{-6}/yr$ scenario 3 and $1.8{\times}10^{-7}/yr$ to scenario 4. The each scenarios have been conducted consequence analysis. 3) The calculated values have been obtained 4.00 to scenario 1, 3.25 to scenario 2, 2.43 to scenario 3 and 1.34 to scenario 4, as the weight value had been applied to the quantitative and normalized criteria of all components. As a risk criteria, scenario 1 have been selected, which is the most dangerous scenario as a result of ranking the scenario. 4) According to the importance of FTA and contribute to scenario 1, the cost-benefit values are yielded $8.05\times10^5[￦/yr]$ to final alternative(Al), $1.55{\times}10^5[￦/yr]$ to final alternative(A2) and $2.32{\times}10^5[￦/yr]$ to final alternative(A3). As a result of final alternative(Al) has been selected, which is the most optimized alternative.

• Journal of Korean Society of Transportation
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• v.19 no.5
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• pp.109-117
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• 2001

The median encroachment accident model proposed in this paper is the first step to develop cost-effective criteria about installing facilities preventing traffic accidents by median encroachment. This model consists of expected annual number of median encroachment on roadway and conditional probability to collide with vehicles on opposite lane after encroachment. Expected encroachment number is related to traffic volume and quote from a study of Hutchinson & Kennedy(1966). The probability of vehicle collision is composed of assumed headway distribution of opposite directional vehicles (negative exponential distribution), driving time of encroaching vehicle and Gap & Gap acceptance model. By using expected accident number yielded from the presented model, it will be able to calculate the benefit of reduced accident and to analyze the cost of installing facilities. Therefore this will help develop cost-effective criteria of what, to install in the median.

• Journal of Nutrition and Health
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• v.36 no.5
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• pp.515-527
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• 2003

Objectives： A meta-analysis of the literatures was conducted to evaluate the cost-effectiveness of medical nutrition therapy by dietitians. Methods : The 30 studies were identified from a computerized search of published research on MEDLINE, Science-Direct and the PQD database until May, 2002 and a review of reference lists. The main search terms were“dietitian”,“dietary intervention”,“nutrition intervention”, “cost”,“cost-effectiveness”and“cost-benefit analysis”. The subgroup analysis was performed by publication year, study design, intervention provider, type of patient (in/out-patient) and type of cost (total cost/direct cost). Two reviewers independently selected trials for inclusion, assessed the quality and extracted the data. Results : The 30 studies were identified using the electric database search and bibliographies. The 17 trials were eligible for inclusion criteria, then the systematic review and a meta-analysis were conducted on effectiveness and cost-effectiveness of medical nutrition therapy. The quality of the studies was evaluated using the quality assessment tool for observational studies. The quality score was 0.515 $\pm$ 0.121 (range : 0.279-0.711, median : 0.466). The meta-analysis of 17 studies based on the random effect model showed that medical nutrition therapy was highly effective in treating the diseases (effect size 0.3092 : 95% confidence interval 0.2282-0.3303). The vote-counting method, one of meta-analysis methods, was applied to evaluate the cost-effectiveness of medical nutrition therapy conducted by dietitians. Two criteria (method 1, method 2) for voting were used. The calculated p-values for method 1 (more conservative method) and method 2 (less conservative method) were 0.1250 and 0.0106, respectively. Medical nutrition therapy by dietitians was significantly cost-effective in the method 2. Conclusion. This meta-analysis showed that the effectiveness of medical nutrition therapy was statistically significant in treating disease (effect size 0.3092), and that the cost-effectiveness of medical nutrition therapy was statistically significant in the method 2 (less conservative method) of vote counting. (Korean J Nutrition 36(5): 515~527, 2003)

• Research in Community and Public Health Nursing
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• v.29 no.1
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• pp.108-119
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• 2018

Purpose: The purpose of this study is to estimate the prevalence of the metabolic syndrome in pre-menopausal housewives and to explore controllable and uncontrollable factors regarding metabolic syndrome. Methods: The study population of this cross-sectional survey was from the Korean Health and Nutrition Examination Survey (KHANES) 2010 through 2015, including the fifth and sixth population-based studies. The criteria for metabolic syndrome include waist circumference, blood pressure, fasting plasma glucose, triglyceride, high-density lipoprotein (HDL) based on Korean Clinical Practice Guideline for Metabolic Syndrome by the Korean Academy of Family Medicine 2015. Results: Among the 2,498 subjects, 247 subjects had metabolic syndrome and the prevalence was estimated to be 9.9%. The number of subjects who met the criterion of HDL was 936 (36.2%), which was the most prevalent among the criteria for metabolic syndrome. Statistically significant (p<.05) factors include age, livinghood benefit group, perceived health status, obesity, family history of DM, sleeping time, awareness of stress,leukocyte, and erythrocyte count. The odds ratio of obesity in the BMI ${\geq}25$ group was 12.59 times as high as that of the BMI <25 group (p<.001) for metabolic syndrome. Conclusion: The prevalence of metabolic syndrome in pre-menopausal housewives in the survey was not low, and it is necessary to develop and apply comprehensive health habit management programs to improve controllable factors including exercise and food intake.

• Journal of Korean Medicine Rehabilitation
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• v.23 no.4
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• pp.129-141
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• 2013

Objectives The aim of this review is to investigate clinical studies for manual therapy on Temporomandibular Joint Disorder and to propose for the better method of studies in the future. Methods We investigated recent clinical studies for manual therapy on Temporomandibular Joint Disorder via searching Pubmed, KISS, KISTI, KERIS, KMBASE and National Assembly Library. 21 domestic and overseas articles were analyzed and the journals, the authors, the published years, countries, methods, periods, techniques of chiropractic, outcome measures, and purpose of those articles were examined. Results Studies on manual therapy were mainly published via Cranio. The diagnostic criteria that most frequently adopted in the overseas articles were research diagnostic criteria for temporomandibular disorders, The technique of chiropractic that most frequently adopted in the articles was passive traction and translation of TMJ. Many of the studies were researched for effectiveness of the manual therapy as the secondary treatment. Conclusions Reviewing the recent clinical studies for manual therapy on temporomandibular joint disorder and figuring out the strong points and weak points of those studies are necessary to future studies. It is anticipated that this review would benefit the in-depth treatments for temporomandibular joint disorder in terms of Korean medicine.

• Journal of Chest Surgery
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• v.35 no.11
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• pp.773-778
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• 2002

Surgery remains the main stay in the treatment of carcinoma of the esophagus and the results of surgery for esophageal cancer have improved over the past 10 years. The ideal operation for cancer of the esophagus should have good palliation, low morbidity and mortality, and optimize both long-term function and survival. The two main approaches currently used for surgical treatment of esophageal cancer are: transthoracic esophagectomy (TTE) and transhiatal esorhagectomy(THE). The advantages of THE are low morbidity and mortality, short operating time, a short hospital stay and low interference with respiratory physiology The selection criteria for this procedure may differ but there are two situations which could clearly benefit from THE; these are epithelial and superficial submucosal lesions, particularly in cases of multiple lesions, and any resectable tumor at any stage with poor clinical status. I reviewed the selection criteria, surgical procedures, and results of THE in esophageal cancer with the literatures.

• The Korean Society of Law and Medicine
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• v.8 no.2
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• pp.69-118
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• 2007

In providing general medical treatments, the medical service contract between the patient and the doctor is the mutually responsible onerous contract. However, the nature of the mutually assumed contract standings of the patient and the doctor has been changing since the implementation of the national health insurance program. For instance, besides the cases of beyond excessive medical charges and medical negligence, if the doctor charged for his/her medical treatments violating the post-treatment/nursing cover criteria, the overpaid medical charge, regardless of being collected with the patient's consent, has to be refunded back to the patient. Medically needed aspects, treatment results, and unfair benefits favoring the patient are not at all taken into consideration in the health insurance scheme. This makes it easier for patients to get refunds for their share of the medical payments by involving the Health Insurance Review & Assessment Service or the National Health Insurance Corporation, without engaging in civil law suits (for reimbursement claim) against doctors. In other words, the doctor's responsibility to provide medical treatments and the patient's responsibility to pay for the medical treatment provided within the contractual realm are being demolished by the administrational arbitration of the National Health Insurance system. The basic rights of medical service providers, and the patient's right to choose are as important constitutional rights, as the National Health Insurance program, which is essential in the social welfare system. Furthermore, the development of the medical fields should not be prevented by the National Health Insurance system. If the medical treatment services can be divided into necessary treatments, general treatments, and high quality treatments, the National Health Insurance is supposed to guarantee the necessary and general treatments to provide medical treatments equally to all the insured with limited financial resources. However, for the high quality treatments, it is recommended that they should not be interfered by the National Health Insurance system, and that they should be left to the private contract between the patient and the doctor.