• Journal of Acupuncture Research
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• v.27 no.3
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• pp.137-146
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• 2010

Objectives : While there are many studies about treatments of facial palsy, no study has been performed on general population of Korea, especially concerning about comparison between western medicine and oriental medicine. This study aimed to investigate magnitude of health visits and treatment patterns for Korean patients with facial palsy through the computerized database of Health Insurance Review and Assessment Service(HIRAS). Methods : According to the HIRAS database over 5 years' period from 2004 to 2008, the medical records of patients with facial palsy as a main diagnosis were extracted. Inclusion criteria of facial palsy are Bell's palsy(G510), Geniculate ganglionitis(G511), Melkersson's syndrome(G512), Other disorders of facial nerve(G518), Disorder of facial nerve, unspecified(G519) in western medicine. And Paralytic face(G016), Deviated eye and mouth(J01), The other facial palsy(J013) were included in oriental medicine. We compared the claim number of western medical care with that of oriental medicine treatment by year and month. Results : The total claim number of facial palsy was increasing on both western medicine and oriental medicine from 2004 to 2008. In western medicine, the claim number of Bell's palsy(G510) is the most. In oriental medicine the inpatients claim number of Deviated eye and mouth(J01) is the most, while outpatients claim number of the other facial palsy(J013) is the most. Conclusions : Medical database of HIRAS provided comprehensive and vast information on epidemiologic characteristics and treatment, which can be more reliable data to expect medical demand for facial palsy in condition that accurate diagnosis and standardized treatment is delivered in clinical settings.

• Health Policy and Management
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• v.14 no.4
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• pp.88-113
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• 2004

Starting from April, 2003, new pre-review system has been introduced and implemented to reduce unnecessary conflict with medical care organizations caused by current retrospective claim review system and to enhance efficiency of review system. The main purpose of pre-review system is to educate doctors to contrive adequacy of medical services. This research mainly focuses on effectiveness of pre-review system's influence on physicians' behavior changes. The analysis-participants were drawn from 1,449 clinics which implemented pre-review system, since April of 2003. The research results are as followings. First, the amount per claim has reduced by $\\3,154$, days of visit per claim by 0.1 day, and amount per visit by $\\412$, which were statistically significant. Second, anesthesiologists have decreased in three indicators the most, and the internists had least of changes. Third, the amount per claim and days of visit per claims has dropped significantly on physicians with less periods of practice and physicians with more ages. Fourth, the clinics without the expensive medical equipments, the city clinics showed significant decrease on days of visit per claim. Fifth, in intervention methods, the one-to-one education showed more significant decrease on amount per visit rather than information feedback by paper. In conclusion, the pre-review system have an impact on self-imposed physician behavioral change. The outcome of this research may be utilized for future extension implementation of pre-review system. Furthermore, it is showed that ability of transitions in medical services review system according to the future transition of payment system and context of health service policy.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• v.72
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• pp.1-24
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• 2016

This study focused on getting clear understanding on the legal bases in terms of plurality of obligors and plurality of obligees through a analysis the PICC(2010) which has been standing firmly as the general principles of international commercial contract. Related to the title of this paper, PICC are dealing with not only plurality of obligors but plurality of obligees. The contents of the former are as follows; presumption of joint and several obligations and obligee's rights against joint and several obligors (arts.11.1.1, 11.1.2, 11.1.3), availability of defences and rights of set-off and effect of performance and set-off (arts.11.1.4, 11.1.5), effect of release or settlement and effect of expiration or suspension of limitation period (arts.11.1.6, 11.1.7), effect of judgment (art.11.1.8), apportionment among joint and several obligors and extent of contributory claim (arts.11.1.9, 11.1.10), rights of the obligee, defences in contributory claims, inability to recover (arts.11.1.11, 11.1.12, 11.1.13) and so on. On the other hand the contents of the latter are as follows; definitions (art.11.2.1), effects of joint and several claims (art.11.1.2), availability of defences against joint and several obligees (art.11.2.3), allocation between joint and several obligees (art.11.1.4). The main subjects are one is when several obligors are bound by the same obligation towards an obligee, the obligations are joint and several when each obligor is bound for the whole obligation, the obligations are separate when each obligor is bound only for its share and the other is when several obligees can claim performance of the same obligation from an obligor, the claims are separate when each obligee can only claim its share, the claims are joint and several when each obligee can claim the whole performance and the claims are joint when all obligees have to claim performance together.

• Korean journal of food and cookery science
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• v.20 no.1
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• pp.100-111
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• 2004

The purpose of this study was to investigate the status of current nutrition labeling on the packaging of the processed foods that provide consumers with a reliable and consistent source of information, which has been considered as a useful aid for food selection and a potent educational tool for nutrition in daily life. The 2,160 processed foods purchased at the supermarket on September, 2002, were divided by food category issued from the 2002 food codes and assessed in the terms of the nutrition composition labeling and nutrition claims. Nutrition composition labeling was found on 356 of the 2160 processed foods items. Milk and dairy products had 49.7％ of nutrition composition labeling, which was the largest number among the food category. Tables were most frequently used as the type of nutrition composition labeling (79.8％). Nutrition composition including many different ways of expression, such as a table of nutrition composition, indication of nutrition composition, analysis table of nutrition composition and comparative table of nutrition composition, made frequent use of nutrition composition labeling titles (78.7％). The various unit of measures were use in the nutrition labeling of the processed foods, per l00g or 100$m\ell$ was the highest (44.6％) under the currently practiced nutrition labeling. The correct labeling standard with nutrient content and ％ RDA except energy, was used on 47.8％ of labels, and those with only liability indication nutrient and liability indication nutrients plus discretion indication nutrients were 25.3 and 22.5％ respectively. The processed foods with nutrition claims were 8.0％ (172 items). Nutrition claims were divided in two ways: nutrient content claims and nutrient comparative claims. The most frequently used claims were contained in the former (44.4％) and more or plus in the latter case (16.3％). Ca was the most popular item as a nutrition claim nutrient (50.6％).

• Journal of Korean Medical Science
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• v.33 no.53
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• pp.343.1-343.8
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• 2018

Background: Linkage of public healthcare data is useful in stroke research because patients may visit different sectors of the health system before, during, and after stroke. Therefore, we aimed to establish high-quality big data on stroke in Korea by linking acute stroke registry and national health claim databases. Methods: Acute stroke patients (n = 65,311) with claim data suitable for linkage were included in the Clinical Research Center for Stroke (CRCS) registry during 2006-2014. We linked the CRCS registry with national health claim databases in the Health Insurance Review and Assessment Service (HIRA). Linkage was performed using 6 common variables: birth date, gender, provider identification, receiving year and number, and statement serial number in the benefit claim statement. For matched records, linkage accuracy was evaluated using differences between hospital visiting date in the CRCS registry and the commencement date for health insurance care in HIRA. Results: Of 65,311 CRCS cases, 64,634 were matched to HIRA cases (match rate, 99.0%). The proportion of true matches was 94.4% (n = 61,017) in the matched data. Among true matches (mean age 66.4 years; men 58.4%), the median National Institutes of Health Stroke Scale score was 3 (interquartile range 1-7). When comparing baseline characteristics between true matches and false matches, no substantial difference was observed for any variable. Conclusion: We could establish big data on stroke by linking CRCS registry and HIRA records, using claims data without personal identifiers. We plan to conduct national stroke research and improve stroke care using the linked big database.

• Journal of the Korea Institute of Building Construction
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• v.20 no.6
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• pp.527-535
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• 2020

This study analyzed main causes of claims in EPC/Turnkey projects. For this purpose, this study referred to the FIDIC silver book, which lists the international standard contract conditions for EPC/Turnkey projects. The most frequent cause of claim was delay. A process was then proposed to determine whether the owner or contractor was the responsible party when the delay claim occurred. The proposed process was for damages for delay which is the conditions of contract for indemnities against delay claim. The process was based on conditions of the contract of two previous EPC/Turnkey projects that were constructed in 2010, the FIDIC silver book, as well as the obligations of owner and contactors. The proposed process is applicable depending on the conditions of the contract and the owner's meaning. Furthermore, by identifying the responsible party, this study will contribute in identifying the possible claim types before concluding a contract and writing the specific contract.

• International conference on construction engineering and project management
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• 2017.10a
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• pp.281-290
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• 2017

As various stakeholders are involved in construction projects, disputes between the parties are more likely to occur, which is a very important issue for the participants in the projects. Claims in construction projects, however, are very complex and thus difficult to manage. In particular, as the cause of a claim in the preceding stage that has not been resolved in a timely manner has an effect on the cause of a claim in the following stage, it is difficult to find a point of compromise regarding a claim caused by the relationship between the causes that occur in the preceding and following stages. In this regard, this study sought to examine the rules for the generation of change order claims, which occur most frequently among the construction claims, and thus to select the key management targets through the analysis of the relationship between the causes of claims arising in the preceding and following stages for the efficient management of claims. It is expected that the use of rules for the generation of change order claims as well as of representative and similar cases will help the construction practitioners in judging claims, considering the relationships among the causes of the claims. Meanwhile, in this study, association analysis was conducted regarding the causes of the occurrence of change order claims in a design-build delivery method, and therefore, it is necessary to verify the effectiveness of the method when applied to other delivery methods.

• The Journal of Korea Institute of Information, Electronics, and Communication Technology
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• v.17 no.4
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• pp.221-228
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• 2024

Predicting insurance claims is a key task for insurance companies to manage risks and maintain financial stability. Accurate insurance claim predictions enable insurers to set appropriate premiums, reduce unexpected losses, and improve the quality of customer service. This study aims to enhance the performance of insurance claim prediction models by applying ensemble learning techniques. The predictive performance of models such as Random Forest, Gradient Boosting Machine (GBM), XGBoost, Stacking, and the proposed Dynamic Weighted Ensemble (DWE) model were compared and analyzed. Model performance was evaluated using Mean Absolute Error (MAE), Mean Squared Error (MSE), and the Coefficient of Determination (R²). Experimental results showed that the DWE model outperformed others in terms of evaluation metrics, achieving optimal predictive performance by combining the prediction results of Random Forest, XGBoost, LR, and LightGBM. This study demonstrates that ensemble learning techniques are effective in improving the accuracy of insurance claim predictions and suggests the potential utilization of AI-based predictive models in the insurance industry.

• Journal of dental hygiene science
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• v.15 no.6
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• pp.815-824
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• 2015

This study aims to figure out the current state of health insurance education provided to dentists and personnel in charge of insurance claim as well as the effects of experiences in education on their knowledge of health insurance standard and actual application. As a result of analysis on 100 data sheets related to dentistry and 100 data sheets related to personnel in charge of insurance claim (a total of 200 data sheets), following results were generated. Insurance claim personnels showed higher score than dentist in knowledge of health insurance standard and it was significant statistically. Knowledge of insurance claim personnel showed significant differences in educational experiences, in health insurance for the latest three years and average hours of education per session whereas that of dentists did not indicate any significant differences. The level of practical application of dentists was significantly different (p<0.05) according to experiences in insurance claim, and that of insurance claim personnel significantly varied (p<0.05) depending on age, experiences of insurance education and average hours of education. The longer average hours of education, the higher level of practical application. Experiences of insurance education turned out to affect on the knowledge of health insurance standard significantly (p<0.05) on the part of dentists and insurance claim personnel, and the level of experiences in insurance claim and knowledge of health insurance standard on the part of dentists and insurance claim personnel turned out to affect on practical application significantly (p<0.001). Judging from the result, continuous education needs to be conducted in order to enable dentists and insurance claim personnel to maintain the level of knowledge about health insurance and practical application.

• Journal of the Korean Operations Research and Management Science Society
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• v.15 no.1
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• pp.83-97
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• 1990

We consider an insured who wishes to determine his optimal reporting strategy over a given planning horizon, when he has option of reporting of not reporting his at-fault accidents. Assuming that the premium in future period is continually adjusted by the insured's loss experience, the insured would not report every loss incurred. Rather, considering the benefits and costs of each decision, the insured may want to seek a way of optimizing his interests over the planning horizon. The situation is modeled as a dynamic programming problem. We consider an insured's discounted expected cost minimization problem, where the premium increase in future period is affected by the size of the current claim. More specifically, we examine two cases ; (1) the premium increase in the next is a linear function (a constant fraction) of the current claim size; (2) the premium increase in the next period is a concave function of the current claim size. In each case, we derive the insured's optimal reporting strategy.