• Title/Summary/Keyword: Claim analysis

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An Analysis of Single PPM Quality Innovation's Status using Covariance Structure Model (공분산구조모델에 의한 싱글 PPM 품질혁신 운동 추진현황 분석)

  • Koo, Il-Seob;Kim, Tae-Sung
    • Journal of Korean Society of Industrial and Systems Engineering
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    • v.28 no.4
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    • pp.102-108
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    • 2005
  • Single PPM Quality Innovation Movement is originally developed quality program in Korea for supplier's quality level-up since 1995. The quality target is below the 10ppm(parts per million) in outgoing quality and delivered goods plus field claim. Recently 1,053 companies is received Single PPM Quality Certification from government. This quality program is to realized the anticipated results not only duality level's increasing, but also company's confidence, competitiveness. We were able to obtain participations of 75 questionnaire, and derived statistics by means of SPSS/PC version 10.0. In this study, we find the bottleneck factor for promotion and upgrade S-PPM, and suggest a way out of difficulties.

An AHP Approach to Evaluate the priorities of Manufacturing Performance Criteria in Korean Automobile Parts Manufacturing Company (AHP에 의한 한국자동차부품제조사의 제조성과기준의 중요도 평가)

  • Kim, Tae-Soo
    • Journal of Korean Society of Industrial and Systems Engineering
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    • v.34 no.3
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    • pp.115-122
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    • 2011
  • The critical role played by manufacturing performance measurement systems in achieving competitive success is increasingly recognized. Developing an integrated performance measurement model is significant for strategic management. This study consist of several principal steps. Performance criteria from the literature and an questionnaire were utilized prior to building the performance model. The AHP(Analytic Hierarchy Process) is utilized to evaluate the weight of each criterion when generating the performance measurement model for Korea automobile parts manufacturing company. AHP analysis showed clear difference in the priority between 5 criteria and 24 sub-criteria in terms of manufacturing performance of Korean automobile parts manufacturing company. The result of priority evaluation in the 5 criteria of 2nd level was ranked quality, cost, delivery, employee, flexibility. And the critical sub-criteria in the 24 sub-criteria of 3rd level was ranked claim rate, process defect rate, outsourcing parts defect rate, ability to quality management innovation, claim cost, etc.

Consumers' Ad Responses towards Marketing Motives and Ad Appeals in Hotels' Green Advertising

  • Yoon, Donghwan;Kim, Byeong-Yong
    • Culinary science and hospitality research
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    • v.23 no.6
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    • pp.99-109
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    • 2017
  • This study aims to investigate the impacts of marketing motive (public- vs. firm-interest) and ad appeal (soft- vs. hard-sell) types on consumers' ad attitudes and behavioral intention in hotels' green advertising. From 711 US respondents, a multivariate analysis of covariance (MANCOVA) was employed to test main effects of marketing motive and ad appeal types on ad recipients' affective and cognitive ad attitudes, while controlling their environmental consciousness. Further, the study conducted a multiple regressions analysis to examine the influence of ad attitudes on respondents' intention to visit the hotel. The study found that a public-serving claim can yield more positive affective ad attitude than a firm-interested claim, regardless of ad image type (soft- or hard-sell image). The result also revealed that a soft-sell ad image can elicit more positive affective ad attitude than a hard-sell one. On the other hand, the study showed that consumers' affective and cognitive ad attitudes are significant predictors of behavioral intention (i.e., visit intention). The study provided theoretical and managerial implications for hospitality researchers and hotel marketers to effectively design hotels' green advertising to ultimately increase consumers' visit intention.

Role of the medical claims review (의적클레임검토의 역할 및 기능)

  • Lee, Sin-Hyung
    • The Journal of the Korean life insurance medical association
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    • v.26
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    • pp.31-39
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    • 2007
  • Background and main issue: In the Korean insurance market, an outstanding issue is the decrease of margin of risk ratio. This affects the solvency and profitability of insurance companies. Insurance medicine, which has been developed in Western countries, is so-called medical risk selection or medical underwriting. Medical risk selection is based on clinical follow-up study and mortality analysis methodology. Unfortunately, there have been few clinical follow-up studies, and no intercompany disease analysis system is available in the Korean insurance market. In practice, we use underwriting guidelines, which were developed by some global reinsurance companies. However, these guidelines were developed under clinical follow-up studies performed abroad. So, we cannot rule out underestimation of excess mortality factors such as mortality ratio, excess death rate, and life expectancy. It is necessary to perform medical assessment in claims administration. Comparing the insured's statement by medical records with products' benefit according to this procedure, we can make sound claim decisions and participate in the role of sound underwriting. We can call this scientific procedure as the verification of medical claims review. Another area of medical claims review is medical counsel for claims staff. Result: There is another insurance medicine in addition to medical risk selection. Independent medical assessment by medical records of insured is medical claims review. Medical claims review is composed of verification and counsel.

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Analysis of Argumentation in Middle School Science Classroom Using Argument-Based Inquiry (논의기반 탐구(Argument-Based Inquiry) 과학수업에서 나타나는 중학생들의 논의과정 분석)

  • Lee, Minji;Kwon, Jeongin;Nam, Jeonghee
    • Journal of the Korean Chemical Society
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    • v.59 no.1
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    • pp.78-87
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    • 2015
  • The purpose of this study was to investigate the argumentation of middle school students during the argument-based inquiry. A total of sixty eight 8th grade middle school students participated in this study and they performed six argument-based inquiry programs. Data were collected from two of the latest programs by audio-recording and transcription of each group engaging in argumentation. The study findings showed that; first, the most frequent element of argumentation in the all of stages of the two programs was following order: 'claim' and 'request and response' and 'simple agreement'. The most active argumentation was showed at the designing experiments stage and the most inactive was showed at the generating questions stage. Second, as a result of analyzing the argumentation level for each stage of the argument-based inquiry, a high level of argumentation was shown at the claim and evidence stage, and a low level of argumentation was shown at the generating questions stage in the argumentation structure. As a result of the validity of argumentation, the validity of argumentation was the highest level in the claim and evidence stage.

The Reference-Class Problem and the Qua-Problem (준거집합 문제와 자격의 문제)

  • Kim, Han-Seung
    • Korean Journal of Logic
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    • v.15 no.2
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    • pp.223-250
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    • 2012
  • The reference-class problem is known as a problem that frequentism on the nature of probability is supposed to encounter. Alan H$\acute{a}$jek argues that other theories on the nature of probability also meet this problem inevitably and claims that we can resolve the problem by regarding conditional probabilities as primitive. In this paper I shall present an adequate way of understanding the reference-class problem and its philosophical implications by scrutinizing his argument. H$\acute{a}$jek's claim is to be classified into the following two: (i) probability is relative to its reference class and (ii) what is known as the 'Ratio' analysis of conditional probability is wrong. H$\acute{a}$jek believes that these two are to be closely related but I believe these two should be separated. Moreover, I shall claim that we should accept the former but not the latter. Finally, regarding the identity condition of reference class I shall distinguish the extensional criterion from the non-extensional one. I shall claim that the non-extensional criterion is the right one for the identity condition of reference class by arguing that the reference-class problem should be regarded as an instance of the qua-problem.

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Trends on the Curtailment of Drug Expenditure Before and After the Seperation between Prescription and Dispensing in General Hospitals By Drug Types (의약분업 전후 일부 종합병원의 약제종류별 약제비 삭감추이)

  • Lee, Sun-Hee;Jo, Heui-Sug;Lee, Hye-Jean
    • Korea Journal of Hospital Management
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    • v.8 no.2
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    • pp.93-110
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    • 2003
  • Fiscal crisis in the medical insurance has put the pressure upon hospitals by increasing the rate of curtailment, since the implementation of the separation between prescription and dispensing of Drug. The purpose of this study is to analyze the curtailment for antibiotics, injected drug and other drugs expenditure before and after the system of separation between prescribing and dispensing. Data were gathered from 13 general hospitals and used for analysis of trends on antibiotics and injected drug expenditure, and curtailment in 2000-2001 at three months intervals. The results were as follows; The curtailment rate of antibiotics expenditure has been increased in outpatient and inpatient since 2000. The curtailed antibiotics cost and injected drug cost in outpatient under the prescription within the hospital and in inpatient increased. The ratios of curtailment versus expenditure had increased in antibiotics, injected drugs, anticancer drugs, antiulcer drugs, albumine, antiinflammatory drugs. These results suggest that claim review system in social health insurance were over-focused mainly to control the cost and it might to impede the validity of claim review function in health insurance system. Therefore, it's needed to develope the scientific and reasonable parameter & criteria for claim review of drug expenditure.

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Environment Dynamism and Strategic Technology Resource Protection: Claims of Priority of Korean High-tech Electronics Firms (환경 역동성과 전략적 기술자원의 보호: 한국 하이테크 전자기업의 우선권주장출원)

  • Kim, Doyoon;Shin, Dongyoub
    • Knowledge Management Research
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    • v.22 no.1
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    • pp.57-84
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    • 2021
  • In this paper, we explore market and environmental factors which affecting organization's priority claim application which is more powerful and prompt strategic method to protect technology from competitors under uncertain and volatile environments. This study empirically examines why organizations strategically choose the priority claim application which is more strong tactics to protect technology as the source of sustainable competitive advantage. We suggest that market and environmental factors, such as exogenous shock, volatility, and uncertainty, may also affect strategic decision that organization take patent application with claiming priority. The results of our analysis of priority claim application in the Korean high-tech electronics industry from 1994 to 2008 showed that these three strategic factors affected the technology protection decision and organization's status also moderate theses effects, as predicted in our hypotheses.

Warranty Cost Models for a Product with a Two-Dimensional Warranty Policy (이차원 보증정책을 갖는 제품의 보증비용 모형)

  • ;D.N.P Murthy
    • Journal of Korean Society for Quality Management
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    • v.28 no.1
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    • pp.57-77
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    • 2000
  • A two-dimensional warranty policy, two types of warranty criteria, such as the age and mileage of an automobile, are employed simultaneously to determine the eligibility of a warranty claim. We deal with the analysis of a variety of combined two-dimensional free replacement warranty(FRW) and pro-rata replacement warranty(PRW). In this paper we also propose the analysis of policies with item failures modelled using the one-dimensional and two-dimensional approach, respectively. We obtain expressions for the expected warranty costs and illustrate through numerical examples.

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Impact of a 'Proactive Self-Audit Program of Fraudulent Claims' on Healthcare Providers' Claims Patterns: Intravenous Injections (KK020) (부당청구 예방형 자율점검제가 의료기관의 청구행태에 미치는 영향: 정맥 내 일시주사(KK020)를 중심으로)

  • Hee-Hwa Lee;Young-Joo Won;Kwang-Soo Lee;Ki-Bong Yoo
    • Health Policy and Management
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    • v.34 no.2
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    • pp.163-177
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    • 2024
  • Background: This study aims to examine changes in fraudulent claim counts and total reimbursements before and after enhancements in counterfeit claim controls and monitoring of provider claim patterns under the "Proactive self-audit pilot program of fraudulent claims." Methods: This study used the claims data and hospital information (July 2021-February 2022) of the Health Insurance Review and Assessment Service. The data was collected from 1,129 hospitals assigned to the pilot program, selected from the providers who filed a claim for reimbursement for intravenous injections. Paired and independent t-tests, along with regression analysis, were utilized to analyze changing patterns and factors influencing claim behaviors. Results: This program led to a reduction in the number of fraudulent claims and the total amount of reimbursements across all levels of hospitals in the experimental groups (except for physicians below 40 years old). In the control group, general hospitals and hospitals demonstrated some significant decreases based on the duration since opening, while clinics showed significant reductions in specified subjects. Additionally, a notable increase was observed among male physicians over the age of 50 years. Overall, claims and reimbursements significantly declined after the intervention. Furthermore, a positive correlation was found between hospital opening duration and claim numbers, suggesting longer-established hospitals were more likely to file claims. Conclusion: The results indicate that the pilot program successfully encouraged providers to autonomously minimize fraudulent claims. Therefore, it is advised to extend further support, including promotional activities, training, seminars, and continuous monitoring, to nonparticipating hospitals to facilitate independent improvements in their claim practices.