• Title/Summary/Keyword: Claims Analysis

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A Constitutional Study on the Unborn Human Life : Focusing on the Right to Life of the Fetus and the Embryo (출생 전 생명에 대한 헌법적 고찰 - 태아 및 배아의 생명권과 그 제한을 중심으로 -)

  • Kim, Eun-Ae
    • The Korean Society of Law and Medicine
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    • v.10 no.1
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    • pp.39-75
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    • 2009
  • The development of the biomedical science and technology has extended an argument about a status in constitutional law of unborn human life and a protection of the potential human life to that of an embryo and a gamete beyond a fetus. This argument has been focused on whether we should provide unborn or potential human life with human dignity and the right to life that are guaranteed by the constitutional law altogether or separately. If the right to life is given to unborn or potential human life, on what grounds can we restrict this right. Those who argue for the unity of the right to life with human dignity and the inseparability of those two claims that the right to life in itself should be guaranteed absolutely. According to the constitutional law, however, any constitutional right of the human person within the protection of essential part of the right can be compared with each other and restricted with some valid reasons from the legal perspective. This measure is unavoidable in reality because one right can come into conflict with another right frequently. Since fetus and embryo are in a process of developing into the human person, it is difficult to think that they are the same with the human person. For that reason, it is hard to consider that the right to life of fetus or embryo is the same with that of the human person. However, since a fetus has a special status as a potential human person, and an embryo also has a special value as a potential fetus upon an implantation, the right to life of fetus or embryo should be judged differently according to the stage of their development. A study on a constitutional status and protection of a fetus and an embryo is essential because unborn or potential human life is the origin of human person. Therefore, we have to make much account of their right to life and seek the legal respect for their inherent value.

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Measuring the Burden of Major Cancers in Korea Using Healthy Life-Year (HeaLY) (건강생활년을 이용한 우리 나라 주요 암 질환의 질병부담 측정)

  • Yoon, Seok-Jun;Kim, Chang-Yup;Shin, Young-Soo;Choi, Yong-Jun
    • Journal of Preventive Medicine and Public Health
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    • v.34 no.4
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    • pp.372-378
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    • 2001
  • Objectives : This study introduced the healthy life-year(HeaLY), a composite indicator of disease burden, and used it to estimate the burden of major cancers in Korea. Methods : We collected data from the national death certificate database, the national health insurance claims database and the abridged life table. This data was used to create a spreadsheet and estimate the burden of major cancers by sex in terms of HeaLYs. Results : The burden of 10 major cancers for males was 2,248.97 person-year in terms of HeaLYs. Stomach cancer, liver cancer, and lung cancer were responsible for 75.2% of the burden of 10 major cancers. The disease burden of 10 major cancers for females was estimated to be 1,567.58 person-years. About two thirds of HeaLYs lost were from stomach cancer, liver cancer, lung cancer, colorectal cancer, and breast cancer. The rankings among 10 major cancers were somewhat different in terms of both HeaLYs and deaths as the HeaLY method considers both mortality and morbidity. Conclusions : Despite the limitations of the data sources, we conclude that HeaLY can aid in setting policy priorities concerning major cancers by estimating the disease burden of these cancers. Time-series analysis of the disease burden using HeaLY and DALY will elucidate the strengths and weaknesses of both methods.

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A Preliminary Research for Empirical Analysis on the Validity of Public Lending Right: Focus on the Comparison between Popular Borrowing Books and Best Sellers (공공대출보상권 도입의 타당성에 대한 실증적 검토를 위한 기초 연구 - 인기대출도서와 베스트셀러의 비교를 중심으로 -)

  • Lee, Hosin
    • Journal of the Korean Society for Library and Information Science
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    • v.52 no.1
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    • pp.179-202
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    • 2018
  • The public lending right is a system in which government provide compensation to authors on the premise that the sale of books is reduced due to the book borrowing of the library. Recently, the claim that the public lending right should be introduced in Korea has been continuously raised by the authors. This study was conducted as part of the basic work to demonstrate whether the claims of public lending right are based on reasonable premises. The library's popular lending books and bookstore bestseller books were compared to analyze the similarities and differences. Through this process, we derive necessary factors to prove the validity of the introduction of the public lending right and suggest follow - up study. In addition, we recalled the social meaning of book lending in libraries.

The Effects of Hospital Resources on the Service Uses: Hospital Service Area Approach (병원서비스지역 내 병원자원과 의료서비스 이용 간의 관련성 분석)

  • Kwak, Jin-Mi;Kim, Da-Yang;Seo, Eun-Won;Lee, Kwang-Soo
    • Health Policy and Management
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    • v.25 no.3
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    • pp.221-228
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    • 2015
  • Background: This study explored the relationship between hospital resources and services uses in outpatient/inpatient-based hospital service area (HSA) in Korea. Methods: Study hospitals included all acute care hospitals except tertiary hospitals. Inpatient and outpatient hospital claims from the Korean National Health Insurance (NHI) program in 2010 were used to identify the service uses. Hospital resources and the degree of insurance premium in study areas were identified with the NHI corporation data. Study variables were computed by summing the service uses or hospital resources of study hospitals in each HSA. Service uses were represented by the total medical charges and number of visits/inpatient days. Hospital resources were measured by number of beds, number of doctors, and number of computed tomography (CT). The economic status of NHI enrollees in each HSA was controlled by the average monthly premium of NHI program per household in each HSA. The degree of using local hospitals was controlled with the localization index. Results: Analysis results showed that hospital resources such as beds, CT were statistically related to the service uses. And also localization index was found to have positive significant relationships with service uses. Conclusion: Hospital resources such as beds, CT had not only positive impacts on inpatient service uses, but also influences on the outpatient setting. Health policy makers will require monitoring and assessing the hospital resources in Korea.

Readability Comparison of Pro- and Anti-Cancer Screening Online Messages in Japan

  • Okuhara, Tsuyoshi;Ishikawa, Hirono;Okada, Masahumi;Kato, Mio;Kiuchi, Takahiro
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.12
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    • pp.5237-5242
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    • 2016
  • Background: Cancer screening rates are lower in Japan than those in western countries. Health professionals publish procancer screening messages on the internet to encourage audiences to undergo cancer screening. However, the information provided is often difficult to read for lay persons. Further, anti-cancer screening activists warn against cancer screening with messages on the Internet. We aimed to assess and compare the readability of pro- and anti-cancer screening online messages in Japan using a measure of readability. Methods: We conducted web searches at the beginning of September 2016 using two major Japanese search engines (Google.jp and Yahoo!.jp). The included websites were classified as "anti", "pro", or "neutral" depending on the claims, and "health professional" or "non-health professional" depending on the writers. Readability was determined using a validated measure of Japanese readability. Statistical analysis was conducted using two-way ANOVA. Results: In the total 159 websites analyzed, anti-cancer screening online messages were generally easier to read than pro-cancer screening online messages, Messages written by health professionals were more difficult to read than those written by non-health professionals. Claim ${\times}$ writer interaction was not significant. Conclusion: When health professionals prepare pro-cancer screening materials for publication online, we recommend they check for readability using readability assessment tools and improve text for easy comprehension when necessary.

Effects of Continuity of Care on Diabetes-Related Avoidable Hospitalizations among Middle- and Old-Aged Patients: Analysis of National Health Insurance Claims Data (건강보험 청구자료를 이용한 진료 연속성이 당뇨 관련 예방 가능 입원에 미치는 영향 분석: 중·고령군을 중심으로)

  • Kim, Boah
    • Health Policy and Management
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    • v.29 no.3
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    • pp.277-287
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    • 2019
  • Background: Diabetes is known as one of the most important ambulatory care sensitive conditions. This study purposed to assess the status of continuity of care (COC) and diabetes-related avoidable hospitalizations (DRAHs) of a group of middle- and old-aged patients and to observe the relationship of the two elements by the two age groups. Methods: This study utilized the National Health Insurance Service's National Sample Cohort data and the subjects are diabetes patients of 45 and over, classified into two groups of 'middle-aged'(45-64 years) and 'old-aged'(${\geq}65years$) patients. The dependent variable was DRAHs, which was defined in accordance with the definition of the Organization for Economic Cooperation and Development "Health Care Quality Indicators" project. COC, as an independent variable, is measured by the COC index in this study. Two-part model (multi-variate and multi-level analyses) was utilized. Results: Factors associated with the status and the number of DRAHs differed by each age group. Meanwhile, the two-part model showed that higher COC was associated with a lower risk of preventable hospitalizations in both middle- and old-aged groups. Conclusion: Study findings can provide health policy insights and implications in order to strengthen the primary care system for further improvement of diabetes management, especially for middle- and old-aged groups.

The effects of low level laser radiation on bacterial growth

  • Chung, Wendy;Petrofsky, Jerrold S.;Laymon, Michael;Logoluso, Jason;Park, Joon;Lee, Judy;Lee, Haneul
    • Physical Therapy Rehabilitation Science
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    • v.3 no.1
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    • pp.20-26
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    • 2014
  • Objective: The low level lasers currently in the market vary in wavelength, dosage, and frequency. These devices are used with much different clinical pathology. Most notably, some studies claim that wounds heal faster with low level laser therapy due to the fact that bacteria commonly found in wounds are killed by laser light. Systemic and meta-analysis studies found the difficulty of comparison of numerous research studies because of differences in the intensities and frequencies of low level laser treatment (LLLT). The purpose of this study was to determine the effectiveness of LLLT on controlling bacterial growth. Design: Cross-sectional study. Methods: Variables included LLLT dosage and wavelength on 3 bacteria commonly seen in wounds, strains of Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa were used on commercially available 5.0-cm agar plates. Blue, green, and red, ultraviolet (UV) and infrared laser light sources were adjusted to either low or high intensity settings. Five Petri dishes at a time were placed directly beneath laser light sources with the exception of UV which was placed six inches below the suspended light and infrared which was placed directly on top of the Petri dish lid. Each group of five Petri dishes was irradiated for 15 minutes. Results: The results showed no effect of any of 9 different LLLT intensities or colors on bacteria growth compared to sham light. Conclusions: At least for claims of bacterial growth inhibition with LLLT, no support for this claim can be found here.

Variations in Pharmacy Payment of Korea National Health Insurance and a New Taxonomy of Community Pharmacies (건강보험 약국 급여비 분석과 약국 유형화 연구)

  • Cheong, Chelim;Choi, Sang-Eun;Lee, Hwayoung;Kim, Jini
    • YAKHAK HOEJI
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    • v.57 no.1
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    • pp.63-69
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    • 2013
  • The objectives of the study are to investigate pharmacy remuneration levels stratified by the number of prescriptions dispensing and the type of nearby medical facilities using the Korean National Health Insurance (NHI) database, and to classify community pharmacies based on the characteristics. Claims data of all community pharmacies were extracted from the Korean NHI database from January 1 to June 30, 2010. A total of 14,985 pharmacies were included for the analysis. The remuneration amounts per pharmacist were directly associated with the number of prescription dispensing, and varied by the type of nearby medical facilities where more than 90% of prescriptions dispensed at the pharmacy are issued from. We classified pharmacies to six groups according to the number of prescription dispensing and the type of nearby medical facilities; (1) pharmacies with equal to or less than 200 prescriptions per month per pharmacist, (2) pharmacies near a general hospital, (3) pharmacies near a regular hospital, (4) pharmacies near a clinic, (5) pharmacies near multi clinics, and (6) pharmacies that do not belong to the above types. Compared to pharmacies near a clinic or multi clinics, pharmacies near a general hospital showed a lower number of prescription dispensing per pharmacist, but the income from dispensing fees was higher (p<0.05). The new taxonomy of community pharmacies can be a useful basis for further policy development in pharmacy remuneration system.

Anti-Fraud in International Supply Chain Finance: Focusing on Moneual Case

  • Han, Ki-Moon;Park, Sae-Woon;Lee, Sunhae
    • Journal of Korea Trade
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    • v.24 no.1
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    • pp.59-81
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    • 2020
  • Purpose - This study analyzes the scope of due diligence and risks of banks and K-Sure in trade finance covered by EFF focusing on Moneual case, one of the latest and biggest trade finance fraud cases in Korea. Also, we suggest anti-fraud measures in trade finance on the part of banks and K-Sure in order to give them a desirable way of due diligence and reasonable risk management of export insurance. Design/methodology - Based on Moneual case of trade finance fraud, this study employs the methodology of an extended literature review and analysis of court decisions. Findings - Seoul High Court of Korea failed to decide whether K-Sure was wholly obliged to pay the insurance against the banks' EFF claims, but issued a compulsory mediation order, judging that both the banks and K-Sure were responsible by 50:50. The court may have judged that both the parties had lacked their due diligence in the trade finance. It is quite difficult for trade finance providers to manually investigate whether the transaction is suspected of trade finance fraud, so digitalization of trade finance which can facilitate the prevention and detection of trade fraud needs to be realized quickly. Since there has been no international rule available for open account trade finance up till now, clearly stipulated EFF terms on the exporter's genuine export obligation might have protected K-Sure from the disaster. Originality/value - This study investigates the due diligence of the banks and K-Sure in Moneual case which few researchers have considered, to the best of our knowledge. This study also suggests several practical methods (including block chain) to prevent complicating trade finance fraud amid increasing use of an open account, and further offers reasonable risk management of EFF employing international factoring rule which is also related to problematic open account trade finance.

Analysis of factors affecting antibiotic use at hospitals and clinics based on the defined daily dose (병원 및 의원급 일일사용량 기준 항생제 사용량에 영향을 미치는 요인)

  • Lee, Eun Jee;Lee, GeunWoo;Park, Juhee;Kim, Dong-Sook;Ahn, Hyeong Sik
    • Journal of the Korean Medical Association
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    • v.61 no.11
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    • pp.687-698
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    • 2018
  • Inappropriate antibiotic use significantly contributes to antibiotic resistance, resulting in reduced antibiotic efficacy and an increased burden of disease. The objective of this study was to investigate the characteristics of prescribers whose antibiotics use was high and to explore factors affecting the use of antibiotics by medical institutions. This study analyzed the National Health Insurance claims data from 2015. Antibiotic prescription data were analyzed in terms of the number of defined daily doses per 1,000 patients per day, according to the World Health Organization anatomical-therapeutic-chemical classification and methodologies for measuring the defined daily dose. We investigated the characteristics of prescribers and medical institutions with high antibiotic use. Multivariate regression analyses were performed on the basis of characteristics of the medical institution (number of patients, type of medical institution [hospital or clinic], age of the physician, etc.). The number of patients and number of beds were found to be significant factors affecting antibiotic use in hospitals, and the number of patients, region, and medical department were significant factors affecting antibiotic use at the level of medical institutions. These findings are expected to help policy-makers to better target future interventions to promote prudent antibiotic prescription.