• Title/Summary/Keyword: Claims Review & Assessment

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A Nationwide Study on the Epidemiology of Head Trauma and the Utilization of Computed Tomography in Korea (건강보험심사평가원 환자표본자료를 이용한 국내 두부손상의 역학 및 뇌 CT 시행 분석)

  • Park, So Young;Jung, Jae Yun;Kwak, Young Ho;Kim, Do Kyun;Suh, Dong Bum
    • Journal of Trauma and Injury
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    • v.25 no.4
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    • pp.152-158
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    • 2012
  • Purpose: To understand the epidemiology of head trauma and the utilization of brain CT in Korea, we analyzed a national sampling data set, the National Patient Sample obtained from the Health Insurance Review and Assessment Service. Methods: We retrospectively collected and analyzed demographic and clinical data on enrolled patients from the National Patient Sample based on medical claims data for 2009. The data included patient's age, sex, treatment date, diagnosis codes, procedure codes related with CT, holiday or night consultation fee, and fee for emergency management services. Results: In 2009, the estimated population with head trauma was 819,059(1.8%), and the rate of brain CT utilization was 22.4%. Children ages 5 to 15 were the most commonly injured group(22.8%), but had the lowest brain CT utilization(16.5%). The mean age of the estimated population with head trauma was $34.9{\pm}0.5years$ old, and male patients accounted for 60.5% of that population. Intracranial injury was found in 8.6% of all head traumas, and the rate of intracranial injury in children was lower than it was in adults(4.1% vs. 10.9%, p<0.001). Twenty- three percent of patients with head trauma visited the emergency department (ED). More patients with head trauma visited medical facilities in the daytime on weekdays(66.5% vs. 33.5%, p<0.001), but head CT was performed more frequently at night or on weekends/holidays(16.1% vs. 34.7%, p<0.001) There is low incidence of head trauma in the winter in children (p<0.001). In the multivariate logistic regression analysis, patients who were adults, female, or ED visitors were more likely to undergo brain CT (odds ratio (OR): 1.65, 95% confidence interval (CI): 1.47-1.84; OR: 1.40, 95% CI: 1.27-1.54; OR: 7.80, 95% CI: 6.91-8.80, respectively). Conclusion: In this study, we analyzed the national epidemiologic trend for head trauma, and the pattern of utilization of brain CT.

The clinical utilization of radiation therapy in Korea between 2009 and 2013

  • Kang, Jin-Kyu;Kim, Mi-Sook;Jang, Won-Il;Seo, Young Seok;Kim, Hee Jin;Cho, Chul Koo;Yoo, Hyung Jun;Paik, Eun Kyung;Cha, Yu Jin;Song, Hyun Jin
    • Radiation Oncology Journal
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    • v.34 no.2
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    • pp.88-95
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    • 2016
  • Purpose: The purpose of this study was to estimate the clinical utilization of radiation therapy (RT) in Korea between 2009 and 2013. Materials and Methods: We analyzed open claims data from the Health Insurance Review and Assessment Service. The subjects were patients who had diagnostic codes C00-C97 or D00-D48 according to the 10th revision of the International Classification of Diseases, with procedure codes indicating RT treatment. Results: The total number of patients who received RT in 2009, 2010, 2011, 2012, and 2013 were 45,571, 49,593, 54,671, 59,172, and 61,485, respectively. Among them, the total numbers of male and female patients were 20,780/24,791 in 2009, 22,711/26,882 in 2010, 24,872/29,799 in 2011, 27,101/32,071 in 2012, and 27,941/33,544 in 2013. The five cancers that were most frequently treated with RT between 2009 and 2012 were breast, lung, colorectal, liver, and uterine cervical cancers. However, the fifth most common cancer treated with RT that replaced uterine cervical cancer in 2013 was prostate cancer. The three leading types of cancer among the male patients were lung, colorectal, and liver cancers, whereas in female patients, they were breast, uterine cervical, and lung cancers. The type of cancer most commonly treated by RT was cancer of the central nervous system in patients aged 20 years or less, breast cancer in patients aged 30-50 years, and lung cancer in patients aged 60 years or more. Conclusion: Data from this study provided the clinical utilization of RT in Korea between 2009 and 2013.

Decrease in Incidence of Febrile Seizure following Social Distancing Measures: A National Cohort Study in South Korea

  • Park, Kyu Hyun;Choe, Young June;Shim, Youngkyu;Eun, Baik-Lin;Byeon, Jung Hye
    • Pediatric Infection and Vaccine
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    • v.28 no.3
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    • pp.144-148
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    • 2021
  • Purpose: Nonpharmaceutical measures, such as social distancing, have resulted in unintended consequences, including a decrease in the incidence of childhood diseases. This study aimed to estimate the impact of social distancing on the incidence of febrile seizure (FS) in Korea using nationally representative data. Methods: We used claims data from the Health Insurance Review and Assessment Service, a single-payer database capturing >95% of the Korean population. The database included any inpatient encounter with a FS diagnosis from January 2010 to September 2020 for those aged 0-5 years old. We aggregated the monthly number of cases to estimate the incidence per 100,000 patient-years in 2020 (January 1 to September 30) for the same periods in 2010-2019. Results: The incidence of FS in 2020 ranged from 113 per 100,000 (95% confidence interval [CI], 108-118 per 100,000) in January to 27 per 100,000 (95% CI, 25-30 per 100,000) in September, whereas the average FS incidence in 2010-2019 ranged from 116 per 100,000 (95% CI, 112-121 per 100,000) in January to 101 per 100,000 (95% CI, 97-106 per 100,000) in September. Conclusions: The incidence of FS decreased by -38% in 2020, suggesting that social distancing contributed towards decreasing the incidence of FS.

Risk Assessment Model for the Delay Protocol in the Conditions of Contract of International Construction Projects (해외 건설공사 공기지연사건의 합리적 대응을 위한 계약조건 리스크 평가 방법)

  • Lee, Hwangku;Shin, Dongwoo;Kim, Kyungrai;Cha, Heesung;Kim, Youngjae
    • Korean Journal of Construction Engineering and Management
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    • v.18 no.6
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    • pp.65-77
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    • 2017
  • Recently, many Korean major construction companies are suffering from profit loss mainly due to a direct impact from delays in their overseas projects. In general, changes are inevitable in a large-scale project, and most of changes are directly linked to construction delay. Therefore, in the event that an extension of time is necessary due to a change, the contractor must manage the delay based on the condition of the contract to effectively manage risks from delay to the completion date. Thus it is important to understand delay protocol defined in the condition of the contract early in the project, but there have been few or no study to propose methodology or tool to support this effort. This paper presents a review on the project planning and controling practices of major Korean construction companies along with the issues on delay claims and disputes in mega-international projects and suggests a tool to assess delay risk in the condition of the contract. To propose a delay risk assessment model for international construction projects, major standard conditions of contract have been reviewed including FIDIC Red Book(1999), PSSCOC(2014) and SIA 9th Edition(2010). To reflect recent trend of major international owners, standard conditions which they are utilizing for their projects also have been reviewed including those of ARAMCO and QP. The model provides a categories of risks to be reviewed on the condition of the contract along with standard level of the risk which is common in the international standard form of the contracts. This study also performed a case study on an actual international project to confirm the effectiveness of proposed model to identify and respond to a delay risk of a project.

A Study on the Current State of Pediatric Dentists and the Adequacy of Supply and Demand Based on Covered Services (소아치과 전문의 인력 현황 및 공급 적정성에 관한 연구 - 급여 진료 항목을 기준으로)

  • Yeo Won Lim;Yong Kwon Chae;Ko Eun Lee;Ok Hyung Nam;Hyoseol Lee;Sung Chul Choi;Mi Sun Kim
    • Journal of the korean academy of Pediatric Dentistry
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    • v.50 no.3
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    • pp.360-372
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    • 2023
  • The aim of this study was to identify the current state of pediatric dentists, evaluate the adequacy of pediatric dentist supply and demand, and find out the perception of all pediatric dentists on the current state of pediatric dentists and policy establishment. An Online survey was conducted among pediatric dentists. The questionnaire was subdivided into 'general characteristics', 'number of dental treatments and working days per year', 'proportion of covered services', 'perceptions of supply and demand of pediatric dentists'. Through the Korean Academy of Pediatric Dentistry, the Health Insurance Review and Assessment Services, the National Health Insurance Service (NHIS), and the Korean Statistical Information Service, the current state of pediatric dentists, the number of claims for covered services, and the decrease in births per year were investigated. Dental clinics claiming to be pediatric dentistry reached half of all medical institutions, but only 3.78% of pediatric dentists actually worked. 61.36% of all pediatric dentists were concentrated in the metropolitan area, showing a national imbalance. Although the population of children and adolescents have continuously decreased over the past 20 years, the number of NHIS-covered services has shown a continuous increase. Over the past 10 years, the optimal supply of pediatric dentists has been maintained at around 4,000. According to the analysis, 92.15% of pediatric dentists thought that it was necessary to prepare policies and support measures at the government level. This study is expected to be used as basic data for establishing a demand estimation method for pediatric dentistry specialists in the future.