• 한국수학교육학회지시리즈B:순수및응용수학
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• 제11권4호
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• pp.275-285
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• 2004

In this paper, the time series models for the number of reported death claims of compulsory automobile liability insurance in Korea are studied. We found that IMA${(0, 1, 1)}\;{\times}\;{(0, 1, 1)}_{12}$ would the most appropriate model for the number of reported claims by the Box-Jenkins method.

• Journal of Preventive Medicine and Public Health
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• 제28권3호
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• pp.640-650
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• 1995

After the introduction of National Medical Insurance in 1989, the medical demand has rapidly increased. The impact of increased medical demand was followed by an increase in the number of claims in need of review. We studied a new, fair method for reducing the number of claims reviewed. We analysed 90,583 outpatient claims submitted between September and October; claims were made for services given August of 1994. We finally suggested a screening system for claims review using a statistical method of discriminant analysis of the medical costs. The results were as follows. 1. In the cut-off group, age, days of medication, number of hospital or clinic visits, and total charge were significantly high. The cut-off rates according to the hospital-type and existence of accompanied disease were significantly different 2. According to ICD, the cut-off rate was highest in peripheral enthesopathies and allied syndromes(20.76%), lowest in acute sinusitis(0.93%). The mean charges were significantly different according to ICD and existence of cut-off. 3. We build discriminant functions by ICD with such discriminant variables as patient age, sex, existence of accompanied disease, number of hospital or clinic visits, and 9 detailed hospital or clinic charges included in claim. 4. We applied the discriminant function for screening those claims that were expected to be cut-off. The sensitivities comprised from 40% to 70%, and specificities from 70% to 95% by ICD. Acute rhinitis had highest sensitivity(100.00%) and other local infections of skin and subcutaneous tissue had highest specificity(98.45%). The expected number of cut-off was 17,762(19.61%). The total sensitivity was 49.62%, the total specificity was 82.57% and the error rate was 19.66%. We lacked economic analysis such as cost-benefit analysis. But, if the new method of screening claims using discriminant analysis were applied, the number of claims in need of review will reduce considerably.

• 건설관리
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• 제6권6호
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• pp.27-28
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• 2005

• 한국생활과학회지
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• 제9권4호
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• pp.491-503
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• 2000

The purpose of this study is to investigate the purchase behavior, response, and complaining behavior for discounting claims in clothing products. The subjects are composed of 360 female consumers. Data were collected through questionnaire. Descriptive analysis was used for analysis of this study. The findings of this study were as follows: First, female consumer used department store for buying discount apparel products the most. The percentage of buying casual or sports wear for discounting was the most. Most consumers purchased clothing products when discounting at 20-40 percentages. Second, even if, consumers tended to distrust discounting claims, they were satisfied with discount apparel products. Especially, they were satisfied with price, design, color, and size, while they were dissatisfied with sewing and fabric in discount products. Third, most consumer knew the knowledge of consumer rights, but most dissatisfied consumers did not assert positive consumer's right. Therefore, marketer should increase the accessibility of their complaint receiving mechanism for dissatisfied consumers in retail environment.

• 무역학회지
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• 제47권3호
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• pp.177-190
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• 2022

This study is designed to identify the differences in the types and importance of trade claims at the national level. For analysis data, abstracts of arbitration and court judgments published on the website of the United Nations Commission on International Trade Law are collected and used. The target countries are China and the United States, with 102 cases from China and 59 cases from the United States. By applying topic modeling techniques to the collection decisions of China and the United States, trade claims are categorized, and the importance of each type is identified using the network centrality index derived through semantic network analysis. The analysis results are as follows. First, the main types of trade claims were the same for both the United States and China: product nonconformity, delivery issues, and payments. However, in China, the order of product nonconformity > delivery issues > payments was important, and in the United States, payments > product nonconformity > delivery issues were found to be important. This study is significant in that it presents a strategic trade claim management plan using a quantitative methodology.

• 한국건설관리학회:학술대회논문집
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• 한국건설관리학회 2001년도 학술대회지
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• pp.46-53
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• 2001

정부의 지속적인 사회간접시설의 건설로 많은 대형공공공사가 발주되고 있으며, 이에 따라 많은 건설 클레임이 발생되고 있으며, 그 .중에서도 현장여건상이 클레임은 발생가능성이 높은 부분이다. 특히 현장여건상이 클레임은 여타 클레임과 달리 공사 초기에 발생하여 여타의 클레임보다 큰 손실을 초래할 수 있으므로 이에 대한 예방방안의 필요성이 증대되고 있다. 본 연구는 국내의 대형공공공사 중 일괄공사계약으로 발주된 공사에서 발생한 현장여건상이 클레임의 원인을 분석하고, 향후 이러한 클레임을 예방할 수 있는 예방방안을 제시하였다. 본 연구에서 제시하고 있는 예방방안으로는 첫째 수급자의 입찰관행 개선, 둘째 수급자의 현장조사 책임한계 정립, 셋째 발주자의 면책조항 재검토 그리고 마지막으로 계약금액 조정의 유연성을 확보하기 위한 방안 등을 제시하고 있다. 또한 상기의 예방방안에 대한 단·장기적 대안도 제시했다. 이러한 예방방안들은 발주자와 수급자 사이에서 현장여건상이 클레임의 해결에 사용될 수 있을 것으로 판단된다.

• 대한예방한의학회지
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• 제19권2호
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• pp.51-56
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• 2015

Objective : We analyzed present condition of cooperative medical care using claims data of HEALTH INSURANCE REVIEW & ASSESSMENT SERVICE form patients treated by Korean-Western cooperative medicine. The study aimed to offer guidelines in selecting disease-related research in developing Korean-Western convergence technology. Method : Based on the patients using Korean medical service, we analyzed claims data of patients using Korean medical service and western medical service from January 2012 to December 2013. We were assigned to the server remotely. With the concept of 'episode of care', we rebuilt claims data and analyzed present condition of cooperative medical usage. Results : We analyzed present condition of cooperative medical care per episode of care. Among outpatients, Low back pain, lumbar region(M5456) was the highest number. Among inpatients, Sciatica due to intervertebral disc disorder(M511) was the highest number. Conclusion : Based on the claims data provided by HEALTH INSURANCE REVIEW & ASSESSMENT SERVICE, we have derived a list of multy frequently disease frequently treated by cooperative medical care by analyzing present condition.

• 보건행정학회지
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• 제16권3호
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• pp.37-51
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• 2006

This study evaluates the reliability of the discharge status variable m health insurance claims for identifying in-hospital patient deaths. This study used 2002 national health insurance claims and the cause of death statistics from Korean national statistical office. The Study data set included acute myocardial infarction (AMI) and coronary artery bypass graft (CABG) surgery patients in 133 general and tertiary hospitals. The gold standard containing patient death information was made and then compared with that of claims data. The hospitals were classified into four groups based on the number of deaths in each hospital. Simple kappa coefficients were calculated to evaluate the agreements of patient deaths between the gold standard and the insurance claims. CABG (83.9%) showed higher agreements than AMI(73.0%) in matched in-hospital patient death information between data sets. Simple kappa coefficients of CABG (0.63) and AMI (0.59) showed moderate or good agreements. The agreements, however, varied depending on the disease or hospital types. The fact that the agreements are only moderate to good indicates that the accuracy of in-hospital death information in claims is not high. n the variable is used to identify patient deaths, it may mislead people. Therefore, efforts should be made to improve the reliability of the discharge status variable in health insurance claims.

• 한국건축시공학회:학술대회논문집
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• 한국건축시공학회 2021년도 가을 학술논문 발표대회
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• pp.248-249
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• 2021

Planning and Scheduling in Korean has been developed from Bar Chart to CPM, integrated management and EVM were attempted. As growing of overseas projects, Scheduler was also recognized as important one. However, the reality is that most Korean construction projects still remain in the preparation of construction plan and construction schedule in 1990s. The global Planning and Scheduling trend is EOT claims. I would like to understand the global trend of EOT claims and EOT analysis, and to find out Planning and Scheduling measures to successfully promote EOT claims.

• Korean Journal of Acupuncture
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• 제34권3호
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• pp.126-135
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• 2017

Objectives : The purpose of this study was to describe the type of claimed adverse events related to Korean Medicine practices in South Korea. Methods : Claims with regard to the Korean Medicine practice submitted to the Korea Medical Dispute Mediation and Arbitration Agency from April 2012 to December 2016 were collected. We analyzed claims that explicitly reported the type of Korean medicine intervention and were deemed as being adverse events as defined by the Korea Good Clinical Practice. Claims that did not mention the Korean medicine practice explicitly or those related to the patient's dissatisfaction to the service rather than adverse health outcomes were excluded. Types, related interventions and the suspected severity of claimed adverse events were summarized. Results : Of 197 claims obtained, 140 claim cases were eligible and 144 claimed events were deemed as possible adverse events of the Korean medicine practice. Pain(16%), local infection/inflammation(12%) and neurological symptoms(11%) were the most frequently reported types of claimed adverse events. Thirty-nine claimed serious adverse events(SAE) were identified, including pneumothorax(28.2%) and death(17.9%). Conclusions : A wide range of claimed adverse events were identified. Routine monitoring of claims data may provide undetected safety information with regard to the Korean medicine practice. High risk of misclassification of the intervention and claimed adverse events due to insufficient information is the main caveat of this study.