• Title/Summary/Keyword: Coverage criteria

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Considerations in Allowing Voluntary Non-Reimbursable Treatments from a Public Law Perspective - A Commentary on Supreme Court Judgment 2010 Doo 27639, 27646 (ruled on June 8, 2012 by the Grand Bench) - (임의비급여 진료행위의 허용여부에 관한 공법적 고찰 - 대법원 2012. 6. 18. 선고 2010두27639, 27646 전원합의체 판결에 대한 평석 -)

  • Ha, Myeong-Ho
    • The Korean Society of Law and Medicine
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    • v.14 no.2
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    • pp.173-214
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    • 2013
  • Traditionally, the Supreme Court has held that medical treatment agreements covered by national health insurance should be distinguished from other medical treatment agreements which are viewed as a consummation of the autonomous free will between doctor and patient. Namely, the Supreme Court views medical treatment agreements covered by national health insurance to be bound by the National Health Insurance Law with the intent to promote the applicability and comprehensiveness of the national health insurance scheme. Yet, issues of voluntary non-reimbursable treatments are triggered not only by the mistakes or moral hazard of medical care institutions but also by systemic limitations of national health insurance coverage criteria. Thus, there is a need for legislative measures that allow certain medical treatments to be included or reflected in the national health insurance coverage system so that patients may receive prompt and flexible medical treatments. To reflect such concerns, the Supreme Court made an exception for voluntary non-reimbursable treatments and developed a strict test to be applied in such cases in Supreme Court Judgment 2010 Doo 27639, 27646 (ruled on June 8, 2012 by the Grand Bench). Such judgment, however, is not a fundamental overturn of the Supreme Court's prior rulings that voluntary non-reimbursable treatments are not allowed under the law. It is only a slight revision of its previous stance for cases in which there is a lack of legislative measures to make coverage of a new yet valid medical treatment possible under the current national health insurance coverage system.

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National Health Insurance Coverage for Dental Implant and Denture (진료현장의 건강보험 틀니와 임플란트의 건강보험진료)

  • Choi, Hyeonmi
    • The Journal of the Korean dental association
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    • v.54 no.6
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    • pp.457-467
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    • 2016
  • The National Health Insurance Service(NHIS) has been selectively covering the elderly on the dental implant and removable denture treatment and gradually expanding the eligibility criteria. Every dentist needs to have a good understanding of the insurance policy to provide qualified dental service to the beneficiaries and to avoid confusions and complications. In order to help dentists understand the NHIS requirements, the definitions, categories, and procedures of dental implant and conventional denture treatment are suggested.

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Accessibility Automatic Inspector Library for EPUB and its Components (전자책 장애인 접근성 자동 검증도구용 라이브러리 연구)

  • Kim, Hyun-Young;Lim, Soon-Bum
    • Journal of Korea Multimedia Society
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    • v.20 no.2
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    • pp.330-335
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    • 2017
  • We have heard about several keywords of the fourth industrial revolution such as automation, artificial intelligence and connectivity. And electronic publishing systems and ebooks will enable us to experience a new industrial revolution without discrimination. On that level, it is necessary to study a method of automatic accessibility tool for electronic publishing. There are some studies on accessibility standard specifications, accessibility guidelines, and accessibility certificate criteria. but there is little research about automatic inspection tools in electronic publishing area. This paper proposed a library for accessibility inspector of EPUB and its components based on IDPF EPUB accessiblity guidelines and TTA accessibility certificate criteria for reading disabled people. After implementing the library that can be connected to SIGIL, which is the most widely used in Korea, we verified its functionality and its coverage with Korean commercial EPUB files.

Proposal of Test Scenario Set for Wireless Location Determination Technologies Performance Evaluation (무선 측위 시스템의 성능 평가를 위한 시험 시나리오 집합 제안)

  • Son Seok-Bo;Kim Young-Baek;Park Chan-Sik;Lee Sang-Jeong
    • Journal of Institute of Control, Robotics and Systems
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    • v.12 no.8
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    • pp.759-764
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    • 2006
  • This paper introduces test plan and scenario sets proposed by CDG(CDMA Development Group)for wireless location determination technologies performance evaluation, and proposes new test criteria and scenario sets which are more suitable in Korea environment. We propose two scenario sets. One is based on wireless network coverage, and another is based on test types. We evaluate the performance of AGPS(Assisted-GPS) receiver designed by Hanyang Navicom Co., ltd. and analyze the results according to proposed test criteria and scenario sets.

A Study on Floor Slip Resistance Standard and Test Method for BF Certification (BF인증을 위한 바닥 마감재 미끄럼 성능기준 및 측정방법에 대한 연구)

  • Shin, Dong-Hong;Seong, Ki-Chang;Park, Kwang-Jae
    • Journal of The Korea Institute of Healthcare Architecture
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    • v.25 no.3
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    • pp.75-83
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    • 2019
  • Purpose: There are no clear criteria for slip performance in the BF certification process, so the evaluator relies on subjective judgments depending on the field situation. Physical criteria for determining the slip performance of various floor finishes are not clear. C.S.R., the only criterion currently being used to check slip performance, may raise questions about its coverage, feasibility and reliability. Method: For an analysis of domestic standards and status, KS L 1001, KS M 3510, and KS F 2375. External standards are analyzed for ADA Standard, ANSI Standard, and BS EN Standard. Analyze the test methods and evaluation criteria of O-Y-PSM, BPT, and the dynamic slip resistance test used in these criteria. It also presents an improvement plan for the rational presentation of standards. Results: To date, various kinds of test methods and measuring devices of the slip resistance coefficient have been developed, but there are not many ways to trust useful results related to user safety. Reliability and thoroughly verified test methods and criteria should be used to assess the slip performance of the floor. In order to improve the standard for the evaluation of slip performance in Korea, the existing standard should first be raised to the same level as the overseas standard, and the application of the discriminatory standard should be applied considering the characteristics and usage patterns of each space. Implication: Currently, Korean standards propose various test methods, but the proper use of test methods, scope and assessment criteria are not established, so improvement of the comprehensive standard is necessary.

Analysis of Interference Protection Criteria for Interoperability of Radar Systems (레이다 시스템 상호 간 운용을 위한 간섭 보호 기준 분석)

  • Kim, Jung;Jung, Jung-Soo;Kwag, Young-Kil;Kim, Jin-Goog;Jeon, Young-Chan
    • The Journal of Korean Institute of Electromagnetic Engineering and Science
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    • v.25 no.4
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    • pp.434-441
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    • 2014
  • Recently, a mutual interference threat has been increasing among the radar systems due to the rapid growth of the military radar operation. In this paper, the radar interference protection criteria is presented for interoperability in terms of the radar coverage and target detection probability in association with the international recommendation on the interference spectrum by ITU-R. The required criteria for the minimum allowable interference is also presented in terms of INR. In order to ensure the maximum detection probability of the radar under the mutual interference situation, only 5 % of detection range loss is allowed for the case of INR of -6 dB, and required SNR is presented at each INR in terms of the detection range and detection probability. This result will be useful for establishing the interference protection criteria in the combined military radar systems.

An AFLP-based Linkage Map of Japanese Red Pine (Pinus densiflora) Using Haploid DNA Samples of Megagametophytes from a Single Maternal Tree

  • Kim, Yong-Yul;Choi, Hyung-Soon;Kang, Bum-Yong
    • Molecules and Cells
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    • v.20 no.2
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    • pp.201-209
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    • 2005
  • We have constructed an AFLP-based linkage map of Japanese red pine (Pinus densiflora Siebold et Zucc.) using haploid DNA samples of 96 megagametophytes from a single maternal tree, selection clone Kyungbuk 4. Twenty-eight primer pairs generated a total of 5,780 AFLP fragments. Five hundreds and thirteen fragments were verified as genetic markers with two alleles by their Mendelian segregation. At the linkage criteria LOD 4.0 and maximum recombination fraction 0.25(${\theta}$), a total of 152 markers constituted 25 framework maps for 19 major linkage groups. The maps spanned a total length of 2,341 cM with an average framework marker spacing of 18.4 cM. The estimated genome size was 2,662 cM. With an assumption of equal marker density, 82.2% of the estimated genome would be within 10 cM of one of the 230 linked markers, and 68.1% would be within 10 cM of one of the 152 framework markers. We evaluated map completeness in terms of LOD value, marker density, genome length, and map coverage. The resulting map will provide crucial information for future genomic studies of the Japanese red pine, in particular for QTL mapping of economically important breeding target traits.

An Analysis on the Deployment Methods for Smart Monitoring Systems (스마트 모니터링 시스템의 배치 방식 분석)

  • Heo, No-Jeong
    • The Journal of the Institute of Internet, Broadcasting and Communication
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    • v.10 no.6
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    • pp.55-62
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    • 2010
  • Monitoring systems are able to report certain events at region of interest(ROI) and to take an appropriate action. From industrial product line full of robots to fire detection, intrusion detection, smart grid application, environmental pollution alarm system, monitoring system has widely used in diverse industry sector. Recently, due to advance of wireless communication technology and availability of low cost sensors, intelligent and/or smart monitoring systems such as sensor networks has been developed. Several deployment methods are introduced to meet various monitoring needs and deployment performance criteria are also summarized to be used to identify weak point and be useful at designing monitoring systems. Both efficiency during deployment and usefulness after the deployment should be assessed. Efficiency factors during deployment are elapsed time, energy required, deployment cost, safety, sensor node failure rate, scalability. Usefulness factors after deployment are ROI coverage, connectivity, uniformity, target density similarity, energy consumption rate per unit time and so on.

The Patterns of Korean Medicine Usage with Coverage by Private Health Insurance -Based on Usage and Consumption of Korean Medicine Report in 2014- (민간보험가입여부가 한방의료이용에 미치는 영향요인 -2014년 한방의료이용 및 한약소비실태조사(보건복지부)를 중심으로-)

  • Sung, Angela Dongmin;Park, Haemo;Kim, Hyundo;Lee, Sungdong
    • Journal of Society of Preventive Korean Medicine
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    • v.21 no.1
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    • pp.67-81
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    • 2017
  • Objectives : The purpose of this study was to analyze the report conducted in 2014 by the Ministry of Health and Welfares on influences of private insurance coverage on the use of Korean medicine. Methods : We analyzed Ministry of Health and welfares report on the use and consumption of Korean medicine to fit the purpose of this study. Comparison between private insurance holders and non-holders was made in the areas of sociodemographic characteristics, patient distribution by disorders, total number of disorders and existence of complex diseases, general perception of Korean medicine, and medical expenses and visits. Logistic regression analysis was made to verify the private insurance coverage. Results : Among sociodemographic characteristics, significant differences were observed in age distribution, education, professions, income level, and housing factors. But genders, area of residence, and marital status didn't show significant differences. Other significant differences including side effects, experience with Korean medicine, herbal medicine and acupuncture treatments, and main visiting facilities were shown between private insurance holders and non-holders. Majority of disorders treated with Korean medicine were musculoskeletal issues, and criteria of number of disorders, multiple diseases factors, and medical expenses/visits showed significant differences between the two groups. Conclusions : Summarizing above results indicate that holding a private insurance in addition to National Health Insurance contributes significant influences on the use of Korean medicine.

The Effect of the National Health Insurance Coverage of Chuna Therapy on the Costs and Service Uses of Chuna Therapy in Automobile Insurance Oriental Medical Institutions (추나요법 건강보험 급여 적용이 자동차보험 한방의료기관의 추나요법료 및 의료이용에 미치는 영향)

  • Kim, Kyung-Hwa;Cho, Hyung-Kyung;Lee, Kwang-Soo
    • Health Policy and Management
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    • v.31 no.3
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    • pp.344-354
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    • 2021
  • Background: The purpose of this study was to analyze the effect of national health insurance coverage of Chuna therapy in April 2019 on the costs and service uses in automobile insurance. Methods: This study used the claim data from Health Insurance Review and Assessment Service. A total of 189,912 inpatients and 1,550,497 outpatients who received Chuna therapy covered by automobile insurance in oriental medical institutions were included. The analysis period was from July 2018 to December 2019, and a total of 18 months before and after April 2019, when Chuna therapy was covered by national health insurance. Interrupted time series analysis was applied to analyze the impact on the costs and service uses of Chuna therapy in automobile insurance before and after April 2019. Results: From July 2018 to December 2019, for 189,912 inpatients the cost and the number of times for Chuna therapy per capita were increased by 22.0% and decreased by 7.3% respectively right after the implementation of the policy. In the case of 1,550,497 outpatients, the cost of Chuna therapy per capita tends to be increased by 0.4% in overall study periods and increased 28.4% immediately after the implementation of the policy. Meanwhile, the number of times and visits for Chuna therapy per capita tends to be increased by 0.4% in overall study periods but decreased by 0.4% after the implementation of the policy. Conclusion: Results suggest that if the national health insurance coverage of oriental medicine services increases according to the policy stance for benefit expansion in national health insurance, the criteria for providing national health insurance benefits should be considered with the comprehensive impacts on the costs and service uses of automobile insurance.