• Journal of Korean Academy of Nursing Administration
• /
• v.14 no.3
• /
• pp.219-228
• /
• 2008

Purpose: The purpose of this study was to develop a measurement scale of nursing competence for nurses working in general wards, and to test the validity and reliability of the scale. Method: A methodological study design was used, consisting of 3 steps as conceptual framework decision, measurement items development, and testing of validity and reliability. In order to verify content validity, 16 experts reviewed the concept of each competences and measurement items. The developed measurement items were tested from 301 nurses in one hospital. Factor analysis and item analysis were applied to establish the scale's construct validity and reliability. Result: The final scale consists of nine dimensions with 70 items. The overall scale reliability had a Cronbach's alpha of 0.98, and the demensions Cronbach's alpha ranged from 0.88 to 0.95. The factor loading of construct validity was from 0.40 to 0.83. The explained variance from the 9 extracted factors was 70.93% of the total variance, and final factors were labeled as critical thinking, resources management and professional development, ability of ward management, application of nursing process, ethical accountability, respectful consideration, patient centered approach, crisis management, and leadership. Conclusion: This measurement scale can be utilized to evaluate nursing competence for nurses working in general wards.

• Journal of The Korean Society of Clinical Toxicology
• /
• v.17 no.1
• /
• pp.21-27
• /
• 2019

Purpose: Mortality rate in the health services research field is frequently considered as a proxy for measuring healthcare quality. We compared the mortality rate and hospitalization levels among patients with poisoning. Methods: A population-based study of hospital size and level based on the Korean health insurance and assessment service was conducted to identify the impact of hospital level on patient mortality. Results: We analyzed a total of 16,416 patients, of which 7,607 were from tertiary hospitals, 8,490 were from general hospitals, and 319 were from hospitals. The highest mortality rate of diagnosis regarding poisoning was T60.31 (other herbicides and fungicides, 16%), followed by T60.0 (organophosphate and carbamate insecticides, 12.7%). There was no statistical difference in mortality among hospital levels for gender. Among age groups, tertiary hospitals had lower mortality than general hospitals and hospitals for patients aged more than 70 years (11.9% mortality at tertiary vs 14.2% at general and 23% at hospital; p=0.003, adjusted z score=-6.9), general hospitals had lower mortality than tertiary hospitals and hospitals for patients aged 18 to 29 (0.6% at general vs 2.4% at tertiary and 3.7% at hospital; p=0.01, adjusted z score=-4.3), and hospitals had lower mortality than tertiary hospitals and general hospitals for patients between 50 and 59 years of age (0% at hospital vs 6.4% at general and 8.3% at tertiary; p=0.004). Conclusion: Overall, there was no significant difference between mortality and hospital level among poisoned patients. However, to establish an efficient treatment system for patients with poisoning, further studies will be needed to identify the role of each facility according to hospital level.

• The Journal of Korean Society for School & Community Health Education
• /
• v.20 no.3
• /
• pp.53-65
• /
• 2019

Objectives: The purpose of this study is to examine the current status of cancer screening among subjects in the lung cancer screening cycle and to analyze the factors affecting the cancer screening of subjects in the lung cancer screening cycle. Methods: This study used the 'National Health and Nutrition Survey 7th Year (2017)' surveyed nationwide as the main data. The subjects are lung cancer screening projects, the dependent variable is early cancer screening, the independent variables are gender, age, marital status, household income level, education level, national health insurance type, private health insurance, The number of chronic diseases, general health examination, smoking status, drinking status, moderate intensity physical activity, stress perception rate, and weight control efforts were determined. Results: The results of this study showed that factors affecting early cancer screening of lung cancer screening subjects were gender, age, marital status, education level, national health insurance, smoking status, drinking status, moderate physical activity, and weight. Irrespective of the control effort, it was found that the private medical insurance, the number of chronic diseases, the medical examination, and the stress perception rate were affected. Conclusion: If the lung cancer screening subjects recognize the importance of early cancer screening themselves and create a social environment to increase their participation rate, lung cancer screening patients and their families will help them to live a healthy life.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
• /
• v.15
• /
• pp.119-136
• /
• 2001

The purpose of this paper is to consider how to decide the cause of loss or damage to the transport goods when maritime accident occurs. In marine insurance, the underwriter is liable for any loss or damage proximately caused by a risk insured(MIA Art.55). So it is very important to determine the proximate cause of loss or damage to ascertain whether it is to be recoverable under the policy. But there is no definite conception or rule what is the proximate cause. It was left to the tribunal as a question of fact. In this paper, I will suggest the general rules to determine the proximate cause of loss or damage of the transport goods in marine insurance. First, in MIA 1906, there is the rule of proximate causation and it has been established the effective causation by cases since 1918. Second, in Institute Cargo Clauses(B) & (C), there are rules of considerably relaxed standards to determine the causation of loss of or damage using the "attributable to" and "caused by" basis. Third, it is noted, under the complex causation situation, there are difference basises to decide the liability of underwriters between the case of successive occurrence of single risk and the case of concurrent occurrence of several risks. Forth, in practice, it couldn't be ascertained the underwrier's liability by a definite rule and it should be fully considered the circumstances and conditions of the loss.

• Journal of Korean Neurosurgical Society
• /
• v.65 no.2
• /
• pp.173-179
• /
• 2022

Disabilities can emerge due to traumatic spinal fractures. In terms of sacrococcygeal spine, because of its unique anatomic structure with minimal movement, the possibility for it to have a disability is relatively low. In Korea, unlike most disability criteria, private insurance companies acknowledge angular deformities caused by vertebral fractures as disabilities according to their degree, so there were several cases where patients required compensation, arguing angular deformity caused by sacrococcygeal fracture, which in some cases led to legal conflicts. Except the Act Welfare of Persons with Disabilities which recognizes only severe angular deformity affecting internal organs as disability and the industrial accident disability evaluation which does not recognize coccygeal fracture as disability but rarely recognizes sacral vertebra deformity equivalent to compressive deformation, there is little or no case where angular deformity is recognized as disability. Given the impairment evaluation standards in social insurance, McBride system, American Medical Association (AMA) guides, and newly proposed standards by the Korean Academy of Medical Sciences (KAMS), the most contentious point in the general terms and conditions of private insurance is spinal deformity. To overcome controversy over disability evaluation, the private insurance sector is now applying criteria for axial skeleton to sacrococcygeal vertebrae through revision of standards. Under these circumstances, it is fair to recognize sacrococcygeal fracture as impairment in terms of the pelvis only when the fracture leaves serious deformity and neurological symptoms with clear relevancy. Though it may not be easy to develop accurate disability evaluation standards, improvement is necessary to remove any irrationalities and make the standards as objective as possible.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
• /
• v.33 no.2
• /
• pp.115-118
• /
• 2022

Fibrolipomas are a rare microscopic variant of lipomas, characterized by mature adipose tissue interspersed with dense fibrous connective tissue. These lesions are rarely observed in the head and neck region and represent <0.6% of all benign tumors of the larynx and hypopharynx. Their clinical presentation depends on the location and size of lesions. Patients present with variable symptoms; however, fibrolipomas of the larynx and hypopharynx are clinically important because these tumors can cause unpredictable airway obstruction, particularly during general anesthesia induction. We present a case of a hypopharyngeal fibrolipoma in a 61-year-old patient with frequent dyspnea, dysphagia, and muffled voice. Laryngoscopy revealed a well-demarcated pedunculated ovoid mass involving the larynx. We performed laryngomicrosurgery using a carbon dioxide laser for surgical excision and subsequent evaluation confirmed the diagnosis of fibrolipoma. We report a case of hypopharyngeal fibrolipoma, together with a literature review.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
• /
• v.76
• /
• pp.125-145
• /
• 2017

Where an insurer has unreasonably refused to pay a claim or paid it after unreasonably delay, the existing law in England does not provide a remedy for the insured. Accordingly, the insured is not entitled to damages for any loss suffered as a result of the insurer's unreasonable delay. This legal position differs from the law in Scotland and most major common law jurisdictions. LC thought that the legal position in England is anomalous and out of step with general contractual principles. LC considered that a policyholder should have a remedy where an insurer has acted unreasonably in delaying or refusing payment of claim, and, therefore, recommended a statutory implied term in every insurance that the insurer will pay sums due within a reasonable time and breach of that term should give rise to contractual remedies, including damages. More detailed recommendations of LC are as followings. First, it should be an implied term of every insurance contract that, where an insured makes a claim under the contract, the insurer must pay sums due within a reasonable time. Secondly, a reasonable time should always include a reasonable time for investigating and assessing a claim. Although a reasonable time will depend on all the relevant circumstances, for example, the following things may need to be taken into account, that is, (1) the type of insurance, (2) the size and complexity of the claim, (3) compliance with any relevant statutory rules or guidance, and (4) factors outside the insurer's control. Thirdly, if the insurer can show that it had reasonable grounds for disputing the claim(whether as to pay or not, or the amount payable), the insurer does not breach the obligation to pay within a reasonable time merely by failing to pay the claim while the dispute is continuing. In those circumstances, the conduct of the insurer in handling the dispute may be a relevant factor in deciding whether the obligation was breached and, if so, when. Fourthly, Normal contractual remedies for breach of contract should be available for breach of the implied term to pay sums due within a reasonable time. Finally, In non-consumer insurance contracts, the insurer should be permitted to exclude or limit its liability for breach of the obligation to pay sums due within a reasonable time, unless such breach was deliberate or reckless, and such an insurer's right to contract out will be subject to satisfying the transparency requirements.

• Journal of dental hygiene science
• /
• v.15 no.6
• /
• pp.768-774
• /
• 2015

The purpose of this study was to grasp the benefits from pit and fissure sealants and to analyze the factors of influencing the benefit amount by using the raw data of the Korea National Health and Nutrition Examination Survey for 2007~2013 targeting the subjects aged from 6 years in full to 18 years. The analysis was used STATA 11.0. As a result of the analysis, the following conclusions were obtained. It rose up to 1.24 pieces after carrying out the national health insurance coverage from averagely 0.93 piece until the year in 2007~2009 (up to November) when is before enforcing the national health insurance coverage in the pit and fissure sealants. The benefits from pit and fissure sealants depending on general characteristics were surveyed to be higher in the higher income level, in the more subscription to health insurance and private insurance, and in the more toothbrushing frequency per day. The factors that have influence upon the benefits from pit and fissure sealants were shown to include whether or not to have the national health insurance coverage in the pit and fissure sealants, income level, health insurance type and private insurance subscription appearance, and one-day toothbrushing frequency. Synthesizing the results, a rise in the benefits from pit and fissure sealants is shown in 2010 based on December 2009 when the national health insurance coverage in the pit and fissure sealants was implemented, but is showing the tendency of declining again from 2011. To increase the benefits from pit and fissure sealants, it is thought that the schemes will need to be discussed such as reinforcing publicity on the national health insurance coverage in the pit and fissure sealants, expanding a support for low-income bracket, and differentiating the outpatient cost sharing according to socio-economic level.

• Health Policy and Management
• /
• v.29 no.2
• /
• pp.195-205
• /
• 2019

Background: The food and food service influence the quality of life and the general health condition of older persons living in long-term care (LTC) facilities. Purchasing good food materials is a ground of good food service. In Korea, the residents in LTC facilities should pay for the cost of food materials and ingredients out of their pocket because it is not covered by LTC insurance. This study explored what factors affect the cost of food materials paid by LTC facility residents and which factor affects most. Methods: We used data from the study on out-of-pocket payment on national LTC insurance, which surveyed 1,552 family caregivers of older residents in LTC facilities. We applied conditional multi-level model, of which the first level represents the characteristics of care receivers and caregivers and its second level reflects those of LTC facilities. Results: We found that the facility residents with college-graduated family caregivers paid 11,545 Korean won more than those with less than elementary-graduated ones. However, the income level of family caregivers did not significantly affect the amount of the food material cost of the residents. The residents in privately owned, large, metropolitan-located facilities were likely to pay more than those in other types of facilities. The amount of the food material cost of the residents was mainly decided by the facility level factors rather than the characteristics of care recipients and their family caregivers (intra-class correlation=82%). Conclusion: These findings suggest that it might be effective to design a policy targeting facilities rather than residents in order to manage the cost of food materials of residents in LTC facilities. Setting a standard price for food materials in LTC facilities, like Japan, could be suggested as a feasible policy option. It needs to inform the choice of LTC users by providing comparable food material cost information. The staffing requirement of nutritionist also needs to be reviewed.

• KDI Journal of Economic Policy
• /
• v.30 no.2
• /
• pp.99-128
• /
• 2008

Nearly all Koreans are insured through National Health Insurance(NHI). While NHI coverage is nearly universal, it is not complete. Coverage is largely limited to minimal level of hospital and physician expenses, and copayments are required in each case. As a result, Korea's public insurance system covers roughly 50% of overall individual health expenditures, and the remaining 50% consists of copayments for basic services, spending on services that are either not covered or poorly covered by the public system. In response to these gaps in the public system, 64% of the Korean population has supplemental private health insurance. Expansion of private health insurance raises negative externality issue. Like public financing schemes in other countries, the Korean system imposes cost-sharing on patients as a strategy for controlling utilization. Because most insurance policies reimburse patients for their out-of-pocket payments, supplemental insurance is likely to negate the impact of the policy, raising both total and public sector health spending. So far, most empirical analysis of supplemental health insurance to date has focused on the US Medigap programme. It is found that those with supplements apparently consume more health care. Two reasons for higher health care consumption by those with supplements suggest themselves. One is the moral hazard effect: by eliminating copayments and deductibles, supplements reduce the marginal price of care and induce additional consumption. The other explanation is that supplements are purchased by those who anticipate high health expenditures - adverse effect. The main issue addressed has been the separation of the moral hazard effect from the adverse selection one. The general conclusion is that the evidence on adverse selection based on observable variables is mixed. This article investigates the extent to which private supplementary insurance affect use of health care services by public health insurance enrollees, using Korean administrative data and private supplements related data collected through all relevant private insurance companies. I applied a multivariate two-part model to analyze the effects of various types of supplements on the likelihood and level of public health insurance spending and estimated marginal effects of supplements. Separate models were estimated for inpatients and outpatients in public insurance spending. The first part of the model estimated the likelihood of positive spending using probit regression, and the second part estimated the log of spending for those with positive spending. Use of a detailed information of individuals' public health insurance from administration data and of private insurance status from insurance companies made it possible to control for health status, the types of supplemental insurance owned by theses individuals, and other factors that explain spending variations across supplemental insurance categories in isolating the effects of supplemental insurance. Data from 2004 to 2006 were used, and this study found that private insurance increased the probability of a physician visit by less than 1 percent and a hospital admission by about 1 percent. However, supplemental insurance was not found to be associated with a bigger health care service utilization. Two-part models of health care utilization and expenditures showed that those without supplemental insurance had higher inpatient and outpatient expenditures than those with supplements, even after controlling for observable differences.