• Title/Summary/Keyword: General Insurance

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A Study on the Propriety of the Medical Insurance Fee Schedule of Surgical Operations - In Regard to the Relative Price System and the Classification of the Price Unit of Insurance Fee Schedule - (수술수가의 적정성에 관한 연구 - 상대가격체계와 항목분류를 중심으로 -)

  • Oh Jin Joo
    • Journal of Korean Public Health Nursing
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    • v.2 no.2
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    • pp.21-44
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    • 1988
  • In Korea, fee-for service reimbursement has been adopted from the begining of medical insurance system in 1977, and the importance of the relative value unit is currently being investigated. The purpose of this study was to find out the level of propriety of the difference in the fees for different surgical services, and the appropriateness of the classification of the insurance fee schedule. For the purpose of this study, specific subjects and the procedural methodology is shown as follows: 1. The propriety of the Relative Price System(RPS). 1) Choice of sample operations. In this study, sample operations were selected and classified by specialists in general surgery, and the number of items they classified were 32. For the same group of operations the Insurance Fee Schedule(IFS) classified the operations into 24 separate items. In order to investigate the propriety of the RPS, one of the purpose of this study, was to examine the 24 items classified by the IFS. 2) Evaluation of the complexity of surgery. The data used in this study was collected The data used in this study was collected from 94 specialists in general surgery by mail survey from November I to 15, 1986. Several independent variables (age, location, number of bed, university hospital, whether the medical institution adopt residents or not) were also investigated for analysis of the characteristics of surgical complexity. 3) Complexity and time calculations. Time data was collected from the records of the Seoul National University' Hospital, and the cost per operation was calculated through cost finding methods. 4) Analysis of the propriety of the Relative Price System of the Insurance Fee Schedule. The Relative Price System of the sample operation was regressed on the cost, time, comlexity relative ,value system (RVS) separately. The coefficient of determination indicates the degree of variation in the RPS of the Insurance Fee Schedule explained by the cost, time, complexity RVS separately. 2. The appropriateness of the classification of the Insurance Fee Schedule. 1) Choice of sample operations. The items which differed between the classification of the specialist and the classification of medical, Insurance Fee Schedule were chosen. 2) Comparisons of cost, time and complexity between the items were done to evaluate which classification was more appropriate. The findings of the study can be summarized as follows: 1. The coefficient of determination of the regression of the RPS on-cost RVS was 0.58, on time RVS was 0.65, and on complexity RVS was 0.72. This means that the RPS of Insurance Fee Schedule is improper with respect to the cost, time, complexity separately. Thus this indicates that RPS must be re-shaped according to the standard element. In this study, the correlation coefficients of cost, time, complexity Relative Value System were very high, and this suggests that RPS could be reshaped I according to anyone standard element. Considering of measurement, time was thought to be the most I appropriate. 2. The classifications of specialist and of the Insurance Fee Schedule were compared with respect to cost, time, and complexity separately. For complexity, ANOVA was done and the others were compared to the different values of different classifications. The result was that the classification of specialist was more reasonable and that the classification of Insurance Fee Schedule grouped inappropriately several into one price unit.

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The Characteristics and Service Utilization of Home Nursing Care Beneficiaries Under the Korean Long Term Care Insurance (장기요양방문간호 이용자의 특성 및 이용실태)

  • Lee, Jung-Suk;Han, Eun-Jeong;Kang, Im-Ok
    • Research in Community and Public Health Nursing
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    • v.22 no.1
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    • pp.33-44
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    • 2011
  • Purpose: This study examined the characteristics and service utilization of home nursing care beneficiaries under the Korean Long-Term Care Insurance (LTCI). Methods: We used assessment data and claim data of National Health Insurance Corporation from July to August 2008. Data were composed of subjects who were the beneficiaries of home nursing care. Results; A total of 634 subjects were analyzed. Of the subjects, 57.1% were 75 years and over. The average score of nursing care need was only 0.71 and the percentage of those whose nursing care need score was zero was 58.0%. More than half of the subjects had partially dependent musculoskeletal conditions, and 75.5% had two or more comorbidities. A third of them usedonly home nursing care, and another third used both home nursing care and general home care at the same time. Those who needed sore care used the largest home nursing care benefits. Conclusion: Home nursing care of LTCI performs community-based healthcare services under LTCI. Throughout the past two years, however, it has not been active. Understanding the characteristics of its users is important in order to develop effective strategies for activating home nursing care.

Korean National Health Insurance Value Incentive Program: Achievements and Future Directions

  • Kim, Sun-Min;Jang, Won-Mo;Ahn, Hyun-Ah;Jeong, Hyang;Ahn, Hye-Sook
    • Journal of Preventive Medicine and Public Health
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    • v.45 no.3
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    • pp.148-155
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    • 2012
  • Since the reformation of the National Health Insurance Act in 2000, the Health Insurance Review and Assessment Service (HIRA) in the Republic of Korea has performed quality assessments for healthcare providers. The HIRA Value Incentive Program (VIP), established in July 2007, provides incentives for excellent-quality institutions and disincentives for poorquality ones. The program is implemented based on data collected between July 2007 and December 2009. The goal of the VIP is to improve the overall quality of care and decrease the quality gaps among healthcare institutions. Thus far, the VIP has targeted acute myocardial infarction (AMI) and Caesarian section (C-section) care. The incentives and disincentives awarded to the hospitals by their composite quality scores of the AMI and C-section scores. The results of the VIP showed continuous and marked improvement in the composite quality scores of the AMI and C-section measures between 2007 and 2010. With the demonstrated success of the VIP project, the Ministry of Health and Welfare expanded the program in 2011 to include general hospitals. The HIRA VIP was deemed applicable to the Korean healthcare system, but before it can be expanded further, the program must overcome several major concerns, as follows: inclusion of resource use measures, rigorous evaluation of impact, application of the VIP to the changing payment system, and expansion of the VIP to primary care clinics.

A Study on Drone's Liability on Flight in South Korea

  • Kwak, Young-Am
    • Journal of Distribution Science
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    • v.14 no.3
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    • pp.5-10
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    • 2016
  • Purpose - This paper analyzed the accident of drone and related insurance goods which can be coverable with regard to drone accident. The study range is limited in the owner's care, custody, and the control of drone in South Korea, but military area and law and regulation of the drone would be exceptional. Research design, data, and methodology - With regard to drone's flight, drone can make possible risks and can give severe damage to the people. To carry out this research, literature survey and review such as journal, thesis and publications were adopted. Results - As for the insurance coverage from drone's accident involved in the purpose of business, insurance coverage depends on 'commercial general liability insurance'. However, in case of personal hobby including leasure intention, insurance coverage depends on 'living liability insurance'. Conclusions - From a drone's accident, operator and owner of the drone may face the property damage to the drone itself, and then can give severe damage or loss to the people such as physical injuries and property damage. Peoples should be concerned about having the awareness of drone's accident with insurance coverage.

Management Strategies for Medical Expenses Depending on Type of Diseases for Patients of Seafarers Insurance - Focused on Busan - (선원보험 수진자의 상병유형에 따른 진료비 관리방안 - 부산지역을 중심으로 -)

  • Park, Eun-Ha;Hwang, Byung-Deog
    • The Korean Journal of Health Service Management
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    • v.10 no.4
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    • pp.1-11
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    • 2016
  • Objectives : The aim of this study is to investigate the actual condition of the occurrence and recovery of medical expenses through seafarers insurance and to provide basic data that will be helpful in the establishment of efficient hospital management strategies for medical expenses of insurance companies depending on the type of seafarers insurance. Methods : Three general hospitals located in Busan, Korea, were selected, and seafarers insurance claim data was collected from January 1, 2012 to December 31, 2013(24 months) and analyzed. There were 5,490 cases in total. Results : There was a significant difference in the distribution of disease incidence, accrued medical expenses, reimbursement of medical expenses, and the actual condition of medical receivables depending on the insurance company. Conclusions : Therefore, differentiated payback strategies for medical expenses are needed that consider the various seafarers insurance companies and their treatment characteristics.

A Study on the Risks Excluded of Marine Insurance Claims (해상보험 클레임의 면책위험에 관한 고찰)

  • Jung Sung-Hoon;Choi Hyuk-Jun
    • Journal of Arbitration Studies
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    • v.15 no.2
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    • pp.125-162
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    • 2005
  • This paper examined excluded risks of insurer in marine insurance generally, and found out the existing studies on the excluded risks, which were accomplished partially and fragmentarily, to conduct a comparative analysis of marine insurance based on the general flow of claim adjustment. It arranges the existing studies to settle a dispute between the parties -insurer and assurer- and studies the excluded risk based on risk change of the insured by analyzing characteristic and class of security violation, and meaning, form, effect of risk change. it inquires into and analysis cases of the Korean Supreme Court related to the exclusion and illegal act of marine insurance to compare marine theorists' opinion with commercial law.

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A Classification of Conversion Factors of Relative Values in the National Health Insurance (건강보험 환산지수의 유형별 분류방안)

  • Kim, Jin-Hyun;Choi, Byung-Ho
    • Journal of Society of Preventive Korean Medicine
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    • v.10 no.2
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    • pp.147-158
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    • 2006
  • The purpose of this paper is to review the empirical study results of conversion factors(unit prices) for relative values of health care services in the national health insurance system and establish optimal classification of health care institutions for feasible contract of conversion factors between National Health Insurance Corporation(NHIC) and provider groups, based on legal backgrounds and types of health care service delivery system. some empirical research evidences shows the validity of applying multiple conversion factors to annual contract for reimbursement in the national health insurance. Policy recommendations suggest that clinic, hospital, general hospital, tertiary hospital, dental clinic, oriental medical clinic, pharmacy, and public health centers would be a basic category of provider groups for a meaningful price contract between the NHIC and providers.

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An Empirical Simulation for the Relevance of Alternative Systems to Unemployment Insurance in Korea

  • Yun, Jungyoll
    • Journal of Labour Economics
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    • v.25 no.3
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    • pp.59-86
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    • 2002
  • Using the simulated data set which is based upon the data set merging Economically Active Population Survey(EAPS) and the Supplementary Survey (SS) in 1998-2001, this paper examines the relevance of alternative programs Unemployment Insurance Savings Account (UISA) and Pension-funded Unemployment Benefit (PUB) - to unemployment insurance system in Korea. Estimating the relative size of unemployment benefit and IA balance under a specific type of UISA or PUB by simulation, this paper yields the two main results. First, replacing UI by UISA with the same benefit being maintained would be beneficial in terms of search efficiency in general, although its effectiveness is a little doubtful as for the non-regular workers. Second, the PUB is better than UISA as an alternative to UI, and also works relatively well even for the non-regular workers.

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Study on Contribution Rate of Essential Factor Market of Insurance Development to Economic Growth: Demonstration Analysis based on Chongqing in China

  • Shen, Haicheng
    • Asian Journal of Business Environment
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    • v.2 no.2
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    • pp.27-33
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    • 2012
  • Purpose - The article studies aims to construct the center of economy in the upriver area of Chang Jiang, and has realistic significance probing into the contribution of insurance essential factor market to economic development on the contribution role of essential factor market of insurance in financial industry development to economic growth in Chongqing in both aspects of direct and indirect contribution by the way of demonstration analysis. Research data and methodology - The data are from Statistic Yearbook in Chongqing in 1997-2008.The conclusion shows that essential factor market of insurance development falls behind of economic growth in direct aspect; BBD, BLD and FIR could pull economic growth, but ID just restrain economic growth in Chongqing. Results -The estimate coefficient sigh of BDD, BLD, FIR are plus but ID is not, it is to say the increase of bank deposit dump could impel economic growth, which is accord with general thought. Conclusions - At last, the article Having Studied on the contribution role of essential factor market of insurance in financial industry development to economic growth in Chongqing by the way of demonstration analysis.

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