• Journal of the Korean Society of Safety
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• v.25 no.6
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• pp.137-145
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• 2010

This study examined the possibility of applying the industrial accident insurance balance ratio to the calculation of the converted accident ratio in the credibility assessment of the PQ. Some correlations between the industrial accident insurance balance ratio and the converted accident ratio were found in the general tendency, however, there were no significant correlations between the two in the individual companies. Therefore, this study came to the conclusion that it is not appropriate to directly apply the industrial accident insurance balance ratio to the calculation of the converted accident ratio.

• Journal of the Korean Society of Radiology
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• v.14 no.6
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• pp.801-810
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• 2020

In this study, the health insurance application of PET and the change in the pay standard were examined, and the amount of health insurance use over the past 10 years was analyzed. Positron tomography was applied as health insurance in 2006, and after ¹⁸F-FDG was first applied as health insurance, positron tomography tests using various radioactive isotopes have been applied as health insurance. As of 2019, the number of positron emission tomography tests was 198,651 cases, and the treatment amount was about 88.3 billion won, and the number of tests according to general characteristics was higher in men than in women, and by age, the number of tests was the highest in 60s. The number of outpatient examinations was higher than that of inpatient examinations, and the number of examinations in tertiary hospitals(68.2%) was significantly higher than that of general hospitals and hospitals. As for the test site, torso test was the most common at 86.6%, and radioisotope was the most at 93.6% using ¹⁸F-FDG. The change in the use of PET for 10 years increased steadily from 2010 to 2014, but the amount of use decreased sharply afterwards as the recognition of asymptomatic long-term follow-up tests was deleted due to the government's change in health insurance application standards in 2014. As changes in health insurance standards have a great influence on changes in health insurance usage, continuous monitoring will be required in the future.

• Health Policy and Management
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• v.5 no.1
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• pp.80-105
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• 1995

Assuming that we introduced integration of medical insurance society for self-employed, this study was conducted to examine effects and results after the integration and to research more effective method for integration. To assess effects and results of the finacial status of 266 insurance societies after intergration, the data were obtained from "The Medical Insurance Program for Self-Employeds Statistical Yearbook in 1992". The major finding are as follows : 1. Three alternative integration proposals were made. First alternative proposal was consisted of 232 medical insurance societies, second was 187, and third was 115. 2. As the results of average number of the insured per insurance societies of medical insurance program for self-employed every alternative proposal, first was 88, 119 persons, second was 108, 576, and third was 178, 967 from 76, 576 persons of present socienties. 3. It was true that the more average size of societies increased, the more average administration expenditure per 1, 000 insured reduced. 4. The average size of societies grew bigger, the rate of general expenditure to general revenue more improved. Also, the rate of benefits to contributions was changed for better. But if not to have had correct analysis and precise preparation for integration, effects and results of integration were always not optiized. 5. According to results of simple regression formulas, it was proved that the more the average size of societies was increased, the more result was advantaged. 6. The law of majority and the economy of scale were applied in this study, and it was necessary to analyze and assess effectiveness and efficiency of integration. Therefore, when the integration of medical insurance societies for self-employeds will be performed, it must be taken into consideration. Among three alternative proposals, third was showed more effective alternative than anothe, second was presented more ineffective result than present system. To achieve more effective and efficient integration of regional medical insurance societies throughout the result of the regression formula on present cost curve, it is necessary to operate well-integrated societies and to know appropriative countermeasures of present situation of each societies. Also, for integrating regional medical insurance societies, it is necessary to continue more deep research through practical model activity and to investigate the effective size and managed method of the societies.societies.

• The Journal of the Korean life insurance medical association
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• v.2 no.1
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• pp.253-259
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• 1985

In medical selection of Daehan Education Insurance, for 6 months from June 1st, 1984 to November 30th, 1984 we examined 2523 persons, who were supposed to receive general test and Normal subject test Then we did syphilis test by selecting the way of R.P.R. card test and repeatedly confirming the examination serologically. The results are as follows: 1) As results of R.P.R. card test, 30 out of 1592 males are positive(1.89%) and 10 out of 931 females are positive(1.1%). 40 out of total 2523 persons are positive(1.6%). 2) As results of T.P.H.A, 28 out of 1592 males are positive(1.76%) and 9 out of 931 females are positive. 37 out of total 2523 persons are positive(1.47%). 3) When R.P.R. card test is compared with T.P.H.A test, 40 persons by R.P.R. showed that 2 males and female are negative and only 37 persons are positive in T.P.H.A test. And so the result agreement rate of R.P.R. card test and T.P.H.A test showed 92.5%. 4) In the age-distribution males have high positive rates in 30's and 40's and females have high positive rates in 20's and 40's when the subjects are normal.

• Health Policy and Management
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• v.22 no.3
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• pp.451-465
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• 2012

In order to strengthen assurance of National Health Insurance, co-payment should be reduced. This can happen with collaborative efforts of patients, medical institutes, and government altogether at the same time. This research applied Dutton(1986)'s medical service research model with high R-square, and analyzed 2008 Korea Health Panel Data (Beta Version 1), that was examined by Korea Institute for Health and Social Affairs and National Health Insurance, in order to figure out influential variables on co-payment. In result of Multiple Linear Regression Analysis, R-square was 46.7%, the older the age, the patients who had surgery, the longer days of hospital treatment are, the higher gross income of a household is, the more hospitalized in upper grade general hospitals, and the more upper grade rooms and selecting a doctor are used. The results have statistical significance. When conducting research applying medical service research model, there is a need to apply Dutton(1986)'s medical service research model with high R-square. In order to strengthen assurance of National Health Insurance, first conditions should be that patients are hospitalized in upper grade general hospital, and at the same time, are patients who had surgery with long stay of hospitalization. In addition, if proven that patients used upper grade rooms and selecting a doctor due to lack of regular treatment and rooms, for certain number of days of such hospitalization, it is suggested to be provided with health care insurance in upper grade rooms and selecting a doctor in calculating co-payment limit.

• Journal of Arbitration Studies
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• v.22 no.1
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• pp.89-110
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• 2012

No-fault automobile insurance system is a statutory scheme to provide automobile accident victims with compensation for certain expenses arising from personal injuries occurring in car accidents. New York State has enacted No-Fault Law to ensure that the injured in automobile accidents be paid rapidly by their own insurance company for medical expenses, lost earnings regardless of fault, replacing common law system of reparation for personal injuries under tort law. Its primary purpose is to facilitate compensation without the need to exhaust time-consuming litigation over establishing the existence of fault and the extent of damages. No-Fault Law allows arbitration as a method for settling the no-fault insurance disputes. No-fault arbitration, however, differs in a significant way from general arbitration system. First, No-Fault Law provides the parties with the option to submit any dispute involving no-fault automobile insurance to arbitration. Second, no-fault arbitration attempts to speed its procedure incorporating various methods. Third, the parties are required to seek review of arbitral awards by master arbitrator prior to seeking court's review. Fourth, the parties have right to bring de novo action in court if master arbitrator's award exceeds $5,000. Given the current state of law in Korea, it may not be easy to introduce no-fault arbitration system into Korea in the context of automobile insurance disputes settlement as its law has a long-established reparation system based on tort liability and no-fault arbitration system has its own features that differ from general arbitration system. Nonetheless, it could be suggested that no-fault arbitration be introduced in other fields which require speedy dispute resolution and a third party's decision to settle the disputes. The optional right of submitting disputes to arbitration as provided by No-Fault Law of New York State may offer a ground to supprot the effectiveness of an optional arbitration agreement.

• The Journal of the Korea Contents Association
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• v.17 no.4
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• pp.585-595
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• 2017

The purpose of this study is to analyze the difference of medical care between medical assistance and health insurance patients to evaluate the increase of medical care costs due to the moral hazard of medical care patients and to provide a basis for rational medical care policy decision. For this purpose, we compared health insurance benefit data for Seoul citizens by gender, age, and type of medical institutions. The results of the analysis are as follows. First, all of the hospitalized and outpatient use of the advanced general Hospitals, medical assistance patients were less than those of the health insurance patients, so that the medical assistance patients could not use the high cost medical services. Second, in general hospitals, patients with health insurance are often hospitalized. On the other hand, medical assistance patients use a lot of outpatient services because they are less burdened. Third, in hospitals and clinics, medical benefits patients often use inpatient and outpatient services. Therefore, medical assistance patients are likely to use unnecessary medical care of outpatient and hospitalization clinics and hospitals, outpatient of general hospitals. But, in hospitalization and outpatient use in advanced general hospitals and medical assistance patients can not use due to excessive medical burden. Therefore, the policy to reduce the burden of medical expenses for patients with severe illness will continue, and the medical care patients using clinics and hospitals should be careful not to use unnecessary medical services.

• Korea Journal of Hospital Management
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• v.26 no.1
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• pp.71-82
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• 2021

Purpose: The purpose of this study is to estimate incomes and costs of the medical clinics by using secondary data. Methodology: The medical incomes and costs were estimated from 405 clinics operated by sole practitioner providing out-patient services among all clinics subject to the Medical Cost Survey on National Health Insurance Patients in 2017, excluding dental clinics and oriental medical clinics. The incomes and costs of the medical clinics were reflected with incomes and costs of health insurance benefits and were calculated by types of medical services (i.e., basic care, surgery, general treatment, functional test, specimen test and imaging test). The costs were classified as follows: labor costs, equipment costs, material costs and overhead costs. Secondary data was used to estimate the incomes and costs of the medical clinics. For allocation bases for costs for each type of the medical service, the ratio of revenue from health insurance benefits by types of medical services was applied. However, labor costs were calculated with the activity ratio by types of medical services and occupations, using clinical expert panel data. Finding: The percentage of health insurance income for all medical income was 73.1%. The health insurance cost per clinic was 401,864 thousand won. Labor cost accounted for the largest portion of the health insurance income was 191,229 thousand won (47.6%), followed by management cost was 170,018 thousand won (42.3%), materials cost was 35,434 thousand won (8.8%), and equipment costs was 5,183 thousand won (1.3%). Practical Implications: This study suggests a method of estimating incomes and costs of medical clinic services by using secondary data. It could efficiently provide incomes and costs to assess an appropriate level of the health insurance fee to the clinics.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• v.17
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• pp.93-125
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• 2002

This paper aims to find a reasonable solvency margin system in non-life insurance industry and also to evaluate the appropriateness of the current solvency margin regulation system in Korea. The current solvency margin system in Korea, based on EU's solvency margin model, was introduced during the 1997 financial crisis. The solvency requirement is not based on non-life insurer's risk, but simply on written premiums. The current solvency margin for general insurance, such as fire, marine, and automobile insurance, is determined by the greater between a premium-based amount and a claim-based amount, where the premium-based solvency margin is calculated by multiplying the net written premium for the preceding year by the premium based solvency margin ratio. Also, the amount of solvency margin for long term insurance is set at 4% of the policy reserve of the long term insurance. Still, there exist many differences between the current solvency margin regulation system in Korea and EU's model. This paper focuses on the rationality of the solvency margin regulation system, and compares the current system in Korea with EU's model and the RBC(Risk Based Capital) system in U.S. and Japan. Finally, this paper suggests a more specific and reasonable solvency margin system to be developed in Korea.

• Journal of Korean society of Dental Hygiene
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• v.16 no.1
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• pp.61-67
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• 2016

Objectives: The purpose of the study is to investigate the knowledge of the dental health insurance standard of elderly denture in the dental hygienists. Methods: A self-reported questionnaire was completed by 183 dental hygienists in Busan and Gyeongnam. The questionnaire consisted of general profiles of the subjects(11 items) and 10 items of the dental health insurance standard of the elderly denture including subject of spplication, application method, calculation of range, and temporary denture. Each question was measure by Likert 5 points scale. Cronbach's alpha was 0.936 in the study. The data were analyzed using SPSS 20.0 program. Results: The knowledge of the dental health insurance standard on the elderly denture in the dental hygienists was high in cognition of the renewed standard change(p<0.001), individual career(p<0.05), and recognition of the current standard(p<0.05). Conclusions: It is continuously necessary to inform the dental hygienists of the knowledge of dental health insurance standard. The web-based program for the dental health insurance education should be provided continuously for the dental hygienists.