• Journal of Preventive Medicine and Public Health
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• 제31권3호
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• pp.471-480
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• 1998

This study was undertaken in order to estimate the accuracy of disease code of the Korean National Medical Insurance Data and disease the characteristics related to the accuracy. To accomplish these objectives, 2,431 cases coded as notifiable acute communicable diseases (NACD) were randomly selected from 1994 National Medical Insurance data file and family medicine specialists reviewed the medical records to confirm the diagnostic accuracy and investigate the related factors. Major findings obtained from this study are as follows : 1. The accuracy rate of disease code of NACD in National Medical Insurance data was very low, 10.1% (95% C.I. : 8.8-11.4). 2. The reasons of inaccuracy in disease code were 1) claiming process related administrative error by physician and non-physician personnel in medical institutions (41.0%), 2) input error of claims data by key punchers of National Medical Insurer (31.3%) and 3) diagnostic error by physicians (21.7%). 3. Characteristics significantly related with lowering the accuracy of disease code were location and level of the medical institutions in multiple logistic regression analysis. Medical institutions in Seoul showed lower accuracy than those in Kyonngi, and so did general hospitals, hospitals and clinics than tertiary hospitals. Physician related characteristics significantly lowering disease code accuracy of insurance data were sex, age group and specialty. Male physicians showed significantly lower accuracy than female physicians; thirties and fortieg age group also showed significantly lower accuracy than twenties, and so did general physicians and other specialists than internal medicine/pediatric specialists. This study strongly suggests that a series of policies like 1) establishment of peer review organization of National Medical Insurance data, 2) prompt nation-wide expansion of computerized claiming network of National Medical Insurance and 3) establishment and distribution of objective diagnostic criteria to physicians are necessary to set up a national disease surveillance system utilizing National Medical Insurance claims data.

• 산경연구논집
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• 제9권5호
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• pp.93-104
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• 2018

Purpose - This study is to investigate the relationship among emotional intelligence, self-efficacy and job stress of foreign life insurance consultants focusing on the mediating effect of self-efficacy. Regarding job security, in general foreign life insurance companies in Korea have more severe working conditions in terms of required contract performance. For foreign life insurance consultants, they are assumed to need higher level of emotional intelligence and self efficacy to meet the conditions. In this study, focus is cast on these aspects. Research design, data, and methodology - Basically the research is conducted upon questionnaires responded by foreign life insurance consultants. That is, data are collected from 255 sample of insurance consultants who work for a foreign owned life insurance company. The Questionnaire measure the level of emotional intelligence, self-efficacy and job stress of insurance consultants. The data are analyzed using pearson's correlation coefficient and hierarchical multiple regression, descriptive statistics, t-test, ANOVA, Durbin-Watson test. Results - The general characteristics of respondents are gender, age, marital status, education level, income monthly, career length, change jobs no, working day per week, call no. per week, meeting no. with client per week, contract regularity, contract no. per month and cancellation contract per year. The mean of emotional intelligence is 2.63, self-efficacy is 3.44 and job stress is 2.20. Emotional intelligence is composed with mean value of self emotion appraisal(3.93), other's emotion appraisal(3.78), regulation of emotion(3.29) and use of emotion(3.52). The mean of self efficacy is composed with mean value of self-confidence(3.41), self-regulated efficacy(3.59) and preference task difficulty(3.30). The job stress is composed with mean value of job requirement(2.61), lack of job autonomy(1.99), conflict of personal relations(1.99), job instability(2.38), organizational system(2.19) and inappropriate compensation(2.07). There is a significant positive correlation between emotional intelligence and self-efficacy. The emotional intelligence and self-efficacy are significantly negative correlation with job stress. The self-efficacy is showed a mediating variable between emotional intelligence and job stress. Conclusions - To decrease job stress level, foreign life insurance company should find the factors to improve the emotional intelligence and self-efficacy of life insurance consultants, and develop appropriate plans using a mediating role of self- efficacy between emotional intelligence and job stress.

• 간호행정학회지
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• 제11권4호
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• pp.449-467
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• 2005

Purpose: This study aims to offer the fundamental data in order to cost the nursing service on the basis of the NIC and a close examination of the interventions that are contained in the health insurance cost list under the system of the current health insurance. Methods: The data is handled with the SPSS 10.0 program. The participants' general peculiarity is calculated in terms of the real number and the percentage, and the performing frequency of the nursing interventions is calculated in terms of the mean and the standard deviation. the correlation between the participants' general peculiarity and the performing frequency of the nursing interventions is analysed with t-test or one way ANOVA of SPSS. Results: In the performing frequency of the nursing interventions, the domain of "the physiological: basic" was the highest as 2.69${\pm}$1.21, the domain of "the behavioral" was the lowest as 2.11${\pm}$1.12. There were 50 core interventions in the medical unit, 48 in the surgical unit, 24 in the MICU and 33 in the SICU. The health insurance cost items contained commonly in the core interventions of each unit were 12, and the health insurance cost items except 12 items contained commonly in the core interventions of each unit were appeared 14 items in the medical unit, 6 in the surgical unit, 7 in the MICU and 2 in the SICU. The core interventions contained commonly in four units of the medical unit, the surgical unit, the MICU & the SICU are 18. And among these, the core interventions contained in the health insurance cost items are 10; pain management, hyperglycemia management, analgegic administration, medication administration: intravenous, oxygen therapy, pressure ulcer prevention, fluid management, fluide monitoring, intravenous(IV) insertion, intravenous(IV) therapy. As the result of the comparison & analysis between the core interventions of the NIC and the health insurance cost items, the core interventions contained in the health insurance cost list are 21(29 as the health insurance cost items). Conclusion: In the performing frequency of the nursing interventions, the domain of "the physiological: basic" is being performed most frequently, and in the performing frequency of the core interventions, the interventions of the domain of "the physiological: complex" is being performed most frequently. On the basis of these results, the writer hopes that the attempts to interlink the nursing interventions into the nursing cost by using of standard terms and the efforts to cost the nursing services would also be made in the future constantly.

• Environmental Analysis Health and Toxicology
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• 제30권
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• pp.12.1-12.7
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• 2015

Objectives In South Korea, health insurance data are used as material for the health insurance of national whole subject. In general, health insurance data could be useful for estimating prevalence or incidence rate that is representative of the actual value in a population. The purpose of this study was to apply the concept of episode of care (EoC) in the utilization of health insurance data in the field of environmental epidemiology and to propose an improved methodology through an uncertainty assessment of disease course and outcome. Methods In this study, we introduced the concept of EoC as a methodology to utilize health insurance data in the field of environmental epidemiology. The characterization analysis of the course and outcome of applying the EoC concept to health insurance data was performed through an uncertainty assessment. Results The EoC concept in this study was applied to heat stroke (International Classification of Disease, 10th revision, code T67). In the comparison of results between before and after applying the EoC concept, we observed a reduction in the deviation of daily claims after applying the EoC concept. After that, we categorized context, model, and input uncertainty and characterized these uncertainties in three dimensions by using uncertainty typology. Conclusions This study is the first to show the process of constructing episode data for environmental epidemiological studies by using health insurance data. Our results will help in obtaining representative results for the processing of health insurance data in environmental epidemiological research. Furthermore, these results could be used in the processing of health insurance data in the future.

• 융합보안논문지
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• 제15권6_2호
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• pp.79-87
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• 2015

최근 허위입원을 이용한 보험범죄가 증가하여 사회문제화 되고 있다. 급격하게 증가하고 있는 허위 과다입원을 통한 보험범죄에 민간보험회사가 대응하는 데에는 한계가 있고, 실제 적발하기에 어려움이 있다. 보험범죄의 증가는 보험회사의 경영악화 뿐만 아니라 보험계약자의 손해를 야기하고, 결국 국가 전체적인 피해로 귀결된다. 보험범죄의 위법성을 분명하게 인식시키기 위해서는 현행법에서 보험범죄에 대한 규정을 명시하는 것이 바람직하다. 일반 사기죄의 구성요건과 차별화된 '보험사기죄'를 신설하고, 보험범죄의 행위태양이나 조직적 가담의 정도 등에 따른 차별화가 요구된다. 또한 민사제재의 도입과 조직적 보험범죄에 대한 가중처벌 규정의 신설이 요구된다. 중복보험사실을 생명보험 가입시에 고지하도록 법규의 개정이 요구된다. 그리고 불필요한 장기입원을 제한할 수 있는 입원기준 마련이 필요하다. 아울러 보험회사 조사요원에게도 조사권을 부여하는 방안으로 민간조사원 제도의 도입이 필요하다. 또한 보험회사와 수사기관 등 유관기관 사이의 정보공유관련법을 마련하고 보험범죄 적발이 가능한 정보 데이터베이스를 구축하며, 보험범죄인지시스템에 SNA기법을 도입하여 조직적 공모사기를 찾아낼 수 있도록 해야 할 것이다.

• 대한치과기공학회지
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• 제38권4호
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• pp.327-342
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• 2016

Purpose: The purpose of this study was to investigate the cognition of denture fabrication activities and its cost in National Health Insurance for elderly denture. Methods: A self-administered questionnaire was completed by 41 dental laboratories' owner who was research subjects of HIRA(Health Insurance Review & Assessment Service)'s policy research for elderly denture in 2011. The questionnaire consisted of general characteristics of the subjects, dental technicians' knowledge of national health insurance coverage of elderly denture, job-related changes after national health insurance coverage of elderly denture including validity of denture fabrication activity classification and the cost for each service. Each question was measured by Likert 5 point scale or frequency. The collected data were analyzed by SPSS 16.0. Results: Most of the research subjects had been fabricating national health insurance coverage denture(92.7%), also had ample knowledge of national health insurance coverage denture for elderly. Job-related changes after national health insurance coverage of elderly denture revealed marginal differences in the quality. The validity of fabrication activity classification of resin based complete denture was $3.71{\pm}1.023$ by Likert 5 point scale. Conclusion: The goal of national health insurance for elderly denture is to promote elderly's health and well-being. To fabricate denture is a very important part of the denture treatment. For this reason, denture fabrication activity classification and the cost analysis plan should be duly reflected in the policy of national health insurance for elderly denture.

• 사회복지연구
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• 제45권3호
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• pp.151-178
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• 2014

대만의 분절된 사회보험 체계는 높은 계층화 효과를 보이는 보수주의 복지체제의 일반적 특성으로 간주된다. 그러나 대만의 사회보험은 서구의 보수주의 복지국가들과는 다른 차별성을 보인다. 첫 번째로 대만의 사회보험은 초기부터 다양한 급부를 제공하는 종합보험의 형식으로 발달하였다. 두 번째로 노동보험과 공무원보험의 계층화 효과가 서로 다르게 나타나는데, 노동보험은 노동자라는 보편적 지위에 기반한 탈계급적 보험 형식을 취한 반면, 공무원보험은 직종과 지위별로 분절된 체계로 발전하였다. 본 논문은 이러한 대만의 사회보험체계를 국가의 복지개입의 의도하지 않은 결과와 가입자들의 이해, 특히 공무원과 노동자 사이의 정치적, 경제적, 민족적으로 대립되는 정체성이 결합하여 만들어낸 결과임을 밝히고자 한다.

• 시큐리티연구
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• 제32호
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• pp.151-176
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• 2012

현재 보험범죄는 해마다 증가하고 있으나 정부차원에서 보험범죄를 적발하거나 방지하기 위한 전문조직은 미비한 실정이다. 이러한 보험범죄로 인한 피해는 인명과 국민경제 측면에서 매우 심각한 실정이다. 보험범죄는 보험회사의 경영수지를 악화시키는 것은 물론이고, 보험금의 부정유출로 인해 보험사의 손해율을 악화시킴으로써 보험사 부실의 원인이 될 수 있다. 이는 결국 보험사의 보험료 인상으로 이어져 결국, 보험가입자의 보험료 인상이라는 문제를 야기시킨다. 이러한 이유로 1996년부터 보험회사들은 보상조직 내에 보험사기를 전문적으로 조사하기 위한 보험범죄특별조사팀(Special Investigation Unit, SIU)을 구성하기 시작하였다. 하지만 현재의 SIU는 보험범죄의 예방을 위한 다양한 업무를 효율적으로 수행하기에는 아직 그 인력과 재원이 부족한 수준이다. 따라서 본 연구는 갈수록 심각한 사회문제로 주목받고 있는 보험범죄를 실제 현장에서 담당하고 있는 SIU 구성원을 대상으로 현재의 근무환경과 보험범죄에 대한 일반적 인식이 그들의 직무만족에 미치는 영향에 대하여 알아보았다. 본 연구는 이러한 현장조사 분석을 바탕으로 현재 SIU 구성원들의 보험범죄 인식 및 근무 환경을 분석하고, 직무만족 향상을 통하여 구축할 수 있는 효과적인 보험범죄 대응 방안을 마련하는 데에 목적이 있다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권2호
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• pp.99-111
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• 2021

Background: Attention deficit hyperactivity disorder (ADHD) is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. It has a worldwide pooled prevalence of 5.29%. The characteristics of ADHD can increase the probability of dental treatment, while special behavior management can be required to allow proper treatment. In South Korea, the use of sedation in dental treatment has rapidly increased in recent decades. The present study aimed to investigate the trend and effects of sedation in patients with ADHD undergoing dental treatment in South Korea. Methods: The study used customized health information data provided by the Korean National Health Insurance Service. Among patients with the record of sedative use during the period from January 2007 to September 2019, those with International Classification of Diseases-10 codes for ADHD (F90, F91) were selected; the data of their overall insurance claims for dental treatment were then analyzed. The patients' age, gender, sedative use, and dental treatment were analyzed per year. The annual number of general anesthesia or sedation cases was also analyzed, and changes in the method of behavior management with increasing age were examined. Results: The study involved 7,654 patients with ADHD (6,270 males; 1,384 females). The total number of dental treatments was 137,778, while the number of sedation cases was 16,109, among which 13,052 involved male patients and 3,057 female patients. The number of general anesthesia cases was 631, among which 538 involved male patients and 93 female patients. The most frequently used sedation method in the dental treatment of patients with ADHD was N2O inhalation. The percentage of sedation cases was highest in patients aged 4 years, and it decreased with increasing age. Conclusion: In South Korea, both sedation and dental treatments were slightly more common in patients with ADHD than in the general population. With increasing age, the frequency of dental treatments and the percentage of sedation cases decreased.

• 지적과 국토정보
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• 제45권2호
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• pp.87-100
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• 2015

우리나라는 자연재해로 인한 피해를 복구하기 위해 풍수해보험을 시행하고 있다. 풍수해보험은 국민안전처가 주관하며 민간보험사가 운영하는 정책보험으로 보험계약자가 부담해야 하는 보험료의 일부를 국가 및 지방자치단체에서 보조함으로써 국민이 저렴한 보험료로 예기치 못한 풍수해에 대해 능동적으로 대처할 수 있도록 하는 선진국형 재난관리제도이다. 본 연구에서는 이러한 풍수해보험 관리지도상의 보험요율 산정 시 필요한 보험목적물 GIS DB 구축과 피해율 산정과 GIS를 분석하는 방법에 대하여 연구하였다. 이번 연구에서 구축한 풍수해 보험의 보험목적물은 단독주택, 공동주택, 온실을 대상으로 하였으며 우리나라 전역의 광범위한 데이터를 어떻게 구축하고, 이 데이터를 실제 시스템을 통해 어떻게 운영할 것인지에 대한 방안을 제시하였다.