• 제목/요약/키워드: Health claim

검색결과 261건 처리시간 0.024초

헬스투어 관광지 매력도 증진방안 - 일본 쿠사츠와 이토온천 지역을 중심으로 - (A Study on promoting destination attraction for health tourism visitors - Case of Kusats & Itoh area in Japan -)

  • 최승국;김승주
    • 한국콘텐츠학회:학술대회논문집
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    • 한국콘텐츠학회 2009년도 춘계 종합학술대회 논문집
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    • pp.312-324
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    • 2009
  • 21세기에 들어 복잡해진 생활환경과 고령화의 진전은 현대인으로 하여금 자신의 건강관리에 대한 관심과 욕구를 관광과 여가를 통하여 표출하는 방식의 추세를 보이고 있다. 이러한 추세에 따라 지역의 경제 활성화를 이루려는 노력도 "건강"을 테마로 하는 건강지향 관광지 개발의 방향으로 바뀌고 있으며 지역의 관광자원과 시설, 서비스의 개선을 포함한 지역의 관광매력도를 높일 수 있는 여러 방법이 다각도로 모색되고 있다. 당 논문에서는 상기와 같은 "건강"지향 관광자들이 가장 많이 찾는 온천지를 대상으로 방문요인을 찾아내어 관광지의 매력도를 증진할 수 있는 방안을 모색하였다. 특히 온천지로 일본에서 가장 유명한 쿠사츠지역과 이도우지역의 방문자들을 대상으로 조사하여 양 지역 간의 차이를 찾아내고 차별화된 건강지향 관광자들의 매력도를 증진시킬 수 있는 방안을 제시하였다.

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일부 지역 치과위생사의 치과 건강보험에 관한 지식 및 심사조정률에 미치는 요인 (Analysis of the knowledge and insurance screening review rates of health insurance claims in the dental hygienist)

  • 박신영;문혜리
    • 한국치위생학회지
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    • 제15권3호
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    • pp.353-361
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    • 2015
  • Objectives: The purpose of the study is to investigate the level of knowledge and screening review rates of dental health insurance claims in dental hygienists. This analysis will provide the educational information to the dental hygienists. Methods: A self-reported questionnaire was completed by dental hygienists in Jeonbuk from December 17, 2012 to January 24, 2013. The questionnaire was distributed by ordinary mail or direct visit. Except incomplete answers, 350 data were collected and analyzed. The study instrument was adapted from the structured questionnaire by Hong and Yoo. The questionnaire consisted of education experience of health insurance management, subjective and objective knowledge, insurance screening review, and need for health insurance education. Data were analyzed by SPSS 12.0 program. Cronbach alpha in the objective knowledge on health insurance rate criteria was 0.836 and this was a reliable figure. Results: The subjective knowledge level of dental insurance was higher in the senior dental hygienists. Subgingival curettage was the lowest percentage of correct answers in the objective knowledge. In recent six months, higher review control rate was shown in the higher claim for health insurance and insurance screening review. Conclusions: The majority of the respondents had lower level of knowledge of health insurance claims. The continuous education of dental health insurance will be necessary in the dental hygienists.

치매노인의 서비스 희망과 이용의 일치 여부에 영향을 미치는 요인 (The Correspondence of the Demented Patient's Desired Service with Received Service Type and Its Affecting Factors)

  • 박종연;강임옥;이상이;서수라;서남규;박형근
    • 보건행정학회지
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    • 제17권2호
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    • pp.52-67
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    • 2007
  • Korean government is preparing the long-term care financing and delivery system in order to cope with rapid population aging. The system should be designed to provide demented patients with an appropriate services that the patients want to take, and considered to be necessary for them. In this regard, this study aims to analyse empirically a relationship between the types of long-term care services that demented patients wanted to take and they actually received during 2004. The caregivers of 609 dementia patients, who were randomly selected in a manner of proportional allocation from a nationwide claim database of the Korean National Health Insurance Corporation, were interviewed in September, 2005. Independent variables include socio-demographic characteristics, Activities of Daily Living(ADL) and Instrumental Activities of Daily Living(IADL). To explore the correspondence of the types of long-term care services that demented patients wanted to take and that they actually received, and its affecting factors, we conducted chi-square test and logistic regression analysis. Main findings are as follows. First, while only 20% of study subjects wanted home services as a long-term care services, those who wanted to use the long-term care facilities and general hospital were 37%, 43% respectively. Second, the correspondence rate was just 38% on average, and extremely low in the demented patients who wanted to use long-term care facilities. Third, the demented patients who resided in urban areas and received relatively high level of education showed high correspondence rate. Fourth, the high ADL score was closely related to low correspondence rate.

노인장기요양보험 방문간호 권고군의 방문간호 이용과 의료 이용의 관계 (The Relationship between Home-Visit Nursing Services and Health Care Utilization among Nursing Service Recommended Beneficiaries of the Public Long-Term Care Insurance)

  • 강새봄;김홍수
    • 보건행정학회지
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    • 제24권3호
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    • pp.283-290
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    • 2014
  • Background: This study aimed to examine the relationship between home-visit nursing services and health care utilization under the public long-term care insurance program in Korea. Methods: We analyzed the long-term care need assessment database and the long-term care and the health insurance claim databases of National Health Insurance Service between July 2011 and June 2012. The sample includes a total of 20,065 home-visit nursing recommended-older beneficiaries who use home-visit nursing and/or home-visit care, based on a standard benefit model developed by the Health Insurance Policy Institute of National Health Insurance Service. The beneficiaries were categorized into home-visit nursing use and non-use groups, and the home-visit nursing use group was again divided into high-use and low-use groups home-visit nursing, based on their total annual home-visit nursing expenditure. Two-part models and negative-binomial regression models were used for the statistical analysis. Results: The home-visit nursing use was negatively associated with the number of outpatient visit and cost, while adjusting for all covariates. The home-visit nursing use was also negatively associated with the inpatient cost among the high home-visit nursing use group. Conclusion: The findings implies home-visit nursing use prevents health care utilization. Further studies and policy strategies that can promote and strengthen home-visit nursing services under the public long-term care insurance are necessary in Korea.

The Risk Rating System for Noise-induced Hearing Loss in Korean Manufacturing Sites Based on the 2009 Survey on Work Environments

  • Kim, Young-Sun;Cho, Youn-Ho;Kwon, Oh-Jun;Choi, Seong-Weon;Rhee, Kyung-Yong
    • Safety and Health at Work
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    • 제2권4호
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    • pp.336-347
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    • 2011
  • Objectives: In Korea, an average of 258 workers claim compensation for their noise-induced hearing loss (NIHL) on an annual basis. Indeed, hearing disorder ranks first in the number of diagnoses made by occupational medical check-ups. Against this backdrop, this study analyzed the impact of 19 types of noise-generating machines and equipment on the sound pressure levels in workplaces and NIHL occurrence based on a 2009 national survey on work environments. Methods: Through this analysis, a series of statistical models were built to determine posterior probabilities for each worksite with an aim to present risk ratings for noise levels at work. Results: It was found that air compressors and grinding machines came in first and second, respectively in the number of installed noise-generating machines and equipment. However, there was no direct relationship between workplace noise and NIHL among workers since noise-control equipment and protective gear had been in place. By building a logistic regression model and neural network, statistical models were set to identify the influence of the noise-generating machines and equipment on workplace noise levels and NIHL occurrence. Conclusion: This study offered NIHL prevention measures which are fit for the worksites in each risk grade.

추나요법 건강보험 급여 적용이 자동차보험 한방의료기관의 추나요법료 및 의료이용에 미치는 영향 (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)

  • 김경화;조형경;이광수
    • 보건행정학회지
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    • 제31권3호
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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.

인구집단 기반 건강관리모형의 적용가능성 검토: 한 지역의 의료복지사회적협동조합형 의료기관을 중심으로 (A Study on the Applicability of the Population-Based Health Care Model: Focusing on Social Cooperative-type Medical Clinics in a Local Area)

  • 이근정;오주연;이다희;함명일;이진용
    • 한국의료질향상학회지
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    • 제26권2호
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    • pp.95-103
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    • 2020
  • Purpose: This study was to examine whether a health care model that provides comprehensive medical services based on population groups to members of the medical cooperative is applicable as a policy alternative in terms of medical use and cost. Methods: Data were derived from National Health Insurance claim data in 2019. We compared the medical volume and expenses of patients who visited social cooperative-type medical clinics with other patients, control group who visited other clinics in a local area. Results: The average number of visit days was 25.3 days in social cooperative-type medical clinics, more than 24.2 days in the control group (p=.004). However, the average medical cost per visit was KRW 46 thousand in social cooperative-type medical clinics, which was significantly lower than KRW 51 thousand in the control group (p<.001), and the total medical cost was also KRW 16.1 billion in social cooperative-type medical clinics and KRW 16.9 billion in the control group. Conclusion: We identified that a population-based health care model might change patients' behaviors to health care services and decrease total medical cost. Further population based experiment is needed to develop alternative healthcare model.

노인장기요양보험 등급외 판정자의 관리현황과 개선방안 (A study on the present status and improving management of the non-eligible people in Korean long-term care insurance system)

  • 권진희;한은정;이정석;박종연
    • 보건행정학회지
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    • 제20권2호
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    • pp.104-127
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    • 2010
  • To vitalize the link program of Korean long-term care insurance system to community-based services for non-eligible people, we analysed the claim data from the Korean National Health Insurance Corporation (NHIC), and conducted a questionnaire survey to charging employees of elderly service department at local governments. The subjects were all 81,377 people, 57,454 of them were arranged to community-based services. The link program was more necessary among the missed subjects rather than the arranged people due to the need for physical or psychological assistance. By the result of the survey to the local government employees, 59.5% of subjects responded their proportion of link service was over 10% and under 20%, and 54.3% of them responded their job boundary are not clear. Major type of linking was notification the subject list to local government, 91.4%; proportion of periodical notification on the status of their service link were 57.1%, only 7.1% were followed to manage after the link. Difficult factors at the link process were pointed out the overload by other side work, deficiency of resources, rigidity of priority of link, and so on. Considering these results, to vitalize the community-based services to the non-eligible people, it may be essential the active participation of the subjects, construction of parts working in coordination among the institutions including NHIC, local governments, and service providers; development of various services for maintenance or promotion of the non-eligible peoples' health and functional status; and active participation of institutions from the third sector, and so on.

추나 요법 건강보험 급여화에 따른 외래 청구 현황 및 의료이용 분석 (Analysis of Outpatient Claim Trends and Utilization According to Health Coverage for Chuna Manual Therapy)

  • 동재용;주진한;윤상헌
    • 한국병원경영학회지
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    • 제28권3호
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    • pp.47-57
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    • 2023
  • Purpose: Health expenditure and utilization of Korean medicine are increasing every year. Since Chuna Manual Therapy was covered by National Health Insurance in 2019, it is predicted that the usage of Chuna Manual Therapy would be also increasing. However, there are few studies about Chuna Manual Therapy using Korean National Health Insurance claims database. Therefore, we will investigate the utilization trend of outpatient's Chuna Manual Therapy using Korean National Health Insurance database and suggest political implications. Methodology: The Korean National Health Insurance claims database was used to identify outpatient's Chuna Manual Therapy usage spanning 4 years from 2019-2023 and the number of Chuna Manual Therapy claims were approximately 18.61 million. Findings: The number of Chuna Manual Therapy claims and patients, health expenditure of Chuna Manual Therapy have been increasing spanning 4 years among over 65 aged. In the case of female patients, the number of Chuna Manual Therapy claims was more than male patients and health spending related to Chuna Manual Therapy was also higher than male patients. Most patients visited Korean medicine clinics due to musculoskeletal diseases, and most claims were from rural regions. Practical Implication: Since Chuna Manual Therapy was covered by National Health Insurance in 2019, Utilization of Chuna Manual Therapy has been increased overall. In particular, Chuna Manual Therapy is mostly implemented in the elderly, Korean medicine clinics, and local areas, thus policy managers will need to consider this.

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건강보험에 있어서 의사와 환자간의 법률관계 - 임의비급여 문제를 중심으로 - (Legal Standings of the Patient and the Doctor within the National Health Insurance - With its focus on the issue of arbitrary medical charge cover -)

  • 현두륜
    • 의료법학
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    • 제8권2호
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    • pp.69-118
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    • 2007
  • In providing general medical treatments, the medical service contract between the patient and the doctor is the mutually responsible onerous contract. However, the nature of the mutually assumed contract standings of the patient and the doctor has been changing since the implementation of the national health insurance program. For instance, besides the cases of beyond excessive medical charges and medical negligence, if the doctor charged for his/her medical treatments violating the post-treatment/nursing cover criteria, the overpaid medical charge, regardless of being collected with the patient's consent, has to be refunded back to the patient. Medically needed aspects, treatment results, and unfair benefits favoring the patient are not at all taken into consideration in the health insurance scheme. This makes it easier for patients to get refunds for their share of the medical payments by involving the Health Insurance Review & Assessment Service or the National Health Insurance Corporation, without engaging in civil law suits (for reimbursement claim) against doctors. In other words, the doctor's responsibility to provide medical treatments and the patient's responsibility to pay for the medical treatment provided within the contractual realm are being demolished by the administrational arbitration of the National Health Insurance system. The basic rights of medical service providers, and the patient's right to choose are as important constitutional rights, as the National Health Insurance program, which is essential in the social welfare system. Furthermore, the development of the medical fields should not be prevented by the National Health Insurance system. If the medical treatment services can be divided into necessary treatments, general treatments, and high quality treatments, the National Health Insurance is supposed to guarantee the necessary and general treatments to provide medical treatments equally to all the insured with limited financial resources. However, for the high quality treatments, it is recommended that they should not be interfered by the National Health Insurance system, and that they should be left to the private contract between the patient and the doctor.

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