• Title/Summary/Keyword: Health claim

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Through analyzing the health insurance data provided by Health Insurance Review & Assessment Service (HIRA) of Korea, understanding the characteristic of patient who were diagnosed somatic dysfunction and analysis of the current local status of the usage of code M99 (건강보험심사평가원 데이터의 분석을 통한 체성기능부전 환자의 특성 및 M99 진단명의 사용현황 분석)

  • Shin, Jae-Kwon;Joo, Han-Soo;Lee, Seong-Yup;Shin, Ye-Sle;Ko, Won-Il;Park, Ki-Byung;Kim, Min-Kyu;Ha, In-Hyuk
    • The Journal of Churna Manual Medicine for Spine and Nerves
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    • v.11 no.1
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    • pp.53-64
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    • 2016
  • Objectives : The aim of this study is to assess the usage of diagnosis codes for somatic dysfunctions and the general characteristics of patients diagnosed with the code, by analyzing health insurance data provided by the Health Insurance Review & Assessment Service(HIRA) of Korea. This investigation is intended to outline future and willing to contribute to further use of diagnosis code and the approach of Oriental Medicine to somatic dysfunction. Materials and Methods : By analyzing HIRA data, those diagnosed with M99 codes, a code attributed to somatic dysfunction, were selected for analysis. Patients included were assessed for the relevant general characteristics, and the specific diagnostic criteria. The current usage rates and noteworthy characteristics of diagnostic codes of somatic dysfunctions were assessed. A comparative analysis between clinical departments and subcategories, and a comparative analysis to data of 2014 was conducted. Results : Patients given M99 codes constituted a small minority of all patients diagnosed in 2011 as shown by HIRA data. The codes were more frequently to older patients, females, outpatients, and those who filed for Health Insurance compensation. Medical institutions participating in the diagnosis were mostly primary care facilities, usually specializing in orthopedic(Western medicine sector) and internal medicine (Oriental Medicine sector). The most registered code in 2011 and 2014 was M995. The same trend can be observed in Oriental/Western medicine institutions and Public health center, on the other hand, between them, have some different patterns both 2nd and 3rd. Conclusions : This investigation is that of current usage of diagnostic codes of somatic dysfunction. HIRA insurance claim data was analyzed. Based on the current results, more precise diagnostic standards of somatic dysfunction are warranted. This study will provide a foundation for future Oriental Medicine approach to somatic dysfunctions.

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The Determinants of the Length of Stay in Hospital for Schizophrenic Patients: Using from the Health Insurance Claim Data of Inpatients (조현병 환자의 재원일수 결정요인 : 건강보험 입원환자데이터셋 자료를 이용하여)

  • Jeon, Yun-Hee;Jung, Mi-Yeong
    • Journal of Digital Convergence
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    • v.18 no.1
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    • pp.257-263
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    • 2020
  • This study was conducted to improve the quality of National Health Policy by analysing the effects of sociodemographic characteristics, Medical institutions characteristics and characteristics of Admission-Discharge on the length of stay in hospital for schizophrenic patients from the data of Health Insurance Review & Assessment Service. The subjects were 4,692 patients who were diagnosed with schizophrenia as main diagnosis from the data records of HIRA-NIS 2016. Regression analysis was performed to evaluate the effect on the length of stay. Sociodemographic characteristics, hospital characteristics and characteristics of Admission-Discharge were used as explanatory variables and length of stay in hospital was used as a dependent variable. The result of study showed that female, age, medical aid, the kind of hospital, gangweon-do and with mental disease were found to be the factors that affect the length of stay. The significance of this study is to use the public data for evaluating factors that affect the length of stay in hospital for schizophrenic patients. But this study did not consider disease severity, so further study is needed for evaluation of the effects of factors on the length of stay according to disease severity.

The Selection and Supplementation of Core Data for Injury Surveillance (손상감시를 위한 핵심데이터 선정과 보완)

  • Lim, Joon-Kyu;Kim, Han Kyoul;Rhee, Hyun-Sill
    • Journal of Digital Convergence
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    • v.18 no.9
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    • pp.265-275
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    • 2020
  • The burden of injury is widely considered to be very severe in our society. Nonetheless, we don't have enough data for injury surveillance. The objective of this research is to select and supplement CORE DATA for injury surveillance. For this purpose, this study had analyzed the literature such as the Quality Assessment Report about 'Causes of Death Statistics', 'Health Insurance Statistics' and 'Hospital Discharge Injury Surveillance' according to the six dimension of Statistics Quality. The analysis result is that 'Cause of Death Statistics' and 'Health Insurance Statistics' have the usefulness as the CORE DATA for injury surveillance. But there is a significant shortcoming in the Health Insurance Statistics, which is that there is a lack of the data about the external causes of injury. For supplementing the defect, this study proposes the system that the medical institutions should obligatorily report the external causes of injury when claim National Health Insurance Medical Care Expenses. As the results of this system, we can expect 'Establishing of Injury pyramid', 'Data Connecting with the National Pension' and 'Improving the Promptness of Injury Data'. And we expect the follow-up study for the realization of this system.

Prevalence of Nutrition Labeling and Claims on Processed, and Packaged Foods (시판 가공식품의 영양표시 실태 조사)

  • Kwon, Kwang-Il;Park, So-Hyun;Lee, Jun-Hyung;Kim, Jee-Young;Yoo, Kwang-Soo;Lee, Jee-Sun;Kim, Seo-Young;Sung, Hyun-I;Nam, Hye-Seon;Kim, Jong-Wook;Lee, Hye-Young;Park, Hye-Kyung;Kim, Myung-Chul
    • Korean Journal of Community Nutrition
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    • v.12 no.2
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    • pp.206-213
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    • 2007
  • This study investigated the prevalence of nutrition labeling and claims on processed and packaged foods. The final database consists of 1,287 foods, which were collected in two supermarkets in the Seoul area from September to November, 2006. An estimated 78% of KFDA-regulated processed, and packaged foods have nutrition labels. Nutrient content claims on food labels were identified in 21% of the foods which have nutrition labels. The prevalence of nutrition labels in this study is much higher than in previous studies due to the current expansion of the mandatory labeling regulation. However, false labeling and misleading contents claims were also identified. The food label is an important tool for enhancing the public's understanding of healthy choices of processed foods. Therefore, to maximize the benefits of the nutrition labeling regulation, industries, government agencies and health professionals should work together to help consumers make healthy dietary choices and improve their health.

Nonsteroidal Anti-inflammatory Drugs Utilization Patterns among the Elderly with Osteoarthritis at Primary Ambulatory Care Units in Busan Metropolitan City, Korea (부산지역 의원급 외래 노인 골관절염환자의 비스테로이드소염제 사용양상평가)

  • Choi, Nam-Kyong;Kim, Yoon-I;Lee, Seung-Mi;Park, Byung-Joo
    • Journal of Preventive Medicine and Public Health
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    • v.37 no.2
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    • pp.150-156
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    • 2004
  • Objectives : To investigate the utilization patterns of non-steroidal anti-inflammatory drugs (NSAIDs) among the elderly with osteoarthritis (OA) undergoing primary ambulatory care in Busan metropolitan city, Korea. Methods : OA patients, aged 65 years and over, were identified from the Korean National Health Insurance Review Agency drug prescription database. The subjects had at least one episode of claim for OA (ICD-10-CM: M15-M19) between August 1, 2000 and February 28, 2002. Trends in the determinations of NSAIDs utilization were identified using chi-squared tests for trend. Results : There were 47,711 osteoarthritic patients. The total number of visits by these patients was 177,443, with a total frequency for NSAID prescriptions of 214,952. Seventy-nine percent of the OA patients were female. NSAIDs were prescribed on 133,284 visits (75.1%) and the proportion of prescriptions was significantly increased with age. Only the proportion of visit when NSAIDs were prescribed decreased, from 65.1 to 43.5%, during the study period (p<0.001). However, the proportion of combined treatments with anti-ulcer drugs was increased. The use of NSAIDs injections was decreased. Of the individual NSAIDs, diclofenac (28.7% of total frequency of NSAID prescriptions), piroxicam (15.0%) and talniflumate (8.7%), were the most frequently prescribed. Among the NSAIDs prescribed OA visits, 45.7% used two or more NSAIDs. Conclusion : The total proportion of NSAIDs prescribed to the osteoarthritic patients was higher than in other studies. The decline in the use of NSAIDs during the study period, and the frequent selection of safer medications, such as combination therapy with anti-ulcer drug, may reflect the risk awareness of the use of NSAIDs.

Consumer Perception Survey for the Improvement of Nutrition Labeling (Nutrition Comparative Claim) on Sodium Content (가공식품의 나트륨함량표시 개선을 위한 소비자 인식도 조사)

  • Kang, Eun-Jin;Lee, Hwa Jung;Hwang, Kyung Mi;Koo, Yong Eui;Kim, Gun-Hee
    • Journal of the Korean Society of Food Culture
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    • v.32 no.3
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    • pp.244-257
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    • 2017
  • Nutrition labeling can provide information in order for people to select products suitable for their own health, and sodium content labeling for processed foods is important since sodium is one of the main causes of cardiac diseases. This study had carried out to propose the desirable sodium content labeling by conducting surveys on the awareness of sodium content in processed foods, understanding of sodium content labeling, and requirements for new sodium comparative claims. The survey period was from 12th of September, 2016 through the 24th, during which a self-administered questionnaire survey was given to 1,003 persons through demographic quota sampling by age and region. As a result of the survey, 66.0% of respondents assuring nutrition labeling answered they check sodium content labeling, whereas 83.2% were aware of excessive intake of sodium having a negative effect on health. Exactly 49.9% of respondents answered that the current system for nutrition labeling on processed foods does not help one to understand the content of sodium, whereas 72.9% answered they wanted to compare sodium contents with those of other products when buying or taking processed foods. As 92.5% cited the importance of sodium comparative claims made by processed foods, preparation of a new system for food labeling should be considered by which consumers can easily compare sodium contents with those of other similar products.

The length of hospital stay of the industrial workers with back injury (산업재해 요통근로자의 재원기간에 관한 연구)

  • Lee, Bok-im
    • Korean Journal of Occupational Health Nursing
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    • v.9 no.1
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    • pp.18-29
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    • 2000
  • Back injury is frequent in industry workers and is a common cause of productivity loss. It has been reported that the insured of industrial accident insurance tend to stay in hospital longer than that of other types of insurance. The purpose of this study was to identify factors affecting the length of hospital stay for the treatment of back injury in the workers under industrial accident insurance. The results of this study help insurers develop reasonable industrial accident insurance policy for back injury claims and prevention strategies of work-related back injury. A total of 2,949 patients whose industrial accident insurance claim has been approved for the treatment of work-related back injury from January to December 1999 were included in this study. Relationship between the length of hospital stay and characteristics of patient, work place, back injury, and hospital were assessed using ANOVA, t-test, simple linear regression and multiple resgression. The major findings of this study are as follows : 1. The average length of hospital stay(LOS) was 91.82 days, respectively. 2. Characteristics of Patient LOS of male patients was longer than that of female patients, there was positive correlation between age and LOS and between average wage and LOS. Working period was negatively correlated with LOS. Distance from resident to hospital was positively correlated with LOS and LOS was significantly different dependign on type of duty. 3. Characteristics of Work Place LOS was significantly different depending on types of industry and geographical region of work place. Size of work place was positively correlated with LOS. 4. Characteristics of Back Injury Occupational back pain required shorter LOS compared with back injury due to electric shock. Number of concomitant illnesses and severity of disability were positively correlated with LOS. 5. Characteristics of Hospital Patients treated in community hospitals required significantly longer LOS. Treatment in hospitals with rehabilitation program required decreased LOS. This was more prominent as number of physicians specialized in rehabilitation. 6. Multiple regression analysis revealed that distance form resident to hospital, geographical region of work place, size of work place, number of concomitant illnesses, severity of disability, and type of hospital were factors affecting LOS.

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Variations on Drug Utilization between the Types of Hospital in Some Frequent Diseases (일부 다빈도 질환에서 의료기관 유형별 의약품 사용의 변이)

  • 박실비아
    • Health Policy and Management
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    • v.9 no.2
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    • pp.118-138
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    • 1999
  • This study presents the variations on drug utilization for outpatients' URI, gastritis. and hypertension by the type of hospital- tertiary hospital. general hospital. hospital. clinic. It investigated drug expenses. daily drug expenses. days of medication. the highest price of the drugs used. and the number of the different drugs used for each disease and type of hospital. This study also performed analysis to see how much the variations of variables related to drug use affect the variations of drug expenses. The dependent variable was drug expenses and the independent variables were days of medication. the average price of the drugs used. and the number of the different drugs used. Analysis of the drug utilization was performed on NFMI(National Federation of Medical Insurance) 1994 medical expense claim data. Patients with secondary diseases were excluded. In this study. 379 patients with URI, 386 patients with gastritis. 1.257 patients with hypertension were included. It was founded that there were large variation on drug utilization between the types of hospital for same diseases. Days of medication were longest in tertiary hospitals and shortest in hospitals or clinics. Clinics showed the lowest daily drug expenses in all of the diseases investigated. Daily drug expenses were highest in general hospitals or hospitals. which also tended to use drugs of higher price than other types of hospital. General hospitals and hospitals had larger variations in daily drug expenses and the highest price of drugs. It suggested that drug might be utilized overly in general hospitals and hospitals and some other factors might influence on drug utilization in these hospitals. It was found that the variations of drug expenses were affected by the variations of drug price and days of medication rather than the number of the different drugs. Then the strategy to reduce the variations of drug utilization and to improve the quality of drug utilization should focus on the drug price and days of medication. Further study is needed to assess the quality as well as the variation of drug utilization and to show the factors which affect them.

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Dental Occlusion and Relationship to TMD and Systemic Symptoms (I) (교합이 악구강계 및 전신에 미치는 영향 (I))

  • Bae, Hanna Eun-Kyung;Choi, Byeong-Gap;Kim, Seong-Taek;Kim, Eun-Seok;Park, Eun-Jin
    • Journal of Dental Rehabilitation and Applied Science
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    • v.25 no.4
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    • pp.307-317
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    • 2009
  • A growing interest in management and treatment for patients with temporomandibular disorder(TMD) by many health workers, including oriental medicine doctors, physical therapists as well as dentists, have been noted in South Korea. Some of these health workers claim correlation between dental occlusion, TMD, and systemic symptoms such as tinnitus, dizziness, neck pain, myalgia, low back pain, posture and many other systemic symptoms and many controversial treatments are being carried out on bases of theories and reasons with no strong scientific evidence. This article is a result of preliminary study by authors in gathering scientific data on few of these various treatment modalities for TMD using MEDLINE data, internet and tutorials given by those who are using these TMD treatment methods. The modalities that had been searched are as follows; (1) Craniosacral mechanism (2) Osteopathy (3) Myodontics (4) Chirodontics (5) Dental Distress Syndrome and Quadrant Theorem. An outline of those theories will be introduced, and the contents in detail for respective theory will be reported in the following articles.

Factors Influencing Physicians' Prescriptions in Some Frequent Diseases (일부 다빈도 질환에서 개원의의 의약품 처방에 영향을 미치는 요인)

  • 박실비아;문옥륜;강영호
    • Health Policy and Management
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    • v.8 no.2
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    • pp.166-190
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    • 1998
  • This study presents the status on drug prescription for clinic outpatients' bronchitis, gastritis, and gastric ulcer, and also the physician factors that affects their prescriptions. In this research project the physician factors are as follows: their demographic features, their work related features, education related features, drug information related features and drug promotion related features. The variables in drug prescriptions are drug expenses, daily drug expenses, days of medication, the highest price of the drugs used and the number of the different drugs used. Analysis of the use of prescription drugs was performed on NFMI(National Federation of Medical Insurance) 1994 medical expense claim data. Data on physicians' characteristics were collected by mailing surveys. Patients with secondary diseases were excluded. In this study, 388 adults with bronchitis, 1,038 children with bronchitis, 1,158 patients with gastritis, 369 patients with gastric ulcer were included. The older physicians tend to allow the lower drug costs: this explains that the older doctors who are more experienced less depend on the medicines. It can be also explained that doctors are likely to use the medicines that had been used for their intern and resident practice/training period. General practitioners give more intensive prescription compared to specialists. And specialists prescribed medicines to patients for longer period. The doctors' prescriptions for patients are largely affected by commercial sources. So objective and reliable sources for drug information is needed for patients' benefits. Physician factors explain better at the daily drug expenses, the drug price and the number of different drugs than days of medication. Gastric ulcer are better explained by the prescription model adopted in this study than other diseases.

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