• Journal of Korea Society of Industrial Information Systems
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• v.28 no.2
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• pp.1-9
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• 2023

Research using AI and big data is also being actively conducted in the health and medical fields such as disease diagnosis and treatment. Most of the existing research data used cohort data from research institutes or some patient data. In this paper, the difference in the prediction rate of survival and the factors affecting survival between breast cancer patients in their 40~50s and other age groups was revealed using health insurance review claim data held by the HIRA. As a result, the accuracy of predicting patients' survival was 0.93 on average in their 40~50s, higher than 0.86 in their 60~80s. In terms of that factor, the number of treatments was high for those in their 40~50s, and age was high for those in their 60~80s. Performance comparison with previous studies, the average precision was 0.90, which was higher than 0.81 of the existing paper. As a result of performance comparison by applied algorithm, the overall average precision of Decision Tree, Random Forest, and Gradient Boosting was 0.90, and the recall was 1.0, and the precision of multi-layer perceptrons was 0.89, and the recall was 1.0. I hope that more research will be conducted using machine learning automation(Auto ML) tools for non-professionals to enhance the use of the value for health insurance review claim data held by the HIRA.

• Journal of agricultural medicine and community health
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• v.27 no.2
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• pp.75-86
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• 2002

This study was conducted to investigate the changes in patients and medical services before and after the Separation of Prescription and Dispensing in Health Center. For the purpose of this study, prescription data of 5,890 prescribed patients in March 2000(before the Separation of Prescription and Dispensing) and 3,496 prescribed patients in March 2001(after the Separation) in 4 Health Centers located in Gyeongsangbuk-do and Gyeongsangnam-do were collected. For investigation of the change of character of prescribed patients and the disease, sex, age, chief diagnosis, the hind of medical insurance, days of visit, days of prescription were investigated by using National Health Insurance claim data. And for investigation of change of prescription, prescribed drugs per each claim, the use rate of antibiotics, injection, and high-price antiphlogistic drug were investigated for acute respiratory disease and musculoskeletal disease. The major results were as follows: For the changes of prescribed patients of each disease, patients with acute respiratory disease were decreased by 49.7% after the Separation of Prescription and Dispensing than before the Separation of Prescription and Dispensing and patients with hypertension(18.1%), patients with musculoskeletal disease(70.5%), patients with diabetes(8.5%), patients with digestive organ disease(71.2%), patients with chronic respiratory disease(76.4%) were decreased. But patients with urethritis were increased by 66.7%. The mean Health Center visited days of prescribed patients decreased significantly after the Separation of Prescription and Dispensing than before in both male and female(p<0.01) and in health insurance patients(p<0.01). For the each of the disease, hypertension, diabetes, musculoskeletal disease decreased. The mean prescribed days increased after the Separation of Prescription and Dispensing than before(p<0.01). According to the kine of disease, the mean prescribed days increased after the Separation of Prescription and Dispensing than before in all the diseases except the urethritis(p<0.01). For acute respiratory diseases, number of prescribed drugs per each claim decreased significantly after the Separation of Prescription and Dispensing(4.7 drugs) than before(4.9 drugs) and the prescription rate of injection decreased significantly from 63.8% to 7.70%, and the prescription rate of antibiotics decreased significantly from 337% to 19.1%(p<0.01). For musculoskeletal diseases before and after Separation of Prescription and Dispensing, number of prescribed drugs per each claim decreased significantly from 3.7 to 3.2 and the prescription rate of injection decreased significantly from 64.9% to 1.7%, and the prescription rate of high-price antiphlogistic drugs increased significantly from 29.1% to 397%(p<0.01). In consideration of above findings, the mean visited days decreased and on the contrary, the mean prescribed days per each prescription increased after Separation of Prescription and Dispensing than before in health centers. For the prescription pattern of physicians, number of prescribed drugs and the prescription rates of injection and antibiotics per each claim decreased, but the prescription rate of high-price antiphlogistic drugs increased after Separation of Prescription and Dispensing.

• Journal of Korean Public Health Nursing
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• v.28 no.3
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• pp.522-535
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• 2014

Purpose: This study was constructed in order to examine factors that influence work-related musculoskeletal disease (WMSD) approvals and current status according to the company size. Method: This is a descriptive study that utilized Industrial Accident Compensation Claim Data. Workplaces with over 35,811 workers derived from the 2012 claim data, which comprised approximately 91.5%, were selected for this study. Then workplaces were divided into three groups according to the number of workers: less than 5, 5~299, and 300 and over. Results: Since 2008, the number of small sized workplaces has increased. The 2012 data showed that 32.5% of workers at small sized workplace had WMSD. However, workplaces with 5~299 workers showed WMSD approval rate of 60%. Of note most WMSD approved workers were employed by manufacturing and construction companies, regardless of the workplace size. Most of them were engaged in elementary tasks. The days of medical treatment at OPD and IPD were most prevalent among workers at the largest workplaces. Conclusions: It is certain from this study that WMSD has been polarized by the company size. More policy attention should be paid to the WMSD status of workers at small sized workplaces which usually do not have their own health office.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.26 no.1
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• pp.36-50
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• 2019

Purpose: The purpose of this study is to analyze the status quo of hospital-based home care utilization in Korea from 2008 to 2017. Methods: Data from a total of 1,396 medical institutions, 350,390 patients, and 3,563 home care nurses were analyzed using claim data from the Health Insurance Review & Assessment Service. Results: The number of hospital-based home care agencies decreased from 177 in 2008 to 115 in 2014. This number started to increase in 2015 and reached 179 in 2017. The number of hospital-based home care patients declined from 35,056 in 2008 to a low of 26,848 in 2013. This number started to increase in 2014 and reached 67,863 in 2017. Essential hypertension was the most common disease among hospital-based home care patients from 2008 to 2015. The number of hospital-based home care visits declined from about 500,000 in 2008 to a low of 362,000 in 2013. This number started to increase in 2014 and reached 658,000 in 2017. Conclusion: It is necessary to vigilantly monitor hospital-based home care agencies, patients, and the utilization of services. This may help establish platforms for providing community and home-based nursing services for the super-aged society in Korea.

• Journal of Preventive Medicine and Public Health
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• v.56 no.4
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• pp.312-318
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• 2023

Objectives: We reviewed the operational definitions of colorectal cancer (CRC) from studies using the Korean National Health Insurance Service (NHIS) and compared CRC incidence derived from the commonly used operational definitions in the literature with the statistics reported by the Korea Central Cancer Registry (KCCR). Methods: We searched the MEDLINE and KoreaMed databases to identify studies containing operational definitions of CRC, published until January 15, 2021. All pertinent data concerning the study period, the utilized database, and the outcome variable were extracted. Within the NHIS-National Sample Cohort, age-standardized incidence rates (ASRs) of CRC were calculated for each operational definition found in the literature between 2005 and 2019. These rates were then compared with ASRs from the KCCR. Results: From the 62 eligible studies, 9 operational definitions for CRC were identified. The most commonly used operational definition was "C18-C20" (n=20), followed by "C18-C20 with claim code for treatment" (n=3) and "C18-C20 with V193 (code for registered cancer patients' payment deduction)" (n=3). The ASRs reported using these operational definitions were lower than the ASRs from KCCR, except for "C18-C20 used as the main diagnosis." The smallest difference in ASRs was observed for "C18-C20," followed by "C18-C20 with V193," and "C18-C20 with claim code for hospitalization or code for treatment." Conclusions: In defining CRC patients utilizing the NHIS database, the ASR derived through the operational definition of "C18-C20 as the main diagnosis" was comparable to the ASR from the KCCR. Depending on the study hypothesis, operational definitions using treatment codes may be utilized.

• Journal of Dairy Science and Biotechnology
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• v.22 no.1
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• pp.53-60
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• 2004

During the past decade, functional foods and nutraceuticals have emerged as a major consumer-driven trend, serving the desire of aging populations to exercise greater control over health, delaying aging, prevent disease and enhance well-being and performance. On a global basis, retail sales of functional food were worth an estimated USD 1,501 billion in 2001. The market for functional food in Korea has increased in the last three years above 10%. Especially value sales rose by over 30% between 1999 and 2001, and are worth around 12,000 billion won in 2001. To regulate functional food represented a rapidly growing market in Korea a new act 'Functional Health Food Act' was announced officially in 2002. The type of functional milk product in Korea market is conventional food containing various functional ingredient. To promote functional food market in milk product sector the introduction of functional and health claim should be taken into account in the future in Korea.

• Journal of the Korea Convergence Society
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• v.12 no.10
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• pp.137-144
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• 2021

The purpose of this study is to analyze the factors affecting the education experience, education needs, and knowledge level of calculation criteria for dental workers. It was conducted on dental workers in Daegu and Gyeongbuk province and an online survey was conducted using Google Survey. We used frequency analysis, crossover analysis, and ANOVA analysis method to find out general characteristic, education experience, education needs, and knowledge level according to education experience and education needs of candidates. As a result of in the knowledge level survey of dental health insurance, there were high rates of incorrect answers to the calculation criteria when the claim program automatically processes it or notifies you through an error window. The level of knowledge of candidates who are experienced, on a claim, and with experience in dental insurance training in the last six months was high. In conclusion, it seems that accurate and correct insurance claims are possible when the dental workers are familiar with the calculation criteria changed through regular dental health insurance education. We look forward to this study providing basic data in preparation of education system for professional dental insurance claims for dental workers.

• The Journal of the Korea Contents Association
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• v.21 no.8
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• pp.305-314
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• 2021

According to the recent judgment of Supreme Court, in case when the National Health Insurance Service pays the insurance to a victim of torts, and then subrogate the victim's claim for damages, the scope of institution's subrogation should be limited to the amount of the assailant's responsibility rate of the institution charge, and the amount of compensation claimed by the victim to the assailant should be calculated in the method of contributory negligence after deduction. The court has judged that the institution could subrogate the whole amount of institution charge in the limit of assailant's damages, and the method of deduction after contributory negligence should be applied when calculating the assailant's damages to the victim. Supreme Court decision is greatly significant in the aspect of harmonizing the nature of health insurance as property right and social insurance as the beneficiaries could get additional supplement, and also seeking the balance between insurer and beneficiary. With the changed legal principles of Supreme Court in the scope of institution subrogation like this, the necessities to complement the litigation relation, legislation, and institution were suggested.

• The Korean Society of Law and Medicine
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• v.13 no.1
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• pp.199-247
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• 2012

According to the review and analysis of medical cases that are assigned to the Supreme Court and all local High Court in 2011 and that are presented in the media, it was found that the following categories were taken seriously, medical and pharmaceutical product liability, the third principle of trust between medical institutions, negligence and causation estimation, responsibility limit, the meaning of medical records and related judgment of disturbed substantiation, Oriental doctors' duties to explain the procedures, IMS events, whether one can claim for each medical care operated by non-physician health care institutions to the nonmedical domain in the National Health Insurance Corporation, and the basis of norms for each claim. In the cases related to medical pharmaceutical product liability, Supreme Court alleviated burden of proof for accidents with medical and pharmaceutical products prior to the practice of Product Liability Law and onset the point of negative prescription as the time of damage strikes to condition feasibility of the specific situation. In the cases related to the 3rd principle of trust between medical institutions, the Supreme Court refused to sentence the doctor who has trusted the judgment of the same third-party doctors the violations of the care duty. With respect to proof of a causal relationship and damages in a medical negligence case, the Supreme Court decided that it is unjust to deny negligence by the materials of causal relationship rejecting the original verdict and clarified that the causal relationship shall not deny the reasons to limit doctors' responsibilities. In order not put burden on patients with disadvantages in which medical records and the description of the practice or the most fundamental and important evidence to prove negligence and causation are being neglected, the Supreme Court admitted in the hospital's responsibility for the case of the neonate death of suffocation without properly listed fetal heart rate and uterine contraction monitor. On the other hand, the Seoul Western District Court has admitted alimony for altering and forging medical records. With respect to doctors' obligations to description, the Supreme Court decided that it is necessary to explain the foreseen risks by the combination of oriental and western medicines emphasizing the right of patient's self-determination. However, questions have arisen whether it is realistically feasible or not. In a case of an unlicensed doctor performing intramuscular stimulation treatment (IMS), the Supreme Court put off its decision if it was an unlicensed medical practice as to put limitation of eastern and western medical practices, but it declared that IMS practice was an acupuncture treatment therefore the plaintiff's conduct being an illegal act. In the future, clear judgment on this matter should be made. With respect to the claim of bills from non-physical health care institutions, the Supreme Court decided to void it for the implementation of the arrangement is contrary to the commitments made in the medical law and therefore, it is invalid to claim. In addition, contrast to the private healthcare professionals, who are subject to redemption according to the National Healthcare Insurance Law, the Seoul High Court explicitly confirmed that the non-professionals who receive the tort operating profit must return the unjust enrichment and have the liability for damages. As mentioned above, a relatively wide range of topics were discussed in medical field of 2011. In Korea's health care environment undergoing complex changes day by day, it is expected to see more diverse and in-depth discussions striding out to the development in the field of health care.

• Journal of Digital Convergence
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• v.19 no.9
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• pp.317-322
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• 2021

This study focuses on user experience of Ant Insurance Platform(insurance product of Alibaba) and provides insights and improvement advises based on the survey conducted. Given that insurance claim is the most controversial part during the whole process, it is essential to conduct corresponding research from users' prospective. Some Chinese users between their 20's and 40's, who are major users of mobile insurance platforms, were selected as a sample group. Questionaire survey, which was made based on measurement items from Information systems success model, as well as in-depth interview was conducted within the group. According to the result, health, among all kinds, is the most difficult insurance to claim, which was mainly cause by security and information concerns. In order to enhance security, more options should be given to users. As for information, complains should be delt carefully and transparently. This study is expected to be used as referential material for mobile insurance platforms and user experience of insurance claims.