• Title/Summary/Keyword: Health insurance act

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Cases and problems of comprehensive administrative compensation deduction for firefighters: focused on emergency medical service case (소방공무원 행정종합배상공제 사례 및 문제점 - 구급사례 중심으로 -)

  • Kim, Jun-Ho;Hong, Young-Pyo;Kim, Gyoung-Yong
    • The Korean Journal of Emergency Medical Services
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    • v.26 no.1
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    • pp.119-127
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    • 2022
  • Purpose: This study aimed to examine the necessity of administrative compensation insurance and claims cases during the emergency medical service process among administrative compensation insurance cases and suggests problems and improvement measures. Methods: We compared the details of administrative compensation insurance claims of 15 cities and provinces, excluding Seoul and Kwangju, from 2017 to 2020 by requesting details disclosure of the comprehensive deduction for administrative compensation in 17 cities and provinces across the country. Results: A total of 69 cases were compensated through the administrative comprehensive compensation deductions. There were 53 cases of damage that occurred at the field stage, 14 cases at the transfer and hospital stage, and two other cases. Conclusion: The 119 paramedics, which are the perpetrators, should be active in field activities and free from the psychological pressure caused by increased workload and litigation. Active compensation administration is required for damage cases occurring in the firefighting activities context.

Comparison of Regulatory Systems for Safety and Health Management in Research Laboratories - Case Review between Korea and Germany (연구 실험실 안전보건 관리제도 비교 - 한국과 독일 사례 고찰)

  • Park, Jihoon;Sung, Baeckkyoung;Altmeyer, Matthias Oliver;Kim, Young Jun
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.30 no.2
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    • pp.99-108
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    • 2020
  • Objectives: This study aimed to compare the regulatory systems for laboratory safety and health management between Korea and Germany and discuss the implications. Methods: Laboratory safety and health regulations for legal enforcement and relevant technical guidelines in Korea and Germany were reviewed. Results: Lab safety and health management is enforced by the Act on the Establishment of Safe Laboratory Environment in Korea. Most provisions focus on supervisory control, that is, the principal's liability is emphasized. In addition, there is a lack of laboratory-specific procedures for safety and health management in the act since it is stipulated that other relevant regulations apply to some technical contents. Non-compulsory technical guidelines for lab safety and health management are also provided by the Korea Occupational Safety and Health Agency (KOSHA) in order to enable researchers to follow safe procedures. There is no independent regulation for lab safety and health in Germany, and it is also governed by several regulations. The German Social Accident Insurance Institute provides technical guidelines on lab safety and health, and these contain more specific content to allow them to be followed more easily compared to the KOSHA guidelines. The most remarkable differences between the regulation of each country were contents of the risk assessment and specific protect measures from hazardous agents. Conclusions: Regulatory control is an essential way to prevent accidents, but it is more important to create an environment in which all stakeholders, including individual lab members, are allowed to participate actively in safety and health management activities.

Review of US Health Policy on Acupuncture Application for Opioid Abuse Crisis (침술의 마약성 진통제 남용 해결을 위한 미국 의료정책 고찰)

  • Kim, Juchul;Hyun, Eunhye;Kim, Dongsu
    • The Journal of Korean Medicine
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    • v.41 no.2
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    • pp.137-149
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    • 2020
  • Background: Opioids are a class of drugs found in the opium poppy, and used primarily as a pain reliever. About 130 people die every day from opioid abuse in the U.S., and the number of deaths was 6 times higher than it was 20 years ago. Objectives: To derive the implications on Korean Medicine(KM), this study aimed to investigate the current state of opioids abuse in the U.S. and analyze cases to solve opioids abuse using acupuncture. Methods: Literature on opioids abuse in the U.S. were searched through the websites of government, agency, and research institute. Results: There were several cases using acupuncture on opioids abuse. First, the Act on the use of acupuncture was enacted. Second, the clinical practice guidelines by the American College of Physicians recommended using acupuncture. Third, a large clinical study was conducted on whether acupuncture could replace opioids. Fourth, Vermont and Washington State conducted pilot projects on insurance coverage of acupuncture. Conclusions: As opioids issues are also valid in Korea, KM can serve a critical role in pain management to pursue expanded insurance coverage. In order to do so, building the discourses of KM in opioid issues is critical by defining its medical advantage, conducting large-scale clinical researches and implementing pilot projects to tackle social problems.

Development of Home Visiting Nursing Standards Base on a Long-Term Care Insurance for the Elderly Program (노인장기요양보험제도에 의한 방문간호 표준개발)

  • Kim, Myung-Hee
    • Journal of Korean Public Health Nursing
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    • v.24 no.2
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    • pp.285-301
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    • 2010
  • Purpose: The study was aimed at qualitatively enhancing and promoting a home visiting nursing program established in Korea on July 1, 2008, as part of the Long-Term Care Insurance for the Elderly program. Methods: Structural, procedural and consequential aspects of home visiting nursing care wereclassified on the horizontal axis by applying the standard notions for the evaluation of medical care (Donabedian, 1998). At the same time, the home visiting nursing care service support system and the service provision system weredivided on the vertical axis with reference to the accreditation standards for home visiting nursing care organizations suggested by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO, 2008). The data were collected from June 4, 2008 to October 27, 2008, and were analyzed using SPSS ver. 15.0. Results: Twenty-two (proposed) standards, centered on the standard elements under the conceptual framework of the study, were developed, and comprised structural aspects (n=10), procedural aspects (n=6) and consequential aspects (n=6). Those criteria and indicators underwent two content validity surveys among groups of home visiting nursing care research and training experts. The research produced 22 proposed standards, 50 proposed criteria and 166 proposed indicators. Conclusion: The home visiting nursing care standards developed pursuant to the Long-Term Care Insurance for the Elderly Act and the applicability of these standards need to be verified by home visiting nurses. These proposed standards should prove useful in developing an assessment tool to encourage the qualitative enhancement of visiting nursing care in Korea.

Factors Affecting the Registration and Access Levels of the Pilot Project for the General Physician System among People with Disabilities (장애인 건강주치의 시범사업 수요자의 등록 및 이용수준 영향 요인 분석)

  • Eunhee Choe;Yeojeong Gu;Seungji Lim
    • Health Policy and Management
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    • v.34 no.2
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    • pp.185-195
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    • 2024
  • Background: Disabled people have particularly restricted access to health care. In response to this, the pilot project for the general physician (GP) system for disabled people was implemented in 2018, based on the rights of people with disability to the Health Act in South Korea. However, its participants were 0.2% among the total of those with severe disabilities in 2021. Therefore, this study examined the factors related to registering with a GP and the access level to its services to suggest implications for activating the participation of disabled people. Methods: We analyzed factors affecting the registration with a GP and the number of using the services among the participants of the GP system during May 2018 and December 2021 by conducting hierarchical logistic regression and hierarchical regression. The data were linked with the national health insurance data to examine various predictors, including disability types, socioeconomic status, health status, and GP registration. Results: As a result of analyzing the factors affecting whether or not to register for the pilot project, those with disabilities (physical disabilities, brain lesions, visual, intellectual, mental, and autistic disability) eligible for disability care (odds ratio [OR], 4.157) than other disability, and those living in metropolitan (OR, 4.330) or cities (OR, 3.332) than rural residences were highly likely to enroll the pilot study. Health-related variables also predicted the registration status of the pilot project. The predictors related to GP enrollment types (membership type: general health or disability care, GP's affiliation: clinics or hospitals) significantly influenced levels of access to services. Conclusion: It is necessary to develop the GP project for disabled people by considering the variation in types of disability, residences, and health. Further study will be needed to investigate the impact of GPs on the level of participation among disabled people.

The necessity of ban on opening and operating the multiple medical institutions in medical law in Dental case (의료법에서의 의료기관 이중개설 금지조항의 필요성에 대한 치과 사례연구)

  • Ju, Jin-han;Lee, Ga-yeong;Jung, Ku-chan;Lee, Jae-yong;Min, Gyeong-ho
    • The Journal of the Korean dental association
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    • v.57 no.9
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    • pp.514-522
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    • 2019
  • In accordance with Article 33(8) of the Korean Medical Law, it is stated that a medical person cannot open or operate a medical institution by borrowing the name of another medical person. However, the publicity of medical care is threatened by the recent illegal network dental clinics. The purpose of this study is to investigate the actual condition of illegal network dentistry and to analyze the cases and to find out the reason why the prohibition of double opening & operating of medical institution. As a result, the illegal network dental clinics treated less health care insurance treatment such as dental caries and periodontal treatment than general dental hospitals. In contrast, the rate of implementation of illegal network dentistry was high in endodontics treatment and extraction, which could lead to uninsured treatments such as crowns and implants. As a result of Supreme Court precedent analysis, it is concluded that illegal act is not only the opening of a medical institution by borrowing the name of other medical personnel, but also the duplicated operation which has the authority to make decision about management matters of medical institutions. The results of the patient's case survey also showed that excessive dental treatment due to such as dental staff incentive system. In conclusion, the illegal network dental clinics not only threatens the oral health of the public, but also causes leakage of health insurance premiums. In other words, the ban on opening and operating the multiple medical institution should be strictly applied as a strong protection device for protecting the patient in dental case.

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Study on the Present Status and Developments of New Health Technologies of Traditional Korean Medicine (한의 신의료기술 행위 동향 분석)

  • Han, Chang-Hyun;Park, Hwang-Jin;Lee, Bong-Hyo;Lee, Young-Joon;Kwon, Oh-Min
    • Korean Journal of Acupuncture
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    • v.29 no.2
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    • pp.315-326
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    • 2012
  • Objectives : The new health technology assessment system was introduced in April 2007. The purpose of new health technology assessment is assessing safety and efficacy in deciding a behavior of new health technology according to the Health Insurance Act. This study aims to understand the present status of new health technologies of Korean medicine. Methods : This research introduces new health technologies and their present status, and searches for a development direction for the new health technology of Korean medicine in the future. Results : Thirty seven cases(3%) of Korean medicine doctors who utilized new health technologies application were found. In the status about new health technologies application by technologies assortment, diagnostic test techniques were used more often than treatment skills. New medical technology that included korean medicine doctor as actual user was only one item, i.e. HCV antibody test. Conclusions : In order for the new health technology of korean medicine to settle down well, continuous interest and efforts of both government and medical community are necessary.

Trends of Industrial Injuries among Long-Term Health Care Workers in Korea (한국 요양보호사 산업재해의 연도별 변화추이)

  • Son, Mia;Jeon, Geo-Song;Bae, Dong-Chul;Son, Byungchang;Kim, Taeun;Yun, Jae-Won
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.31 no.2
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    • pp.156-172
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    • 2021
  • Objectives: To investigate the trends of industrial injuries among long-term health care workers in Korea Methods: T7866 injuries were selected from the total industrial injuries approved by the Industrial Accident Compensation Insurance Act(Occupational Safety and Health Act) among long-term health care workers between 2007 and 2016 in Korea. We analyzied the trends of industrial injuries according to work process, occurrence type, and causes. Results: The industrial injuries among long-term health care workers increased since 2012. The mostly occurred area for industrial injuries were low back areas, which is related that the most serious industrial injuries occurred when the one long-term healthcare worker lift manually the recipient, from bed(ondol, Korean floor heating system) to a wheelchair, bed to bath bed, and wheelchair to bath chair. In addition to this, lack of workforce, increased work intensity due to overwork contributed the increasing of occupational injury. Conclusions: This study suggests that the main causes of industrial injuries were Lack of facilities and equipment for small private long-term care institutions, The physical load that goes into lifting the recipient directly, work intensity such as excessive workload and increased work speed. We suggest that the social publicization of long-term care service for the elderly, avoiding ways to lift recipients directly, introducing lifting machines as well as improving working methods, and reducing the workload of caregivers are required.

A Study on the Type of Violations of Medical Law Regulations Which Restrict Opening a Medical (의료법상 의료기관 개설제한의 위반유형에 관한 연구)

  • Kim, Joon Rae
    • The Korean Society of Law and Medicine
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    • v.15 no.2
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    • pp.345-366
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    • 2014
  • Because the health care or medical sector has such characteristics as publicity, professionality, and exclusivity, it cannot be left to the free market system. As a consequence, the state has restricted the establishment of medical institutions in order to protect the life and health of people. Also, the medical law has regulated to permit the establishment of medical institutions by only medical personnel and a few corporate bodies and to ban the establishment of medical institutions under disguised ownership as well as double opening of medical institutions by medical personnel. Nevertheless, there are still many cases that non-medical personnel have dominantly established medical institutions under disguised ownership of other medical personnel or nonprofit corporation. Because they are willing to recover their investment costs as soon as possible, these illegally established medical institutions are likely to make patients undergo unnecessary tests or to perform the excessive treatments and, as a result, are likely to cause infringement on the health and lives of the people. In addition, even if the misconduct is uncovered, the rate at which the costs already paid is very low and, as a result, the damages are straightly connected to the people's loss. On the other hand, there are also increasing number of cases that medical personnel or nonprofit corporations are establishing medical institutions against the medical law regulations. The examples of this illegality are also the double opening of medical institutions and the establishment of medical institutions under disguised ownership by medical personnel or nonprofit corporations. And the damages in these cases may not differ from those in the above cases. In this study, regarding medical law regulations restricting opening a medical institution, I will review the intent of those regulations, the type of violations and criminal punishments, and the possibility of recovery from unlawful profit by the National Health Insurance Act. And then, I would like to find a way for rational improvement of each.

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Study on National Protected Health Information for Secondary Use and De-identification (의료정보의 2차 이용을 위한 국내 비식별화 대상 정보에 관한 연구)

  • Kim, Cheoljung;Yeo, Kwangsoo;Lee, Pilwoo;In, Hanjin;Moon, Byeongjoo;Song, Kyoungtaek;Yu, Khigeun;Baek, Jongil;Kim, Soonseok
    • Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology
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    • v.6 no.8
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    • pp.15-23
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    • 2016
  • Recently the interest in secondary use of medical information has emerged. But the domestic legislation or guidelines, such as being able to say that already specialize in healthcare information, can be seen a 'national medical privacy guidelines'. However the guidelines have suggested that only a violation of privacy laws in the medical information, it does not defined clearly with respect to protected health information(PHI) for secondary use. In this paper, we learn the HIPAA(Health Insurance Portability and Accountability Act) Privacy Rule of the US legislation which provides a non-identifiable screen instructions for secondary utilization of medical information, domestic guidelines and other country's guidelines. comparing with the HIPAA, national medical privacy guidelines and the domestic studies, we propose a new domestic target non-identifying information suitable for the domestic field and present future research direction.