• 한국콘텐츠학회논문지
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• 제18권1호
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• pp.268-276
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• 2018

건강과 의료비 부담에 대한 관심이 높아지면서 실손형 민간의료보험 가입자가 증가하고 있다. 민간의료 보험과 의료 이용의 관련성 분석에서 중요한 과제인 내생성 통제에 관해 도구변수 추정법이 제안되고 있지만 적절한 도구변수 발굴의 한계로 많이 활용되지 못하고 있다. 본 연구는 실손형 민간의료보험이 가입자의 외래 및 입원 의료 이용량에 미치는 영향을 새로운 도구변수를 활용하여 분석하였다. 본 연구는 한국의료패널 2014년 조사 자료를 이용하였으며, 분석 대상자는 11,436명이다. 실손형 민간의료보험 가입 변수의 내생성을 통제하기 위하여 도구변수(개인연금 가입 여부, 동거 가구원 수)를 활용하여 회귀분석을 수행하였다. 실손형 민간의료보험 가입은 외래방문 횟수와 입원 횟수를 유의하게 증가시키는 것으로 분석되었으며, 개인연금과 동거 가구원 수는 내생성을 통제하기 위한 도구변수로서 적합한 것으로 검증되었다. 제한된 의료자원의 효율적 사용을 위해 실손형 민간의료보험이 의료 이용에 미치는 영향 및 효과에 대한 지속적인 모니터링과 평가가 필요하다.

• 한국병원경영학회지
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• 제22권2호
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• pp.58-69
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• 2017

Recently, with the increase in the number of private health insurance subscribers, interest in overuse of the medical service is increasing. This study analyzed the impacts of private health insurance (PHI) on medical institution selection in outpatient service utilization among persons with arthritis. In order to control patients' health status, we extracted outpatient episodes with the same disease (KCD6, M13) from Korea Health Panel. The unit of analysis was an outpatient visit with arthritis in 2014 (n=23,363). In the light of insurance coverage, we redefined three type of private health insurance (ex, indemnity, fixed benefit, and non-insured) as a test variable and two type of medical institution (ex, hospital and physician visit) as a dependent variable. We conducted a probit regression analysis to identify the impacts of PHI on medical institution selection controlling for heteroscedasticity. The results of this study showed that the insured with indemnity were more likely to choose hospital departments than clinics (marginal effect=0.0475, p=0.000). The impact of participation of fixed benefit PHI was not as clear as that of indemnity type (marginal effect=0.0162, p=0.047). In conclusion, this study confirmed that PHI, particularly indemnity type has a significant impact on the selection of medical institutions. Healthcare policy makers should consider that PHI not only affects the overall quantitative increase in healthcare utilization, but also influences the selection of medical institutions.

• 보건의료산업학회지
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• 제11권3호
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• pp.51-64
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• 2017

Objectives : This study examined the effect of private health insurance on medical care utilization by subscription type. Methods : The data used were the six waves of the Korea Health Panel (2009-2014), and 16,187 persons were the subjects of the analysis. We performed a panel regression with a fixed effects model. Results : Indemnity private health insurance was positively related to the number of physician visits, number of admissions, and total length of stays. However, fixed-benefit private health insurance was not related to medical care utilization. Conclusions : The result of this study, which shows the difference by subscription type in the effect of private health insurance on medical care utilization, suggests that continuous monitoring of indemnity private health insurance is needed in the future.

• 한국병원경영학회지
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• 제19권4호
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• pp.57-68
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• 2014

Since the introduction of National Health Insurance(NHI) in 1977, it has grown rapidly and contributed to extend patient's access to the health care services. However, limited coverage for health care services of NHI has been ongoing challenge and private health insurance(PHI) has been rising as an alternative source of enhancing coverage and saving out-of-pocket(OOP) expenditure for patients. In this study, after controlling for socio-demographic, economic, health related variables, we identified the patients' healthcare utilization and subsequent OOP expenditure depending on their PHI enrollment and their enrollment types(fixed benefit, indemnity, fixed benefit plus indemnity). Data were collected from the 2010 Korean Health Panel. The unit of analysis was a member of household(n=13,324). Of the 13,324 cases, 70.7% of patients held PHI, in detail, fixed benefit(47.0%), indemnity(3.6%), fixed benefit plus indemnity(20.1%). Major findings showd that patients who enrolled in PHI used more outpatient services(outpatient visit, number of physician visit, number of examination) and spent more OOP expenditure than non-PHI patients. There were also differences of healthcare utilization and OOP expenditure among the types of PHI. In addition, PHI patients used more inpatient services(inpatient use, number of hospitalization, LOS), but there was no significant difference between PHI and non-PHI patients with regard to the OOP expenditure. Thus, we could not find any distinct relationship between the types of PHI and patients' tertiary hospital use. Policy-makers should need careful political deliberation for monitoring the effect of PHI on health care utilization and subsequent expenditure not only to improve patients' coverage but also to save their OOP expenditures.

• 수산해양교육연구
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• 제26권5호
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• pp.1044-1057
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• 2014

This study has seen about a indemnity system of fishery damage by natural disasters such as a problem and improvement methods of government aid system and system on accident insurance for cultured fishery products. Recently, in the situation that the demage of aquaculture industry caused by frequent typhoon resulted from global warming and abnormal changed of weather is nasty, the accident insurance for cultured fishery products is necessary to show its true quality and to protect fishers against natural disasters owing to the limitation of government's aid for them. However, The objects of accident insurance for cultured fishery products which is progress on, is too short to apply, so that it is absolutely insufficient to fulfill the demands of culturing fishermen. Therefore, It could be a certain preparation to magnify the range of object items of it and to convert the trial industry being adjusted to limited area into full scale industry to adjust over all nationally. Furthermore, This insurance is complicated and strict to join rather than other insurances. As it can be seen by examples that got in trouble, despite culturing fishermen applied to join the insurance, they took all demage because the insurance was not realized. So, It is hard to say that causes impute the responsibility of it to the authority of insurance, not culturing fishery. They should simplify the registration process, limit the period each registration process and consider a countermeasure to complete it. Concerning compensation for the loss, agriculture part is easier to investigate the loss due to remained dead crop damaged by natural disaster, meanwhile, in fishing part, especially in case of cultivation of fish, it is difficult to investigate the loss and demage because crops are blown all together with typhoon when it comes plus the facilities of them are also very old. Consequently to solve the problem needs more positive attitude as it is policy insurance.

• 무역상무연구
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• 제34권
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• pp.77-108
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• 2007

The traditional name given to the insurance of third party liabilities and certain contractual liabilities which arise in connection with the operation of ships is protection and indemnity(P & I) insurance. P & I insurance is very different from traditional hull and machinery insurance in that shipowners' hull and machinery insurance is designed primarily to protect the assured against losses to his vessel, whereas P & I insurance seeks to indemnify an shipowner in respect of the discharge of legal liabilities he has incurred in operating his own vessels. This study is to examine the background of establishment of British P & I clubs md, therefore, the identity of P & I insurance. The present British P & I clubs are the remote descendants of the many small and local hull mutual insurance clubs that were formed by British shipowners in the end of 18th century. At that time, British shipowners were dissatified with the state of marine insurance market and, therefore, established clubs together in mutual hull insurance clubs. After the removal of the company monopoly in 1824, greater competition had a good effect on the rates, terms of cover and service offered by the commercial marine insurance market and by Lloyd's underwriters, and the hull clubs became less necessary and went into decline. The burden of British shipowners on liabilities to third parties was steadily increased after the middle of the 19th century, but the amount insured under hull policy was limited in the insured value of the ship. Eventually, the first protection club, that is, the Shipowners' Mutual Protection Society was formed in 1855. It was designed to like past mutual hull clubs, but to cover liabilities for loss of life and personal injury and also the collision risks excluded from the current marine policies, particularly the excess above the limits in hull policies. In 1870, the risks of liability for loss of or damage to cargo carried on board the insured ship was first awarded by the British shipowners. After 1874, many protection clubs formed indemnity club to cover the risk of liability for loss or damage to cargo. As mentioned above, British P & I clubs have been steadily changed according to the response of shipowners under the rapidly changing law of British shipowners' liability, and so on in the future.

• Journal of Preventive Medicine and Public Health
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• 제49권2호
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• pp.118-128
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• 2016

Objectives: The purposes of this study were to examine the status of children and adolescents with regard to enrollment in private medical insurance (PMI) and to investigate its influence on their utilization of medical services. Methods: The present study assessed 2973 subjects younger than 19 years of age who participated in five consecutive Korea Health Panel surveys from 2009 to 2012. Results: At the initial assessment, less than 20% of the study population had not enrolled in any PMI program, but this proportion decreased over time. Additionally, the number of subjects with more than two policies increased, the proportions of holders of indemnity-type only ('I'-only) and of fixed amount+indemnity-type ('F+I') increased, whereas the proportion of holders with fixed amount-type only ('F'-only) decreased. Compared with subjects without private insurance, PMI policyholders were more likely to use outpatient and emergency services, and the number of policies was proportionately related to inpatient service utilization. Regarding outpatient care, subjects with 'F'-only PMI used these services more often than did uninsured subjects (odds ratio [OR], 1.69), whereas subjects with 'I'-only PMI or 'F+I' PMI utilized a broad range of inpatient, outpatient, and emergency services relative to uninsured subjects (ORs for 'I'-only: 1.39, 1.63, and 1.38, respectively; ORs for 'F+I': 1.67, 2.09, and 1.37, respectively). Conclusions: The findings suggest public policy approaches to standardizing PMI contracts, reform in calculation of premiums in PMI, re-examination regarding indemnity insurance products, and mutual control mechanisms to mediate between national health insurance services and private insurers are required.

• 디지털융복합연구
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• 제18권10호
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• pp.175-180
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• 2020

최근 활성화 되고 있는 인슈어테크(InsurTech) 산업에서의 인공지능(AI)을 활용한 보험서비스 마케팅 사례연구를 통해, 보험산업 생태계에서 혁신적인 기술(예: 인공지능, 기계학습 등)이 어떻게 활용되고 있는지 살펴보았다. 특히, 국내·외 서비스 사례연구를 통해 인공지능기술을 활용하여 파괴적 혁신을 가져온 미국의 레모네이드(Lemonade)사의 챗봇을 이용한 신속하고, 간편한 보험가입 및 보험금 지급 서비스, 국내 AI컴퍼니의 광학 문자 인식(OCR)기반의 진단서 입력을 통해 예상 보험금이 산출되는 보험금 산정서비스를 고찰해 보았다. 사례분석 결과 인공지능 기반의 수많은 고객데이터를 활용한 기계학습을 통해 보험 가입 및 지급 절차에 있어 리드타임을 획기적으로 단축하였고, 고객과 보험사간의 분쟁이 많은 보험금 산정에 있어서도 정확하고 합리적인 보험금을 산출함으로써, 고객만족과 고객가치를 높일 수 있었다.

• 산학경영연구
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• 제11권
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• pp.415-437
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• 1998

우리나라 보험통계현황(保險統計現況)에서 보면 수출적하(輸出積荷)인 경우가 최근 3년간 전위험담보조건(全危驗擔保條件)이 95%이상을 상회하고 있다는 것과 신(新). 구약관(舊約款)의 사용내역을 보면 구약관(舊約款)의 사용이 2배 이상을 상회한다는 것을 보여주고 있다. 이는 하주(荷主)의 입장에서 보면 적하보험약관상(積荷保險約款上) 입증책임(立證責任)과 손해보상범위(損害補償範圍)에 문제점이 있다는 것을 설명해주고 있다. 또한 하주(荷主)의 보험마인드에도 운송인에의 구상권행사(求償權行使)가 복잡함으로써 보험자에게 전가(轉嫁)하려고 하는 의도도 있겠다. 따라서 피보험자(被保險者)인 입장에서 입증책임(立證責任)의 원칙과 손해보상범권(損害補償範圈)에 있어서는 화물의 특성을 고려한 동업자약관(同業者約款)(Trade Clause)의 도입(導入)과 적극적인 활용(活用)이 이루어져야 할 것이다.

• 한국중재학회지:중재연구
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• 제15권3호
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• pp.267-301
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• 2005

Following the increased economic corporations between the South and North Korea, many companies participate the corporation program. They needs insurance policy as a scheme for the transfer of risk from those individual company to it to an insurer. This paper review the possibility of the North Korea insurance authorities and research the origin, history, structure and context of the North Korea insurance law. The North Korea Insurance law differ from the South Korea and China's. North Korea Insurance authority has not capability of doing insurance business both side of underwriting and indemnity. Partly, it caused the uncertainty, insufficient and vague of the insurance law. The writer conclude that the North Korea insurance law faced to the needs of modernization. Especially, the Gyesung Industrial Complex Insurance Regulation couldn't cover the investor and company's risk because it is not based on the nature and basic principles of insurance.