• 시큐리티연구
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• 제32호
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• pp.151-176
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• 2012

현재 보험범죄는 해마다 증가하고 있으나 정부차원에서 보험범죄를 적발하거나 방지하기 위한 전문조직은 미비한 실정이다. 이러한 보험범죄로 인한 피해는 인명과 국민경제 측면에서 매우 심각한 실정이다. 보험범죄는 보험회사의 경영수지를 악화시키는 것은 물론이고, 보험금의 부정유출로 인해 보험사의 손해율을 악화시킴으로써 보험사 부실의 원인이 될 수 있다. 이는 결국 보험사의 보험료 인상으로 이어져 결국, 보험가입자의 보험료 인상이라는 문제를 야기시킨다. 이러한 이유로 1996년부터 보험회사들은 보상조직 내에 보험사기를 전문적으로 조사하기 위한 보험범죄특별조사팀(Special Investigation Unit, SIU)을 구성하기 시작하였다. 하지만 현재의 SIU는 보험범죄의 예방을 위한 다양한 업무를 효율적으로 수행하기에는 아직 그 인력과 재원이 부족한 수준이다. 따라서 본 연구는 갈수록 심각한 사회문제로 주목받고 있는 보험범죄를 실제 현장에서 담당하고 있는 SIU 구성원을 대상으로 현재의 근무환경과 보험범죄에 대한 일반적 인식이 그들의 직무만족에 미치는 영향에 대하여 알아보았다. 본 연구는 이러한 현장조사 분석을 바탕으로 현재 SIU 구성원들의 보험범죄 인식 및 근무 환경을 분석하고, 직무만족 향상을 통하여 구축할 수 있는 효과적인 보험범죄 대응 방안을 마련하는 데에 목적이 있다.

• 한국직업건강간호학회지
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• 제12권1호
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• pp.80-88
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• 2003

Rehabilitation has emerged in recent years as major topic for the handicaped in industrial accident compensation insurance(IACI). Specially social support helps the handicaped adjust themselves psychosocially to handicap. This study was conducted to examine different contents and perceived social support, and provide guidlines for specific and proper rehabilitation for the handicaped of IACI. This study is a descriptive study which were collected through two phases using structured questionnaire. In the first stage, surveys were performed via telephone interviews. In the second stage, surveys were performed via home-visit subjects in the first stage included the handicaped of IACI. Finally data were collected from 338 subjects and analyzes by SPSS/PC+10. The instruments of this study were the perceived social support scale which developed by Lee(1996). These scales in the form of 5-point Likert type, consists of 20 items, including 3 subscales of emotional support, informational support, instrumental support. The mean score of social support was 57.2, emotional support 21.0, informational support 21.2 and instrumental support 15.2. The mean of depression for psychosocial factors is 37.5. Threre were significant differences in total perceived social support; age, job status, handicaped degree in IACI, post-traumatic complication and use of instrument. Emotional support was significant differences; age, number of dependent family, job status, handicaped degree in IACI, use of instrument and depression. Informational support was significant differences; job status, posttraumatic complication, use of instrument and depression. Instrumental support was significant differences; sex, job status, handicaped degree in IACI, use of instrument, and depression. The current system of the Labor Welfare institute is not appropriate for solving health problems of the handicaped in IACI. Therefore, it is necessary to develop the plan which can provide the handicaped in IACI high-quality rehabilitation services, so that they must use those services in the community without being dependent on hospitals. This study proposes home visit nursing services as the way to provide various health services within community for the handicaped in IACI.

• 한국항해항만학회지
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• 제32권3호
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• pp.237-244
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• 2008

국제노동기구는 2006년 2월23일 해사노동기준에 관하여 그 동안의 협약 및 권고를 가능한 한 최신화 하고 모든 기준을 통합하여 단일의 문서로 된 해사노동협약을 채택하였다. 이 협약은 제4편 규정 제4.5조에 선원에게 적용되는 사회보장에 관하여 규정하고 있다. 규정 제4.1조 선내 및 육상에서의 의료관리, 규정 제4.2조 선박소유자의 책임에 관한 조항도 사회보장과 관련되어 있다. 우리나라가 이 협약을 비준하기 위하여서는, 우선 먼저 국내 관련법령이 협약상 선원 사회보장 요건을 충족할 수 있는지를 검토하고, 불충분한 부분에 대하여는 이를 정비할 필요가 있다. 따라서 이 연구에서는 협약상 선원의 사회보장에 관한 요건을 수용할 수 있도록 현행 국내 관련 법령과 협약 사이의 차이점을 밝히고, 이 과정에서 도출된 문제점에 관하여 그 해결 방안을 제시하고자 한다.

• 한국사회복지학
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• 제37권
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• pp.119-141
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• 1999

본고는 산재보험 급여체계 내에서 나타나고 있는 일부급여의 비합리적 과잉급여 현상과 협소한 급여범위와 급여의 미흡성 그리고 제한성 문제는 장기적으로 사회보험의 건전한 체제정립을 저해함은 물론 장기적으로 불공평성으로 인한 수급자의 제도에 대한 왜곡인식과 악용이 늘게되고 가입자의 제도 참여에 대한 불만과 회의적 시각이 누적되어 결국은 제도에 대한 신뢰를 상실시킬 수 있다는 우려에서 연구의 필요성을 인식하였다. 산재보험에 있어서 궁극적인 목적인 급여의 적절성을 보장하기 위하여 급여에 의하여 수급자가 오히려 부를 축적할 수 있는 기회로 왜곡되거나 또는 급여체계의 목적에서 벗어난 적정이상의 소득이 발생되지 않도록 하여야 하는 점도 급여체제의 올바른 기능 수행에 있어서 중요한 과제로 판단하였다. 또한 사회보험제도 내에서 각 급여부분의 보장 수준에 평준화를 통하여 수급권자가 일부 급여에 대하여 집착을 보이지 않도록 하는 급여별 보장 수준의 평준화의 확립도 중요한 제도적 발전의 관건으로 인식하여 급여의 적절성과 평준화를 위한 문제점과 개선방안을 제시하고자 하였다. 다만 무분별한 급여수준의 삭감은 오히려 사회보험 발전에 저해요소로 작용할 위험이 높은 점을 감안하여 급여제도의 함으로 인하여 제도가 목적으로 하지 않는 비합리적인 부분으로서 적정이상의 급여를 제거하고, 오히려 급여부분에서 상대적으로 급여의 협소성과 미흡성으로 지적되는 보장기능에 대한 보완 작업을 통하여 제도 자체의 급여체제에 대한 형평성 및 공평성을 확보할 수 있는 대안을 제시하고자 하였다. 따라서 본 연구에서는 산재보험 급여체제에 있어서 과잉 또는 중복 지급되는 급여부분을 구체적으로 지적하고 이를 급여에 있어서 미흡한 부분으로 전환 방안을 제시함으로써 제도의 합리성을 확보하고 제도의 건전성을 확보함으로써 산재보험의 장기적인 제도발전에 기여하고자 하였다.

• Journal of Preventive Medicine and Public Health
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• 제42권1호
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• pp.5-11
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• 2009

Objectives : This study was conducted to estimate the socioeconomic cost of injuries in South Korea. Methods : We matched claims data from national health insurance, automobile insurance and industrial accident compensation insurance(IACI), and mortality data obtained from the national statistical office from 2001 to 2003 by patients unique identifier. Socioeconomic cost included both direct cost and indirect cost: the direct cost was injury-related medical expenditure and the indirect cost included loss of productivity due to healthcare utilization and premature death. Results : The socioeconomic cost of injuries in Korea was approximately 1.9% of the GDP from 2001 to 2003. That is, 12.1 trillion KRW(Korean Won) in 2001, 12.3 trillion KRW in 2002, and 13.7 trillion KRW in 2003. In 2003, direct medical costs were 24.6%(3.4 trillion KRW), the costs for loss of productivity by healthcare utilization were 13.0%(1.8 trillion KRW), and the costs for loss of productivity by premature death were 62.4%(8.6 trillion KRW). Conclusions : In this study, the socioeconomic cost of injuries in Korea between 2001 and 2003 was estimated by using not only health insurance claims data, but also automobile insurance, IACI claims and mortality data. We conclude that social efforts are required to reduce the socioeconomic cost of injuries in Korea, which represented approximately 1.9% of the GDP for the time period specified.

• 보건행정학회지
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• 제16권4호
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• pp.128-146
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• 2006

The objective of this paper is to examine the proportion and characteristics of non-emergent patients at emergency departments. The observational survey was conducted using a structured form used by emergency medicine specialists or senior residents on June 7-20, 2005. 1,526 patients at ten emergency centers took part in this study. The structural form contained type of insurance, route and means of emergency department (ED) visit, triage based on the Manchester Triage Scale(MTS)-modified criteria, emergency level based on the government defined rule, type of emergency centers (Regional Emergency Medical Center; REMC, Local Emergency Medical Center; LEMC, Local Emergency Agency; LEA), as well as patient's general information. Data were analyzed using SAS statistical program(V.8.2). Descriptive analysis was performed to describe the magnitude of non-emergent patients. ${\chi}^2-analysis$ and logistic regression analysis was performed to identify the nonurgent patients' characteristics. In the MTS-modified criteria, we found a 15.3% rate of non-emergent patients. This rate differed from that of non-emergent patients obtained using government's rule. In particular, there were inaccuracies in the definition of government rule on non-emergent patients, so it is necessary to apply the new government rule regarding classification of non-emergent patients. There were significant differences in the rate of non-emergent patients according to type of ED, means of ED visit, time to visit, and insurance. Non-emergent patients are more likely to visit a D-type ED(LEA having less than 20,000 patients annually), not to use ambulance, to have 'Automobile Insurance, Industrial Accident Compensation Insurance, or pay out-of-pocket'. Non-emergent patients tend to visit ED due to illness rather than injury. Further studies on the development' of triage scale and reexamination of the government's rule on emergency visits are required for future policy in this area.

• 보건행정학회지
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• 제32권2호
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• pp.180-189
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• 2022

Background: Social support contributes directly and indirectly to maintaining physical, mental, and social well-being. The aim of the study was to identify the impact of social support on self-rated health among Korean industrial accident workers. Methods: This study used data from the panel study of workers' compensation insurance (PSWCI). The final subjects were 2,759 workers who responded to a 2018 to 2020 PSWCI. Social support was defined as social contact with friends, neighbors, family, and social participation activities like religious activity, social activity, and club activity. Multivariate logistic regression analysis was performed to investigate causal relationships between social support and self-rated health using a generalized estimating equation model. Results: Proportion of workers' good self-rated health steadily increased (2018: n=1,447, 63.2%; 2019: n=1,542, 66.2%; 2020: n=1,653, 67.3%). Higher levels of social contacts with friend (worse: reference; same: β=0.442) and higher levels of social activity (yes: reference; no: β=-0.173) were especially associated with good self-rated health. Conclusion: This study confirmed social support positively influenced self-rated health among the self-rated health of industrial injured workers. The results of this study suggested that recovery policies that the government served should include programs enhancing social support for improving health among industrial injured workers.

• 한국경영과학회:학술대회논문집
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• 한국경영과학회 2008년도 추계학술대회 및 정기총회
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• pp.342-345
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• 2008

산재 발생 시 산재근로자는 근로복지공단을 통해서 각종 급여를 받게 된다. 본 논문은 심사 과정과 급여지급 후에 부정수급으로 판명된 산재 청구 건을 데이터 마이닝을 통해서 분석하여 부정수급의 유형을 발견하고자 한다. 이 연구에서는 서울관내 4개 지사에서 8년 동안(2000년$\sim$2007년)의 총 61,536명의 최초요양 신청을 한 산재근로자 자료를 대상으로 하였고, 종속변수에 영향을 미치는 8개의 독립변수를 선택해서 사용한다. 데이터 마이닝을 적용함에 있어서 가장 효율적인 허위 부정 탐지 모델을 만들기 위해 의사결정나무분석(Decision Tree)과 로지스틱 회귀분석(Logistic Regresion)등의 다양한 기법을 적용하여 결과를 비교분석 하고, 오분류 비용을 적용하여, 최적의 분류결정 값을 가지는 모델을 도출한다. 분석결과, 로지스틱 회귀분석이 산재보험 부정수급 유형 발견에 보다 효과적인 모델로 판명되었다. 또한 판별점(Cut-Off) 0.01로 했을 때 4개변수(요양기간, 업종형태, 의료기관, 재해발생형태)가 부정수급에 탐지하는데 영향력이 큰 변수로 선정되었다.

• 한국안전학회지
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• 제11권1호
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• pp.99-107
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• 1996

This survey is to compare the the number of accidents which were occurred in 24 construction companies with the average accident in construction industry. The number of accidents in 24 companiesis is lower than the average accident, then it is classified "save", otherwise it is classified "loss". This survey is conducted to have top management be interested and invest for safety by recognizing that safety management could be profit for the company. The result of this survey is as follows : The total save amount in 1992 is 44,780mi11ion Won and average is 1,870mi11ion Won, with being 11, 200mi11ion Won by reduction amount of deaths and 33,580mi11ion Won by reduction amount of injuries. In 1993 the total is 33,330mi11ion Won and average is 1,390mi11ion Won, and in 1994 the total is 38, 720mi11ion Won and the average is 1,610mi11ion Won. This result is save amount of workmen's compensation insurance with excluding the indirect costs for accidents. The company which ranked the highest save amount is B Construction Company with being 15.1 billion Won and the next is A Construction Company during 3 years. The Company which ranked highest percentage of save amount to sales amount is Q Heavy industry with being 0.359% and the next is B Construction Company during 3 years.pany during 3 years.

• 한국직업건강간호학회지
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• 제22권2호
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• pp.102-111
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• 2013

Purpose: This study was conducted to analyze the characteristics of work-related musculoskeletal diseases (MSD) and the factors for approving MSD by the parts of the body. Methods: The analysis was done using the data which were drawn from the Industrial Accident Compensation Insurance that is operated by the Korea Worker's Compensation & Welfare Service. The data were composed of total cases related to the work-related diseases from 2006 to 2009. In addition, MSD data input by an investigator were collected. The factors associated with MSD were analyzed using ${\times}2$ and multiple logistic regression. Results: MSD approved cases have increased since 2006 and the proportion of the approved work-related MSD cases in the workers with work-related diseases in 2009 were 33.4%. Spinal approved cases were the highest percentage and upper and lower extremities cases gradually increased. The factors for approving upper extremity were found to be age, company size, type of industry, working duration, and in the case of spine to be company size and heavy lifting. Conclusion: Work-related MSD have increased and the factors that affected MSD by the parts of the body varied. Management strategy must be established to prevent MSD by the parts of the body.