• 한국임상약학회지
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• 제20권3호
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• pp.242-247
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• 2010

Controlling inappropriate antibiotics prescribing for acute upper respiratory infections(URI) is a very important for prudent use of antibiotics and resistance control. Health Insurance Review and Assessment Service (HIRA) introduced Prescribing Evaluation Program and publicly reported antibiotics prescribing rate for URI of each health institution. We performed segmented regression analysis of interrupted time series to estimate the effect of public report on antibiotics prescribing rate using national health insurance claims data. The results indicate that just before the public report period, clinics' monthly antibiotics prescribing rate for URI was 66.7%. Right after the public report, the estimated antibiotics prescribing rate dropped abruptly by 12.3%p. There was no significant changes in month-to-month trend in the prescribing rate before and after the intervention.

• 품질경영학회지
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• 제37권4호
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• pp.43-51
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• 2009

This study was designed to analyze the relationship of process quality, result quality and management performance in Korean insurance industry. For this study the linkage scheme of service quality concept is used on PZB model and BSC(Balances Score Card) system. In the linkage model, the 5 service qualitry factors used in PZB model are used as the result quality variables, and internal process factor, learning/growth factor in BSC are used the process quality variables affecting the result quality variables. And also customer satisfation factor and financial performance index are used as the management performance variables. In the ivsurance industry, the process quality variables were verified to meaningfully affect the result quality variables, and the result service quality variables were verified to affect the management performance indices. As the result, the process quality and the service quality must be emhanced for the competitiveness of Korean insurance industry.

• Journal of Preventive Medicine and Public Health
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• 제50권5호
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• pp.294-302
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• 2017

Objectives: The objectives of this study were to investigate the agreement between medical history questionnaire data and claims data and to identify the factors that were associated with discrepancies between these data types. Methods: Data from self-reported questionnaires that assessed an individual's history of hypertension, diabetes mellitus, dyslipidemia, stroke, heart disease, and pulmonary tuberculosis were collected from a general health screening database for 2014. Data for these diseases were collected from a healthcare utilization claims database between 2009 and 2014. Overall agreement, sensitivity, specificity, and kappa values were calculated. Multiple logistic regression analysis was performed to identify factors associated with discrepancies and was adjusted for age, gender, insurance type, insurance contribution, residential area, and comorbidities. Results: Agreement was highest between questionnaire data and claims data based on primary codes up to 1 year before the completion of self-reported questionnaires and was lowest for claims data based on primary and secondary codes up to 5 years before the completion of self-reported questionnaires. When comparing data based on primary codes up to 1 year before the completion of selfreported questionnaires, the overall agreement, sensitivity, specificity, and kappa values ranged from 93.2 to 98.8%, 26.2 to 84.3%, 95.7 to 99.6%, and 0.09 to 0.78, respectively. Agreement was excellent for hypertension and diabetes, fair to good for stroke and heart disease, and poor for pulmonary tuberculosis and dyslipidemia. Women, younger individuals, and employed individuals were most likely to under-report disease. Conclusions: Detailed patient characteristics that had an impact on information bias were identified through the differing levels of agreement.

• 디지털융복합연구
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• 제13권1호
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• pp.191-203
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• 2015

금융서비스에서 IT산업은 운영을 위한 기반산업이며, 경쟁에서 생존하기 위한 필수적인 도구이다. 이렇듯 금융서비스에서 IT의 중요성은 어떠한 산업보다 크다고 볼 수 있다. 따라서 본 연구는 금융서비스 산업을 6개의 산업으로 세분화하고 IT를 하드웨어와 소프트웨어 나눈 후, IT 두 분류가 각 금융서비스 산업 미치는 경제적 효과를 분석하였다. 이를 위해 사용된 자료는 2000년부터 2009년까지의 산업연관표이고, 사용된 모형은 수요유도모형의 생산유발효과와 부가가치유발효과 그리고 공급유도모형의 공급지장효과 마지막으로 물가파급효과이다. 분석결과 IT 하드웨어보다 IT 소프트웨어 및 서비스 산업이 금융서비스에 더 크게 영향을 미치는 것으로 나타났다. 특히, IT 소프트웨어의 공급지장효과는 2000년 대비 2배 이상 증가하여 IT 소프트웨어 1원 생산 시 금융서비스 전체에 0.0847원의 효과를 나타내는 것으로 나타났다. 또한 금융서비스 분야 중 중앙은행 및 예금취급기관이 IT 산업의 가장 크게 영향을 받고 있는 것으로 나타났다. 이러한 연구 결과는 IT 산업과 금융서비스의 상호의존성은 지속적으로 증가하고 있는 것을 보여주고 있다.

• 통상정보연구
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• 제9권2호
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• pp.41-64
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• 2007

A life insurance industry's market is reaching a state of saturation recently, and the competition is as time goes by intense among the non-life insurance industry. Consequently, the insurance companies must grope a new source of revenue and develop a new business model for a stability growth. At the forked road, the insurance companies must group the existing and new customers in order to find the royal customers, and develop a new service with them. Accordingly, it is the time to study the advance of PB field and the royal customer management that will maintain and expand the new relations with them. Besides, the PB was the service to begin in needs of the specific group, but now it is regarded as a new source of high profit in the age of universal financial service among the financial circles. As a consequence, the PB marketing is introduced in haste, and such trend seems to be continued. Therefore, the plans that help the domestic insurance company reflect the characteristic of the insurance and expand the scope of business into the scope of property management according to the needs of customers under a universal financial service trend will be studied.

• 약학회지
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• 제53권3호
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• pp.138-144
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• 2009

The purpose was to implement drug utilization review (DUR) for whom were diagnosed with chronic kidney disease (CKD) population using health insurance claim data. This study constructed drug utilization database using Health Insurance Review and Assessment Service (HIRA) database and selected contraindicated drugs with kidney based on previously developed drug utilization guide and reviewing other countries' examples. Main outcome measures were the proportion of prescription for 1 or more drugs of concern. The cohort included 115,948 subjects, who were diagnosed with chronic kidney disease. Inappropriate drugs with CKD patients was some used, and the most commonly prescribed classes were aluminum drugs. However it is difficult to find problems with inappropriate drug because claims data doesn't have laboratory data. Based on the result of retrospective drug utilization review study, more studies should be analysed drug utilization patterns and monitoring system should be developed.

• Journal of Chest Surgery
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• 제49권sup1호
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• pp.20-27
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• 2016

Background: This study analyzed the association between the volume of heart surgeries and treatment outcomes for hospitals in the last five years. Methods: Hospitals that perform heart surgeries were chosen throughout Korea as subjects using from the Health Insurance Review and Assessment Service. The treatment outcome of the heart surgeries was defined as the mortality within 30 postoperative days, while the annual volume of the surgeries was categorized. Logistic regression was used as the statistical analysis method, and the impacts of the variables on the heart surgery treatment outcomes were then analyzed. Results: The chance of death of patients who received surgery in a hospital that performed 50 or more surgeries annually was noticeably lower than patients receiving operations from hospitals that performed fewer than 50 surgeries annually, indicating that the chance of death decreases as the annual volume of heart surgeries in the hospital increases. In particular, the mortality rate in hospitals that performed more than 200 surgeries annually was less than half of that in hospitals that performed 49 or fewer surgeries annually. Conclusion: These results indicate that accumulation of a certain level of heart surgery experience is critical in improving or maintaining the quality of heart surgeries. In order to improve the treatment outcomes of small hospitals, a support policy must be implemented that allows for cooperation with experienced professionals.

• 보건행정학회지
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• 제22권3호
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• pp.383-402
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• 2012

The purpose of this study is to investigate the factors affecting family caregiver financial burden of out-of pocket expenses for the nursing home service under Long-term Care Insurance System. We conducted a national cross-sectional descriptive survey from July to September 2010 to collect data based on the long-term care benefits cost specification. Total 1,016 family caregivers completed questionnaires. 185 subjects of total were excluded from the data analysis due to being answered by user(18 cases), or caregivers not to pay for services expenditures(122 cases), having a missing data on family caregivers characteristics(45 cases). Finally, 831 subjects were included in the study. The average financial burden was 3.18(${\pm}0.71$). We divided subjects into two groups by level of burden, high-burden group and low-burden group. In the result of the multiple logistic regression analysis, family caregiver financial burden was significantly higher in family caregivers with ages 40 to 49 compared to less than 40, lower educational level, unsatisfaction for long-term care service, high percentage(more than 50%) of cost-sharing and high total out-of pocket expenses(more than 300,000 won) for long-term care services. Also, Family caregivers who are spouse felt higher financial burden compared to son. This study is meaningful as the first attempt to measure family caregiver financial burden for long-term care service and to identify factors affecting the financial burden. Family caregivers felt financial burden of out-of pocket expenses for the nursing home service. The policy makers, the insurer, and the providers need to pay attention to ease family caregiver financial burden.

• 보건행정학회지
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• 제21권4호
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• pp.599-616
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• 2011

This research was performed to investigate the determination factors of medical service to cover the fee for selecting a doctor which is one of the most important causes of debilitating national health insurance in Korea. Data was from Korea Health Panel and analyzed by Dutton(1986)'s medical service model which was an extended Anderson Model and was widely used in the researches on determination factors of medical service. The results were as follows; In the determinants of selecting a doctor in specialized medical institutions and general hospitals, patients with serious diseases selected doctors more often than other patients. By industrial accident compensation insurance law and enforcement ordinances, insurance covers the fee of selecting a doctor in the hospitals appointed by Labor Welfare Corporation for the patients in critical conditions under industrial accident compensation insurance, while health insurance patients pay the fee themselves for selecting a doctor in all cases. It is suggested that patients with serious diseases proved by medical opinion be provided with health care insurance in selecting a doctor and that the health insurance benefit coverage be enhanced by staged lowering of patient's cost-sharing.

• 의료법학
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• 제8권2호
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• pp.69-118
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• 2007

In providing general medical treatments, the medical service contract between the patient and the doctor is the mutually responsible onerous contract. However, the nature of the mutually assumed contract standings of the patient and the doctor has been changing since the implementation of the national health insurance program. For instance, besides the cases of beyond excessive medical charges and medical negligence, if the doctor charged for his/her medical treatments violating the post-treatment/nursing cover criteria, the overpaid medical charge, regardless of being collected with the patient's consent, has to be refunded back to the patient. Medically needed aspects, treatment results, and unfair benefits favoring the patient are not at all taken into consideration in the health insurance scheme. This makes it easier for patients to get refunds for their share of the medical payments by involving the Health Insurance Review & Assessment Service or the National Health Insurance Corporation, without engaging in civil law suits (for reimbursement claim) against doctors. In other words, the doctor's responsibility to provide medical treatments and the patient's responsibility to pay for the medical treatment provided within the contractual realm are being demolished by the administrational arbitration of the National Health Insurance system. The basic rights of medical service providers, and the patient's right to choose are as important constitutional rights, as the National Health Insurance program, which is essential in the social welfare system. Furthermore, the development of the medical fields should not be prevented by the National Health Insurance system. If the medical treatment services can be divided into necessary treatments, general treatments, and high quality treatments, the National Health Insurance is supposed to guarantee the necessary and general treatments to provide medical treatments equally to all the insured with limited financial resources. However, for the high quality treatments, it is recommended that they should not be interfered by the National Health Insurance system, and that they should be left to the private contract between the patient and the doctor.