• Title/Summary/Keyword: Insurance beneficiary

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Industry of Employment and Spontaneous Abortion of Female Workers (여성의 종사산업과 자연유산)

  • Park, Joung-Soon;Na, Myung-Chae;Paek, Do-Myung;Moon, Ok-Ryun
    • Journal of Preventive Medicine and Public Health
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    • v.27 no.2 s.46
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    • pp.242-257
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    • 1994
  • In Korea, female workforce has reached more than 40% of total working population, but the effects of work on spontaneous abortion are yet to be examined. This study as conducted to investigate the occupational effects on spontaneous abortion. Medical insurance claim data were used to examine the effects of the employment status and industry of employment on spontaneous abortion. The study population was composed of females, aged $15{\sim}44$, who were the beneficiary of medical insurance in the month of June, 1993. The working females covered by medical insurance for industrial workers, had the highest age-adjusted Spontaneous Abortion rate (SAB rate=claim frequency of spontaneous abortion/claim frequency of complication of pregnancy, childbirth and the puerperium), 6.65% whereas female dependants of medical insurance for industrial workers had the lowest age-adjusted SAB rate, 4.54%. Among industrial workers, the workers in manufacturing industry had the highest age-adjusted Spontaneous Abortion ratio(SAB ratio=claim frequency of spontaneous abortion/claim frequency of completly normal delivery), 43.2/100 whereas those in financing and service industry had age-adjusted SAB ratio, 16.2/100 and 20.5/100, respectively. The results of the study suggest the adverse effect of manufacturing Industry on reproduction. Work environments such as chemical exposures, overwork, awkard posture, and job stress should be further studied for their effects on reproductive functions of female.

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Study on Needs and Satisfaction of Service Related to Assistive Device and Assistive Device for Long-Term Care Elderly : Focused on Beneficiary Older Adults People in Long-term Care Insurance (노인복지용구의 품목 및 서비스의 만족도와 요구도에 대한 연구:노인장기요양보험 등급 인정자를 중심으로)

  • Woo, Ji-Hee
    • The Journal of the Korea Contents Association
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    • v.19 no.9
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    • pp.348-356
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    • 2019
  • This study is was to suggest improvement of assistive device for the elderly according to investigate the satisfaction and the needs of assistive device for elderly. The subjects were 184 beneficiary older adults in long-term health insurance who used home care service in I city and D city. Data were analyzed using SPSS 20.0. With the exception of cognitive assistance grade, subjects were showed from 'normal' to ' satisfied' on a types of assistive device and services related to assistive device. I, II grade subjects needed assistive device for self-care. III, IV and V grade subjects needed assistive device for safety and health maintenance. In the service related assistive device, All subjects needed service on 'periodic follow-up service', 'expert on assistive device' and 'comprehensive evaluation'. This results is significant in that it suggest to needed assistive device in accordance with grade unlike previous studies. Results of this study will expected to utilize as a basic evidence for improvement of assistive device, service related to assistive device for elderly.

Influence of Qualitative Information Gap of Industrial Accident Compensation Insurance's Rehabilitation Programs on Satisfaction with Work and Daily Life. - Mediation Analysis of Self-esteem (산재보험 재활사업 프로그램 질적 정보격차가 직무와 일상생활 만족에 미치는 영향 - 자존감의 매개효과 검정)

  • Shim, Hyun-Jin;Rhee, Hyun-Sill
    • The Korean Journal of Health Service Management
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    • v.10 no.1
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    • pp.143-154
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    • 2016
  • Objectives : The aim of this study was to validated the effectiveness of the information gap in work and daliy life satisfaction. Additionally, this study attempted to verify the mediating effect of self-esteem. Methods : The study examined 327 students who participated in a study on the PSWCI 1st Wave by KCOMWEL. Data were analyzed through descriptive statistics using the reliability test in SPSS 22.0 Ver. Moreover, hypothesis testing was analyzed with covariance based on structure equation modeling (CB-SEM) using Amos 21.0 Ver. Results : The low information gap has a positive effect on satisfaction with work and daily life. Additionally, self-esteem also has a positive effect on each satisfaction measure. However, self-esteem does not have a mediating effect between information gap and each satisfaction measure. Conclusions : The results of the study found the factor of effect on effect factor on beneficiary's satisfaction of industrial accident compensation insurance. Therefore, new ways need to be found that reduce the information gap and increase self-esteem.

Developing the Inpatient Sample for the National Health Insurance Claims Data (입원 환자 표본 개발에 관한 연구: 국민건강보험 청구자료를 중심으로)

  • Kim, Logyoung;Sakong, Jin;Kim, Yoon;Kim, Sera;Kim, Sookyeong;Tchoe, Byongho;Jeong, Hyoungsun;Lee, Taerim
    • Health Policy and Management
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    • v.23 no.2
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    • pp.152-161
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    • 2013
  • Korea has a single National Health Insurance program and all citizens are covered under this program, accounting 97% of the population, approximately 50 million people. Claims submitted by Health care providers are reviewed by Health Insurance Review and Assessment (HIRA) for the reimbursement. HIRA database contains not only individual beneficiary's information, but also healthcare service information such as diagnosis, procedures, prescriptions and tests for them. HRA database has gained attention as importance source for research due to its rich healthcare information and the demand of HIRA database has increased. Due to its tremendous size, however, researchers have had problems in accessing the database to conduct research. To meet this demand, we conducted a study to develop the inpatient sample data from HIRA database for research. This study has two purposes: 1) to determine a needed sample size; 2) to test reliability and validity of the sample data. We determined an adequate sample size to ensure representativeness and generality with additional consideration for convenience of calculation. The minimum sample size was 729,904 for the generality, and 488,861 for representativeness. After considering the convenience of calculation, our final sample size was 13% of the population, which was about 7.7 million beneficiaries. Age (5 years interval) and gender were used as stratification variables for sampling. In order to examine whether this sample data appropriately reflect population, we tested the reliability and validity of the sample data. From the sample data, we computed average expenditure of total claims per inpatient for 2011, frequency of top 30 disease, estimation of the number of stroke patients from the sample data, and then compared them to those from the population. Results confirmed reliability and validity of the sample data.

Factors Associated with the Non-Use of Beneficiaries of Long-Term Care Insurance Service: The Case of Jeollanam-do Province (노인장기요양보험 인정자의 미이용 관련요인 분석: 전남지역을 대상으로)

  • Kuk, Kyung-Nam;Kim, Roeul;Lim, Seungji;Park, Chong-Yon;Kim, Jaeyeun;Chung, Woojin
    • Health Policy and Management
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    • v.24 no.4
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    • pp.349-356
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    • 2014
  • Background: This study aimed to explore factors associated with the non-use of beneficiaries of long-term care insurance services for the elderly in Jeollanam-do Province by analyzing a dataset obtained from National Health Insurance Service. Methods: The study sample consists of 1,663 individuals who were evaluated as eligible for long-term care insurance services in Jeollanam-do Province during the period of July 1, 2008 through June 30, 2009. As a dependent variable, the non-use of the service was defined as one when a beneficiary had used it once or more times during one year after he or she was evaluated as eligible and as zero otherwise. A proportion analysis was conducted to describe characteristics of study sample. Chi-square tests were used to compare general characteristics between beneficiaries who had used the services and those who had not used them. Multiple logistic regressions were performed by three models including additional sets of explanatory variables such as socio-demographic characteristics, health conditions, and economic status. Results: Main results are summarized as follows. The proportion of beneficiaries who had not used the service was 14.5% of all beneficiaries. According to the results from the model using all explanatory variables, the factors associated with the non-use of the services were residence location, dwelling place, type of desired service, level of care needs, and instrumental activities of daily life limitations. Conclusion: In particular, regarding the type of desired service, the cash benefit showed a high likelihood of the non-use of the service; it had an odds ratio (OR) of 50.212 (95% confidence interval [CI], 24.00-105.04) compared with home service. In case of dwelling place, a hospital showed also a high likelihood of the non-use with an OR of 20.71 (95% CI, 10.12-42.44) compared with home.

An Analysis of Health Care Services for the Elderly in Rural Areas: Its Demand in Projection and Policy Implications (우리나라 농촌지역(시.군 통합모형)의 노인보건의료 자원 수급계획에 관한 연구)

  • 정영일;정문호;강성홍;이창은
    • Korean Journal of Health Education and Promotion
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    • v.12 no.1
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    • pp.22-46
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    • 1995
  • This is an effort to project health care resources in need for the elderly in the future when advanced transportation systems would greatly reduce geographical accessibility to health care services for the rural elderly. Two areas, Kimhae and Chuncheon, were selected for the study. Projection of health professionals and health care institutions for the elderly were made based on the analysis for the morbidity and illness behavior reported to two data sources, National Survey for the Elderly in 1992 by Korea Institute for Health and Social Affairs and beneficiary data by Korea Medical Insurance Cooperation for those living in the study areas in 1992. Projected number of health professionals and health care institutions were estimated for each area under study in years of 2010 and 2030, with those in a Japanese being used as a standard. Policy implications were discussed.

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Hospital Services Utilization in Type-I Medicaid Elderly Beneficiaries (의료급여 1종 노인 수급권자의 입원이용)

  • Lim, Seung-Joo
    • Journal of East-West Nursing Research
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    • v.15 no.2
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    • pp.63-70
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    • 2009
  • Purpose: The purpose of this study was to evaluate hospital service utilization by the types of hospitals in Type I Medicaid claims frequently cited by elderly beneficiaries. Methods: Three frequently claimed inpatient diseases were selected: cerebral infarction, hypertension and diabetes mellitus. Relevant data were collected for the year 2008 from the computer database of the National Health Insurance Corporation. The data was analyzed using SPSS by descriptive statistics, ANOVA and coefficient of variation. Results: The coefficient of variance of hospitalization per episode was higher than daily hospital expenditure among hospitals for all three diseases. The coefficient of variance of hospitalization per episode was highest for cerebral infarction. The coefficient of variation of hospital expenditure per hospital day was highest for hypertension. Conclusions: Evaluating of the volume and pattern of hospital service utilization and the appropriateness for hospital admission for Type-I Medicaid elderly beneficiaries is important for Medicaid-based case management.

A Difference in Utilization of Cancer Inpatient Services by Income Class of Residents in Jeju Island (제주도 주민의 소득계층에 따른 암 입원 의료이용의 차이)

  • 김철웅;이상이;홍성철
    • Health Policy and Management
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    • v.13 no.3
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    • pp.104-128
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    • 2003
  • Equity in health care has taken priority in the Korean government's policy agenda after the government-led national health insurance achieved universal coverage in 1989 along with the final inclusion of the self-employed as beneficiary. The purpose of this study is to examine the extent to which there exists difference or inequality in the utilization of health care, especially cancer inpatient services among income classes. We analysed the utilization of cancer inpatient services of residents in Jeju Island for a year of 2000, using the national health insurance data for qualification of beneficiaries and utilization of health care. The independent variable are 10 income classes based on the national health insurance fee imposed on each household for a year of 2000. The dependent variables of this study are an amount of cancer inpatient health care utilization measured by cancer admission days and cancer treatment costs. Also, cancer inpatient health care utilization is analysed by three categories divided into utilization in medical care institutions (1) within Jeju Island, (2) outside Jeju Island, and (3) all within and outside Jeju Island. We measured concentration index of cancer inpatient health care utilization. This analysis showed negative concentration index within Jeju Island and positive outside Jeju Island, and positive in all within and outside Jeju Island. This results suggest inequality against the relatively poor income groups in utilization of cancer inpatient health care services. Especially, inequity of cancer inpatient health care would be more serious in Jeju Island of Korea, considering that lower income groups reportedly have higher incidence rates in most of cancer and thus use more health services.

Difference in Resource Utilization according to Beneficiary Characteristics of the Long-term Care Facilities (노인장기요양보험 이용자 특성에 따른 자원사용량 차이)

  • Lee, Sue-Hyung;Shin, Ho-Sung
    • Health Policy and Management
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    • v.20 no.1
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    • pp.19-36
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    • 2010
  • Fee for long-term care insurance in Korea are determined in proportion to resources utilized according to severity rather than based on categorization of beneficiaries in consideration of the characteristics of resource utilization. This adoption is based on the assumption that as beneficiaries of long-term care insurance, characteristically, demands social services rather than needs medical treatments, the characteristics of beneficiaries and the quality of utilized resources are comparatively homogenous. Therefore, the proposition is that the size of resource consumed by beneficiaries in the same grade is identical. However, even in the same grade, the level of utilized resources is different depending on the characteristic of beneficiaries. In this regard, this study is to examine whether there are differences in the volumes of utilized resources depending on the characteristics of beneficiaries even in the same grade. We analyzed time study data for 2003, 2005, 2006 which conducted by the Korea Institute for Health and Social Affairs. To look at differences in the volumes of utilized resources, we identified characteristics of beneficiaries that influence utilized resource volumes and categorized services provided by facilities into the rehabilitation treatment category, the problematic behavior category, and the physical malfunction category. Then, we examined each service in consideration of service difficulty levels and wage weights. The result of examination showed that differences in utilized resource volumes exist in all three grades depending on the characteristics of beneficiaries. Especially, in the first grade with a high level of seriousness, utilized resource volumes were different for those three service categories and the problematic behaviour category considered dementia was found to consume the largest volume of resources. Moreover, there was the inversion phenomenon of utilized resources volumes between the grades. This result indicates that utilized resource volumes are different even in the same grade depending on the characteristics of beneficiaries and it is required to consider case-mix for reflection of the volumes of utilized resources depending on the characteristics of beneficiaries.

Perception and Need for Industrial Accident Compensation Insurance in Industries which have less than 5 Employees (5인 미만 사업장의 산재보험에 대한 사업주와 근로자의 인식도 및 요구도 조사)

  • Yun, Soon-Nyung;Jung, Hye-Sun;Lee, Bok-Im;Lee, Hyun-Joo;Lee, Hyun-Jeong;Kim, Hwa-Joong
    • Korean Journal of Occupational Health Nursing
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    • v.9 no.2
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    • pp.121-131
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    • 2000
  • This study was conducted to acquire data in order to institute an effective industrial accident compensation insurance(IACI) system. The subjects were employers and employees in small scale industries which have less than 5 employees. The questionnaires consisted of questions on perception and need for IACI. A total of cases were 181 employers and 105 employees participated in the study. Perception and need of employers and employees were assessed using the ANOVA, t-test. The results were as follows ; 1. Workplaces examined mostly in manufacturing(78.9%), industries with one employee(44.1%). Beneficiary rate of IACI 4.4%. 2. 60.0% of employees had experienced an industrial accident and in most cases employers paid the cost of medical treatment. 45.0% of employers nd 50.0% of employees were not aware that IACI had been put into effect starting July, 1, 2000. 52.0% of employers had no type of industrial accident compensation. 3. The need of outcome measures, especially of employers and employees who had an IACE, were higher than those without an IACI. Employers and employees who had experienced an industrial accident outnumbered those who hadn't. The results of this study reveal that there is a great need for the institution of an IACI and health promotion policy in small scale industries.

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