• Journal of Preventive Medicine and Public Health
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• v.22 no.2 s.26
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• pp.259-267
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• 1989

The objective of this study was to analyze the influence of the hospital and insurer in causing delayed reimbursement of medical insurance benefits. We analyzed major variables at three different sized hospitals to examine the effect of the hospital and insurer using the two-way ANOVA method. The results were as follows: 1. The time interval between claim by hospitals and payment of the benefit was statistically different according to hospital in both admission and outpatient care. 2. The time needed by the insurer for investigating the claims was statistically different according to hospital and insurer in both admission and outpatient care. There was interaction between the hospital and insurer factors in outpatient care. 3. Although there was interaction between the hospital and insurer factors in admission care, the time interval between claim and payment was statistically different. In outpatient care, the payment interval between claim and payment was also statistically different according to the hospital and insurer.

• Journal of the Korean Operations Research and Management Science Society
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• v.40 no.3
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• pp.39-48
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• 2015

Even though ruin probability is a fundamental value to determine the insurance premium and policy, the complexity involved in computing its exact value forced us resort to an approximate method. In this paper, we first present an exact method to compute ruin probability under the assumption that the claim size has a GPH distribution, Then, for the arbitrary claim size distribution, we provide a method computing ruin probability quite accurately by approximating the distribution as a GPH. The validity of the proposed method demonstrated by a numerical example. The GPH approach seems to be valid for heavy-tailed claims as well as usual light-tailed claims.

• Transactions of the Korean Society of Automotive Engineers
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• v.21 no.1
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• pp.107-112
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• 2013

Base on insurance vehicle collision and bodily injury claim reports, 23,655 cases of vehicle to vehicle accidents occurred in Korea 2010 are investigated in order to understand vehicle damage severities, repair costs and occupant injury types. The results of our statistical analysis reveal that minor damages with small dent or scratches on vehicle body panels which is assumed to imply during very low speed crashes are major portion of accident severities types. The most vulnerable body regions due to the real-world accident are neck. The 86.3% of total injured driver in minor rear damaged vehicles has reported neck pains and they are followed by whole bodies and head but with much lower occurrence rates.

• The Journal of the Korean life insurance medical association
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• v.27 no.2
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• pp.96-106
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• 2008

Herniate disc disease is one of the biggest problem in claim of insurance as well as in medical. Herniate disc disease have recently increased, and it is ranked 8th in claim reasons recently. As an underwriter and physical therapist, I want to study interrelationship of insurance and disc disease. I think it is necessary to know about knowledge of medical, so this study is given some space to structure of spine, cause of herniated disc disease, role of disc, methods of classification of disable (McBride method and AMA method), and spine disability stage. disc surgery is divided laparoscope disc surgery and spine surgery. I analysis it some factors- gender, age, occupation, re-surgery, and state of after surgery - through searching medical papers. I suggest below conclusion to underwriter because it can be useful to make questionnaire, and underwriter can expect prognosis. conclusion The negative factors of disc surgery (compare to other cases) were as follows: 1. endoscope disc surgery: $20{\sim}40year$ old man, hospitalization period more than 5 days. 2. spine surgery: $45{\sim}70year$ old woman, hospitalization period more than 15 days. 3. re-surgery experience: exist 4. working condition: a person who draws a small income, non-regular worker, working period is less than 1 year. 5. method of surgery: pedicle screw fixation. spine fusion surgery, artificial disc surgery. 6. post surgery condition: appearance of muscle weakness, paralysis, reference pain, lordosis, kyphosis, and complication. smoker or take a drink.

• Korean Journal of Clinical Pharmacy
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• v.22 no.4
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• pp.291-303
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• 2012

As respiratory tract infections (RTI) account for about 60% of all antibiotic prescriptions in outpatient care setting, there are significant concerns about emerging resistance that are largely due to the excessive or inappropriate use of antibacterial agents for viral respiratory infections. This study was aimed to develop retrospective drug utilization review (DUR) program of antibiotics for RTIs using Delphi methods. Retrospective DUR criteria of antibiotics for RTIs were identified based on clinical practice guidelines and opinion of experts. Expert panel members were clinical doctors and pharmacists and Delphi method was applied by survey on 16 members of panels. The claim data from Korean Health Insurance Review & Assessment (HIRA) were used to examine trends in outpatient antibiotic prescription between Janunary to December of 2008. As results, Quality index for RTI was assessed for the claim type, antibiotics use of quantity, duration, number and cost. Antibiotic prescription rate for RTIs, Defined Daily Dose (DDD), and duration of antibiotics use were more recognized as significant quality index by experts' opinion. Use of first line agents suggested by guidelines was low and duration of antibiotics use was shorter compared to the recommendations. Antibiotics were over prescribed for RITs. However, dose and duration of antibiotics were under-used.

• Journal of the Korea Institute of Building Construction
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• v.13 no.6
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• pp.541-548
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• 2013

During the administration of a construction project, various types of participants are engaged in the project. From the design phase to the maintenance phase, these participants may confront many risks. To avoid these risks, participants should utilize an insurance company or a bond company. The types of risks and liability that a construction manager may face are listed in the construction law or contract. But there are some arguments related to risk transferring and the content of risks. For this reason, construction managers must carefully consider any possible risks in the contract and the construction law. Therefore, for construction managers to deal with risks appropriately, the introduction of a legal requirement to carry professional liability insurance, a defined compensation range for damages, a method of guarantee in the event of defects, a defined compensation claim period for damage, and a method of damage claim were suggested in this study.

• The Journal of the Korea Contents Association
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• v.21 no.8
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• pp.305-314
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• 2021

According to the recent judgment of Supreme Court, in case when the National Health Insurance Service pays the insurance to a victim of torts, and then subrogate the victim's claim for damages, the scope of institution's subrogation should be limited to the amount of the assailant's responsibility rate of the institution charge, and the amount of compensation claimed by the victim to the assailant should be calculated in the method of contributory negligence after deduction. The court has judged that the institution could subrogate the whole amount of institution charge in the limit of assailant's damages, and the method of deduction after contributory negligence should be applied when calculating the assailant's damages to the victim. Supreme Court decision is greatly significant in the aspect of harmonizing the nature of health insurance as property right and social insurance as the beneficiaries could get additional supplement, and also seeking the balance between insurer and beneficiary. With the changed legal principles of Supreme Court in the scope of institution subrogation like this, the necessities to complement the litigation relation, legislation, and institution were suggested.

• Journal of the Korean Data and Information Science Society
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• v.18 no.4
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• pp.1093-1101
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• 2007

Bonus-Malus system in automobile insurance rewards claim-free policyholders by premium discounts and penalizes policyholders with claims by premium surcharges. The purpose of adopting bonus-malus system is to alleviate differences in risk propensity. A well-known side-effect of bonus-malus system is the tendency of policyholders to pay small claims themselves and not report them to their, in order to avoid future premium increases. This phenomenon is called hunger for bonus. In this paper, we introduces an alternative approach to the Bonus-Malus system in automobile insurance - the approach is based on a deductible theory; and then search for a proper way combining both of them. Also, we construct a new algorithm to determine the optimal strategy of the policyholder based on the proposed model.

• The Journal of the Korean life insurance medical association
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• v.29 no.2
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• pp.22-28
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• 2010

Medical risk selection or mortality analysis is very important in insurance medicine. Among many kind of source articles there have been several limitations. There are few long-term follow-up studies in rare disease, as Romeo's article. We can do mortality analysis of this type using cause of death within the article and assumption of expected mortality q'. In the case of article which is published in foreign country such as Tikkanen et al, we can use comparative group from the control group within source article. It is another way for mortality analysis of limited article. However Retrospective study even performed in Korea, is unusable for estimation of extra-mortality.

• Journal of the Korean Society of Safety
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• v.32 no.3
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• pp.151-159
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• 2017

This study deals with characteristics and risk of a PM based on user survey result, road driving test and data analysis of PM accident. Text mining method is applied to extract PM accident data from Big Data, which are claim data of private insurance company. Road driving test and survey on safety, convenience, noise, overtake ability, steering ability, and climbing ability of PM are performed to evaluate user's safety and convenience considering domestic road condition. As the result of claim data analysis, annual average increase rate of PM accident is 47.4% and average compensation of personal mobility is higher than that of bicycle by maximum 1.5 times. 79.8% of PM accident is self-caused accident due to unskilled driving and age-specific diagnosis rate of driver over 60 is higher than that of under 60. Diagnosis rate of over 60 at lower limb, foot, rib and spine is especially higher than that of under 60. As the result of road driving test and user survey, satisfaction level on safety and convenience of PM is evaluated as close to that of bicycle and satisfaction level of PM is increased after boarding. Overtake ability, steering ability, and climbing ability of PM are evaluated as same or better than that of bicycle but warning equipment to pedestrian or bike such as horn is required because noise level of PM during driving is too low. Finally, user survey result shows that bicycle road is suitable for PM and safety standard, advance-education and insurance are required for PM. It is suggested that drivers' license for PM can be replaced by advance-education. Results of this study can be used to prepare safety measures and legal basis for PM operation.