• Health Policy and Management
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• v.30 no.2
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• pp.253-262
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• 2020

Background: The public health care system of a country is shaped and driven by its historical background as well as social, economic, and cultural structures. This study sheds light on the unique features, strengths, and weaknesses of the health insurance systems of South Korea (Korea) and Peru. Methods: The capacity mapping tool was used to explore the Korean and Peruvian population and geographical structures; health insurance laws, regulations, and policies; payment systems; eligibility and contribution collection; and long-term care insurance. Results: The study found that the Korean government took the lead in integrating multiple insurers into a single-payer system in an effort to reinforce and stabilize its health insurance system in 2000. Peru has been developed mixed model such based on taxes and contributions, to address a gap between different social classes. Peruvian government developed a two-axis system, one for low-income earners, financed by taxes, and another financed by contributions paid by workers and government officials in the formal sector. Peru has introduced many variations to its fee payment and insurer systems, target population, and coverage scope, and maintains its health insurance system accordingly to this day. Conclusion: The current study provides observation of the Health Insurance System in two different countries and helps to understand possible ways to improve the health insurance system in both countries. Based on this study, Peru will be able to see how its system differs from Korea's and benefit from the related policy implications.

• The Journal of the Korea Contents Association
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• v.21 no.4
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• pp.96-110
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• 2021

Korea is faced with the challenge of adapting to the world's fastest - growing low birthrate, aging society, and low growth with low interest rate era. With low fertility and aging population, the factors of financial income of health insurance are decreasing, and the increase of public interest in health, high cost medical technology and the development of medicine are leading to increase expenditure of health insurance. In this study, I will examine the strengthen protection of health insurance, financial stabilization, and fairness of medical care. First, the present status and limitations of health insurance were identified through domestic policy report, domestic and foreign literature, and precedent research. Second, the foreign health insurance policy measures to stabilize the finances were examined separately. Based on this study, in order to maintain sustainable health insurance through reinforcement and financial stabilization of health insurance, the current financial income structure of health insurance must be renovated. It will be necessary to expand government subsidies and discover new tax revenues. In addition, a policy to save finances by reorganizing the medical bill payment system and medical delivery system will also be needed.

• Journal of dental hygiene science
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• v.18 no.3
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• pp.182-187
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• 2018

As the elderly population increases, they are increasingly affected by oral health problems. Therefore, efforts are being made to improve the oral health of older people, alleviate mental discomfort, and reduce unmet dental needs. This study was conducted to confirm the relationship between the National Health Insurance Elderly Denture Coverage and the unmet dental need for the edentulous elderly, as part of the protection policy. We analyzed the 2011 and 2013 Community Health Survey data of the edentulous elderly, aged 75 years or older, before 2012. In order to more precisely confirm the effects of the denture donation policy on unmet dental care, basic life recipients who were subject to the free elderly prosthetic project were excluded from the analysis. The final analysis included 20,400 subjects. According to our investigation of the factors that affect the unmet dental needs of the elderly, the National Health Insurance Elderly Denture Coverage did not affect unmet dental needs. The statistically significant variables that affected the unmet dental needs of the elderly were education and income levels, which are representative socioeconomic status variables. The lower the level of education, the unhealthier the dental care experience, and income levels showed a similar tendency. The elderly who have a low socioeconomic status are more likely to experience unmet dental needs because they lack the knowledge and socioeconomic ability to pay for dental care. Therefore, the policy for health protection of the entire elderly population should be continuously expanded. In addition, the socioeconomically vulnerable groups may have health problems due to the restriction of medical use, which may lead to quality of life deterioration.

• Korean Journal of Radiology
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• v.22 no.3
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• pp.442-453
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• 2021

Artificial intelligence (AI) will likely affect various fields of medicine. This article aims to explain the fundamental principles of clinical validation, device approval, and insurance coverage decisions of AI algorithms for medical diagnosis and prediction. Discrimination accuracy of AI algorithms is often evaluated with the Dice similarity coefficient, sensitivity, specificity, and traditional or free-response receiver operating characteristic curves. Calibration accuracy should also be assessed, especially for algorithms that provide probabilities to users. As current AI algorithms have limited generalizability to real-world practice, clinical validation of AI should put it to proper external testing and assisting roles. External testing could adopt diagnostic case-control or diagnostic cohort designs. A diagnostic case-control study evaluates the technical validity/accuracy of AI while the latter tests the clinical validity/accuracy of AI in samples representing target patients in real-world clinical scenarios. Ultimate clinical validation of AI requires evaluations of its impact on patient outcomes, referred to as clinical utility, and for which randomized clinical trials are ideal. Device approval of AI is typically granted with proof of technical validity/accuracy and thus does not intend to directly indicate if AI is beneficial for patient care or if it improves patient outcomes. Neither can it categorically address the issue of limited generalizability of AI. After achieving device approval, it is up to medical professionals to determine if the approved AI algorithms are beneficial for real-world patient care. Insurance coverage decisions generally require a demonstration of clinical utility that the use of AI has improved patient outcomes.

• The Journal of the Korean life insurance medical association
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• v.30 no.2
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• pp.8-11
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• 2011

Insurance medicine has been known to medical risk selection. The role of insurance medicine is sound maintenance of insurance system. So it's function is medical underwriting of life risks. However, emerging market has insufficient medical epidemiological research that is necessary for estimation of extra-risk and such market is usually lack of full understanding of life insurance among insurance customers. This problem makes difficult of performing the medical underwriting, as an original insurance medicine. Medical contributions at the stage of claims adjudication comparing the coverage provided in the product, with the information provided in the claims, based on medical records and the agreement between them. This is called medical verification. The insurance doctors can also use their medical knowledge to help the claims staff with informing claimants about the medical basis of claims decisions.

• The Korean Journal of Applied Statistics
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• v.13 no.2
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• pp.247-263
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• 2000

Natural catastrophe is defined as all damages caused by natural phenomenon such as typhoon, flood, inundation, windstorm, tidal wave, tremendous snowfall, drought,earthquake and to on It is classified at a huge hazard because of the large severity ofdamage In Korea, Fire Insurance policy includet the coverage clauses and rates of naturalcatastrophe like'Flood , Inundation Coverage Clause'and'Earthquake Coverage Clause'These clauses and rates do not reflect accurate risk of flood, inundation and earthauakein Korea. because those are tariff from other countries Hence, we determine the claimsize distributions and the rates for typhoon coverage and flood-inundation coverage byusing statistical methods which have not been used so far in Korean non-life insurance,and calculate appropriate premium for policyholder's interest

• Journal of Korean society of Dental Hygiene
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• v.16 no.4
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• pp.531-538
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• 2016

Objectives: The purpose of the study is to investigate recognition and adequacy of dental service providers regarding dental prosthodontic treatment covered by dental auto insurance system. Methods: A self-reported questionnaire was completed by 320 dentists and dental hygienists in Seoul, Gyeonggido, and Incheon from February 22 to March 21, 2016. The questionnaire consisted of recognition and needs of auto insurance (4 items), and recognition of prosthodontic treatment covered by dental auto insurance system. Likert five point scale was used in the questionnaire. Data were analyzed by SPSS 21.0 program. Cronbach's alpha was 0.856 in the study. Results: The average of recognition was 2.62 and that of adequacy of auto insurance coverage was 1.98. The reasonable price of crown treatment was from 400,000 to 500,000 Korean Won in 67.9 percent of the dentists. But 49.8 percent of the dental hygienists answered that the reasonable price of crown was 300,000 to 400,000 Korean Won. The dentists preferred to treatment fee covered by dental auto insurance. The dental hygienists had a preference to combination of dental auto insurance and medical insurance fee. Conclusions: The opinion of the dental care providers should be considered and the adequate coverage of insurance would improve the dental health care.

• The Korean Journal of Applied Statistics
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• v.25 no.3
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• pp.485-501
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• 2012

This research is to find a design D that minimizes forecast variance in d dimensions over the candidate space ${\chi}$. We want a robust design since we may not know the specific covariance structure. We seek a design that minimizes a coverage criterion and hope that this design will provide a small forecast variance even if the covariance structure is unobservable. The details of an exchange or swapping algorithm and several properties of the parameters of coverage criterion with the unknown correlation structures are discussed.

• Journal of Korean society of Dental Hygiene
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• v.21 no.1
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• pp.89-98
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• 2021

Objectives: The purpose of this study was to investigate the perception and satisfaction of caregivers and parents after being covered by health insurance for light-curing composite resin fillings, and to contribute to the settlement of the expansion and coverage of health insurance. Methods: A survey was conducted on caregivers who visited two dental institutions in the Gyeonggi-do area, and parents who joined internet cafes (online communities) in the Gyeonggi-do area from June 2 to September 2, 2020. 225 responses were collected eventually, and 212 valid responses were used as analysis data. Results: 67.0% of the study subjects were aware of the permanent teeth resin fillings being covered by health insurance and the satisfaction was relatively high (91.5%). There was a statistically significant difference in the perception of permanent tooth resin filling benefits according to the child's oral condition (p=0.025) and the parents' own interest in oral health (p=0.039). Conclusions: Based on the results of this study, it is necessary to increase the accessibility to the initial treatment for dental care of children through active promotion of detailed items of permanent teeth resin fillings.

• Research in Community and Public Health Nursing
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• v.21 no.4
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• pp.502-511
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• 2010

Purpose: The purpose of this study was to investigate the influencing factors of influenza vaccination in the elderly participating in lifetime transitional health examination. Methods: This study was a secondary analysis of data collected from lifetime transitional health examination (for 66-year-old people) conducted by the National Health Insurance Corporation (NHIC) from January 1 to December 31, 2008. Questionnaires were received from NHIC to obtain information regarding gender, chronic diseases, health-related behaviors, and ADL. A total of 255,333 participants who responded all the questions in the questionnaire were included in the analysis. Collected data were analyzed by descriptive statistics, ${\chi}^2$ test, and multiple logistic regression. Results: The influenza vaccine coverage rate in 66-year-old people was 66.1%. The influenza vaccine coverage rate was higher in female elders and those with hypertension, diabetes, heart disease or past smoking, and lower in those with stroke, current smoking, drinking, no-exercise or ADL-dependency. Conclusion: Strategies for improving the influenza vaccination coverage rate in the elderly are needed. The strategies should give priority to the elderly with current smoking, drinking, and no-exercise, and home visiting programs are needed for the elderly with stroke and ADL-dependency.