• 보험의학회지
• /
• 제32권2호
• /
• pp.28-32
• /
• 2013

We studied trends of cardiac valve surgery using insurance data. 368 persons were included our study. We studied whether there are frauds or not. Only 4 cases were done at less than 1year from an insurance contract. We reviewed medical records of all persons. We could find the type of valve disease in 211 cases. The findings are atrial valve 40.1%, mitral valve 34.6% and others 25.3%. When we divided by materials of surgery, mechanical valves were used in 68.8% of men and 70.6% of woman. The main causes of valve disease were infection(55.1%). And degenerative valve disease 32% and congenital valve disease were 13%. We cannot find definite evidence of insurance frauds in the cardiac valve surgery. But there are some limitation in data analysis.

• Journal of Multimedia Information System
• /
• 제8권1호
• /
• pp.69-74
• /
• 2021

This paper accumulates the product structure data such as bond obligation ratio and investment ratio for variable insurance using crawling from the insurance company's API, also accumulates variable insurance income and project expenses for variable insurance using crawling from the API of life insurance association. From these accumulated data, the correlation coefficient between fund product and customer preference is calculated with an investment algorithm, and variable insurance funds by customer investment preference and product structure are recommended according to market conditions. From the simulation results, it is shown that the proposed variable insurance management system properly recommends and manages variable insurance according to customer preferences.

• Environmental Analysis Health and Toxicology
• /
• 제30권
• /
• pp.12.1-12.7
• /
• 2015

Objectives In South Korea, health insurance data are used as material for the health insurance of national whole subject. In general, health insurance data could be useful for estimating prevalence or incidence rate that is representative of the actual value in a population. The purpose of this study was to apply the concept of episode of care (EoC) in the utilization of health insurance data in the field of environmental epidemiology and to propose an improved methodology through an uncertainty assessment of disease course and outcome. Methods In this study, we introduced the concept of EoC as a methodology to utilize health insurance data in the field of environmental epidemiology. The characterization analysis of the course and outcome of applying the EoC concept to health insurance data was performed through an uncertainty assessment. Results The EoC concept in this study was applied to heat stroke (International Classification of Disease, 10th revision, code T67). In the comparison of results between before and after applying the EoC concept, we observed a reduction in the deviation of daily claims after applying the EoC concept. After that, we categorized context, model, and input uncertainty and characterized these uncertainties in three dimensions by using uncertainty typology. Conclusions This study is the first to show the process of constructing episode data for environmental epidemiological studies by using health insurance data. Our results will help in obtaining representative results for the processing of health insurance data in environmental epidemiological research. Furthermore, these results could be used in the processing of health insurance data in the future.

• 통상정보연구
• /
• 제10권4호
• /
• pp.513-532
• /
• 2008

The purpose of this study was to analyze which factors have had impacts on extension export insurance charge of Korean export insurance. In order to attainment of this study, an empirical study was proceeded. The export insurance charge was hired as the dependent variable and export insurance premium, insurance compensation charge, export insurance collection charge and export insurance fund were used as independent variables. Data was used for estimation are the annually data from 1969 to 2007. From results of this analysis, we find the hired variables have highly correlation among them and the most influential factor turns out to be export insurance fund. Main results of this study was as follows : i) The export insurance fund must be increased immediately. ii) It is necessary that Korea Export Insurance Corporation give their attention to the compensate amount of export insurance compensation on specific insurance item. iii) It is necessary that Korea Export Insurance Corporation extension the collection efforts of the export insurance. iv) A reasonable raising of export insurance premium need to be done.

• 경영정보학연구
• /
• 제5권1호
• /
• pp.49-60
• /
• 2003

본 연구의 목적은 현재 심각한 사회 및 경제 문제로 대두되고 있는 보험사기를 효과적으로 적발하기 위하여, visualization 데이터마이닝 tool을 실제 사례에 적용하여 그 타당성을 검증하는데 있다. 이를 위하여 최근 가장 효과적인 visualization 데이터마이닝 tool로 인정되고 있는 i2사의 Analyst's Notebook을 활용하여 대량의 보험금 청구 자료로부터 보험사기의 혐의가 가는 거래를 찾고, 이를 근거로 보첩사기의 혐의를 입증하는 일련의 과정을 검토하였다. 그 결과 visualization 데이터마이닝 tool이 대량의 보험금 청구 자료에서 혐의가 가는 거래를 찾는 단순한 예측의 수준을 넘어, 관련 범죄를 추적하여 체계적, 계획적으로 기획된 보험사기단을 추적해내는 성과를 올렸다. 따라서 보험사기 둥과 같은 부정거래나 범죄 행위를 적발하는 데는 visualization 데이터마이닝 tool이적합한 것으로 판명되었다.

• 한국병원경영학회지
• /
• 제26권1호
• /
• pp.71-82
• /
• 2021

Purpose: The purpose of this study is to estimate incomes and costs of the medical clinics by using secondary data. Methodology: The medical incomes and costs were estimated from 405 clinics operated by sole practitioner providing out-patient services among all clinics subject to the Medical Cost Survey on National Health Insurance Patients in 2017, excluding dental clinics and oriental medical clinics. The incomes and costs of the medical clinics were reflected with incomes and costs of health insurance benefits and were calculated by types of medical services (i.e., basic care, surgery, general treatment, functional test, specimen test and imaging test). The costs were classified as follows: labor costs, equipment costs, material costs and overhead costs. Secondary data was used to estimate the incomes and costs of the medical clinics. For allocation bases for costs for each type of the medical service, the ratio of revenue from health insurance benefits by types of medical services was applied. However, labor costs were calculated with the activity ratio by types of medical services and occupations, using clinical expert panel data. Finding: The percentage of health insurance income for all medical income was 73.1%. The health insurance cost per clinic was 401,864 thousand won. Labor cost accounted for the largest portion of the health insurance income was 191,229 thousand won (47.6%), followed by management cost was 170,018 thousand won (42.3%), materials cost was 35,434 thousand won (8.8%), and equipment costs was 5,183 thousand won (1.3%). Practical Implications: This study suggests a method of estimating incomes and costs of medical clinic services by using secondary data. It could efficiently provide incomes and costs to assess an appropriate level of the health insurance fee to the clinics.

• Asia pacific journal of information systems
• /
• 제1권1호
• /
• pp.147-163
• /
• 1991

The insurance industry is highly competitive since it is difficult to differentiate one company's service from another. This paper examines how Ankuk Fire & Marine Insurance has differentiated its service and improved its competitive edge against others by using electronic data interchange (EDI). In order to improve its service level, Ankuk Fire Insurance has significantly reduced paper work by transmitting information electronically to its customers. This was possible with standardized product codes and databases which were installed both on the Ankuk and customer premises. Ankuk Fire Insurance transmits its customer's insurance information to the customer's database instead of hand-carrying or mailing it. The main benefits of this has been: (1) fewer errors as data does not need to be re-entered, (2) faster customer service with electronic data delivery, and (3) better quality customer service due to highly structured relationships with customers. EDI will soon be available to all insurance companies due to the goverment's aggressive promotion of a KTNet plan. Ankuk Insurance, therefore, needs to adopt the standardized protocol recommended by KTNet and develop new products which will give them a competitive edge and minimize the possibilities of losing their clients to other insurance firms.

• 한국정보시스템학회지:정보시스템연구
• /
• 제31권2호
• /
• pp.217-238
• /
• 2022

Purpose This study aims to develop a work-related injury and illness monitoring geographic information system that analyzes and visualizes the types of work-related injury and illness based on workers' compensation insurance big data. Design/methodology/approach Using the developed system, we explained the process of monitoring the areas of the applied workplace, medical care application, index, and medical care institution. We also showed examples of analyzing the index and medical care institution area. By applying the system, we can intuitively recognize the current status of workers' compensation insurance and confirm the basic information necessary for managing the current status of workers' compensation insurance. Findings We generated more helpful information by combining workers' compensation insurance data and designated medical care institution data. We were able to apply the severity score and the vulnerability index of work-related injury and illness to the system as a demonstration. To efficiently manage workers' compensation insurance, it was necessary to integrate workers' compensation insurance and designated medical care institution data, as well as the data from various sources.

• 대한안전경영과학회지
• /
• 제15권4호
• /
• pp.393-399
• /
• 2013

The purposes of this study were to seek beauty industry parts' current social insurance admission status. To achieve the purposes, questionnaire was distributed to a total of 470 beauty artists and data were analyzed by statistical analysis. The result of study proposed that hairdresser showed the highest awareness and field of nail art showed the lowest awareness in social insurance admission status. Social insurance admission status shows that beauty artists in hair field had the most applicants of national pension, health insurance, workers' compensation insurance and beauty artists of skin field had the highest desire for social insurance application. This study hopes to be used as base line data of social insurance applicants' accurate status and application.

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