• 한국IT서비스학회지
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• 제6권2호
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• pp.1-18
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• 2007

Many researches have been done in insurance fraud as the amount and frequency of insurance fraud have been increasing continuously. In particular, the development of insurance fraud detection system using large database management techniques including data mining or link analysis based on visual method have been the main research topic in insurance fraud. However, this kinds of detection system were very ineffective to find unintentional insurance fraud happened by accident even though it was so good to find intentional and organized crime insurance fraud. Therefore, this research suggests insurance fraud as an ethical decision making and applies TPB(Theory of Planned Behavior) for the finding of reasons and prevention strategies of unintentional insurance fraud happened by accident. The results of research show that TPB is very appropriate model to explain the behavior of insurance fraud and that insurance agents force to do insurance fraud as affecting perceived behavior control. Therefore, education and pubic relations for insurance fraud are very effective for preventing insurance fraud and developing insurance service industry.

• Journal of the Korean Data and Information Science Society
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• 제26권6호
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• pp.1523-1535
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• 2015

We investigate the effect of introduction of the bancassurance system on cost efficiency in the Korean insurance industry between 1997 and 2012. Our estimation results indicate that introduction of this system contributed positively to efficiency of life insurance companies in Korea. Increase in a one standard deviation of bancassurance increases cost efficiency by 0.08 which is equivalent to 12 percent of mean cost efficiency. Recognising that the bancassurance system is a relatively new concept, our results indicate that the bancassurance system can be a policy measure to improve productivity in an emerging insurance market. The results illustrate that positive effects have accrued particularly to medium-sized companies and domestic companies, contrary to the prevailing perception that increased competition through bancassurance is more beneficial to large companies and foreign companies.

• 가정과삶의질연구
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• 제6권1호
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• pp.117-129
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• 1988

The purposes of this study are 1) to explore the evaluating attribute of family life- insurance 2) to examine the relationship between evaluation attribute variables and level of consumer satisfaction/ dissatisfaction (CS/D), and 3) to investigate the sociodemographic variables and psychological variables which influence the purchase of life-insurance. The data used in this study include 432 households of 208 life-insurance purchasers and 224 non-purchasers Statistics used for the data analysis are x2, factor analysis, multiple regression and a discriminant analysis. The resulting major findings are as follows; 1) The evaluating attributes are saving function, convenience. economic payoff, safety for future accident, agreement of insurance, and reputation of brand. 2) Among these factors. the most important factors. in CS/D of life-insurance are saving function, and reputation of brand. 3) the purchase of life-insurance has been influenced by such sociodemographic variables as husband's age , family income, and family life-cycle. Psychological variables such as attitude of life, perceived risk, consumer attitude about insurance business did not influence the purchase of life -insurance significantly. As mentioned above, we can conclude that Korean purchasers of life-insurance are using irrational evaluating attributes. Therefore more education of the consumers and more information about life-insurance purchases are necessary. Especially low-income households and first step of family life-cycle families are turned out to need more education as well as more information.

• Journal of health informatics and statistics
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• 제43권4호
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• pp.318-328
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• 2018

Objectives: People are living longer, but often with diseases or chronic conditions. As a consequence, interest in resolving insurance blind spots is growing. This study provides substandard risk-relevant statistics to help substandard risks who are likely to fall in insurance blind spots obtain insurance coverage, such as the reimbursement of medical costs, as well as to stimulate insurance product development. Methods: This study uses National Health Insurance Service (NHIS) cohort data to determine the relevant statistics. The incidence rates of severe diseases are derived and compared against standard risks to establish a set of relative risk factors. These incidence rates of standard and substandard risks are then compared. Results: Currently, an individual's cancer history is used in the underwriting process for simplified issue insurance. However, underwriting focusing on hospitalization and procedures related to serious illnesses could lower premiums for substandard risks. Moreover, the statistical results could be used to expand the coverage of health insurance products. Conclusions: This study's relative risk factors can be used to derive simplified issue premium rates for substandard risks. They can also be used to implement discount and loading schemes for medical reimbursement insurance and help insurance companies implement proactive risk management.

• 한국임상약학회지
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• 제21권3호
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• pp.193-207
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• 2011

Purpose: The purpose of this study is to assess appropriateness of current standard for insurance coverage by Health Insurance Review & Assessment Service (HIRA) on chemotherapy used in the treatment of advanced non-small cell lung cancer (NSCLC), by reviewing a variety of clinical evidences, and thereby, if needed, to propose an updated evidence-based recommendations. Methods: We collected data from HIRA regarding on the insurance standard which includes the scope and conditions for coverage on systemic chemotherapy of NSCLC. We performed a search for clinical databases and examined the most current clinical evidence from clinical literature including various clinical practice guidelines. Based on the collected data the appropriateness of HIRA standard for insurance coverage of chemotherapy of NSCLC was assessed. Results: Collected data demonstrated that HIRA standard did not reflect the most current clinical practice and evidence. Some were inappropriately listed in HIRA formulary and accepted as a chemotherapy being covered by insurance, despite the lack of evidences of clinical efficacy or superiority over other chemotherapeutic agents or regimens. In addition, there seems to be a need for a modification on the standard for insurance coverage of certain newer chemotherapeutic agents based on the current accumulated data showing their clinical efficacy and benefits in the selected group of NSCLC patients. Therefore, we concluded that current HIRA standard for insurance coverage on chemotherapy of NSCLC needs to be revised and we proposed an updated recommendation based on these latest clinical evidences. Conclusion: The standard for insurance coverage of chemotherapy should be continually examined its appropriateness based on the most recent clinical evidences in a timely manner so as to provide the most effective and safe therapy to cancer patients.

• 지역사회간호학회지
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• 제22권1호
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• pp.33-44
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• 2011

Purpose: This study examined the characteristics and service utilization of home nursing care beneficiaries under the Korean Long-Term Care Insurance (LTCI). Methods: We used assessment data and claim data of National Health Insurance Corporation from July to August 2008. Data were composed of subjects who were the beneficiaries of home nursing care. Results; A total of 634 subjects were analyzed. Of the subjects, 57.1% were 75 years and over. The average score of nursing care need was only 0.71 and the percentage of those whose nursing care need score was zero was 58.0%. More than half of the subjects had partially dependent musculoskeletal conditions, and 75.5% had two or more comorbidities. A third of them usedonly home nursing care, and another third used both home nursing care and general home care at the same time. Those who needed sore care used the largest home nursing care benefits. Conclusion: Home nursing care of LTCI performs community-based healthcare services under LTCI. Throughout the past two years, however, it has not been active. Understanding the characteristics of its users is important in order to develop effective strategies for activating home nursing care.

• 한국보건간호학회지
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• 제30권3호
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• pp.512-525
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• 2016

Purpose: Ageing in place may improve the quality of life of frail elderly and decrease their costs of services. The purpose of this study was to examine the factors that influence the institutionalization of elderly using home care services in a Korean long-term care insurance system. Methods: This study used the data of '2009 Satisfaction survey of Korean long-term care system'. The survey proceeded to use a sampling data based on region, level of long-term care need, and insurance type among the beneficiaries between August and September 2009. The onset dates of institutionalization of 1,095 participants were ascertained from long-term care insurance claim data. This study calculated the hazard ratio through the Cox Proportional Hazard Model. Results: A total of 176 subjects who were institutionalized in nursing homes were included. There were higher risks in the group that included those who were 85 years and over, had dementia or fracture, used home-visit nursing service, and were not supported by direct family. Conclusion: The results of this study have policy implications to supplement the home care service system and postpone nursing home institutionalization of elderly.

• Management Science and Financial Engineering
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• 제3권1호
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• pp.39-56
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• 1997

This paper applies the binary tree classifier and discriminant analysis methods to predicting failures of banks and insurance companies. In this study, discriminant analysis is generally better than the binary tree classifier in the classification of bank defaults; the binary tree is generally better than discriminant analysis in the classification of insurance company defaults. This situation can be explained that the performance of a classifier depends on the characteristics of the data. If the data are dispersed appropriately for the classifier, the classifier will show a good performance. Otherwise, it may show a poor performance. The two data sets (bank and insurance) are analyzed to explain the better performance of the binary tree in insurance and the worse performance in bank; the better performance of discriminant analysis in bank and the worse performance in insurance.

• Communications for Statistical Applications and Methods
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• 제31권3호
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• pp.323-336
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• 2024

The accurate forecasting of insurance claims is a critical component for insurers' risk management decisions. Hierarchical Bayesian parametric (BP) models can be used for health insurance claims forecasting, but they are unsatisfactory to describe the claims distribution. Therefore, Bayesian nonparametric (BNP) models can be a more suitable alternative to deal with the complex characteristics of the health insurance claims distribution, including heavy tails, skewness, and multimodality. In this study, we apply both a BP model and a BNP model to predict group health claims using simulated and real-world data for a private life insurer in Indonesia. The findings show that the BNP model outperforms the BP model in terms of claims prediction accuracy. Furthermore, our analysis highlights the flexibility and robustness of BNP models in handling diverse data structures in health insurance claims.

• International Journal of Contents
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• 제4권3호
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• pp.1-9
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• 2008

The Korean life insurance industry has undergone profound changes, such as the beginning of the variable insurance in July 2001 and the bancassurance enforcement in August 2003. However, little empirical research has analyzed data that includes the bancassurance of life insurance companies operating in Korea. In response to this lack of research, this paper applies DEA (data envelopment analysis) models to measure and decompose their efficiency. We discovered that life insurance companies operating in Korea are a little different in their composition ratio of inputs and outputs, due to the increased variety of distribution channels and new products. We provided efficiency scores, return to scale, and reference frequencies. We also decomposed CCR, BCC, and SBM efficiency into scale efficiency and MIX efficiency. So, we try to investigate whether the sources of inefficiency were caused by the inefficient operation of DMU, disadvantageous conditions, the difference of the composition ratio in inputs and outputs with reference sets, or any combination of the above. Most companies in the sample display had either constant or decreasing returns to scale. The efficiency rankings were less consistent among models and efficient DMUs. In response to this problem, we used the super-efficiency model to rank them and then compared the rankings of the DMUs among the various models. It was also concluded that the availability of panel data, rather than cross-sectional data, would greatly improve the validity of the efficiency estimates.