• Title/Summary/Keyword: Insurance rate

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Traditional Korean Medicine Usage and Perception: a comparative study between the general population and the disabilities

  • Han, Ji-Eun;Kim, Jihye;Kim, Kyeong Han;Lee, Ji-Yeon;Sung, Soo-Hyun
    • Journal of Pharmacopuncture
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    • v.25 no.1
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    • pp.24-36
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    • 2022
  • Objectives: This study is a comparative analysis of the satisfaction and recognition characteristics for traditional Korean medicine (TKM) in people with disabilities and the general population of Korea. Methods: Here, 5,000 subjects were categorized into two groups based on a disability rating using the data from the 2017 National Survey for the Usage of Korean Medicine. The relationships among the sociodemographic characteristics, TKM usage status, recognition of TKM usage, and recognition of the effectiveness of the TKM treatment were analyzed based on the disease. The response reliability was verified using the chi-square test analysis method. Results: Disabilities corresponded with low rates of high school or higher education (44%, 83.5%) and no jobs (56.9%, 33.5%), mostly the status of the low-income class with a monthly household income of < 1,500 USD (50.9%, 10.5%), poor health conditions (55.2%, 9.8%), high chronic disease prevalence rate (69.0%, 19.9%), high medical care rate (11.2%, 0.5%), and low commercial health insurance subscription rate (44%, 74.2%). Furthermore, people with disabilities visited TKM institutions more often (88.8%, 74.1%) with a high frequency TKM usage rate of ≥ 1-2 times a month (26.2%, 15.3%). They also reported that the cost of using the TKM was very high (14.7%, 8.8%) and that primarily the application of insurance benefits should be improved (52.6%, 47.5%). The treatment effectiveness for diseases was high for musculoskeletal disorders for both people with disabilities and the general population. Conclusion: Preferential application of insurance benefits for musculoskeletal diseases must be extended to the TKM treatment as well, as people with disabilities have a high recognition for these conditions with TKM. It is difficult to perform randomized controlled trials on people with disability. Therefore, large-scale observational and cohort studies should be conducted. We hope this study will help establish a suitable TKM policy for people with disabilities.

The Accuracy of ICD codes for Cerebrovascular Diseases in Medical Insurance Claims (의료보험청구자료중 뇌혈관질환 상병기호의 정확도에 관한 연구)

  • Park, Jong-Ku;Kim, Ki-Soon;Lee, Tae-Yong;Lee, Kang-Sook;Lee, Duk-Hee;Lee, Sun-Hee;Jee, Sun-Ha;Suh, Il;Koh, Kwang-Wook;Ryu, So-Yeon;Park, Kee-Ho;Park, Woon-Je;Kim, Chun-Bae
    • Journal of Preventive Medicine and Public Health
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    • v.33 no.1
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    • pp.76-82
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    • 2000
  • Objectives : We attempted to assess He accuracy of ICD codes for cerebrovascular diseases in medical insurance claims (ICMIC) and to investigate the reasons for error. This study was designed as a preliminary study to establish a nationwide surveillance system. Methods : A total of 626 patients with medical insurance claims who indicated a diagnosis of cerebrovascular diseases during the period from 1993 to 1997 was selected from the Korea Medical Insurance Corporation cohort (KMIC cohort: 115,600 persons). The KMIC cohort was 10% of those insured who had taken health examinations in 1990 and 1992 consecutively. The registered medical record administrators were trained in the survey technique and gathered data from March to May 1999. The definition of cerebrovascular diseases in this study included cases which met ore of two criteria (Minnesota, WHO) or 'definite stroke' in CT/MRI finding. We questioned the medical record administrators to explain the error if the final diagnoses were not coded as stroke. Results : The accuracy rate of the ICMIC was 83.0% (425 cases) Medical records were not available for 8.2% (51 cases) due to the closing of hospitals, the absence of a computer system or omission of medical record, etc. Sixty-three cases (10.0%) were classified as impossible to interpret due to insufficient records in 'major clinical symptoms' or 'neurological deficits'. The most common reason was 'to meet review criteria of medical insurance benefits (52.9%)'. The department where errors in the ICMIC occurred most frequently was the department for medical insurance claims in the hospital. Conclusion : The accuracy rate of the ICMIC was 83.0%.

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Analysis of Institutional Factors Influencing Regional Variations in the Cesarean Section Rate (제왕절개 분만율의 지역간 변이에 영향을 미치는 의료기관 특성요인 분석 -의료보험관리공단 대상자를 중심으로-)

  • 안형식;권영대;이영성;김명기;김용익;신영수
    • Health Policy and Management
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    • v.1 no.1
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    • pp.27-41
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    • 1991
  • The purpose of this study is to estimate cesarean section rate in Korea and analyze characteristics of health care institution which affect regional variation in the rate. We have searched vaginal and cesarean section deliveries among Diagnosis Related Group dat based upon insurance claim bills which have been submitted to Korean Insurance Corporation for two years since March, 1985. The results are as follows: 1. Out of all delivery cases of 87,500, cesarean section rate was 16.3% (14,299 cases). 2. Cesarean section rate varied according to size and ownership of health care institutions. In above 6- bed sized hospitals, the rate was at about 20% higher than small sized institutions, but rather in hospitals that have more than 500 beds, it was somewhat low. Classified by the hospital ownership, the rate was low at 18.4% in hospitals of religious organization and highest at private or corporate hospitals. 3. This study shows large regional variation in cesarean section rate; there are two times differences between region with the highest and lowest rate. Strongly related factors in that variation was the ownership of health care institution and urbanization variables. Low level of cesarean section rate in a region is explained by high proportion of delivery cases at institutions of religious organization and at insitutions in county level site. This result shows that apart from medical conditions of patients, indications of cesarean section differs from health care providers, and especially ownership of institution strongly affect them. Cesarean section rate in Korea is supposed to be at high level and development of utilization review programs to keep appropriate cesarean section rate is needed.

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The Benefits of the National Health Insurance and Oriental Medical Services (건강보험의 보장성과 한방의료 급여확대방안)

  • Kim, Yoon-Hee;Kim, Jin-Hyun
    • Journal of Society of Preventive Korean Medicine
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    • v.11 no.1
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    • pp.139-151
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    • 2007
  • This paper evaluated the benefits of the National Health Insurance(NHI) and suggested the necessity of extending some oriental medical services into the benefits schedule in the NHI. Comparing the rate of public financing in national health expenditure in OECD countries and measuring out-of-pocket payments in total medical cost showed the level of insurance payments to total medical cost is approximately $50%{\sim}60%$ in Korea, which is quite insufficient to pay household medical expenses, although the NHI covers the whole population. A few of consumers' priority surveys for medical needs suggested herb medicine, muscle treatment, and manufactured herb medicine be included in the list of the NHI benefits, based on efficiency and equity criteria. It was estimated that the NHI can afford to cover these three items of oriental medical services.

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Radiological Observation of Coin Lesion in Chest P.A (폐장(肺臟)의 Coin병소(病巢)에 관한 방사선학적(放射線學的) 고찰(考察))

  • Kang, Shin-Hwa
    • The Journal of the Korean life insurance medical association
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    • v.2 no.1
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    • pp.128-134
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    • 1985
  • Circumscribed solitary pulmonary nodule is often founded on the plain chest P-A. Even if many study results of coin lesion have been reported by some scholars, it is still very difficult to judge whether the coin lesion is to be benign or malignant. In order to avoid unnecessary surgical treatment, it must be made an examination and analysis very carefully in advance. In the chest P-A, we can grasp the aspects of the site and size of lesion, marginal state of lesion, calcification, cavity, and the growth rate in comparison to follow-up chest P-A. On the basis of above-mentioned analysis, we have to judge whether it is benign or malignant, and decide the next examinations. And then the doctor make diagnosis definitely by the clinical history, plain chest P-A, tomography, bronchography, CT, variable laboratory findings.

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A Study on the Mortality of Insureds (생명보험(生命保險) 가입자(加入者)의 사망(死亡)에 관한 고찰(考察))

  • Mah, Soon-Cha
    • The Journal of the Korean life insurance medical association
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    • v.2 no.1
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    • pp.116-121
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    • 1985
  • We've reviewed 518 cases of claims by death that had occured for one year from April, 1983 to March, 1984. As a result, we came to following conclusions; First, the greater part of the death were due to Accidental death(19.1%), Heart disease(18.9%), Malignant neoplasm(17.4%), Liver cirrhosis(10.6%), and the Cerebrovascular disease(9.7%), which were occupied by 75.7% of the whole. Second, classifying them by medical examinations or non medical, death in case of non medical examination showed 89% of the whole. And for age, section ranging from 41 to 50, from 51 to 60 and from 31 to 40 took the overwhelming portion by 27.4%, 26.6%, and 17.4% respectively, those of which showed 71.4% of the whole. Third, for the period elapsed, death within 1 year from the entrance showed 31% and that from 1 year to under 2 years 20.5%. Thus the rate of early death under 2 years stood for 51.5% of the whole.

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Review of Bladder cancer (방광암의 이해)

  • You, Hyun Wook
    • The Journal of the Korean life insurance medical association
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    • v.33 no.2
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    • pp.18-24
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    • 2014
  • Bladder cancer is one of the most common cancers affecting men and women and thus has a profound impact on health care. The majority of patients (75%) with newly diagnosed urothelial tumors have non-muscle invasive disease confined to the bladder mucosa or the lamina propria. The most important risk factors for the development of bladder cancer are smoking and occupational exposure to toxic chemicals. Painless visible hematuria is the most common presenting symptom of bladder cancer. Cystoscopy and urine cytology are currently the recommended tools for diagnosis of bladder cancer. Excluding muscle invasion is an important diagnostic step, as outcomes for patients with muscle invasive bladder cancer (MIBC) are less favorable. For non-muscle invasive bladder cancer (NMIBC), the high rate and frequency of recurrence and the concern for disease progression - especially in patients with high-risk tumors - mandate careful strategies for tumor surveillance. The surveillance strategies should be based on available prognostic factors and in particular data from the EORTC risk tables.

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A Study on the Mortality of Insureds Medical Dept. (생명보험가입자(生命保險加入者)의 사망(死亡)에 관(關)한 고찰(考察))

  • Mah, Soon-Cha
    • The Journal of the Korean life insurance medical association
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    • v.4 no.1
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    • pp.86-92
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    • 1987
  • We've reviewed 704 cases of claims by death that had occured for one year from April, 1985 to March, 1986. As a result, we came to following conclusions; First, the greater part of the death were due to Accidental death(25.0%), Malignant neoplasm(21.2%), Heart disease(12.9%), Liver cirrhosis(9.1%), and the cerebrovascular disease(5.5%), which were occupied by 73.7% of the whole. Second, classifying them by medical examinations or non medical, death in case of non medical examinations showed 94.3% of whole. And for age, section ranging from 40 to 49, from 50 to 59, and from 60 to 69 took the overwhelming portion by 28.6%, 24.2%, and 16.6% respectively, those of wich showed 69.4% of the whole. Third, for the period elapsed, death within 1 year from the entrance showed 16.9% and that from 1 year to under 2 years 18.8%, Thus the rate of early death under 2 years stood for 35.7% of the whole.

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OPTIMAL UNEMPLOYMENT INSURANCE BENEFIT STRUCTURE

  • Yun, Jungyoll
    • Journal of Labour Economics
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    • v.23 no.2
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    • pp.39-59
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    • 2000
  • Given the constraint that the unemployment benefit is not allowed to vary freely over the unemployment duration, this paper examines the optimal UI benefit structure. In particular, identifying the conflicting effects of benefit amount and benefit duration upon incentive and insurance, this paper characterizes the optimal combination of UI benefit amount and duration. Based upon some important factors determining the optimal UI benefit structure that are derived from the model, a set of directions for UI reform in Korea have been proposed.

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