• 의료법학
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• 제15권1호
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• pp.185-209
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• 2014

While the local health insurance and the employment-based insurance were integrated in July 2000, the insured is divided into employment-based insured and the local insured and the relevant premium has been applied to both groups. The health insurance premium having the feature of social solidarity has to be determined depending on income, that is, the ability to pay in accordance with the principles of social insurance. While employment-based insurance premium has been determined depending on the earned income, the local insurance premium for the local insured has been determined by scoring gross income(evaluated income), property and possession of automobiles. A variety of improvement approaches has been implemented including introduction of the employment-based insurance premium ceiling system (2002) and the change of property scoring system for the local insured (2006). However, the health insurance system which was merged in 2000 has been implemented up to now without significant change even though there were lots of socio-demographic change including increase of income level and the population structure such as low birth and aging. In other words, it is required to implement the premium rating system securing the income-based equity. Nevertheless, it was inevitable to apply the diverse rating standards in the early stage because it was very difficult to verify the income of the self-employed. Although the income verification rate was significantly increased from 23% in 1989 to 44% in 2010, the irrational standards including property, automobiles, living standard and activity rate have been still applied to the local insured because it is difficult to secure the validity of insurance premium rating system and it severely lacks of security. This paper investigated whether the current insurance premium rating system for the local insured imposing the premium on the basis of 'gender' and 'age' complies with the basic human rights secured by the current Constitution of the Republic of Korea with respect to the practical and theoretic irrationality of insurance premium rating system and standards for he local insured. In accordance with the analysis results, this paper proposed the approach to improve the system.

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

• 대한건축학회논문집:구조계
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• 제35권1호
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• pp.29-36
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• 2019

In the past, social insurance premiums, such as national pension and national health insurance, is contained within the costs of construction projects, have been lowered due to price competition of companies participating in the bidding. The government is implementing the "Ex-post settlement system" to improve the problem. Therefore, the purpose of this study is to examine the concept of an Ex-post settlement system and background of its introduction and to identify problems in the management of the system. The problems of the Ex-post settlement system are: 1) avoiding the participation of construction workers, 2) the rigidity of the insurance premium settlement method in construction field, and 3) the cause of direct construction cost reduction. The ways to improve these problems are: 1) excluding social insurance premiums from construction project cost, 2) securing flexibility of the settlement method of insurance premiums in construction field, and 3) expanding the scope of persons eligible to participate in social insurance.

• 보건행정학회지
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• 제30권2호
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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.

• 무역학회지
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• 제45권3호
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• pp.133-146
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• 2020

In the UK's the insurance law 2015, a remedy for breach of warranty in marine insurance was introduced. Also, if the insured proves that breach of warranty in marine insurance does not affect damages, the insurer pays the insurance money to the insured. The UK's marine insurance law has served as the governing law that has been the standard for the marine insurance industry for a long time. Korea and China were heavily influenced by the UK maritime insurance law. Therefore, this study analyzed the cases of breach of warranty in marine insurance in Korea and China. Through this, the insurer avoid the insurance contract for an accident that occurred after the breach of warranty. this result will be different under the new revised insurance law system. With the revision to The Insurance Act 2015, one of the biggest change in the insurance system is that it is possible to remedy of the violations of warranty. However, such a revision of the law requires considerable attention as it also changes the interpretation and judgment of the courts. Accordingly, a practical response of the insurance industry is required. It is necessary to prepare for possible disputes in practice.

• 의료법학
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• 제10권2호
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• pp.37-82
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• 2009

Korea has gained the much more performances in the fields of pubic health laws and related policies on the basis of the substantial economic achievements. In 1977, the social medical insurance was established for companies with more than 500 employees, and in 1989, Korea successfully achieved the national medical insurance system covering the total population within only 12 years beginning with multiple insurers. There remained some problems, however, to be improved such as both the low level of contribution rates and benefit packages due to the inefficiency in utilizing limited medical resources. In 2000, all insurers were unified into a single insurer (National Health Insurance Corporation), and special independent Health Insurance Review & Assessment Service (HIRA) was also established. From the origin of medical insurance system in 1977, the Korean reimbursement system has been fee-for-service system, and after the establishment of HIRA, it has been providing objective and expert medical cost review services and health quality assessment services.

• 보건행정학회지
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• 제31권4호
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• pp.423-436
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• 2021

This article summarizes the structure of China's current social health insurance system and reviews the development status of China's private health insurance (PHI). China's medical security system is mainly composed of two parts: basic medical insurance (BMI) and PHI. Among them, the BMI provides reimbursement of basic medical expenses for the insured persons according to different proportions. PHI is a necessary supplement to the BMI and provides assistance to the insured persons in the event of illness or accident. By having PHI, people can obtain medical protection outside the coverage of BMI. In the development of PHI in China, the total medical cost is high and the insurance market size is large, but the proportion of PHI expenditure is low and the personal burden is high. Through this Chinese case, it will be helpful for mutual development between Korean PHI and national health insurance, for Korean insurance companies to enter the Chinese market, and for removing the medical burden on the people.

• 한국콘텐츠학회논문지
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• 제10권8호
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• pp.349-359
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• 2010

본 논문은 온라인보험 청약 프로세스에서 고객들이 보험설계를 마친 후에 프로세스를 종료하지 않고 실제 구매 단계인 청약신청 단계로 유인하기 위해서 개인화된 보험금 지급사례와 보험통계 정보를 제공하는 온라인보험 판매지원시스템을 설계하였다. 온라인보험 판매지원시스템은 사례기반추론의 최근접 이웃 추출법을 이용하여 입력된 고객 특성과 보험금 지급사례간의 유사도를 측정하고, 사례의 최신도를 반영하여 최종유사도가 가장 높은 보험금 지급사례를 고객에게 제시한다. 또한 최종 선정된 보험금 지급사례의 속성과 일치하는 보험통계 정보를 추가적으로 추출하여 보험금 지급사례와 동시에 집약적으로 제공한다. 이를 통해서 고객들에게 보험의 중요성과 필요성을 더욱 깊이 인식시켜 청약신청 단계로 유인시킴으로써 온라인보험의 판매를 지원하게 된다.

• 보건행정학회지
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• 제11권2호
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• pp.29-57
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• 2001

Since the inauguration of the medical insurance system in 1977, the increasing medical expenses which can be menace to tile finance of the medical insurance system, have become major concern in the medical insurance field In Korea. This study focuses on the determinants of the medical expenses in the health insurance in Korea and analyzes the impact of these factors on the increase in the medical expenses. The empirical work is done using the pooled cross-section and time-series data of the medical insurance for the self-employeds and the industrial workers from the year 1995 to 1997. The result of this study shows that the main determinants of the medical expenses in the health insurance are the ratio of the population of the aged to the total population, the frequency of the utilization, number of doctors per capita and the regime changes. Although the increasing trend in the medical expenses seems to be unavoidable, we probably need to add some efficiency to the medical expenses by suppressing the supply and the utilization of the unnecessary medical services. The fee-for-service reimbursement system of today can't suppress the supply of the unnecessary medical services effectively. So we need to convert the present fee-for-service system into DRG's which is known to reduce the medical costs. The increase in the medical expenses comes from a lot of factors. Therefore, we should develop more systematic and comprehensive measures to control the soaring medical expenses in consideration of the various factors such as demand, supply, and the organizational side of the medical system.

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