• 한국융합학회논문지
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• 제6권6호
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• pp.247-253
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• 2015

본 연구에서는 한국과 일본의 암검진 사업의 수검율에 영향을 주는 정책적 요인에 대한 융합연구를 통해 분석하였다. 그 결과는 첫째로 국민건강보험제도의 보험자가 단일보험자일 경우 통합적인 암검진 사업이 가능하기 때문에 검진율에 영향을 미칠 것으로 분석되었다. 둘째로 암과 같은 중증질병에 걸렸을 때 예상되는 의료비 부담이 높으면 경제적 인센티브가 작동하게 되어 검진율에 영향을 미칠 것으로 분석되었다. 일본의 경우에는 건강보험에서 보장하지 않는 비급여항목이 거의 없고 본인부담상한제 등이 잘 정비되어 있어 중증질환이라도 의료비부담이 낮기 때문에 암검진의 수검율이 개선되지 않는 측면이 있다. 일본은 건강보험제도의 보장성 강화가 암검진에 대한 경제적 인센티브를 약화시키는 정책적 요인으로 작용한 것으로 나타났다.

• 한국IT서비스학회지
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• 제16권3호
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• pp.17-45
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• 2017

Health Information Exchange (HIE) is expected to improve the quality and efficiency of care by allowing providers online access to healthcare information generated by other providers at the point of care. However, the adoption of the technology in Korea has been slow since its pilot program in 2007~2010 at Seoul National University Bundang Hospital. The objective of this study was to survey stakeholders on the incentive program for the facilitation of HIE adoption. We surveyed 39 experts representing 6 categories of stakeholders-provider, insurer, government, information service firms, customers, and medical informatics experts for the interviews. Interview questions included program objectives, program participation requirements, incentive payment method, and administrative burden for program participation. Experts indicated that the quality of care was the most important value the program should aim to achieve through the HIE adoption. They suggested that the requirements and administrative burden for participation should be kept at minimum to recruit a large number of providers to the program, which is an indicator of program success. Experts were divided on the payment method whether the incentive should be paid as a part of the fee payment scheme operated by the National Health Insurance (NHI) or should be a payment made independent of the NHI. The source of the divide was conflict of interest among stakeholders as to who pays for the program, and the insurer and consumer groups were against the NHI taking the financial burden. It appeared to be the most significant factor for the successful program launching to resolve the gap in perceptions about benefits of the technology among stakeholders and to win the willingness to pay for the program.

• 무역상무연구
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• 제72권
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• pp.57-80
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• 2016

Since 2006, the Law Commission and Scottish Law Commission have been engaged in a major review of insurance contract law, finally leading to the legislation of Insurance Act 2015. According to the enforcement of the Insurance Act 2015 on 12 August 2016, ss 18~20 of the Marine Insurance Act 1906(MIA 1906) were repealed and substituted by the new concept of fair presentation. This article intends to analyze the legal implications through the comparative research between the duty of fair presentation in Insurance Act 2015 and ss 18~20 of MIA 1906. The major changes in Insurance Act 2015 are designed to (1) encourage active engagement by the insurer rather than passive underwriting, asking questions of the insured if the desired information is not provided at the stage of proposal; (2) encourage policyholders to structure and signpost their presentation in an clear and accessible way, and prevent data dumps; (3) give guidance as to how the insured should prepare a fair presentation, by undertaking a reasonable search of available information and giving examples of what circumstances might be material; (4) clarify whose knowledge in the insured's organization is attributed to the insured for the purposes of disclosure; (5) clarify the exceptions to the duty of disclosure, including circumstances "which are known or presumed to be known to the insurer"; and (6) replace the remedy of avoidance in all circumstances with more proportionate remedies. This is a default regime, which may be altered by agreement between the parties.

• 한국산학기술학회논문지
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• 제21권1호
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• pp.417-425
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• 2020

본 논문에서는 손해보험회사의 특별계정 의존도가 기업가치와 어떠한 관련성을 가지는지에 대하여 연구하였다. 심태섭 외(2015)에서도 언급하고 있듯이 보험회사의 특별계정은 일반계정과 다른 속성을 가진 계약으로 구성되어 있으므로, 보험회사의 특별계정 의존도에 따라 기업가치가 달라질 가능성이 있다. 이에 본 논문에서는 2011년도부터 2018년도까지 국내 상장 손해보험회사의 분기별 재무제표 자료와 주가자료를 이용하여 특별계정 의존도가 기업가치에 대해 갖는 관계를 분석하였다. 분석결과, 손해보험회사의 특별계정 의존도를 나타내는 변수는 손해보험회사의 기업가치에 대하여 유의적인 음(-)의 관련성을 가지는 것으로 나타났다. 이러한 연구결과는 손해보험회사의 특별계정 의존도가 높고 낮음에 따라 총괄계정 순자산과 순이익이 동일한 상황에서 해당 손해보험회사의 기업가치는 달라질 수 있음을 시사한다고 할 수 있다. 본 연구는 기업가치 극대화 관점에서 특별계정의 운용에 대한 경영적 시사점을 제공함과 아울러 특별계정의 운용성과를 보다 직접적으로 확인할 수 있는 공시제도가 필요할 것임을 시사한다.

• 무역학회지
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• 제44권2호
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• pp.83-94
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• 2019

Article 17 of the Marine Insurance Act (MIA) states that "A contract of marine insurance is a contract based upon the utmost good faith, and if the utmost good faith be not observed by either party, the contract may be avoided by the other party." In the Carter v. Boehm case, Lord Mansfield was the first to provide a comprehensive description of the duty of utmost good faith, which is analyzed here. This judgement not only laid the foundation for the Modern English Insurance Act, but it also influenced the draft of the English Insurance Act of 2015, which aimed at correcting distortions that occurred during the application of statue law and common law thereafter. The duty of utmost good faith, applied between Lord Mansfield's insured and insurer presents the context of information asymmetry of the insured and insurer entering contracts. In the absence of information asymmetry, in contrast to the effects of being in both sides of the duty of utmost good faith, alleviating the duty of disclosure of the insured, and it is also clear that the warning of the severity of the retrospective avoidance of the breach of duty of disclosure and the need for its limited application have already been pointed out. Furthermore, considering the principle of retrospective avoidance, the duty of utmost good faith should be understood as a concept limited to the duty of disclosure before a contract is concluded

• 한국병원경영학회지
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• 제2권1호
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• pp.1-21
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• 1997

In order to analyze the shifts in the volume and profits of Computed Tomography(CT) and Magnetic Resonance Imaging(MRI) utilization for a year before and after the implementation of insurance coverage for CT, this study has been undertaken examining CT and MRI cost data from 'Y' University Hospital situated in Seoul, Korea. Following are the results of this study: 1. The medical insurance payment for CT, implemented on January 1, 1996, increased CT utilization from January 1996 to April 1996 due to low insurance premiums: however, from May 1996 the number of CT cases significantly decreased as a result of strengthened medical cost reviews and the new 'Detailed standards for approval of CT' announced near the end of April 1996 by the insurer. 2. Since the implementation of insurance coverage for CT, CT fee reduction rates for reimbursements by the insurer to the hospital were 50% and 40% for January and February, respectively, and 31% and 15% for March and April. A significant point in the lowering of the reduction rate was reached in May at 11%; furthermore, since June the reduction rate fell below the average reduction rate for reimbursements for all procedures. If the 'Detailed standards for approval of CT' had been announced before the implementation of insurance coverage for CT, CT utilization would not have been so high due to the need to meet those 'standards'. In addition, loss of hospital profits resulting from the reduction for reimbursements would not have occurred. 3. The shifts in MRI utilization showed that there was no particular change with the beginning of insurance coverage for CT, and the introduction of the 'Detailed standards for approval of CT' made MRI utilization increase because MRI is free of restrictions imposed by the insurer. 4. The relationship between CT utilization and MRI utilization showed that they were supplementary to each other before insurance coverage for CT, but that CT was substituted for MRI because of strengthened medical cost reviews after t~e beginning of insurance coverage for CT. 5. The shifts in volume by patient characteristics showed that the number of inappropriate case patients, according to the insurer's "Standards for approval", decreased more than the number of appropriate case patients after the introduction of insurance coverage for CT. Therefore, the health insurance fee schemes for CT have influenced patient care. 6. The shifts in profits from CT utilization showed a net profit decrease of 31.6%. In order to match the pre-coverage profit level, 5,471 more cases would need to be seen and productivity would need to be increased by 32.7%. This profit decrease resulted from a decrease of CT utilization and low reimbursements. With insurance coverage, net profits from CT were 24.4%, and a margin of safety ratio was 39.6%. Because of the net profits and margin of safety ratio, CT utilization fees for insured appropriate cases could not be considered inappropriate. 7. The shifts in profits from MRI utilization before and after the introduction of CT coverage showed that in order to match pre-CT coverage profit levels, 2,011 more cases would need to be seen and productivity would need to be increased by 9.2%. The reasons for needing to increase the number of cases and productivity result from cost burdens created by adding new MRI units. But with CT coverage already begun, MRI utilization increased. Combined with a minor increase in the MRI fee schedule, MRI utilization showed a net profit increase of 18.5%. Net profits of 62.8% and a 'margin of safety ratio' of 43.1% for MRI utilization showed that the hospital relied on this non-covered procedure for profits. 8. The shifts in profits from CT and MRI utilization showed the net profits from CT decreased by 2.33billion Won while the net profits from MRI increased by 815.7million Won. Overall, these two together showed a net profit decrease of 1.51billion Won. The shifts in utilization showed a functional substitutionary relationship, but the shifts in profits did not show a substitutionary relationship. From these results, We can conclude that if insurance is to be expanded to include previously uncovered procedures using expensive medical equipment, detailed standards should be prepared in advance. The decrease in profits from the shifts in coverage and changes in fees is a difficult burden that should be shared, not carried by the hospital alone. Also, a new or improved fee schedule system should include revised standards between items listed and the appropriateness of the fee schedule should constantly be ensured. This study focused on one university hospital in Seoul and is therefore limited in general applicability. But it is valuable for considering current issues and problems, such as the influence of CT coverage on hospital management. Future studies will hopefully expand the scope of the issues considered here.

• Journal of applied mathematics & informatics
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• 제32권3_4호
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• pp.343-357
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• 2014

In many non-life insurance applications past data are given in a form known as the run-off triangle. Smoothing such data using parametric crisp regression models has long served as the basis of estimating future claim amounts and the reserves set aside to protect the insurer from future losses. In this article a fuzzy counterpart of the Hoerl curve, a well-known claim reserving regression model, is proposed to analyze the past claim data and to determine the reserves. The fuzzy Hoerl curve is more flexible and general than the one considered in the previous fuzzy literature in that it includes a categorical variable with multiple explanatory variables, which requires the development of the fuzzy analysis of covariance, or fuzzy ANCOVA. Using an actual insurance run-off claim data we show that the suggested fuzzy Hoerl curve based on the fuzzy ANCOVA gives reasonable claim reserves without stringent assumptions needed for the traditional regression approach in claim reserving.

• 한국항해학회지
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• 제18권2호
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• pp.111-127
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• 1994

A Contract of marine insurance is a contract whereby the insurer undertakes to indemnity the assurd, in manner and to the extent thereby agreed, against marine losses that is to say, the losses incident to marine adventure. But the matter is that whether the problem of increased risk in insurance law should be understood by matching to nay state under general principle of contract law and whether that we should give any effect is more proper to the original object of the system. For this, it is understood that it is a case to be applied a "clausula rebus sic stantibus" in general today, but it is regarded as the matter that whether "clausula rebus sic stantibs" is charging any position in change of risk and whether we should understood the concept of the risk on the substance of the risk. Accordingly the recognition for the problem like this, study should examine closely into whether any system for the effect of increase in change of risk is more proper and rational system provide the supplementing points through our principle of insurance law and the study by comparing method.by comparing method.

• 한국항해학회지
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• 제18권4호
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• pp.59-81
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• 1994

Korean property and liability insurance companies have underwrited hull insurance without proper undrewriting ability. But after April 1996. in case of Korean insurance market being opened the companies have to make hull insurance rate by themselves. Accordingly, in this study, the writer embodies important factors in making hull insurance rate by an empirical survey. In empirical survey, the writer used a questionnaire, 74 proper data was obtained from 96 officers working in making hull insurance rate in 12 Korean property and liablity insurance companies and 24 the foreign companies at home. Reliability was tested by Cronbach's Alpha and a conceptual validity by Factor Analysis. Hypothesis estabilished in this study was tested by Correlation and Multiple Regression Analysis. Results of testing hypothesis are as follows: Firstly, the traits of insurer and the assured influence significantly(P<0.05) on making hull insurance rate. Secondly, expected loss ratio, ship manager, ship's age, insured amount, level of the cost of repairing and salvage, shipowner, period of insurance, level of overseas rating, profit and expense, trading limits, ship's classification, conditions of insurance, and ship's size influence significantly(P<0.05) on making hull insurance rate.

• 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.