• 무역상무연구
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• 제50권
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• pp.139-161
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• 2011

The retroactive insurance is the system that the Assured, the principal of insurance contract shall be entitled to recover for insured(beneficiary in insurance of persons) loss during the period of insurance covered by this insurance, not withstanding that the loss had occurred before the contract of insurance concluded. The retroactive insurance is applicable to both property insurance and insurance of persons. The commercial law of Korea stipulates its rules in the insurance volume. The ultimate and definite articles of cargo insurance about the retroactive insurance are stipulated in MIA and ICC. In general insurance of persons stipulates relevant articles in the clause. Even though articles pertinent to the retroactive insurance are written explicitly in relevant law, it is difficult to settle the claim just by using specified rules of related regulations. Therefore, a claim is settled down based on the actual facts. After studying some of the actual dispute facts connected with the retroactive insurance having properties mentioned, this paper suggests controversial points and alternative ideas.

• 보건행정학회지
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• 제26권1호
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• pp.71-78
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• 2016

The value of using health insurance claim database is continuously rising in healthcare research. In studies where comorbidities act as a confounder, comorbidity adjustment holds importance. Yet researchers are faced with a myriad of options without sufficient information on how to appropriately adjust comorbidity. The purpose of this study is to assist in selecting an appropriate index, look back period, and data range for comorbidity adjustment. No consensus has been formed regarding the appropriate index, look back period and data range in comorbidity adjustment. This study recommends the Charlson comorbidity index be selected when predicting the outcome such as mortality, and the Elixhauser's comorbidity measures be selected when analyzing the relations between various comorbidities and outcomes. A longer look back period and inclusion of all diagnoses of both inpatient and outpatient data led to increased prevalence of comorbidities, but contributed little to model performance. Limited data range, such as the inclusion of primary diagnoses only, may complement limitations of the health insurance claim database, but could miss important comorbidities. This study suggests that all diagnoses of both inpatients and outpatients data, excluding rule-out diagnosis, be observed for at least 1 year look back period prior to the index date. The comorbidity index, look back period, and data range must be considered for comorbidity adjustment. To provide better guidance to researchers, follow-up studies should be conducted using the three factors based on specific diseases and surgeries.

• 보건행정학회지
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• 제3권2호
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• pp.130-158
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• 1993

This study was written to discover the changes that may exist in the contents of medical services after introduction of health insurance system, and to identify the net-effect of health insurance system on medical services. Uncomplicated nornmal delivery and appendectomy patients were divided into 4 groups, the non-insured in pre-NHI periods(group A), the insured of health insurance for employees in pre-NHI periods(group B), the insured of regional health insurance for city residents in post-NHI periods(group C) and the insured of health insurance for employees in post-NHI periods(group D). The mehtod of matching was applied to control for major demographic differences among these 4 groups of each disease. In pre-NHI period, the medical services and the variation of medical services of the non-insured were compared with those of the insured. The difference between the change of medical services from group A to those of group C, and the change of medical services from group B to those group D is defined as the net-effect of health insurance. The results are as follows. First, in length of stay after delivery or operation, total length of stay, some laboratory examination, amount of several drugs used in appendectomy patients, frequency of sitz bath in delivery patients, there was net-effect of health insurance in increasing direction. Second, length of stay after delivery or operation, total length of stay, some laboratory examination, amount of several drugs used in appendectomy patients and frequency of sitz bath in delivery patients were significantly more in the insured than in the non-insured group in pre-NHI period. Third, the variation of medical services of post-NHI period was not less then those of pre-NHI period. Fourth, antenatal care on which the third party does not pay and the patient pays for all, was diffrerent by socioeconomic and educational level of patients.

• 한국산학기술학회논문지
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• 제20권10호
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• pp.47-53
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• 2019

본 연구는 기존 연구에서 초점을 맞춘 1기간 모형과는 달리 2기간 모형에서 위험회피성향의 증가에 따라 노력의 투입에 따라 손실의 크기와 발생확률이 동시에 감소하는 손실통제 노력의 변화를 살펴보고 있다. 노력의 투입과 손실의 발생시점간의 시점 분리를 고려한 본 연구의 가정은 장기에서 위험회피성향의 영향을 관찰할 수 있게 해준다. 그 결과 첫째, 손실함수 및 비용함수에 추가적인 제약이 존재했던 단기 모형인 기존 연구와는 달리 장기에서는 위험회피성향의 증가가 손실통제 노력의 증가를 가져왔다. 둘째, 손실통제 노력을 자가보험 노력 및 자가보호 노력으로 세분화해 볼 때, 위험회피성향의 증가가 자가보험 노력은 증가시키나 자가보호에 미치는 영향이 불분명하던 기존 단기모형의 결과와는 달리, 장기에서는 위험회피성향의 증가로 인해 자가보험 노력 및 자가보호 노력이 모두 증가한다는 것을 알 수 있다. 셋째, 평균이 0인 배경위험이 존재하는 경우 2기간 모형에서 위험회피성향의 증가에 따라 손실통제 노력이 증가할 충분조건은 효용함수가 신중성 조건을 나타내는 것이다.

• 보건행정학회지
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• 제2권2호
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• pp.221-237
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• 1992

The reasons for cost inflation in medical insurance expenditure are classified into demand pull inflation and cost push inflation. The former includes increase in the number of beneficiaries and utilization rate, while the latter includes increase in medical insurance fee and the charges per case. This study was conducted to analyze sources of increases of expenditure in medical insurance demonstration area by the period of 1982-1987 which was earlier than national health insurance and the period of national health insurance(1988-1990). The major findings were as follows: Medical expenditure in these areas increased by 9.4%(15.1%) annually between 1982 and 1990 on the basis of costant price(current price) and for this period, the yearly average increasing rate of expenses for outpatient care[10.5%(15.8%)] was higher than that of inpatient care [7.3%(12.6%)]. Medical expenditure increased by 6.3%(8.9%) annually between 1982 and 1987, the period of medical insurance demonstration, while it increased by 10.7%(18.9%) after implementing national health insurance(1988-1990). Medical expenditure increased by 35.9%(45.9%) between 1982 and 1987. Of this increase, 115.2%(92.1%) was attributable to the increase in the frequencies of utilization per beneficiary and 61.0%(68.1%) was due to the increase in the charges per case, but the expenditure decreased by 76.2%(60.2%) due to the reduction in the number of beneficiaries. Beteen 1988 and 1990, the period of national health insurance, medical expenditure increased by 21.2%(41.4%). Of this increase, 87.5%(46.4%) was attributable to the increase in the frequencies of utilization per beneficiary and 52.4%(73.4%) was due to the increase in the charges per case, and of the increase in the charges per case, 69.6%(40.8%) was attributable to the increase in the days of visit per case. Medical expenses per person in these areas increased by 78.2%(89.0%) between 1982 and 1987. Of this increase, 76.6%(69.1%) was attributable to the increase in the frequencies of utilization per beneficiary and 23.4%(30.9%) was due to the increase in the charges per case. For this period, demand-pull factor was the major cause of the increase in medical expenses and the expenses per treatment day was the major attributable factor in cost-push inflation. Betwee 1988 and 1990, medical expenditure per person increased by 31.2%(53.1%). Of this increase, 60.8%(37.2%) was attributable to the demand-pull factor and 39.2%(62.8%) was due to the increase in the charges per case which was one of cost-push factors. In current price, the attributalbe rate of the charges per case which was one of cost-push factors was higher than that of utilization rate in the period of national health insurance as compared to the period of medical insurance demonstration. In consideration of above findings, demand-pull factor led the increase in medical expenditure between 1982 and 1987, the period of medical insurance medel trial, but after implementing national health insurance, the attributable rate of cost-push factor was increasing gradually. Thus we may conclude that for medical cost containment, it is requested to examine the new reimbursement method to control cost-push factor and service-intensity factor.

• 한국병원경영학회지
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• 제19권3호
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• pp.1-10
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• 2014

The purpose of this study was to present base data for an efficient management of medical expenses at the hospital management by doing grasp of status of medical expenses from seamen's insurance by voluntary agreements. A Object of study is analyzing the data of medical expenses occurred from the total number of 2,699(inpatients 507, outpatients 2,192)cases who were covered by seamen's insurance at a general hospital which is located in Pusan Metropolitan City during 48 months from January 1, 2009 to Dec 31, 2012. The main results of this study are as follows: accrual medical expenses are the ship management companies member of P&I insurance is the most highest but share of receivables are the Korean ocean-going companies member of P&I insurance is the most highest, therefore, Korean ocean-going companies focus strictly than the payments from accounts receivable management should be considered to reduce the occurrence and concerning the turn around period of medical receivables are 4 months to 6 months during a research period. Therefore, it will be needed for managers of hospitals to prepare differentiated management based on the characteristics of each in insurer and to have recovery strategies of uncollected medical expenses.

• 웰빙융합연구
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• 제2권2호
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• pp.1-11
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• 2019

This study empirically examined the effect of female director on tax aggressiveness of listed insurance firms in Nigeria. The main objective of this research was to empirically investigate the effect of female board members on tax aggressiveness, determine the composition and representation of female directors on the board of insurance companies, find out how tax aggressive are listed insurance firms and apply the BLAU (1977) index method to measure female director representation as a departure from conventional approaches specifically in the Nigerian context in the reference period, 2014 to 2018. The population of the study consists of all the quoted insurance firms as at 31st December, 2016. A sample of twenty eight (28) quoted insurance firms was selected and data were collected over the period. Inferential statistic consisting of the General Method of Moment was used for the data analysis. The results obtained reveal that board size is negative and exerts significant impact on tax aggressiveness in insurance firms in Nigeria. The study therefore recommends that the Federal government has to come up with a policy to respond to the marginalization of female on the insurance firm corporate board in Nigeria. The aim of this policy thrust should be targeted at reducing politics and biasness against women on the corporate boards of listed insurance firms.

• 대한본초학회지
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• 제27권2호
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• pp.1-16
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• 2012

Objective : To investigate the current status of prescription drugs in Oriental medical institutes and to draw up a future plan for the revitalization of Oriental medical health insurance, this survey has been performed. Method : The survey has been made with 321 doctors working at Oriental medical institutes in Daegu and Kyungbuk areas for a period of 3 month from June 1, 2010 until September 1, 2010. Result : 1. When it comes to the current status of the use of herbal drugs in Oriental Health insurance, most of doctors surveyed prescribe insurance drugs, and they prescribe insurance drugs to patients, who are less than 20% of total patients visiting their clinics. 2. The awareness of Herbal Health Care Drugs is investigated. When it comes to the understanding of the difference between insurance drugs(powder type drugs) and granular type drugs, doctors admit that they differ only in one aspect, whether or not their being covered by health insurance. Based on the survey results on the understanding of insurance coverage of granular type drugs, doctors, even though they long for granular type drugs to be accepted as insurance drugs, are worrying whether the number of outpatients might dwindle due to increased insurance co-payments. They also point out that the biggest obstacles in the expansion of the granular type drugs as insurance drugs are the lack of understanding of the government and the objection of the Health Insurance Review and Assesment service (HIRA) for fear of increased insurance claims. 3. Upon investigation on Oriental medicine doctors' understandings of herbal pharmaceutical industry, it is found that doctors' responses on pharmaceutical industry are not all positive ones('new product development and neglect of R&D infrastructure' and 'smallness of industry'). When it is investigated what area needs the greatest improvement in herbal pharmaceutical industry, 'securing sufficient capital, good manufacturing, and strengthening quality control', is the highest. 4. When it is asked what are the most needed in order to improve herbal health insurance medicine, responses such as 'the increase in the accessibility to and the utilization of Oriental medical clinics through the diversification of the means of prescriptions', 'the improvement of insurance benefits(cap adjustments)', 'increase the proportion of high quality medicinal plants', 'the ceiling of co-payments(deductible) at 20,000 won or more', 'expansion of the choices of formulations', 'formulational expansions of tablets and pills', and finally 'admittance and expansion of granular type drug as insurance drug' are the highest. 5. Upon investigating the general characteristics of the current status of the usage of Oriental health care herbal drugs, the followings are observed. First, the frequency of use of health insurance drugs by the doctors who use health insurance with general characteristics shows similar differences in case of total monthly sales amount (p<0.001), average number of daily patients (p<0.05). Secondly, as to the willingness of the expanded usage of insurance drugs, similar differences are observed in case of total monthly sales amount (p<0.05). 6. Upon investigating the general characteristics of the perception of Herbal health care drugs, the followings are observed. First, inspecting general characteristics and insurance claims due to increased co-payments(deductible amount) reveals similar differences in case of working period (p<0.01) and in case of total monthly sales amount (p <0.01). Secondly, inspecting general characteristics and the obstacles that hinder granular type drugs from being accepted as health care insurance drugs shows similar differences in case of working period (p<0.05). 7. Upon investigating the general characteristics of the understanding of Oriental Herbal pharmaceutical companies, the followings are observed. First, opinions on the general characteristics of pharmaceutical companies, when examined with variance analysis, shows similar differences in case of total monthly sales amount (p<0.05). Secondly, when opinions are examined on general characteristics and the problems of herbal pharmaceutical companies, similar differences are found in case of working period (p<0.01) and in case of total monthly sales amount (p<0.001). Lastly, opinions on the general characteristics and reforms of pharmaceutical companies, similar differences are observed in case of working period (p<0.001). 8. Upon investigating the general characteristics of the improvement of insurance Herbal drugs, the followings are observed. First, regarding general characteristics and insurance benefits, similar differences are observed in case of working period (p<0.05), in case of total monthly sales amount (p<0.05), and in case of average number of daily patients (p<0.01). Secondly, opinions on the general characteristics and the needs for the improvement of Herbal insurance drugs are examined in 5 different aspects, which are the approval of granular type drugs as insurance drugs, the expanded practices of the number of prescription insurance drugs, the needs of a variety of formulations, the needs of TFT of which numbers of Oriental medical doctors are members for the revision of the existing system, and the needs of adjusting the current ceiling of the fixed amount and the fixed rate. When processed by the analysis of variance, the results show similar differences in case of average number of daily patients (p<0.01). Conclusion : From the results of this study the first measures to take are, to reform overall insurance benefit system, including insurance co-payment system(fixed rate cap adjustment), to expand the number of the herbal drugs to be prescribed matching with insurance benefit accordingly, and to revitalize herbal medicine insurance system through the change of various formulations. In addition, it is recommended to improve the effectiveness of herbal medicine by making plans to enhance the efficacy of herbal medicine and by enabling small pharmaceutical companies to outgrow themselves.

• 한국융합학회논문지
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• 제7권5호
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• pp.201-211
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• 2016

최근의 규제완화 및 금융겸업화 추세로 인한 경쟁의 가속화는 생명보험산업에 큰 영향을 미쳐 생명보험사의 대형화와 인수 합병, 전략적 제휴 등 보험시장구조에 큰 변화를 가져왔다. 본 연구는 이러한 금융환경의 변화가 생명보험산업의 경쟁도에 어떠한 영향을 주었는지를 Panzar-Rosse 모형을 통해 분석한다. 방카슈랑스 시행 이전과 퇴직연금제도 시행 이전의 표본기간을 대상으로 한 분석에서는 H-통계량 값이 음의 값으로 추정되어 국내 생명보험산업이 독점 또는 카르텔로 추정되었으나, 방카슈랑스와 퇴직연금제도 시행 이후의 기간을 대상으로 한 분석에서는 H-통계량 값이 통계적으로 유의하게 양의 값으로 추정되어 생명보험산업이 독점적 경쟁상태로 평가되었다. 분석결과들을 요약하면 방카슈랑스의 시행과 퇴직연금제도의 시행으로 생명보험 회사들의 경영과 서비스의 효율성이 제고 되어 경쟁력 향상이 증진되어서 생명보험산업이 독점적 경쟁상태로 전환되었다고 판단된다.

• 한국산학기술학회논문지
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• 제21권12호
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• pp.469-474
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• 2020

본 연구는 기존의 연구가 설명하지 못하는 저소득계층의 낮은 수요, 위험회피성향이 높을수록 낮은 수요를 보이는 점과 같은 소액보험의 특성을 건강보험에 관한 이론모형을 바탕으로 설명하고 있다. 특히 이러한 특성은 소득이 낮을 수록, 위험회피성향이 높을수록 보험 수요가 높다는 기존의 보험 이론과 배치되는 측면이 존재한다. 본 연구는 기존 1기간 모형에 비해 본 연구는 2기간 모형을 가정하고 있다. 그 결과 첫째, 기존 1기간 모형 하에서와 달리 소득의 감소가 언제나 질병 예방의 노력을 감소시킨다는 것을 보이고 있다. 둘째, 계리적으로 공정한 보험료 하에서 개인이 전부보험을 선택한다는 기존 연구결과와는 달리 소득이 낮은 경우 보험 수요가 낮아질 수 있다는 것을 보이고 있다. 셋째, 본 연구는 미래에 대한 전망이 개선될수록 보험 수요가 낮아질 수 있으며, 넷째, 위험회피성향이 증가할수록 보험수요가 증가해야 한다는 기존 연구결과와는 달리, 보험자에 대한 신뢰 부족 및 파산 우려가 큰 경우 위험회피성향이 증가할수록 보험수요가 오히려 낮아질 수 있다는 것을 이론적으로 증명하고 있다.