• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• v.50
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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.

• Health Policy and Management
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• v.26 no.1
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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.

• Health Policy and Management
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• v.3 no.2
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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.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.10
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• pp.47-53
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• 2019

This study examined the effects of risk aversion on the Self-Insurance-cum-Protection activity (SICP) in a two period model, which is in contrast to existing studies that focused on an one period model. The assumption that there is a time difference between making an effort and incurring loss helps examine the effects of risk aversion in the long-term period. An increase in risk aversion always increases the efforts of SICP, whereas existing studies require additional restrictions to both the loss and cost function. Second, an increase in risk aversion always increases the efforts on self-insurance and self-protection. This result is in contrast to that of existing studies in that an increase in risk aversion increases the efforts of self-insurance, whereas the effects on the efforts of self-protection are unclear. Lastly, when there exists a background risk with zero mean and risk aversion increases in a two period model, the prudence condition of the utility function is a sufficient condition to increase the efforts of SICP.

• Health Policy and Management
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• v.2 no.2
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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.

• Korea Journal of Hospital Management
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• v.19 no.3
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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.

• Journal of Wellbeing Management and Applied Psychology
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• v.2 no.2
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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.

• The Korea Journal of Herbology
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• v.27 no.2
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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.

• Journal of the Korea Convergence Society
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• v.7 no.5
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• pp.201-211
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• 2016

This paper uses the Panzar Rosse model to investigate the competitive conditions in the Korean life insurance companies over the period of 1999 2012. We break down the entire sample period into four distinctive groups and analyze the competitiveness of each period. The results indicate that for the pre-introduction of Bancassurance period, the H-statistic is -1.3984 and the life insurance market is found to be in monopoly or cartel. However, for the post-introduction of Bancassurance period, the H-statistic is 0.9107 and the life insurance market appears to be in monopolistic competition. The results from the introduction of retirement pension system are very similar to those of the introduction of Bancassurance. Overall, the findings indicate that the Korean life insurance market is in long-run equilibrium before the new system introduction, but make adjustments to the new equilibrium.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.12
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• pp.469-474
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• 2020

This study explains the characteristics of micro-insurance based on the theoretical model of health insurance, such as the low demand of low-income people and the lower demand of higher risk aversion. In particular, these characteristics contradict the existing insurance theory which states that the lower the income, the higher the risk aversion, and the higher the demand for insurance. This study postulates a two-period model focusing on health insurance, contrary to a one-period model assumed in existing studies. As a result, first, we show that the decrease in income leads to a decrease in the preventive effort for illness. Second, we offer a model for micro-insurance in which the individual chooses a partial insurance under an actuarially fair insurance premium, while full insurance is optimal in existing studies. Third, we also show that the insurance demand decreases when the outlook for the future improves. Fourth, we finally show that the lack of trust and default risk of the insurer decrease the insurance demand as risk aversion increases.