• Title/Summary/Keyword: Review Claims Data

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Legal and Institutional Outcomes from the 10-year Struggle against Occupational Diseases of Semiconductor workers (반도체 직업병 10년 투쟁의 법·제도적 성과와 과제)

  • Lim, Jawoon
    • Journal of Science and Technology Studies
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    • v.18 no.1
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    • pp.5-62
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    • 2018
  • Over the last 10 years, the fight against occupational diseases of semiconductor workers led by SHARPS(the Supporters for the Health And Rights of People in the Semiconductor industry, NGO) has accomplished considerable achievements, especially in the legal and institutional aspects. First, the court and the government accepted the claims that 24 injured workers respectively filed, recognizing their 10 types of diseases as occupational illness. The court not only expanded the list of work places and diseases that it recognized, but also presented more progressive logic of recognition. The most remarkable achievement among them is the case ruled by the Supreme court in July, 2017. In terms of 'worker's right to know', which is the most important factor in preventing occupational diseases, there have been significant legislative bills, court rulings and government guidelines. The revised bill of the Industrial Safety and Health Act to strengthen workers' rights to know and to introduce the pre-review system on trade secret is currently under review by the National Assembly. The court recently ruled that the government should disclose its inspection results on safety and health management at semiconductor factories. The ministry of labor has drawn up internal guidelines to more actively open its safety and health data to public. This study looks over recent developments in such rulings, bills and guidelines and then, analyzes their implications, laying the groundwork for future actions for worker health in the electronic industry.

Analysis of the Health Insurance Costs of Occupational Therapy in Stroke patients (뇌졸중 환자의 작업치료 보험수가 분석)

  • Kim, Hyun-Jin;Kim, Se-Yun
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.16 no.3
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    • pp.1920-1927
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    • 2015
  • This study examined health insurance costs of occupational therapy in stroke patients. The subjects were stroke patients, who underwent occupational therapy by hospitalization or out-patient centers in 2010. The cost of occupational therapy was analyzed from the insurance claims data of Health Insurance Review and Assessment Service in 2010. The kinds of occupational therapy were divided according to the insurance fee of occupational therapy in 2010. In-patients who received occupational therapy paid the highest rehabilitation treatment fee, whereas outpatients paid the highest nervous system function test fee. The cost of occupational therapy in the special rehabilitation treatment fee was highest by 25.3 billion won. The number of uses of general hospitals was the highest by 180 thousand but the total cost of long-term care hospital was highest by 10.4 billion won. The number of uses and cost by regional groups was highest in Seoul and Gyeonggi-do province. This study is meaningful in that a cost analysis of occupational therapy in stroke patients was performed for the first time using the stroke data from the whole country. The result can be used to provide basic data to improve the insurance fee in the future.

Predictors of Blood Transfusion in Hepatoma Embolization (간종양 색전술 환자의 수혈 영향 요인)

  • Kim, Sang-Mi
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.12
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    • pp.384-389
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    • 2017
  • This study was conducted to investigate the patient and hospital characteristics that affect receiving and non-receiving blood transfusion for hepatoma embolization. We analyzed data describing 757 patients of the Health Insurance Review and Assessment Service's 2011 claims sample data. Chi-squared and logistic regression analysis was performed using STATA 12.0. Logistic regression analysis revealed that anemia (Odds ratio (OR)=9.544, 95% confidence interval (CI)=3.362-27.097), female (OR=2.186, Cl=l.240-3.854), age 65-74 (OR=0.506, CI=0.269-0.952), 1000 over bed (OR=0.053, CI=0.018-0.151), out-department (OR=0.211, CI=0.081-0.551), and 700-999 bed (OR=0.105, CI=0.036-0.304) were significant predictors of blood transfusion in tertiary hospitals. Additionally, anemia (OR=69.681, CI=8.545-568.246) and aged 75 or over (OR=0.112, CI=0.025-0.506) were significant predictors of blood transfusion in general hospitals. This research would expected to cost effective and preliminary data of blood transfusion quality.

Does Artificial Intelligence Algorithm Discriminate Certain Groups of Humans? (인공지능 알고리즘은 사람을 차별하는가?)

  • Oh, Yoehan;Hong, Sungook
    • Journal of Science and Technology Studies
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    • v.18 no.3
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    • pp.153-216
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    • 2018
  • The contemporary practices of Big-Data based automated decision making algorithms are widely deployed not just because we expect algorithmic decision making might distribute social resources in a more efficient way but also because we hope algorithms might make fairer decisions than the ones humans make with their prejudice, bias, and arbitrary judgment. However, there are increasingly more claims that algorithmic decision making does not do justice to those who are affected by the outcome. These unfair examples bring about new important questions such as how decision making was translated into processes and which factors should be considered to constitute to fair decision making. This paper attempts to delve into a bunch of research which addressed three areas of algorithmic application: criminal justice, law enforcement, and national security. By doing so, it will address some questions about whether artificial intelligence algorithm discriminates certain groups of humans and what are the criteria of a fair decision making process. Prior to the review, factors in each stage of data mining that could, either deliberately or unintentionally, lead to discriminatory results will be discussed. This paper will conclude with implications of this theoretical and practical analysis for the contemporary Korean society.

How Does Technostress Influence Employees' Role and Performance in An Organization?: The Moderating Effect of Innovation Support (조직 내 기술스트레스가 역할과 성과에 미치는 영향: 혁신지원의 조절효과)

  • Kim, Geuna;Kim, Sanghyun
    • Information Systems Review
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    • v.16 no.2
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    • pp.97-124
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    • 2014
  • This study applies the concepts of sociotechnical theory and role theory in order to verify the effects of stress (that is, technostress) created from information and computer technology (ICT) concerning role stress and performance. We suggest diverse perspectives concerning the elements leading to technostress along with the stress-creating process of ICT among organizational members. The following four major hypotheses are proposed: (1) Technostress is positively related to role stress (e.g., conflict and overload of roles), adverse psychological outcomes, and adverse IS use related outcomes, (2) Role conflict is positively related to adverse psychological outcomes and adverse IS use related outcomes, (3) Role overload is positively related to adverse psychological outcomes and adverse IS use related outcomes, and (4) Innovation support will play as a moderator between technostress, roles tress, adverse psychological outcomes and adverse IS use related outcomes. A partial least square (PLS) with data gathered data from ICT users of organizations was used to verify the proposed hypotheses. The results supported our claims excluding the hypothesis associated to the relationship between technostress and role stress. We suggest a theoretical implication based on the verification of technostress related to the current concept of stress experienced by individuals within organizations. We also propose that a practical implication concerning the opposite effect of technostress, can be utilized as a method of reducing role stress, and suggests a diagnostic tool for assessing the degree of technostress within organizations.

Assessment of the Availability of Health Insurance Data for Epidemiologic Study of Childhood Aseptic Meningitis (소아 무균성 뇌막염의 역학적 연구를 위한 건강보험자료원의 유용성 평가)

  • Park, Sue-Kyung;Ki, Mo-Ran;Son, Young-Mo;Kim, Ho;Cheong, Hae-Kwan
    • Journal of Preventive Medicine and Public Health
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    • v.36 no.4
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    • pp.349-358
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    • 2003
  • Objectives : Aseptic meningitis is a major cause of Korean childhood morbidity late spring and early summer. However, the nationwide incidences of the disease have not been reported. This study was conducted to evaluate the availability of National Health Insurance data (NHID) for the study of an epidemiological trend in the surveillance of aseptic meningitis in children. Methods : All the claims, under A87, A87.8, and A87.9 by ICD-10, among children below 15 years of age, to the National Health Insurance Corporation, between January and December 1998, were extracted. A survey of the medical record of 3,874 cases from 136 general hospitals was peformed. The availability of the NHID was evaluated by the three following methods: 1) The diagnostic accuracy (the positive Predictive value : proportion of the confirmed aseptic meningitis among the subjects registered as above disease-codes in NHID) was evaluated through a chart review, and according to age, gender, month and region of disease-occurrence. 2) The distribution of confirmed cases was compared with the distribution of total subjects from the NHID, for subjects in General hospitals, or the subjects surveyed. 3) The proportion of confirmed CSF test was confirmed, and the relating factor, which was the difference in CSF-test rate, analyzed. Results : Among 3,874 cases, CSF examinations were peformed on 1,845 (47.6%), and the CSF-test rates were different according to the medical utility (admission vs. OPD visit) and the severity of the symptoms and signs. The diagnostic accuracy for aseptic meningitis, and during the epidemic (May-Aug) and sporadic (Sept-Apr) periods, were 85.0 (1,568/1,845), 86.0 (1,239/l,440) and 81.2% (329/405), respectively. The distributions by age, sex, month or period (epidemic/sporadic) and region, in the confirmed cases, were similar to those in the NHID, in both the subjects at General hospitals and in those surveyed, to within ${\pm}7%$. Conclusions : In this paper, the NHID for the subjects registered with an aseptic meningitis disease-code might be available for an epidemiological study on the incidence-estimation of childhood aseptic meningitis, as the NHID could include both the probable and definite cases. On the basis of this result, further studies of time-series and secular trend analyses, using the NHID, will be peformed.

A Study on the Utilization and Problems of Online Dispute Resolution : Focusing on the Online Arbitration (온라인분쟁해결의 활용과 문제점에 관한 연구 - 온라인중재를 중심으로 -)

  • Yu, Byoung-Yook
    • THE INTERNATIONAL COMMERCE & LAW REVIEW
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    • v.19
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    • pp.191-223
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    • 2003
  • Electronic commerce and the Internet offer unprecedented opportunities. The explosive expansion of the use of the Internet makes it possible for businesses to expand their markets and render services. Global transaction costs are easy to cut off using Internet and transaction speed is faster than before. Where cyberspace is not free from claims, Offline transaction can lead to problems and disputes the same is for cyberspace transactions. However ADR is not meet for the online transaction for speed, cost and open network system, ODR methods to resolve electronic commerce conflicts is crucial for building confidence and permitting access to justice in an online business environment. The use of the Internet and the network in dispute resolution has an impact on the types of communication implied in the relevant processes such as automated negotiation, online mediation and online arbitration and involves new technological issues such as the integrity and confidentiality of data and communication used to transmit and store data. Among the ODR systems Online Arbitration is currently binding both parties disputed and can achieve the aim of dispute award the same as the traditional arbitration. Arbitration is based on the New York Convention 1958, Arbitration Model law 1985 and national Arbitration Act that are founded on territorial area and rested on arbitration agreement, constitution of the arbitral tribunal, due process, final and binding award and enforcement of the arbitration award. To compare with this issues Online arbitration has unnecessarily legal unstability and risk. ODR is the burgeoning field and has created a new issues. All such issues which have been debated in the ADR are composed with ODR. But these are not limited Some of issues are further complicated by the nature of the online environment such as confidentiality and principle of parties. It is true that online arbitration should comply with legal provisions, but which is impossible to adhere of the law. Flexible translation and functional equivalence of legal provisions are needed for acceptance of electronic commerce disputes. Finally electronic commerce now takes place on the Internet, it is inevitable that the commercial world wants access to dispute resolution process that best suits the new commercial environment. ODR methods are processing for development and legal issues are considered by both national and international authorities. Introduction of new Conventions or amend Convention and Model law of ODR comes near.

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Clinical outcome of coronary artery bypass surgery according to using cardiopulmonary bypass machine (심폐기 사용여부에 따른 관상동맥우회술의 임상성과)

  • Cho, Yeon-Hee;Kim, Hyung-Seon
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.19 no.9
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    • pp.146-155
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    • 2018
  • This study was conducted to evaluate the clinical outcomes of coronary artery bypass surgery for ischemic heart disease according to use of a cardiopulmonary bypass machine. The subjects were 10,981 patients who underwent coronary artery bypass grafting for ischemic heart disease from July 2008 to June 2012. Analysis data were retrospectively collected using health insurance claims data. The results of the study showed that mean time to surgery (280 min vs 357 min, p<0.0001) and intubation time (about 24 hours vs 40 hours, p<0.0001) were significantly shorter in the Off-Pump CABG (OPCAB) group than in the On-Pump CABG (ONCAB) group. The rate of reoperation because of postoperative bleeding and hematoma was lower in the OPCAB group (2.7% vs 8.3%, p<.0001). The odds ratio of risk adjusted 30 days mortality rate was 0.339 (0.266-0.434) and the postoperative length of stay was decreased in the OPCAB (p<0.0001). Overall, the 30 days mortality and reoperation rates were lower in the OPCAB, as was the resources use.

The Development of Risk Management Process Model during Bidding Phase for Success of Oversea Construction Projects (성공적 해외건설사업을 위한 입찰단계의 리스크 관리 프로세스 모델 개발 - 발전 플랜트 EPC 사업을 중심으로 -)

  • Seo, Jae-Pil;Ryu, Han-Guk;Son, Bo-Sik;Choi, Yoon-Ki
    • Korean Journal of Construction Engineering and Management
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    • v.17 no.4
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    • pp.76-86
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    • 2016
  • Recently, the Contracts of International Construction Business has been decreased from the beginning of 2015 in Korea, although it has been steadily increased until 2014. This trend could be caused by Low-Price Contracts, the lack of Know-how and experience in operating, the poor management of Claims and Low-Profitability in Business. It has been recognized that the qualitative improvement of Business Contacts are necessary for successful Projects. In the Bidding Process, therefore, Experience data as In-House Data and Lessons Learned for projects should be strategically involved to assure riskless offers. Accordingly the Proposal Process are needed to be organized and enhanced by including processes for risks review about technical, marketing and commercial part during the bidding. This paper proposes a Risk Management Process model during Bidding Phase, using Risk Evaluation Method through the project life-cycle. The Concept of Model is to define CSF (Critical Success Factor) in the bidding process and Risk Factors are linked to CSF and Organization based on RAM (Responsibility assignment matrix).

The clinical utilization of radiation therapy in Korea between 2009 and 2013

  • Kang, Jin-Kyu;Kim, Mi-Sook;Jang, Won-Il;Seo, Young Seok;Kim, Hee Jin;Cho, Chul Koo;Yoo, Hyung Jun;Paik, Eun Kyung;Cha, Yu Jin;Song, Hyun Jin
    • Radiation Oncology Journal
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    • v.34 no.2
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    • pp.88-95
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    • 2016
  • Purpose: The purpose of this study was to estimate the clinical utilization of radiation therapy (RT) in Korea between 2009 and 2013. Materials and Methods: We analyzed open claims data from the Health Insurance Review and Assessment Service. The subjects were patients who had diagnostic codes C00-C97 or D00-D48 according to the 10th revision of the International Classification of Diseases, with procedure codes indicating RT treatment. Results: The total number of patients who received RT in 2009, 2010, 2011, 2012, and 2013 were 45,571, 49,593, 54,671, 59,172, and 61,485, respectively. Among them, the total numbers of male and female patients were 20,780/24,791 in 2009, 22,711/26,882 in 2010, 24,872/29,799 in 2011, 27,101/32,071 in 2012, and 27,941/33,544 in 2013. The five cancers that were most frequently treated with RT between 2009 and 2012 were breast, lung, colorectal, liver, and uterine cervical cancers. However, the fifth most common cancer treated with RT that replaced uterine cervical cancer in 2013 was prostate cancer. The three leading types of cancer among the male patients were lung, colorectal, and liver cancers, whereas in female patients, they were breast, uterine cervical, and lung cancers. The type of cancer most commonly treated by RT was cancer of the central nervous system in patients aged 20 years or less, breast cancer in patients aged 30-50 years, and lung cancer in patients aged 60 years or more. Conclusion: Data from this study provided the clinical utilization of RT in Korea between 2009 and 2013.