• The Korean Society of Law and Medicine
• /
• v.8 no.1
• /
• pp.137-177
• /
• 2007

The medical expenses review system in Korea has developed under fee-for-service system with its own unique structure. The importance of reviewing medical expenses has been emphasized, as the size of medical expenditures moving through the health insurance legal context and its weight in the national economy have increased very rapidly. It is, however, analyzed that the feuds and arguments continue among the stakeholders for the lack of laws supporting the medical expenses review system. The medical expenses review is a series of administrative procedures, deciding whether claims from medical care institutions to the insurer are legal and valid or not. It mainly controls the increase of unnecessarily excessive health insurance claim and prevents fraudulent claim and abuse and checks the less use or unsuitable use of medical resources. It also works a function guarantees medical benefits for the appropriate treatment according to the object of health insurance system as a social insurance scheme. The dispute on legal base of the medical expenses review is about the source of law in the medical expenses review. There are the Health Insurance Act and administrative laws as jus scriptum and the guidelines of review as administrative orders. The medical expenses review should reflect various factors, such as the development of medical healthcare technologies, the health expenditures distribution, the financial situation of the health insurance, and the evaluation on the level of appropriate benefits. It is also likely to adapt to the traits of characters of medicine, and trends and transition, Besides it should judge the legality and the validity of medical benefits expenditures by synthesizing these all factors. And the evaluation system of appropriateness of medical benefits was administrative procedure which was consecutive with reviewing the medical expenses system and it was intended to make up for the result of reviewing the medical expenses in more comprehensive levels.

• Journal of Digital Convergence
• /
• v.10 no.1
• /
• pp.407-412
• /
• 2012

From Jan. 1 2009 to Mar. 31 2009, a study surveyed 295 national clinic medical institutions that was newly enrolled in Health Insurance Review and Assessment Service to identify the factors depending on whether the administrative personnel influences on the management of the clinic medical institutions. The survey showed that the medical institutions with administrative personnels affected more adjustments than those without administrative personnels and it appeared to be statistically significant except one time(p<0.01). The result of the survey tells whether the administrative personnel is or not in medical institutions has important effects on the reduction. So, it is considered that the placement of administrative specialists in the hospital is very important for medical institutions.

• Korean Journal of Clinical Pharmacy
• /
• v.5 no.2
• /
• pp.33-49
• /
• 1995

The purpose of this study is to understand present situation of clinical trials, and evaluate the preparedness of the desiRnated institutions to abide by GCP(Good Clinical Practice) standards during clinical trials. Survey on the status of clinical trials was conducted for the desienated 83 clinical trial hospitals, and response rate was $95.2\%$. The results showed that 39 hospitals have conducted clinical trials to obtain drug manufacturing approval from 1990 to 1994. Most of them were trials on Phase III. Only $46.8\%$ of the institutions had sufficient human resources to perform the clinical trials. Institutions which established IRB(Institutional Review Board) accounted for 41 or $51.9\%$, but those who have a protocol evaluation guideline, or Adverse Drug Reaction(ADR) reporting system were only 12, and 21 Places, respectively. Regarding supervision of the investigational drugs, less than 30 institutions designated pharmacist as a supervisor. In conducting clinical trials, $97.4\%$ of trials had high rates of prior consent of testees, but only part of them-$61.7\%$-gave written consent. The level of conducting GCP is found to be unsatisfactory. Institutions must build the appropriate infrastructure and government must prepare in order to protect testees' rights as well as to ensure validity of the results.

• Journal of Pharmacopuncture
• /
• v.25 no.3
• /
• pp.276-289
• /
• 2022

Objectives: Child and adolescent sleep is an important factor for brain and physical development. Therefore, it is necessary to investigate the prevalence of sleep disorders and nonorganic sleep disorders in children and adolescents and determine the type of utilization of medical institutions. This study analyzed the prevalence and type of medical institutions in Korean children and adolescents with sleep disorders and nonorganic sleep disorders. Methods: This study used data recorded in the Health Insurance Review and Assessment-National Patient Sample (HIRA-NPS) database from 2010 to 2017. Details of medical institution type and patient's sex, age, and treatment type were extracted for patients younger than 20 years with sleep disorders and nonorganic sleep disorders. Results: Among 2,536,478 patients under age 20, we identified 3,772 patients with sleep disorders or nonorganic sleep disorders. From 2010 to 2017, the prevalence of sleep disorders in children and adolescents was 0.07% to 0.09%. The utilization rate of Korean medical institutions was 30.47%. The prevalence of nonorganic sleep disorders and the utilization rate of Korean medical institutions were 0.06% to 0.08% and 45.99%, respectively. Conclusion: The prevalence of sleep disorders and nonorganic sleep disorders in the under-20 population was 0.14% to 0.16%. More than 70% of patients with nonorganic sleep disorder who were younger than 9 years used Korean medical institutions.

• Proceedings of KOSOMES biannual meeting
• /
• 2008.05a
• /
• pp.91-99
• /
• 2008

This paper compares the maritime education of two traditionally maritime countries, Korea and the Philippines, specifically, in their maritime transportation education. The subjects of this review focus on Mokpo National Maritime University (MMU) and the Philippine Merchant Marine Academy (PMMA). The paper presents the curricular and training programs of both institutions and shows the differences in the curriculum designs and methodology of delivery as contained in the requirements of Standards of Training, Certification and Watchkeeping 1978, as amended in 1995 (STCW 95). It also illustrates the social climate of the two countries and the attitude of maritime community in relation with the maritime programs offered by the institutions towards the quality of the fresh maritime graduates.

• Health Policy and Management
• /
• v.13 no.3
• /
• pp.52-70
• /
• 2003

The rate of conversion to Medical-juridical-persons' ownership of medical institutions has increased rapidly since its start in 1970s in Korea. The most sensitive issue to introduce for-profit medical institutions, ignited particularly by the WTO/DDA negotiations, has sparked considerable debate, stemming largely from conflicting views on the theoretical effects of ownership status on organizational behavior. This study surveyed health-related experts' opinions on allowing for for-profit-firms-owned medical institutions. Some fear that the obligation to maximize the share-holders' return on their investment will cause the medical institutions to eliminate necessary but less lucrative services. They may easily fall under more pressure to generate income, and respond more aggressively than not-for-profit medical institutions to financial pressures. Advocates of for-profit ownership of medical institutions argue that greater responsiveness to the demands of the marketplace will lead to larger investment, higher quality and lower costs to consumers. Referring to both foreign countries' experience and domestic experts' opinions, this study suggests for reform of the current Korean Medical-Juridical-Person(MJP) System. Introduction of so-called “Capital-investment” MJPs is recommended where the properties left in case of their dissolution can be distributed to original investors according to the procedures stipulated in their statutes. However, their annual profits are not allowed to be allocated to investors, but should be reinvested for their medical institutions, as is the case in current MJPs. Their legal aspects are also reviewed in this study.

• Review of Korea Contents Association
• /
• v.14 no.3
• /
• pp.25-29
• /
• 2016

• The Journal of Korean Physical Therapy
• /
• v.34 no.1
• /
• pp.26-37
• /
• 2022

Purpose: Japan established the convalescent rehabilitation wards, corresponding to Korea's rehabilitation medical institutions, in 2000 and developed it into the present system through continuous revisions. This study sought to analyze the issues and tasks faced by Japan segregated by the period of revision of convalescent rehabilitation ward-related medical fee regulations, through a literature review and further aimed to explore the direction of development of domestic rehabilitation medical institutions. Methods: Ten revisions of the medical fee regulations were classified into three stages based on quality evaluation: (1) the quantitative expansion stage (2000-2006); (2) quality evaluation introduction stage (2008-2014); and (3) quality evaluation maturity stage (2016-2020). Results: The following issues and tasks emerged: (1) For the quantitative expansion stage; insufficient rehabilitation within the ward, insufficient after-hour rehabilitation, insufficient connection with acute-stage hospitals and maintenance facilities, and the low ratio of specialists. (2) For the quality evaluation introduction stage; disparity in the manpower between institutions, the necessity of a 365-day rehabilitation system, avoidance of critical patients, and the problem that an increase in the amount of rehabilitation did not lead to a qualitative improvement. 3) For the quality evaluation maturity stage; cream-skimming issues in selecting patients, inappropriate evaluation of rehabilitation effects, and the necessity of follow-up measures after discharge. Conclusion: It is worth referring to the established regulations in Japan, and concurrently it is necessary to strengthen the evaluation of the structures, processes, and results when operating and evaluating rehabilitation medical institutions in Korea taking into account the side effects that could be identified in Japan.

• Korean Journal of Clinical Pharmacy
• /
• v.25 no.4
• /
• pp.280-285
• /
• 2015

Objectives: To suggest direction for improving policies by understanding current management of narcotics or psychotropic drugs and analyzing their distributions and usage. Method: We conducted a comparison analysis between health insurance claims and the amount supplied to health care institutions for narcotics or psychotropic drugs through health insurance claims data and drug distribution supply data from 2010 to 2012 collected from Korea Pharmaceutical Information Service Center (KPIS). Furthermore, we carried out literature investigation and online search to comprehend the current management of narcotics drugs in Korea. Results: The amount supplied to medical institutions for all drugs in 2012 was 19.4 trillion won, which increased from 19.5 trillion in 2011 by 0.54%. For narcotic drugs, the amount supplied was 318.4 billion won in 2011 and increased to 335.1 billion won by 5.3% in 2012, which exceeded the rate of increase for the amount supplied for all drugs. The proportion of amount claimed in the total amount supplied to medical institutions for all drugs was 60.5% in 2012, whereas the proportion of amount claimed for narcotic drugs was 55.6%, which showed that narcotic drugs were used relatively less within health insurance. Furthermore, management of the current domestic distribution supply data focuses on manufacturing and medical institution supply stages. Conclusion: Hereafter, the management of narcotics or psychotropic drugs needs to be improved by reinforcing active monitoring in optimal prescription and usage in patients by collecting and analyzing information on drug usage of patients.

• International Journal of Computer Science & Network Security
• /
• v.22 no.11
• /
• pp.324-330
• /
• 2022

The United Kingdom is known for the quality of its qualifications. There is a strict quality system with reputable bodies responsible for ensuring that high quality standards are met. In order for new qualifications to be accredited, they must meet all the requirements set out in the regulations for the quality and informatization of Education. The crucial role of the Agency for Quality Assurance of Higher Education (QAA) in the UK for creating high-quality management of higher education institutions is revealed, the influence of informatization tools on its effective mechanism as an independent entity is shown, and positive experience for the educational sector is highlighted. While the universities themselves are responsible for reviewing educational programs at the subject level, the QAA review focuses on verifying internal quality assurance, as well as systems and improvement strategies. The QAA uses a peer review process in which teams mostly consist of academic staff from other institutions to assess the quality of the institution's education. In Scotland, the team also includes an international reviewer. The student is also a member of the Scottish teams. In the UK, attention is paid to providing a cohort of experienced reviewers who can conduct high-quality monitoring and help with advice on improving education. All reviewers must complete training and have permission to participate in the review of educational programs. There are selected committees that are members of the QAA council, each of which is headed by a member of the Council or an independent person approved by the Council. Attention is drawn to the main areas of the QAA's work in the framework of environmental, social and corporate governance.