• 보건행정학회지
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• 제13권1호
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• pp.98-115
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• 2003

Concerns about growing health insurance expenditures became a national Issue in 2001 when the National Health Insurance went into a deficit. Increases in spending for ambulatory care shared the largest portion of the problem. Methods and systems to control the spending should be developed and a system to measure case mix of providers is one of core components of the control system. The objectives of this article is to examine the feasibility of applying Korean Diagnosis Related Groups (KDRGs) to classify health insurance claims for ambulatory care and to identify problem areas of the classification. A database of 11,586,270 claims for ambulatory care delivered during January 2002 was obtained for the study, and the final number of claims analyzed was 8,319,494 after KDRG numbers were assigned to the data and records with an error KDRG were excluded from the study. The unit of analysis was a claim and resource use was measured by the sum of charges incurred during a month at a department of a hospital of at a clinic. Within group variance was assessed by th coefficient of variation (CV), and the classification accuracy was evaluated by the variance reduction achieved by the KDRG classification. The analyses were performed on both all and non-outlier data, and on a subset of the database to examine the validity of study results. Data were assigned to 787 KDRGs among 1,244 KDRGs defined in the classification system. For non-outlier data, 77.4％ of KDRGs had a CV of charges from tertiary care hospitals less than 100％ and 95.43％ of KDRGs for data from clinics. The variance reduction achieved by the KDRG classification was 40.80％ for non-outlier claims from tertiary care hospitals, 51.98％ for general hospitals, 40.89% for hospitals, and 54.99% for clinics. Similar results were obtained from the analyses performed on a subset of the study database. The study results indicated that KDRGs developed for a classification of inpatient care could be used for ambulatory care, although there were areas where the classification should be refined. Its power to predict tile resource utilization showed a potential for its application to measure case mix of providers for monitoring and managing delivery of ambulatory care. The issue concerning the quality of diagnostic information contained in insurance claims remains to be improved, and significance of future studies for other classification systems based on visits or episodes is guaranteed.

• Journal of Chest Surgery
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• 제39권2호
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• pp.117-126
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• 2006

배경: 혈${\cdot}$기흉과 관련하여 우리나라에서 제기된 의료과오 소송들의 양상과 그 결과들을 살펴봄으로써 의사들이 혈${\cdot}$기흉 환자 처치에 있어서 의학적 적응증과 정확한 술기방법 외에 의료법학적으로 고려하여야 하는 부분을 밝혀 발생 가능한 소송에 대처하려 한다. 대상 및 방법: 혈${\cdot}$기흉과 관련된 의료소송 중 재판종결 후 판결문이 공개된 판례들을 대상으로 Lawnb site (www.lawnb.com)와 법원에서 제공하는 법고을 시디롬을 검색하여 혈${\cdot}$기흉 발생 원인, 환자 나이, 기저질환, 소송결과 및 배상금 등을 조사하여 검토하였다. 결과: 대법원 판례 3건, 고등법원 판례가 1건, 지방법원 판례가 3건으로 총 7건의 판결문이 검색되었고 소송결과 3건은 원고가 일부 승소하였고, 4건의 경우는 원고의 청구를 기각하여 파기 환송하였다. 사망 사고의 경우 소송의 원인이 된 사인 중 가장 흔한 원인은 긴장성 기흉이었다. 결론: 혈${\cdot}$기흉과 관련된 소송의 빈도가 높은 것은 아니지만, 환자의 사망 또는 발생한 후유증으로 인해 발생한 손해에 대한 배상액이 상당하다. 소송의 발생은 소아 환자에게 발생한 혈${\cdot}$기흉의 경우가 더 흔하다. 의인성 기흉의 경우 시술 후 방사선 촬영여부가 환자의 예후 및 소송에 있어서 의사를 방어하는 증거로 제시될 수 있고, 충분한 설명에 근거한 동의 역시 중요하다.

• Journal of Preventive Medicine and Public Health
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• 제31권4호
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• pp.814-827
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• 1998

In this study we analyzed the insurance claims data to investigate the medical care utilization pattern of tuberculosis patients in private sector. We selected the claims of principal or secondary diagnosis with tuberculosis from claims database of National federation of Medical Insurance, from December 1995 to November 1996. Both spell-based analysis and person-based analysis were carried out. In spell-based analysis, type and location of treatment facilities, distribution of diagnoses, number of outpatient/inpatient treatments were analyzed. Additionally in person-based analysis, number of tuberculosis patients, demographic characteristics, number of treatments per person, frequency and pattern of change in source of care were analyzed. The results were as follows 1. The number of treatments with tuberculosis was 863,641 from 1 December 1995 to 30 November 1996. The number of patients was 313.964. 2. Most of tuberculosis patients in private sector were treated in general hospital (45.8%) and clinics(42.2%) 3. About 77.7% of tuberculosis patients who were treated more than two times did not change the source of care. 18,9% of tuberculosis patients changed source of care only once. Even when we limited tuberculosis patient to those who were treated more than five times and whose treatment period were longer than six months, 94.7% of patients did not change source of care at all, or changed treatment facility only once. 4. The probability of change in source of rare was higher in pulmonary tuberculosis, in twenties, and in rural area respectively than other tuberculosis. In conclusion, healer shopping of tuberculosis patients was not serious as expected. However special attention is needed to pulmonary tuberculosis in twenties and rural area.

• 국제학술발표논문집
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• The 9th International Conference on Construction Engineering and Project Management
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• pp.1240-1240
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• 2022

Construction projects are fraught with risks from cost or other overruns to accidents along with other issues. This is true whether the relevant organization is an owner, general contractor, CM, specialty-trade contractor, or other entity. When cost issues or other issues confront arise, how should an organization proceed whether attempting to gain additional compensation in terms of cost/other damages or protecting the same against such claims if they do not appear to be warranted? Enter construction cost forensics. This presentation will focus on strategies/techniques with construction cost forensics in these areas in order to be successful. Covered techniques include those to develop and analyze claims including fundamental construction cost analysis techniques. When an unexpected event disrupts a construction project, using sound analytical methods to identify the cause and quantify the extent of the issue will be important for negotiating a fair result or for obtaining a successful outcome in arbitration or litigation. Key examples of uncovering issues via construction cost forensics will be covered in this presentation.

• 보건행정학회지
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• 제34권2호
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• pp.163-177
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• 2024

연구배경: 본 연구는 부당청구 예방형 자율점검제 시범사업의 "개선요청 통보 및 모니터링" 중재활동이 의료기관의 중재 실시 전과 후 청구건수와 청구총진료비 청구행태에 있어서의 변화를 검증하고자 하였다. 방법: 자료는 건강보험심사평가원의 2021년 7월부터 2022년 2월까지 시범사업 항목인 '정맥 내 일시주사(KK020)'를 청구한 기관 중 예방형 자율점검제 대상기관으로 선정된 1,129개 의료기관의 청구자료와 신고 현황자료를 활용하였다. 비교 대상을 선정하기 위해 1:3 비율로 성향점수매칭을 사용하였고, 청구행태 변화를 검증하기 위해 대응표본 t-검정과 t-검정을 실시하였다. 또한 청구행태 변화에 차이가 있는 경우 이에 영향을 미치는 요인분석을 위하여 회귀분석을 시행하였다. 결과: 중재 실시 전과 후의 청구행태는 실험군의 모든 의료기관 종별에서 청구건수와 청구총진료비가 유의하게 감소하였고, 의원의 대조군에서는 유의한 증가를 보였다. 의료기관 및 의사 특성에 따른 중재 실시 전·후 청구행태는 실험군은 의원의 의사 연령 40세 미만을 제외하고 모든 종별에서 유의하게 감소하였다. 대조군은 종합병원과 병원은 개원기간에서, 의원은 표시과목에서 일부 유의한 감소가 있었고, 의사 50세 이상 남성에서 유의하게 증가한 것으로 나타났다. 실험군 대상 의료기관의 청구행태에 변화에 대한 회귀분석 결과, 모든 종별에서 중재 실시 전과 후에 청구건수와 청구총진료비가 유의하게 감소하였다. 또한 의료기관과 의사 특성에서 병원은 개원기간이 길수록 유의한 증가를 나타났고, 의원은 소재지역과 표시과목(기타)에서 유의한 감소를 보였다. 결론: 실험군의 부당청구 예방형 자율점검제의 중재 실시 이후 청구경향의 변화가 연구가설대로 감소하는 경향을 보였다. 이는 제도 시행 직후에 의료기관 스스로 청구행태를 개선하고, 교정하는 사전예방적 활동의 효과가 존재하는 것으로 나타났다. 또한 대조군에서도 통보 대상기관 위주의 제도운영방식에도 불구하고 일부 유의한 감소가 나타난 것은 예방형 자율점검제의 간접적인 효과로 볼 수 있다. 따라서 비대상기관에도 청구행태 개선활동이 이루어질 수 있도록 적극적인 홍보와 교육, 간담회 등의 추가적인 지원과 지속적인 모니터링이 필요하다. 이를 통해 부당청구가 감소될 수 있도록 예방형 자율점검제를 확대하는 것이 바람직하다.

• 한국보건행정학회:학술대회논문집
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• 한국보건행정학회 2005년도 추계학술대회
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• pp.361-362
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• 2005

• 한국건설관리학회:학술대회논문집
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• 한국건설관리학회 2002년도 학술대회지
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• pp.341-344
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• 2002

건설시장의 개방 분위기와 더불어 클레임에 대한 부정적 시각의 변화로 인해 국내 건설업계에도 클레임의 제기가 조금씩 증가하고 있는 추세이다. 그러나 아직도 국내 건설업계는 발주자 우위의 오랜 관행으로 인해 많은 클레임요인이 잠재적으로 내재해 있는 상태이며, 이러한 요인들이 관리 및 해결되지 않으면 앞으로 많은 건설분쟁이 발생하리라는 것은 분명한 사실이다. 이에 본 논문은 국내 아파트공사를 대강으로 클레임요인을 조사한 후 설문분석을 통해 클레임요인들이 공기, 원가, 품질과 같은 공사관리항목에 미치는 영향도를 분석하여 가장 먼저 개선되어야 할 클레임요인들을 도출하였으며, 이러한 클레임요인이 발생되는 원인을 관련 계약조항 상에서 찾아 문제점을 지적하고, 예방대책을 제시하였다.

• 대한한의학원전학회지
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• 제27권3호
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• pp.33-46
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• 2014

Objectives : Sosihotang is a typical prescription in Sang Han Lun. And the alternate chills and fever is a Sosihotang's typical symptom. Therefore I will study of how the syndrome of Sosihotang's alternate chills and fever caused. Methods : Examine the claims of the syndrome of Sosihotang's alternate chills and fever in Sang Han Lun. The scholar's claims are not all same. Thus, I analysis the claims of many scholars. Results : The syndrome of Sosihotang has two mechanisms. The move of defensive Gi(衛氣) can explain the occurrence of alternate chills and fever. If the defense Gi enter inside the body, it struggle with pathogenic Gi, the fever is occurred. On the contrary to this, if the defense Gi exits the body the chills occurs because of the lack of defense Gi. Conclusions : The syndrome of Sosihotang could be taken ill by tranmission or direct attack of exogenous pathogenic factors(直中). Symptoms chills and fever occurs due to the entrance and exit of defensive Gi.

• 패션비즈니스
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• 제26권6호
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• pp.82-93
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• 2022

Sustainability is a significant change that fashion industry has undergone. Marketers and brands are looking for guidance in green advertising to most effectively motivate consumers to purchase sustainable fashion products. This study aims to reveal environmental and cultural sustainability claims on message credibility and purchase intention regarding product trendiness. We performed mediation and moderation analyses, using a 2 (sustainability message: environmental and cultural) × 2 (product design: classic vs. trendy) between-subjects experimental design. The PROCESS MACRO was used for the analysis. Results indicate that environmental claim must appear credible to consumers to motivate them to purchase a product. On the other hand, cultural claim, with and without credibility, affected consumer's purchase intention. Moreover, cultural claim and trendy design together influenced message credibility and purchase intention, showing a moderated mediation effect. The study indicates that brands should broaden their perspective regarding sustainability by considering cultural factors when providing sustainability claims. Environmental claim should be clear and transparent to avoid green skepticism. Also, it is important to focus on product's design aspect: making trendy designs. It is difficult to change consumer behavior based only on sustainability value. Thus, brands must coney their consideration of design trends. Theoretical and managerial implications also are discussed.

• 유통과학연구
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• 제21권6호
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• pp.51-68
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• 2023

Purpose: This study aims to explore the impact of green products' claim skepticism on green purchase intention and further investigates the moderating role of environmental concern in the relationship. This study, by drawing the persuasion knowledge model expected that ambiguity avoidance penalizes less familiar brands than familiar brands. Further, the present study building on Hofstede's cultural dimension, specifically, uncertainty avoidance, undertook a scenario to understand any difference that exist between uncertainty avoidance cultural groups. This study also investigates gender differences in green claim skepticism and proclivity to purchase green products. Research design, data, and methodology: For analyzing the relationship relevant hypotheses were designed, and R-programming software was used. To test the hypotheses two independent sample t-test and regression analysis were carried out. Results: The results suggest that consumers' skepticism toward green claims influenced the intention to purchase eco-friendly products. The study finding also confirms the effect is moderated by environmental concern. Also, the findings of two scenarios reveal that consumers in high uncertainty avoidance culture exhibited a greater level of skepticism for green print advertising and green packaging claims when the brand in the advertising and packaging was unfamiliar than when it was familiar. Conclusions: To alter the negative effect of skepticism the consumer should believe the environmental claims are valid so that they can contribute to solving sustainability issues.