• Journal of Preventive Medicine and Public Health
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• v.28 no.3 s.51
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• pp.640-650
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• 1995

After the introduction of National Medical Insurance in 1989, the medical demand has rapidly increased. The impact of increased medical demand was followed by an increase in the number of claims in need of review. We studied a new, fair method for reducing the number of claims reviewed. We analysed 90,583 outpatient claims submitted between September and October; claims were made for services given August of 1994. We finally suggested a screening system for claims review using a statistical method of discriminant analysis of the medical costs. The results were as follows. 1. In the cut-off group, age, days of medication, number of hospital or clinic visits, and total charge were significantly high. The cut-off rates according to the hospital-type and existence of accompanied disease were significantly different 2. According to ICD, the cut-off rate was highest in peripheral enthesopathies and allied syndromes(20.76%), lowest in acute sinusitis(0.93%). The mean charges were significantly different according to ICD and existence of cut-off. 3. We build discriminant functions by ICD with such discriminant variables as patient age, sex, existence of accompanied disease, number of hospital or clinic visits, and 9 detailed hospital or clinic charges included in claim. 4. We applied the discriminant function for screening those claims that were expected to be cut-off. The sensitivities comprised from 40% to 70%, and specificities from 70% to 95% by ICD. Acute rhinitis had highest sensitivity(100.00%) and other local infections of skin and subcutaneous tissue had highest specificity(98.45%). The expected number of cut-off was 17,762(19.61%). The total sensitivity was 49.62%, the total specificity was 82.57% and the error rate was 19.66%. We lacked economic analysis such as cost-benefit analysis. But, if the new method of screening claims using discriminant analysis were applied, the number of claims in need of review will reduce considerably.

• Construction Engineering and Management
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• v.6 no.6 s.28
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• pp.27-28
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• 2005

• Korean Journal of Human Ecology
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• v.9 no.4
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• pp.491-503
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• 2000

The purpose of this study is to investigate the purchase behavior, response, and complaining behavior for discounting claims in clothing products. The subjects are composed of 360 female consumers. Data were collected through questionnaire. Descriptive analysis was used for analysis of this study. The findings of this study were as follows: First, female consumer used department store for buying discount apparel products the most. The percentage of buying casual or sports wear for discounting was the most. Most consumers purchased clothing products when discounting at 20-40 percentages. Second, even if, consumers tended to distrust discounting claims, they were satisfied with discount apparel products. Especially, they were satisfied with price, design, color, and size, while they were dissatisfied with sewing and fabric in discount products. Third, most consumer knew the knowledge of consumer rights, but most dissatisfied consumers did not assert positive consumer's right. Therefore, marketer should increase the accessibility of their complaint receiving mechanism for dissatisfied consumers in retail environment.

• Korea Trade Review
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• v.47 no.3
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• pp.177-190
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• 2022

This study is designed to identify the differences in the types and importance of trade claims at the national level. For analysis data, abstracts of arbitration and court judgments published on the website of the United Nations Commission on International Trade Law are collected and used. The target countries are China and the United States, with 102 cases from China and 59 cases from the United States. By applying topic modeling techniques to the collection decisions of China and the United States, trade claims are categorized, and the importance of each type is identified using the network centrality index derived through semantic network analysis. The analysis results are as follows. First, the main types of trade claims were the same for both the United States and China: product nonconformity, delivery issues, and payments. However, in China, the order of product nonconformity > delivery issues > payments was important, and in the United States, payments > product nonconformity > delivery issues were found to be important. This study is significant in that it presents a strategic trade claim management plan using a quantitative methodology.

• Proceedings of the Korean Institute Of Construction Engineering and Management
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• autumn
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• pp.46-53
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• 2001

Differing Site Conditions('DSC') Claims among construction claims are on the increase as a direct result of the steady construction of Social Overhead Capital Facilities initiated by Government. As DSC claims generally became apparent during the intial stage of the construction project, it is necessary to timely review and study the proposal on the prevention of DSC claims because delayed settlement will incur more substantial damages to all parties concerned. This research is focused on the identification and analysis of the causes for DSC claims as applicable to design-build project in public sector and it presents the possible short term, medium and long term proposals on the improvement of causes related with DSC claims. The major results of this research are summarized as follows: 1. Improvement of contractor's tender practice 2. Contractor's division of responsibility on the site survey 3. Improvement of owner's exculpatory clause 4. Flexibility on the adjustment of contract amount The proposals stated above could be useful in resolving the DSC claims between owner and contractors.

• Journal of Society of Preventive Korean Medicine
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• v.19 no.2
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• pp.51-56
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• 2015

Objective : We analyzed present condition of cooperative medical care using claims data of HEALTH INSURANCE REVIEW & ASSESSMENT SERVICE form patients treated by Korean-Western cooperative medicine. The study aimed to offer guidelines in selecting disease-related research in developing Korean-Western convergence technology. Method : Based on the patients using Korean medical service, we analyzed claims data of patients using Korean medical service and western medical service from January 2012 to December 2013. We were assigned to the server remotely. With the concept of 'episode of care', we rebuilt claims data and analyzed present condition of cooperative medical usage. Results : We analyzed present condition of cooperative medical care per episode of care. Among outpatients, Low back pain, lumbar region(M5456) was the highest number. Among inpatients, Sciatica due to intervertebral disc disorder(M511) was the highest number. Conclusion : Based on the claims data provided by HEALTH INSURANCE REVIEW & ASSESSMENT SERVICE, we have derived a list of multy frequently disease frequently treated by cooperative medical care by analyzing present condition.

• Health Policy and Management
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• v.16 no.3
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• pp.37-51
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• 2006

This study evaluates the reliability of the discharge status variable m health insurance claims for identifying in-hospital patient deaths. This study used 2002 national health insurance claims and the cause of death statistics from Korean national statistical office. The Study data set included acute myocardial infarction (AMI) and coronary artery bypass graft (CABG) surgery patients in 133 general and tertiary hospitals. The gold standard containing patient death information was made and then compared with that of claims data. The hospitals were classified into four groups based on the number of deaths in each hospital. Simple kappa coefficients were calculated to evaluate the agreements of patient deaths between the gold standard and the insurance claims. CABG (83.9%) showed higher agreements than AMI(73.0%) in matched in-hospital patient death information between data sets. Simple kappa coefficients of CABG (0.63) and AMI (0.59) showed moderate or good agreements. The agreements, however, varied depending on the disease or hospital types. The fact that the agreements are only moderate to good indicates that the accuracy of in-hospital death information in claims is not high. n the variable is used to identify patient deaths, it may mislead people. Therefore, efforts should be made to improve the reliability of the discharge status variable in health insurance claims.

• Proceedings of the Korean Institute of Building Construction Conference
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• 2021.11a
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• pp.248-249
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• 2021

Planning and Scheduling in Korean has been developed from Bar Chart to CPM, integrated management and EVM were attempted. As growing of overseas projects, Scheduler was also recognized as important one. However, the reality is that most Korean construction projects still remain in the preparation of construction plan and construction schedule in 1990s. The global Planning and Scheduling trend is EOT claims. I would like to understand the global trend of EOT claims and EOT analysis, and to find out Planning and Scheduling measures to successfully promote EOT claims.

• Korean Journal of Acupuncture
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• v.34 no.3
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• pp.126-135
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• 2017

Objectives : The purpose of this study was to describe the type of claimed adverse events related to Korean Medicine practices in South Korea. Methods : Claims with regard to the Korean Medicine practice submitted to the Korea Medical Dispute Mediation and Arbitration Agency from April 2012 to December 2016 were collected. We analyzed claims that explicitly reported the type of Korean medicine intervention and were deemed as being adverse events as defined by the Korea Good Clinical Practice. Claims that did not mention the Korean medicine practice explicitly or those related to the patient's dissatisfaction to the service rather than adverse health outcomes were excluded. Types, related interventions and the suspected severity of claimed adverse events were summarized. Results : Of 197 claims obtained, 140 claim cases were eligible and 144 claimed events were deemed as possible adverse events of the Korean medicine practice. Pain(16%), local infection/inflammation(12%) and neurological symptoms(11%) were the most frequently reported types of claimed adverse events. Thirty-nine claimed serious adverse events(SAE) were identified, including pneumothorax(28.2%) and death(17.9%). Conclusions : A wide range of claimed adverse events were identified. Routine monitoring of claims data may provide undetected safety information with regard to the Korean medicine practice. High risk of misclassification of the intervention and claimed adverse events due to insufficient information is the main caveat of this study.

• International conference on construction engineering and project management
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• 2005.10a
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• pp.693-698
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• 2005

Evaluation of construction claims history can provide insights to improvement opportunities in a capital project portfolio. This study analyzed construction litigation claims extracted from the U.S. Court of Federal Claims (COFC) history involving the U.S. Naval Facilities Engineering Command (NAVFAC) from 1995-2004. Twenty-four total cases were examined over this period. Both "primary" causes and "root" causes were identified and compared to 666 litigation cases reviewed by the Armed Services Board of Contract Appeals (ASBCA). Based on the analysis, strategies for resolving future disputes are recommend using a 'hybrid' process prior to litigation.