• Title/Summary/Keyword: compensation insurance

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Can Angular Deformity Due to Sacrococcygeal Fracture Cause Permanent Impairment? : Current State and Problems in Korea

  • Cho, Dosang
    • Journal of Korean Neurosurgical Society
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    • v.65 no.2
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    • pp.173-179
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    • 2022
  • Disabilities can emerge due to traumatic spinal fractures. In terms of sacrococcygeal spine, because of its unique anatomic structure with minimal movement, the possibility for it to have a disability is relatively low. In Korea, unlike most disability criteria, private insurance companies acknowledge angular deformities caused by vertebral fractures as disabilities according to their degree, so there were several cases where patients required compensation, arguing angular deformity caused by sacrococcygeal fracture, which in some cases led to legal conflicts. Except the Act Welfare of Persons with Disabilities which recognizes only severe angular deformity affecting internal organs as disability and the industrial accident disability evaluation which does not recognize coccygeal fracture as disability but rarely recognizes sacral vertebra deformity equivalent to compressive deformation, there is little or no case where angular deformity is recognized as disability. Given the impairment evaluation standards in social insurance, McBride system, American Medical Association (AMA) guides, and newly proposed standards by the Korean Academy of Medical Sciences (KAMS), the most contentious point in the general terms and conditions of private insurance is spinal deformity. To overcome controversy over disability evaluation, the private insurance sector is now applying criteria for axial skeleton to sacrococcygeal vertebrae through revision of standards. Under these circumstances, it is fair to recognize sacrococcygeal fracture as impairment in terms of the pelvis only when the fracture leaves serious deformity and neurological symptoms with clear relevancy. Though it may not be easy to develop accurate disability evaluation standards, improvement is necessary to remove any irrationalities and make the standards as objective as possible.

Incidence and magnitude of out-of-pocket payment and factors influencing them in Industrial Accident Compensation Insurance (산재환자의 진료비 본인부담 발생 및 크기와 이에 영향을 미치는 요인)

  • Park, Bo-Hyun;Lee, Tae-Jin;Lim, Wha-Young
    • Health Policy and Management
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    • v.20 no.1
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    • pp.103-124
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    • 2010
  • Objectives: The out-of-pocket payment (OOP) of the Industrial Accident Compensation Insurance (IACI) in Korea was investigated empirically in terms of its incidence, magnitude and factors influencing them. Methods: The subjects were sampled with stratified, randomized methods among medical institutions of which the number of monthly IACI claims exceeded its median as of May 2008. Out of 204 institutions selected, 118 institutions (57.8%) responded to this survey. A total of 24,826 episodes(2,457 inpatient and 22,369 outpatient episodes) were included in this analysis. The incidence and magnitude of OOP of IACI were calculated by characteristics of institution as well as patient. Factors that affected the incidence and magnitude of OOP were investigated through multi-level analysis. Results: The overall incidence of OOP of IACI was 9.9% (25.6% for inpatient and 8.2% for outpatient) and the percentage of OOP among total expenditures was 8.3% on average (7.6% for inpatient and 26.8% for outpatient); 25.2% at traditional oriental medicine hospitals, 9.5% at general hospitals and 2.5% at the industrial-accident-designated medical institutions. The incidence of OOP of IACI was influenced by hospital size, ownership, longer duration of designation (over 5 years) and length of stay. On the other hand, its magnitude was influenced by medium-sized hospital, public hospital, location of large city and length of stay. Extra charges for upper grade room which accommodates less than 4 patients and treatment by specialists were the leading contributors to the magnitude of OOP of IACI. Conclusion: The incidence and magnitude OOP of IACI varied in institution type and were influenced by both institutional and patient's factors. In order to achieve the goal of Industrial Accident Compensation Insurance, appropriate level of compensation, that is, no incidence of OOP, for accident and disease of workers, it is necessary to take measures to reduce incidence and magnitude of OOP.

Analysis of risk factors of the fisherman's in coastal purse seine fishery using the accident compensation insurance proceeds payment data of NFFC (수협 어선원 재해보상보험 자료를 이용한 연안선망어업 위험요인 분석)

  • CHOI, Kyu-Suk;LEE, Chun-Woo;PARK, Su-bong;JANG, Yong-Suk;LEE, Yoo-Won
    • Journal of the Korean Society of Fisheries and Ocean Technology
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    • v.56 no.4
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    • pp.340-346
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    • 2020
  • In this study, the risk factors of coastal purse seine fisherman were analyzed through a survey of fishery workers of coastal purse seine fishery and the accident compensation insurance data of the fisheries workers of the National Federation of Fisheries Cooperatives (NFFC). The classified fishing operation accident data was analyzed through 4M (Man, Machine, Media, Management) model of the National Transportation Safety Board (NTSB) and the accident prevention measures were presented using Harvey's 3E (Engineering, Education, Enforcement) model. The rate of accidents on coastal purse seinens each year was 75.8‰, 36.7‰ and 74.8‰ from 2015 to 2017. The accident frequency resulting from slipping was the highest, and the risk of a contact with gear was low. When comparing each insurance data, the average value of the contact with gear accident was the highest. This research result is expected to be important data in identifying and preventing safety hazards of coastal purse seiner fisherman in the future.

A Study on the Social Security for Seafarers of Maritime Labour Convention, 2006 (2006년 해사노동협약상 선원 사회보장에 관한 연구)

  • Ji, Sang-Won
    • Journal of Navigation and Port Research
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    • v.32 no.3
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    • pp.237-244
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    • 2008
  • The General Conference of International Labour Organization adopted the Maritime Labour Convention, 2006 which created a single, coherent instrument embodying as far as possible all up-to-date standards of existing international maritime Conventions and Recommendations in its Ninety-fourth session on 23 February 2006. This Convention prescribes the social security for seafarers in the Regulation 4.5 in the Title 4. Regulation 4.1-Medical care on board ship and ashore and Regulation 4.2-Shipowner's liability are related to social security for seafarers. For the purpose of ratifying this Convention in our country, first of all, it is necessary to review the domestic laws and regulations concerned whether they fulfill or not the requirements of the Convention and have to make preparation insufficient sections. Therefore, this paper aims to find out different regulations between the domestic law and the Convention, as to be able to accept the requirements regarding the social security of the Convention, also suggest the solution on problems derived in this process.

Factors Determining the Economic Preparation for Later Life of the Elderly with Industrial Injury: Based on Andersen Behavioral Model of Health Care Utilization (산재경험 고령자의 경제적 노후준비에 관한 연구: 앤더슨 모형을 중심으로)

  • Moon, Yong-pil;Won, Seo-jin
    • The Journal of the Korea Contents Association
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    • v.15 no.8
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    • pp.313-325
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    • 2015
  • This study aims to address factors affecting economic preparation of the elderly with industrial injury using Andersen model. In addition, it is also to explore differences in accordance with changes in the employment status between regular employees and non-regular employees. The authors analyze Panel Study of Worker's Compensation Insurance(PSWCI)'s 1st wave data in the logistic regression model. The authors found gender and education were related to economic preparation. In addition, earned income, national health insurance and the degree to which pain interferes with daily life and the lives caused by industrial accidents were associated with economic preparation. But national pension was not statistically significant to economic preparation. Based on the findings, the researchers addressed political implications to enhance financial security of injured workers.

Some Consideration on the Study of ICAO for the Rome Convention Amendment and the Necessity of Domestic Legislation (로마조약의 개정과 국내입법의 필요성에 관한 소고)

  • Kim, Sun-Ihee;Kwon, Min-Hee
    • The Korean Journal of Air & Space Law and Policy
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    • v.23 no.1
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    • pp.3-32
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    • 2008
  • In proportion to recent developments in aviation technology and growth of the air transport market, the risk of damages to third parties caused by aircrafts and the likelihood of unlawful interference on an aircraft in flight has grown larger. The war risk insurance market was paralyzed by the 9/11 terror event. And if another event on the scale of 9/11 occurs, compensations for third party damages will be impossible. Recognizing the need to modernize the existing legal framework and the absence of a globally accepted authority that deals with third party liability and compensation for catastrophic damage caused by acts of unlawful interference, the ICAO and various countries have discussed a liability and compensation system that can protect both third party victims and the aviation industry for the 7 years. In conclusion, in order to provide adequate protection for victims and the appropriate protection for air transport systems including air carriers, work on modernizing the Rome Convention should be continued and the new Convention should be finalized in the near future. Korea has not ratified the relevant international treaties, i.e. Rome Convention 1933, 1952 and 1978, and has no local laws which regulate the damage caused by aircraft to third parties on land. Consequently, it has to depend on the domestic civil tort laws. Most of the advanced countries in aviation such as the United States, England, Germany, France and even China, have incorporated the International Conventions to their national air law and governed carriers third party liability within their jurisdiction. The Ministry of Justice organized the Special Enactment Committee for Air Transport chapter under Commercial Law. The Air Transport chapter, which currently includes third party liability, is in the process of instituting new legislation. In conclusion, to settle such problems through local law, it is necessary to enact as soon as possible domestic legislation on the civil liability of the air carrier which has been connected with third party liability and aviation insurance.

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System Thinking Analysis on The Organizational Entropic Measures: Focusing on Workers' Speedy Compensation (조직의 엔트로피식 처방에 대한 시스템 사고 분석: 산업재해 신속보상을 중심으로)

  • Yang, Jeong-Ho
    • Korean System Dynamics Review
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    • v.14 no.4
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    • pp.63-89
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    • 2013
  • The purpose of this paper is to explain the entropic measures could cause the organization to increase the entropy. The organization as an open system has a tendency to input new energy to adapt itself to the change in its surroundings. This intention of inputting energy into organization is based on the second law of thermodynamics, the laws of entropy.Entropy is a measure of disorder, or a measure of progressing towards thermodynamic equilibrium. The entropy of an isolated system increases. Organizations have to open to their environment, have to do something to reduce their entropy. But, this attempt to reduce entropy entails another entropy. This study shows the side effects by giving examples of illegal receipt of worker's compensation insurance. The implications through the cases of illegal receipt of workers' compensation are as follows. Firstly, organizational policy is that inaction in itself may be the best policy, unless we always think the action best. Secondly, public organization should be careful in substituting business management in the private sector such as customer satisfaction(CS) for the value in public sector. Thirdly, the setting the expiration date of organizational policy could be the way to slow down the degree of entropy.

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The Utilization of Physical Therapies in the Korean Medicine Clinics : A Survey for National Health Insurance Planning (한의원의 한방물리요법 이용 현황과 건강보험 급여화에 대한 인식)

  • Shin, Mi-Sook;Shin, Byung-Cheul;Lee, Myeong-Jong;Kim, Ho-Jun;Song, Yoon-Kyung;Song, Mi-Yeon;Shin, Seung-Woo;Lim, Byungmook
    • Journal of Korean Medicine Rehabilitation
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    • v.19 no.3
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    • pp.101-109
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    • 2009
  • Objectives : This study aimed to investigate the present status of physical therapies provided in the Korean medicine clinics, and to find out the priorities among and the estimated fees of physical therapies for the National Health Insurance plan. Methods : We administered nationwide survey to Korean medicine doctors using the on-line survey system. 16 physical therapies were listed in the Web-based questionnaires, and responders were asked to mark the therapies they used for their patients, and, for each therapy they marked, to fill in the form including the frequencies of service, service fees, target diseases, and priorities for health insurance coverage, etc. Results : Of 488 respondents, 93.7% provide more than one physical therapy for their patients, and each responder uses 5.9 physical therapies on average. 60-90% of physical therapies are being given to patients for free because they are not covered by the National Health Insurance. There is little evidence that the specialties of Korean medicine doctors are related with the use of physical therapies, but, in some therapies, the doctors with longer career years use the physical therapy more frequently. Most physical therapies are applied to the patients with musculoskeletal diseases, cardiovascular diseases, and nervous diseases, etc. Conclusions : Physical therapies are widely used among Korean medicine doctors without proper compensation. This could be the one of the main factors distorting the profit structure of Korean medicine clinics, and it encourages the National Health Insurance to cover physical therapies provided in the Korean medicine clinics.

The Socioeconomic Cost of Injuries in South Korea (우리나라 손상의 사회경제적 비용)

  • Park, Kun-Hee;Lee, Jin-Seok;Kim, Yoon;Kim, Yong-Ik;Kim, Jai-Yong
    • Journal of Preventive Medicine and Public Health
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    • v.42 no.1
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    • pp.5-11
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    • 2009
  • Objectives : This study was conducted to estimate the socioeconomic cost of injuries in South Korea. Methods : We matched claims data from national health insurance, automobile insurance and industrial accident compensation insurance(IACI), and mortality data obtained from the national statistical office from 2001 to 2003 by patients unique identifier. Socioeconomic cost included both direct cost and indirect cost: the direct cost was injury-related medical expenditure and the indirect cost included loss of productivity due to healthcare utilization and premature death. Results : The socioeconomic cost of injuries in Korea was approximately 1.9% of the GDP from 2001 to 2003. That is, 12.1 trillion KRW(Korean Won) in 2001, 12.3 trillion KRW in 2002, and 13.7 trillion KRW in 2003. In 2003, direct medical costs were 24.6%(3.4 trillion KRW), the costs for loss of productivity by healthcare utilization were 13.0%(1.8 trillion KRW), and the costs for loss of productivity by premature death were 62.4%(8.6 trillion KRW). Conclusions : In this study, the socioeconomic cost of injuries in Korea between 2001 and 2003 was estimated by using not only health insurance claims data, but also automobile insurance, IACI claims and mortality data. We conclude that social efforts are required to reduce the socioeconomic cost of injuries in Korea, which represented approximately 1.9% of the GDP for the time period specified.

A Study on Oral Health, Dental Care and Insurance Awareness in the Community During the COVID-19 Period (COVID-19 시기 지역사회 구강건강과 치과 치료 및 보험 인식에 관한 연구)

  • Son, Eun-Gyo;Park, Il-Soon
    • Journal of Digital Convergence
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    • v.20 no.5
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    • pp.643-651
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    • 2022
  • This study was conducted to examine the oral health, dental treatment and insurance awareness of the community during the COVID-19 period from September 1 to October 29, 2021 for patients who visited a local dental clinic in Gangwon-do. For analysis, SPSS Statistics 24.0 program was used. As a result of the analysis, it was found that oral health status, interest in oral health, and awareness of health insurance expansion affect dental treatment during the COVID-19 period. In addition, those who did not receive oral health education, those with a high school diploma or lower, and those with poor oral health showed positive results for dental treatment during the COVID-19. In conclusion, it is necessary to expand publicity on oral health education, and to list the cost of infection control in health insurance and separate compensation materials. In future research, I think that it is necessary to conduct research through a variety of subjects and study the expansion of insurance in detail.