• Title/Summary/Keyword: health insurance standards

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A Study of Nurses' Perception of the Visiting Nursing Services of Long-term Care Insurance (노인장기요양보험 재가간호서비스에 대한 방문간호사의 인식)

  • Kwon, Min-Young;Lim, Ji-Young;Lee, Young-Whee;Kim, Hwa-Soon
    • Journal of Korean Public Health Nursing
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    • v.24 no.1
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    • pp.5-18
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    • 2010
  • Purpose: The purpose of this study is to understand nurses' perception of visiting nursing services of long-term care insurance. Method: The descriptive survey study involved 188 nurses selected by the convenient sampling of visiting nurses who participated in professional education sessions. Results: Of the 188 participants, 149 (79.3%) were aware of long-term care insurance. Awareness of aspects of long-term care services was 78.7% for facility service, 77.7% for ordinary visiting care service, 85.1% for visiting nursing service and 77.7% for visiting bathing service. Concerning visiting nursing service provision, the majority of the study subjects considered nurse-aid not to be the appropriate route for delivery of services including nasogastric tube exchange, tracheostomy tube management and stitch removal. Conclusion: Continuous evaluation and research on the standards and requirements of the nursing workforce is needed to secure and maintain the high quality of visiting nursing services. Exhaustive studies concerning task division and workforce separation according to nursing services type and level of difficulty should be done to develop the appropriate job description for visiting nursing service staff.

Development of Models for Regional Cardiac Surgery Centers

  • Park, Choon Seon;Park, Nam Hee;Sim, Sung Bo;Yun, Sang Cheol;Ahn, Hye Mi;Kim, Myunghwa;Choi, Ji Suk;Kim, Myo Jeong;Kim, Hyunsu;Chee, Hyun Keun;Oh, Sanggi;Kang, Shinkwang;Lee, Sok-Goo;Shin, Jun Ho;Kim, Keonyeop;Lee, Kun Sei
    • Journal of Chest Surgery
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    • v.49 no.sup1
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    • pp.28-36
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    • 2016
  • Background: This study aimed to develop the models for regional cardiac surgery centers, which take regional characteristics into consideration, as a policy measure that could alleviate the concentration of cardiac surgery in the metropolitan area and enhance the accessibility for patients who reside in the regions. Methods: To develop the models and set standards for the necessary personnel and facilities for the initial management plan, we held workshops, debates, and conference meetings with various experts. Results: After partitioning the plan into two parts (the operational autonomy and the functional comprehensiveness), three models were developed: the 'independent regional cardiac surgery center' model, the 'satellite cardiac surgery center within hospitals' model, and the 'extended cardiac surgery department within hospitals' model. Proposals on personnel and facility management for each of the models were also presented. A regional cardiac surgery center model that could be applied to each treatment area was proposed, which was developed based on the anticipated demand for cardiac surgery. The independent model or the satellite model was proposed for Chungcheong, Jeolla, North Gyeongsang, and South Gyeongsang area, where more than 500 cardiac surgeries are performed annually. The extended model was proposed as most effective for the Gangwon and Jeju area, where more than 200 cardiac surgeries are performed annually. Conclusion: The operation of regional cardiac surgery centers with high caliber professionals and quality resources such as optimal equipment and facility size, should enhance regional healthcare accessibility and the quality of cardiac surgery in South Korea.

Curriculum Analysis on Health Management Schools in Republic of Korea: Focusing on Relationship with Licence and Certification (국내 학부 보건관리학과의 교육과정 분석연구: 취득면허·자격과의 관계를 중심으로)

  • Lee, Yuri
    • Health Policy and Management
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    • v.28 no.1
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    • pp.23-34
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    • 2018
  • Background: This study aims to conduct curriculum analysis on health management schools focusing on relationship with licence and certification in Republic of Korea. Methods: Possible employment field, licence and certification as well as curriculum were collected from the home page of 30 health management schools. The subjects and credits of curriculum were analyzed using descriptive statistics. Main subjects by areas were drew using categorization and ranking within qualitative methods. Comparative analysis was conducted for checking relationship between main subject and possible employment field, licence and certification. Results: First, major employment fields after graduation were public health officer, general hospital and clinic, and National Health Insurance Service. Possible licence and certificate were hospital administrator, medical recorder, health education specialist, and medical insurance specialist. Second, total graduate credits were 133.9 including 79.0 for major education, 30.5 for of general education, and 30.5 for elective courses. Third, main subjects were reviewed by areas including basic medicine, health management, hospital business & management, medical records & information, insurance billing & assessment, healthcare marketing & tourism, and health education. There were highest number of subjects on health education area among 8 categories. By subjects, many health management schools open health law, medical terminology, introduction to public health, and biostatistics. Relationship between main subjects and possible employment field, licence and certification in health management schools was strong. Conclusion: It is necessary to review curriculum and for improving educational quality in health management schools. Also, development of curriculum standards for courses in health administration and introduction of accreditation system can be considered.

A study on illegal dental treatment (치과 무면허 불법 시술에 대한 연구)

  • Kim, Hyeongsu;Kim, Vitna
    • Journal of Korean society of Dental Hygiene
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    • v.13 no.2
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    • pp.211-220
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    • 2013
  • Objectives : This study intended to figure out illegal treatment by unlicensed person in dental area and factors, which were considered as user's position on the basis of the local community investigation of health conditions in chungbuk provinces in 2008. Methods : This study used chi-square test and complex sample design of multi-variate logistic regression analysis to question 12,443 peoples who have experience on illegal dental treatment. Results : Multi-variate logistic regression analysis results showed that factors having related to illegal dental treatment are sex, age, education standards, subjective awareness of oral health condition, drinking experience of lifetime, unmet need of dental treatment, chewing difficulty, use of dentures, experience of scaling and the use of interdental care instrument. Conclusions : As a result of this study, in order to root out illegal dental treatment, we need to expand the breadth of health insurance coverage so that it can reduce the burden of dental expenses. Moreover, we need to set out health service of public oral health to inform the importances of maintaining good oral health and the problems of illegal dental treatment by unlicensed person.

Analysis of Influencing Factors that Influence on the Job Satisfaction of Nurses involved in Medical Insurance Reviews (보험심사간호사의 직무만족도에 영향을 미치는 요인)

  • Park, Jeong-Lang;Jung, Sang-Hyuk;Chae, Yoo-Mi
    • Health Policy and Management
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    • v.17 no.4
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    • pp.82-98
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    • 2007
  • This study aimed to analyze the factors that influence the job satisfaction of nurses involved in medical insurance reviews. The study involved a self-administered questionnaire survey which was conducted with to 297 nurses who were in charge of medical insurance reviews between April 10 and April 28, 2000. The average job satisfaction of the subjects was 3.04. The sub-items of job satisfaction were noted to be high for 'professional status'(3.79) and low for wage (2.46). The job satisfaction of subjects showed statistically significant differences with regard to education, career, and volume of service(p<0.05). The average job stress of subjects was 2.57. The sub-items of job stress included problems pertaining to human relationships problem(2.84), conflicts with doctors at work (2.79), and the burden of excessive workloads(2.79), in that order. Multiple regression analysis demonstrated that job satisfaction was significantly low when the job stress was higher. It also showed that the job satisfaction was significantly high as there was more frequency of judgements and higher education. These results suggest that the job stress of nurses involved in medical insurance reviews has a profound impact on their job satisfaction. Therefore, the efforts should be made to reduce their job stress. It may also be beneficial to reinforce the training with the doctors and nurses in order to improve their communication skills. Disseminating more information about insurance standards may also be considered.

Multi-level Analysis of Factors related to Quality of Services in Long-term Care Hospitals (다수준 분석을 이용한 요양병원 서비스 질에 영향을 미치는 요인 분석)

  • Lee, Seon-Heui
    • Journal of Korean Academy of Nursing
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    • v.39 no.3
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    • pp.409-421
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    • 2009
  • Purpose: In this research multi-level analysis was done to identify factors related to quality of services. Patient characteristics and organizational factors were considered. Methods: The data were collected from the Health Insurance Review and Assessment Service(HIRA) data base. The sample was selected from 17,234 patients who had been admitted between January 2007 and May 2008 to one of 253 long-term care hospitals located in Seoul, six other metropolitan cities or nine provinces The data were analyzed with SAS 9.1 using multi-level analysis. Results: The results indicated that individual level variables related to quality of service were age, cognitive ability, patient classification, and initial quality scores. The organizational level variables related to quality of service were ownership, number of beds, and turnover rate. The explanatory power of variables related to organizational level variances in quality of service was 23.72%. Conclusion: The results of this study indicate that differences in the quality of services were related to organizational factors. It is necessary to consider not only individual factors but also higher-level organizational factors such as nurse' welfare and facility standards if quality of service in long term care hospitals is to be improved.

The Trends and Prospects of Health Information Standards : Standardization Analysis and Suggestions (의료정보 표준에 관한 연구 : 표준화 분석 및 전망)

  • Kim, Chang-Soo
    • Journal of radiological science and technology
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    • v.31 no.1
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    • pp.1-10
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    • 2008
  • Ubiquitous health care system, which is one of the developing solution technologies of IT, BT and NT, could give us new medical environments in future. Implementing health information systems can be complex, expensive and frustrating. Healthcare professionals seeking to acquire or upgrade systems do not have a convenient, reliable way of specifying a level of adherence to communication standards sufficient to achieve truly efficient interoperability. Great progress has been made in establishing such standards-DICOM, IHE and HL7, notably, are now highly advanced. IHE has defined a common framework to deliver the basic interoperability needed for local and regional health information networks. It has developed a foundational set of standards-based integration profiles for information exchange with three interrelated efforts. HL7 is one of several ANSI-accredited Standards Developing Organizations operating in the healthcare arena. Most SDOs produce standards (protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance transactions. HL7's domain is clinical and administrative data. HL7 is an international community of healthcare subject matter experts and information scientists collaborating to create standards for the exchange, management and integration of electronic healthcare information. The ASTM specification for Continuity of Care Record was developed by subcommittee E31.28 on electronic health records, which includes clinicians, provider institutions, administrators, patient advocates, vendors, and health industry. In this paper, there are suggestions that provide a test bed, demonstration and specification of how standards such a IHE, HL7, ASTM can be used to provide an integrated environment.

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Through analyzing the health insurance data provided by Health Insurance Review & Assessment Service (HIRA) of Korea, understanding the characteristic of patient who were diagnosed somatic dysfunction and analysis of the current local status of the usage of code M99 (건강보험심사평가원 데이터의 분석을 통한 체성기능부전 환자의 특성 및 M99 진단명의 사용현황 분석)

  • Shin, Jae-Kwon;Joo, Han-Soo;Lee, Seong-Yup;Shin, Ye-Sle;Ko, Won-Il;Park, Ki-Byung;Kim, Min-Kyu;Ha, In-Hyuk
    • The Journal of Churna Manual Medicine for Spine and Nerves
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    • v.11 no.1
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    • pp.53-64
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    • 2016
  • Objectives : The aim of this study is to assess the usage of diagnosis codes for somatic dysfunctions and the general characteristics of patients diagnosed with the code, by analyzing health insurance data provided by the Health Insurance Review & Assessment Service(HIRA) of Korea. This investigation is intended to outline future and willing to contribute to further use of diagnosis code and the approach of Oriental Medicine to somatic dysfunction. Materials and Methods : By analyzing HIRA data, those diagnosed with M99 codes, a code attributed to somatic dysfunction, were selected for analysis. Patients included were assessed for the relevant general characteristics, and the specific diagnostic criteria. The current usage rates and noteworthy characteristics of diagnostic codes of somatic dysfunctions were assessed. A comparative analysis between clinical departments and subcategories, and a comparative analysis to data of 2014 was conducted. Results : Patients given M99 codes constituted a small minority of all patients diagnosed in 2011 as shown by HIRA data. The codes were more frequently to older patients, females, outpatients, and those who filed for Health Insurance compensation. Medical institutions participating in the diagnosis were mostly primary care facilities, usually specializing in orthopedic(Western medicine sector) and internal medicine (Oriental Medicine sector). The most registered code in 2011 and 2014 was M995. The same trend can be observed in Oriental/Western medicine institutions and Public health center, on the other hand, between them, have some different patterns both 2nd and 3rd. Conclusions : This investigation is that of current usage of diagnostic codes of somatic dysfunction. HIRA insurance claim data was analyzed. Based on the current results, more precise diagnostic standards of somatic dysfunction are warranted. This study will provide a foundation for future Oriental Medicine approach to somatic dysfunctions.

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Screening of 56 Herbal formulas covered by the National Health Insurance Service on Dementia-related Factors (World Federation Medical Education Global Standards의 교육과정 표준에 따른 한의학 교육 연구)

  • Lee, Jeong Hyeok;Kim, Byoung Soo
    • The Journal of Korean Medicine
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    • v.39 no.3
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    • pp.28-40
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    • 2018
  • Objectives: The aim of this study is to introduce the WFME Global Standards and Recognition process and to consider Improvement direction of Korean traditional medical curriculum. Methods: To Investigate the Standards and Recognition process of WFME and the traditional medical curriculum of each country(China, Taiwan, Japan, Korea). Results: The WFME Global Standards and Recognition process aims to train doctors who are educated and active in world standard medical Curriculum. The traditional medical colleges have not received recognition, but those colleges in Korea, China and Taiwan contain a lot of standards contents, and they need to be recognized if they belong to WDMS. Conclusions: Korea University of Oriental Medicine has a lot of subjects of WFME Standards and there is a medical education recognition association, which is advantageous for the standardization process of world medical education. Therefore, it is necessary to aim at world standard medicine while preserving the tradition of Oriental medicine, WFME Global Standards should be used to reorganize the curriculum and train a world-class medical professional.

A Study on the Improvement of the Safety Insurance for the Laboratory at the Korean Worker's Compensation Insurance - Focusing on Disability Benefit Pension Type Payment - (산재보험 수준의 연구실안전보험 보장성강화 방안 - 장해보험금 연금형태 지급을 중심으로 -)

  • Song, H.S.;Yee, N.H.;Choi, J.G.;Chun, S.H.;Kim, Jai Jung;Lee, B.H.
    • Journal of the Korean Society of Safety
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    • v.34 no.1
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    • pp.115-121
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    • 2019
  • Background: Due to the diversification and advancement of research, researchers have become to deal with a variety of chemical and biological harmful materials in the laboratories of universities and research institutes and the risk has increased as well. Therefore, it is necessary to strengthen the social safety net for laboratory accidents by strengthening the compensation to the level comparable to that of Korean Workers' Compensation & Welfare Service, when the researchers become physically disabled by laboratory accidents. The purpose of this study is to secure researchers' health rights and to create a research environment where researchers can work with confidence by strengthening the compensation to the level comparable to that of Korean Workers' Compensation & Welfare Service. Method: We analyzed the laboratory accidents by year, injury type, severity of accident and disability grade with the 6 year data from 2011 to 2016, provided by Laboratory Safety Insurance. Based on the analysis result, we predicted the financial impact on Laboratory Safety Insurance if we introduce a compensation annuity by disability grade which is similar to Injury-Disease Compensation Annuity of Korean Workers' Compensation & Welfare Service. Result :As of 2011, the insured number of Laboratory Safety Insurance was approximately 700,000. The Average premium per insured was KRW 3,339 and there were 158 claims. Total claim amount was KRW 130 million, whereas the premium was about KRW 2.3 billion. The loss ratio was very low at 5.75%. If we introduce a compensation annuity by disability grade similar to Injury-Disease Compensation Annuity of Korean Workers' Compensation & Welfare Service, the expected benefit amount for 1 case of disability grade 1 would be KRW 1.6 billion, assuming 2% of interest rate. Given current premium, the loss ratio, the ratio of premium income to claim payment, is expected 41.4% in 2017 and 151.6% in 2026. The increased loss ratio due to the introduce of the compensation annuity by disability grade is estimated to be 11.0% in 2017 and 40.4% in 2026. Conclusion: Currently, laboratories can purchase insurance companies' laboratory safety insurance that meets the standards prescribed by Act on the Establishment of Safe Laboratory Environment. However, if a compensation annuity is introduced, it would be difficult for insurance companies to operate the laboratory safety insurance due to financial losses from a large-scale accident. Therefore, it is desirable that one or designated entities operate laboratory safety insurance. We think that it is more desirable for laboratory safety insurance to be operated by a public entity rather than private entities.