• The Journal of the Korean life insurance medical association
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• v.18
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• pp.117-125
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• 1999

암에 의한 보험금 지급의 증가와 관련하여 1996년, 1년 동안 당사에서 암진단보험금 수혜자에 대한 고찰을 통해 다음과 같은 결과를 얻었다. 1. '96년 암진단보험금 지급은 2,720건 발생하였고, 남자 777명(28.6%), 여자 1,943명(71.4%)였다. 2. 남녀별로 40대, 30대, 50대 순으로 암진단보험금이 지급되었으며, 남자에서는 각각 38.6%, 28.8%, 24.2%였고, 여자에서는 각각 31.8%, 30.3%, 26.6%였다. 3. 남자의 경우 위장계통 암이 323명(41.6%), 여자의 경우 생식기계통 암(유방암 포함)이 968명(52.4%)으로 가장 많았다. 4. 장기별 발생률은 남자는 위(27.5%), 간(22.0%), 폐(8.1%), 여자는 유방(21.2%), 위(14.9%), 자궁경부(13.2%)순으로 나타났다. 5. 경과기간별 암진단보험금 지급 양상은 가입 후 1년 이내 25.1%, 1년에서 2년 이하 18.9%, 1년 후 55.9% 발생하였다. 6. 6개월 이내 암진단보험금은 폐암(15.0%), 갑상선암(14.5%), 자궁경암(13.6%), 유방암(13.1%) 순으로 지급되었다. 7. '96년 암진단보험금 수혜자 중 사망은 '98년 10월 현재 805건(29.6%) 발생하였고, 암종류별 사망률은 간암(76.9%), 폐암(74.0%), 위암(36.3%) 순으로 높았다.

• Journal of Preventive Medicine and Public Health
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• v.45 no.3
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• pp.127-136
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• 2012

The challenge facing the Korean National Health Insurance includes what to spend money on in order to elevate the 'value for money.' This article reviewed the changing issues associated with quality of care in the Korean health insurance system and envisioned a picture of an effective pay-for-performance (P4P) system in Korea taking into consideration quality of care and P4P systems in other countries. A review was made of existing systematic reviews and a recent Organization for Economic Cooperation and Development survey. An effective P4P in Korea was envisioned as containing three features: measures, basis for reward, and reward. The first priority is to develop proper measures for both efficiency and quality. For further improvement of quality indicators, an electronic system for patient history records should be built in the near future. A change in the level or the relative ranking seems more desirable than using absolute level alone for incentives. To stimulate medium- and small-scale hospitals to join the program in the next phase, it is suggested that the scope of application be expanded and the level of incentives adjusted. High-quality indicators of clinical care quality should be mapped out by combining information from medical claims and information from patient registries.

• Health Policy and Management
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• v.2 no.1
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• pp.115-147
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• 1992

The purposes of this paper are twofold : to identify what pathway insured patients are seeking medical care services through, and then, to provide the basis for the prediction and evaluation of the effects of a new policy intervention. To change the patient flow across different types of medical care facilities, this intervention has been enforced since July 1, 1989. It is mainly aimed at discouraging the use of the tertiary hospitals by imposing some restrictions on the patient's choice. The data for analysis were obtained from the claims to the insurance for govermment and school employees. The sample was drawn from the claims for about 1% of the enrollees using medical care facilities during 2 years since January 1, 1985. The sample included 91, 483 for 1985 and 81,914 for 1986, among them the number of patients to initiate the use of medical care service were 66,757 and 59,498 respectively. This paper analysed what types of and how many medical care facilities the patient with same disease had used.

• The Korean Journal of Air & Space Law and Policy
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• v.33 no.1
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• pp.227-260
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• 2018

Recently, as the use of drones increases, the risk of drone accidents and third-party property damage is also increasing. In Korea, due to the recent increase in drone use, accidents have been frequently reported in the media. The number of reports from citizens, and military and police calls regarding illegal or inappropriate drone use has also been increasing. Drone operators may be responsible for paying damages to third parties due to drone accidents, and are liable for paying settlements due to illegal video recording. Therefore, it is necessary to study the idea of providing drone insurance, which can mitigate the liability and risk caused by drone accidents. In the US, comprehensive housing insurance covers damages caused by recreational drones around the property. In the UK, when a drone accident occurs, the drone owner or operator bears strict liability. Also, in the UK, drone insurance joining obligation depends on the weight of the drones and their intended use. In Germany, in the event of personal or material damage, drone owner bears strict liability as long as their drone is registered as an aircraft. Germany also requires by law that all drone owners carry liability insurance. In Korea, insurance is required only for "ultra-light aircraft use businesses, airplane rental companies and leisure sports businesses," where the aircraft is "paid for according to the demand of others." Therefore, it can be difficult to file claims for third party damages caused by unmanned aerial vehicles in personal use. Foreign insurance companies are selling drone insurance that covers a variety of damages that can occur during drone accidents. Some insurance companies in Korea also have developed and sell drone insurance. However, the premiums are very high. In addition, drone insurance that addresses specific problems related to drone accidents is also lacking. In order for drone insurance to be viable, it is first necessary to reduce the insurance premiums or rates. In order to trim the excess cost of drone insurance premiums, drone flight data should be accessible to the insurance company, possibly provided by the drone pilot project. Finally, in order to facilitate claims by third parties, it is necessary to study how to establish specific policy language that addresses drone weight, location, and flight frequency.

• The Journal of the Korean life insurance medical association
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• v.24
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• pp.97-117
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• 2005

Internally Korean insurance market is that whole life products' growth are becoming slowdown that's why new insurance products have appeared on the market in consideration of consumer's needs recently. Externally domestic insurance market competitions has drifted from insurance industry to whole financial industry since bankasurance started. Life insurance companies should open up a new market to survive from severe competitions. Worksite marketing can be an alternative. An insurer make arrangements with an employer about an insurance terms which an insurer offers in Worksite marketing. Then eligible individuals enroll in the plans at their own discretion and pay 100 percent of the premium for coverage through payroll deductions. An employer doesn't need to pay extra money for additional benefit but can raise employee's loyalty and satisfaction of company through worksite marketing. An employee can be covered at discounted premium rate and less strict underwriting guidelines to an insurer compared to individual insurance. In developed countries specially U.S insurance market, Worksite marketing is getting very popular and growing rapidly due to the advantages. Worksite marketing has both individual insurance characters and group insurance characters. Individual insurance characters are that employees enroll in the plans at their own discretion and pay 100 percent of the premium for coverage. Group insurance characters are that actively at work and participation etc. An insurer have to reflect these two characters on Worksite marketing when an insurance company work out a plan for developing products and underwriting guidelines. When an insurer devise worksite products, one should consider participation level which means percentage of eligible employees participating. Participation is related to anti-selection. As we know underwriting is essential for every kind of insurance, especially underwriting plays major role in worksite marketing. We can see that in the below. Firstly, it has a function in calculation of premium rate. When calculate premium rate for worksite products underwriters have to estimate expected participation level and risk factors. So underwriters and acturies keep in close contact with each other. Secondly, underwriting methods are important. When an insurer underwrite worksite products, there are three kinds of underwriting methods. These are Simplified issue underwriting, Full underwriting and Guaranteed issue underwriting. Simplified issue underwriting typically requires no medical examination, but usually requires supplying satisfactory answers to one or several health and/or lifestyle questions. Full underwriting requires a complete medical history questionnaire that may further require an exam. Guaranteed issue underwriting means that coverage is issued without the employee having to provide evidence of insurability. When insurer set the GI limit are usually based on the type of industry, number of eligible employees, the average amount of coverage and participation level. In addition to insurer should have a clear definition of eligible employee on the insurance provision and application form. It will minimize possibility of trouble claims and anti-selection. An insurer also establish preexisting condition exclusion and special guidelines for late entrants. When an insurer introduce Worksite marketing to Korean insurance market, an insurer has to examine market research to analyze potential market and strategy of sales most of all. Also an insurer should review real situation of the U.S, England and Japanese market etc. There are a lot of new technologies about worksite marketing process that an insurer should learn. When an insurer consider many things which we explained it can be a real alternative.

• The Korea Journal of Herbology
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• v.27 no.2
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• pp.1-16
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• 2012

Objective : To investigate the current status of prescription drugs in Oriental medical institutes and to draw up a future plan for the revitalization of Oriental medical health insurance, this survey has been performed. Method : The survey has been made with 321 doctors working at Oriental medical institutes in Daegu and Kyungbuk areas for a period of 3 month from June 1, 2010 until September 1, 2010. Result : 1. When it comes to the current status of the use of herbal drugs in Oriental Health insurance, most of doctors surveyed prescribe insurance drugs, and they prescribe insurance drugs to patients, who are less than 20% of total patients visiting their clinics. 2. The awareness of Herbal Health Care Drugs is investigated. When it comes to the understanding of the difference between insurance drugs(powder type drugs) and granular type drugs, doctors admit that they differ only in one aspect, whether or not their being covered by health insurance. Based on the survey results on the understanding of insurance coverage of granular type drugs, doctors, even though they long for granular type drugs to be accepted as insurance drugs, are worrying whether the number of outpatients might dwindle due to increased insurance co-payments. They also point out that the biggest obstacles in the expansion of the granular type drugs as insurance drugs are the lack of understanding of the government and the objection of the Health Insurance Review and Assesment service (HIRA) for fear of increased insurance claims. 3. Upon investigation on Oriental medicine doctors' understandings of herbal pharmaceutical industry, it is found that doctors' responses on pharmaceutical industry are not all positive ones('new product development and neglect of R&D infrastructure' and 'smallness of industry'). When it is investigated what area needs the greatest improvement in herbal pharmaceutical industry, 'securing sufficient capital, good manufacturing, and strengthening quality control', is the highest. 4. When it is asked what are the most needed in order to improve herbal health insurance medicine, responses such as 'the increase in the accessibility to and the utilization of Oriental medical clinics through the diversification of the means of prescriptions', 'the improvement of insurance benefits(cap adjustments)', 'increase the proportion of high quality medicinal plants', 'the ceiling of co-payments(deductible) at 20,000 won or more', 'expansion of the choices of formulations', 'formulational expansions of tablets and pills', and finally 'admittance and expansion of granular type drug as insurance drug' are the highest. 5. Upon investigating the general characteristics of the current status of the usage of Oriental health care herbal drugs, the followings are observed. First, the frequency of use of health insurance drugs by the doctors who use health insurance with general characteristics shows similar differences in case of total monthly sales amount (p<0.001), average number of daily patients (p<0.05). Secondly, as to the willingness of the expanded usage of insurance drugs, similar differences are observed in case of total monthly sales amount (p<0.05). 6. Upon investigating the general characteristics of the perception of Herbal health care drugs, the followings are observed. First, inspecting general characteristics and insurance claims due to increased co-payments(deductible amount) reveals similar differences in case of working period (p<0.01) and in case of total monthly sales amount (p <0.01). Secondly, inspecting general characteristics and the obstacles that hinder granular type drugs from being accepted as health care insurance drugs shows similar differences in case of working period (p<0.05). 7. Upon investigating the general characteristics of the understanding of Oriental Herbal pharmaceutical companies, the followings are observed. First, opinions on the general characteristics of pharmaceutical companies, when examined with variance analysis, shows similar differences in case of total monthly sales amount (p<0.05). Secondly, when opinions are examined on general characteristics and the problems of herbal pharmaceutical companies, similar differences are found in case of working period (p<0.01) and in case of total monthly sales amount (p<0.001). Lastly, opinions on the general characteristics and reforms of pharmaceutical companies, similar differences are observed in case of working period (p<0.001). 8. Upon investigating the general characteristics of the improvement of insurance Herbal drugs, the followings are observed. First, regarding general characteristics and insurance benefits, similar differences are observed in case of working period (p<0.05), in case of total monthly sales amount (p<0.05), and in case of average number of daily patients (p<0.01). Secondly, opinions on the general characteristics and the needs for the improvement of Herbal insurance drugs are examined in 5 different aspects, which are the approval of granular type drugs as insurance drugs, the expanded practices of the number of prescription insurance drugs, the needs of a variety of formulations, the needs of TFT of which numbers of Oriental medical doctors are members for the revision of the existing system, and the needs of adjusting the current ceiling of the fixed amount and the fixed rate. When processed by the analysis of variance, the results show similar differences in case of average number of daily patients (p<0.01). Conclusion : From the results of this study the first measures to take are, to reform overall insurance benefit system, including insurance co-payment system(fixed rate cap adjustment), to expand the number of the herbal drugs to be prescribed matching with insurance benefit accordingly, and to revitalize herbal medicine insurance system through the change of various formulations. In addition, it is recommended to improve the effectiveness of herbal medicine by making plans to enhance the efficacy of herbal medicine and by enabling small pharmaceutical companies to outgrow themselves.

• Journal of Preventive Medicine and Public Health
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• v.49 no.1
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• pp.53-60
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• 2016

Objectives: The purpose of this study is to examine the magnitude of and the factors associated with the downward mobility of first-episode psychiatric patients. Methods: This study used the claims data from the Korean Health Insurance Review and Assessment Service. The study population included 19 293 first-episode psychiatric inpatients diagnosed with alcohol use disorder (International Classification of Diseases, 10th revision [ICD-10] code F10), schizophrenia and related disorders (ICD-10 codes F20-F29), and mood disorders (ICD-10 codes F30-F33) in the first half of 2005. This study included only National Health Insurance beneficiaries in 2005. The dependent variable was the occurrence of downward mobility, which was defined as a health insurance status change from National Health Insurance to Medical Aid. Logistic regression analysis was used to assess factors associated with downward drift of first-episode psychiatric patients. Results: About 10% of the study population who were National Health Insurance beneficiaries in 2005 became Medical Aid recipients in 2007. The logistic regression analysis showed that age, gender, primary diagnosis, type of hospital at first admission, regular use of outpatient clinic, and long-term hospitalization are significant predictors in determining downward drift in newly diagnosed psychiatric patients. Conclusions: This research showed that the downward mobility of psychiatric patients is affected by long-term hospitalization and medical care utilization. The findings suggest that early intensive intervention might reduce long-term hospitalization and the downward mobility of psychiatric patients.

• The Korean Society of Law and Medicine
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• v.8 no.2
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• pp.119-164
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• 2007

Improving the formal objection system regarding reviewing medical expenses requires authority and confidence in the aspect of well-functioning the health insurance review and assessment system, legally and appropriately. The purposes of improvement of the formal objection system should aim for protecting the people's right of health. On handling the formal objections, the disputes of the rights should be settled economically and promptly by fairness, specialty, and objectivity in the health insurance review and assessment administration. Therefore, in order to promote the administrative specialty of health insurance, the formal objection committee needs to be organized independently and guaranteed expertly. Under the current formal objection system, however, the organization of committee lacks right-relief function, recognition and public relation as a health insurance appeal system, and related professional man powers. It is also analyzed that there are several controversial points, such as mass deliberation to the formal objection committee and its conference procedure. As a measure of improvement, it is analyzed that the committee needs to be organized independently with a proper number of professional man powers. The strict deliberation procedures and the prohibition of the decision-making by non-conference are also required to be empowered. The formal objection procedure provides the beneficiaries and the claims legitimately, so that it secures the legal relations on the health insurance system. Therefore, on the conference process of formal objection, the expert and guaranteed protection should be provided promptly, and its procedures to the appellants should also be assisted kindly.

• Health Policy and Management
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• v.26 no.4
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• pp.333-342
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• 2016

Background: The use of therapeutic materials based on new health technology has increased in recent years in the field of medicine, raising concerns for medical practitioners regarding increased spending on the new therapeutic materials amid the rapid population ageing and increase of chronic diseases in Korea. While therapeutic materials have significant importance in the health care system, they have not been given appropriate attention in the academic world of Korea. The purpose of this study is to identify factors that affect the growth of expenditure on therapeutic materials and to derive implications for an effective management considering the diversity of therapeutic materials. Methods: Using the claims data of the National Health Insurance Services, specific utilization patterns of groups of therapeutic materials in the middle classification level of Health Insurance Review and Assessment Service from 2007 to 2014 were analyzed. Four categories (J5083: drug eluting coronary stent, D0302: nonmetallic anchor, K6014: gauze, K6023: gauze) that exhibit unique patterns with respect to price and volume were selected. Then, decomposition analysis was performed to identify the largest contributor to the spending growth by dividing the products into existing, new, and abandoned products for the period between 2010 and 2013. Results: The effect of new products had larger impact on spending growth than the effect of core items in drug eluting coronary stent (J5083) and nonmetallic anchor (D0302). In addition, existing products in general included items priced relatively lower when compared with another item manufactured by the same company. In the gauze category, however, existing products had the largest impact on expenditure and the effect of volume was greater than that in other categories. Conclusion: This study provides evidence that appropriate management measures classified by the characteristics of therapeutic materials are required for therapeutic materials pricing and reassessment in Korea.

• Journal of Physiology & Pathology in Korean Medicine
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• v.33 no.3
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• pp.181-190
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• 2019

In South Korea, traffic accident patients can be treated under automobile insurance coverage. This study investigated the status of Korean medicine (KM) Automobile insurance system and usage status of main pharmacopuncture in KM clinic which reported that the largest number of automobile insurance fee claims among medical institutions. We surveyed 258 traffic accident patients who were treated at Namsangcheon KM clinic from 2014 to 2018 according to medical chart. The majority of the patients were male and thirties. In traffic accident situation, the highest distribution was car to car crash with 85.66% and 66.67% of the patients visited in the most acute phase. The most frequent treatment period was within 4 weeks and the number of treatments was 10 or less with 72.87%. In total results of treatment, the distribution was exellent with 10.08%, good with 46.90%, fair with 27.13% and poor with 15.89%, and the effective rate was 84.11%. The most frequent treatment period was within 4 weeks with 64.73% and the number of treatments was 10 or less with 72.87%. Of the 242 patients who received pharmacopunture, 91.5% were treated with HO, which was named after Honghwaja and TA, which was named after traffic accidents, and there were significant differences in the number of treatments and symptom improvement between the two groups. In this study, we confirmed the status of automobile insurance treatment and usage of main pharmacopuncture of single KM clinic with symptom improvement. This study can be regarded as one of the basis of KM treatment for the rapidly growing automobile insurance market.