• Archives of Plastic Surgery
• /
• v.49 no.3
• /
• pp.339-345
• /
• 2022

Background Patients that undergo mastectomy for breast cancer with reconstruction may be prone to prolonged opioid use. As risk factors are not well-established, this article sought to better understand the risk factors that may be associated with this. Methods Patients that underwent breast reconstruction between 2010 and 2018 were identified in PearlDiver, a national insurance claims database. Patient demographics and comorbidities were elucidated, and various complications were then identified. Descriptive statistics as well as a multivariate analysis was used to evaluate the association of risk factors and complications. Results Breast reconstruction patients of 24,765 were identified from this database. Obesity, tobacco use, benzodiazepine use, and anticonvulsant use were all associated with prolonged opioid prescriptions greater than 90 days after both alloplastic and autologous reconstruction. Conclusion Prolonged opioid use continues to remain a topic of concern, and particularly in cancer patients that undergo breast reconstruction. Providers should be aware of potential risk factors for this to reduce this chance following breast reconstruction surgery.

• Journal of Preventive Medicine and Public Health
• /
• v.56 no.5
• /
• pp.475-480
• /
• 2023

Objectives: This study examined differences in health care spending and characteristics among older adults in Korea by high-cost status (persistently, transiently, and never high-cost). Methods: We identified 1 364 119 older adults using data from the Korean National Insurance Claims Database for 2017-2019. Outcomes included average annual total health care spending and high-cost status for 2017-2019. Linear regression was used to estimate differences in the outcomes while adjusting for individual-level characteristics. Results: Persistently and transiently high-cost older adults had higher health care spending than never high-cost older adults, but the difference in health care spending was greater among persistently high-cost older adults than among transiently high-cost older adults (US$20 437 vs. 5486). Despite demographic and socioeconomic differences between transiently high-cost and never high-cost older adults, the presence of comorbid conditions remained the most significant factor. However, there were no or small differences in the prevalence of comorbid conditions between persistently high-cost and transiently high-cost older adults. Rather, notable differences were observed in socioeconomic status, including disability and receipt of Medical Aid. Conclusions: Medical risk factors contribute to high health care spending to some extent, but social risk factors may be a source of persistent high-cost status among older adults in Korea.

• Korean Circulation Journal
• /
• v.52 no.11
• /
• pp.808-813
• /
• 2022

Studies showing that coronavirus disease 2019 (COVID-19) is associated with an increased risk of cardiovascular disease continue to be published. However, studies on how long the overall cardiovascular risk increases after COVID-19 and the magnitude of its long-term effects have only been confirmed recently. This is partly because the distinction between cardiovascular risk as an acute complication of COVID-19 or post-acute cardiovascular manifestations is ambiguous. Long-COVID has arisen as an important topic in the second half of the pandemic. This term indicates that symptoms persist for more than two 2 months; following three months of SARS-CoV-2 infection and cannot be explained by other medical conditions. Despite the agreement of these international organizations and experts, it is difficult to define whether there is sufficient medical evidence to prove the existence of long-COVID. However, the Korean government and Korea Disease Control and Prevention Agency (KDCA) are preparing a new platform to assess the long-term impact of COVID-19. Using this data, a prospective cohort of 10,000 confirmed COVID-19 cases will be established. This cohort will be linked with claims data from the National Health Insurance Services (NHIS) and it is expected that increased real-world evidence of long-COVID will be accumulated.

• Journal of Korea Port Economic Association
• /
• v.31 no.2
• /
• pp.41-53
• /
• 2015

In Paracomon Inc. v. Telus Communication, Realice's anchor became entangled with a working fiber-optic submarine cable during its voyage and are presentative of the shipowner(the captain) cut the cable. The owner of the cable brought a claim for the repair cost against the shipowner. The shipowner then advanced a third party claim against a liability insurance underwriter. The Supreme Court of Canada (SCC) held that the shipowner was entitled to limit its liability under the 1976 Convention on the Limitation of Liability for Maritime Claims. The SCC also ruled that even though the misdeed of the shipowner was insufficient to break its right to limitation of liability, its wrongdoing constituted willful misconduct under the 1993 Canada Marine Insurance Act, allowing the underwriter to deny coverage for the incident. Thecasewasthefirsttoaddresstheinterrelationship between the shipowner's right to limit liability under the international convention regime and the availability of liability insurance with respect to such limited liability. This study analyzes the reasoning behind the SCC's judgment and evaluates the appropriateness of this court's decision based on the current maritime industry as well as prevailing maritime law. It concludes that the SCC's decision to declare that the shipowner retained the right to limit its liability is appropriate under the Limitation Convention (1976). However, its declaration that the liability insurer was discharged from liability is not correct in due consideration of the common recognition in the maritime industry, the intended purpose of a third party's right against the liability insurer, and the adoption process of the conduct barring limitation. Based on the SCC's decision, this study finally reviews the issue of the shipowner's right to limit and the coverage of the liability insurer in the Sewol case (2014).

• Journal of Preventive Medicine and Public Health
• /
• v.26 no.4 s.44
• /
• pp.614-627
• /
• 1993

It is well known that a physician's personal characteristic affects his practice pattern. Furthermore, a physician's specialty has powerful influences on his practice pattern. However, despite the fact that specialization has received the most attention for its influence on physician's service behavior, few studies have been conducted on the variations of contents and volume of physician's services. This study has intended to identify factors influencing the practice variations according to various physician characteristics. There are some other evidences that medical care providers are different in using of health services and resources in Korea. Four physician characteristics were selected for the analysis, two demographical factors, age and sex, and two practice factors, place of practice and medical specialty. Also, three indicators of service amount (total amount of insurance claim bill, number of visits per case, number of prescriptions per case) were selected. From the pool of insurance claims for ambulatory care received by the Korean National Federation of Medical Insurance(NFMI), 84,898 cases were randomly sampled. In the meantime using physician database of NFMI, 613 general practitioners (GP), 107 regular family physicians (FP), 483 'grandfather' family physicians(GFP), and 1,157 specialist practitioners(SP) were randomly sampled. Their different practice contents were compared concerning the specialty, age groups, sex, and practice sites (urban-rural) Specialist physicians tend to provide more costly care than do generalists. General practitioners and family physicians usually make fewer following visits and prescriptions. Age is also the important factor in determining the amount of services, which is highest at the physician's age group of 40's. Female doctors and urban practitioners use much more resources than their counterparts respectively. Research findings suggest that physician's characteristics particularly the specialty can affect practice patterns and resource utilizations. Other characteristics such as age and sex are not controllable but physician's specialty is relatively easily controllable during the entire phases of policy implementation. This is all the more true in the individual's initial decision of his specialty. Specialization therefore should receive policymaker's attention for its potential influence on medical care utilization and health care expenditure.

• Journal of dental hygiene science
• /
• v.5 no.1
• /
• pp.7-12
• /
• 2005

This study was conducted to compare and analyze 877 cases of health insurance claims from the first half of 1999 requested to the dental centers of local health centers in rural areas and 510 identical cases from the first half of 2003. It was purposed to understand the trend of rural residents' visits to local health centers and to use the collected data as the basis needed for the vitalization of local dental cares to efficiently improve Korean citizens' dental hygiene. The results were shown as below: 1. The sexes of the visitors were fairly evenly distributed for each year. 2. Among the total of 39 types of diseases treated, 1999 had 31.9% of visits for 'Gingivitis and periodontal diseases' with 25.4% from ages between 10 and 19, for statistically attentive results. On the other hand, 2003 had 46.5% of visits for 'Oral examination' with 52.9% from ages between 0 and 9, for statistically attentive results. 3. For the distribution of age groups, majority in 1999 made visits for dental caries, gingivitis and periodontal disease, whereas majority in 2003 were for oral examination, dental caries, gingivitis and periodontal disease.

• Journal of the Korea Institute of Building Construction
• /
• v.16 no.4
• /
• pp.349-357
• /
• 2016

Recently, the quantity of risk in construction project has been inflated due to the fact that current construction projects have been large and complicated. Therefore, a study on the risk management methods is necessary that can predict and respond to the need in complicated modern construction projects. In this study, the objective is to analyze the cause of accident in actual construction sites and develop a risk assessment model based on insurance claims records. To reach the goal of this study, first, the frequency and severity of accidents are analyzed the causes of accidents based on the classification; progress rate, season, and total construction costs. Second, a risk assessment model is developed by utilizing a multiple regression analysis. The dependent variable is loss ratio of material damage and three categories; natural hazards, geographic information, and construction method & ability, are used as the independent variables. The model's adjusted R-square is 0.455. The contributions of this study will be used as a material for a quantitative risk analysis model development and review of the construction risk factors for future study.

• Journal of Korea Trade
• /
• v.25 no.2
• /
• pp.152-177
• /
• 2021

Purpose - This study analyses the excepted requirement and burden of proof of the carrier due to unseaworthiness through comparison between the marine transport contract and marine insurance contract. Design/methodology - This study uses the legal analytical normative approach. The juridical approach involves reviewing and examining theories, concepts, legal doctrines and legislation that are related to the problems. In this study a literature analysis using academic literature and internet data is conducted. Findings - The burden of proof in case of seaworthiness should be based on presumed fault, not proved fault. The burden of proving unseaworthiness/seaworthiness should shift to the carrier, and should be exercised before seeking the protections of the law or carriage contract. In other words, the insurer cannot escape coverage for unfitness of a vessel which arises while the vessel is at sea, which the assured could not have prevented in the exercise of due diligence. The insurer bears the burden of proving unseaworthiness. The warranty of seaworthiness is implied in hull, but not protection and indemnity policies. The 2015 Act repeals ss. 33(3) and 34 of MIA 1906. Otherwise the provisions of the MIA 1906 remain in force, including the definition of a promissory warranty and the recognition of implied warranties. There is less clarity about the position when the source of the loss occurs before the breach of warranty but the actual loss is suffered after the breach. Nonetheless, by s.10(2) of the 2015 Act the insurer appears not to be liable for any loss occurring after the breach of warranty and before there has been a remedy. Originality/value - When unseaworthiness is identified after the sailing of the vessel, mere acceptance of the ship does not mean the party waives any claims for damages or the right to terminate the contract, provided that failure to comply with the contractual obligations is of critical importance. The burden of proof with regards to loss of damage to a cargo caused by unseaworthiness is regulated by the applicable law. For instance, under the common law, if the cargo claimant alleges that the loss or damage has been caused by unseaworthiness, then he has the burden of proof to establish the followings: (i) that the vessel was unseaworthy at the beginning of the voyage; and that, (ii) that the loss or damage has been caused by such unseaworthiness. In other words, if the warranty of seaworthiness at the inception of the voyage is breached, the breach voids the policy if the ship owner had prior knowledge of the unseaworthy condition. By contrast, knowingly permitting the vessel to break ground in an unseaworthy condition denies liability only for loss or damage proximately caused by the unseaworthiness. Such a breach does not, therefore, void the entire policy, but only serves to exonerate the insurer for loss or damage proximately caused by the unseaworthy condition.

• The Korean Society of Law and Medicine
• /
• v.23 no.2
• /
• pp.171-209
• /
• 2022

There were also many medical-related rulings in 2021, among which the rulings reviewed in this paper are as follows. The first relates to a case in which the medical record, which is the primary judgment data regarding the presence or absence of medical negligence, has been modified. The court judged whether there was negligence on the basis of the first written medical record without considering the contents of the medical record that was later modified. Next, the ruling on the case of asking for liability for damages for prescription of anti-obesity drugs recognized negligence related to prescription, but denied liability for property damage by denying a causal relationship, and recognized only alimony for violation of the duty of explanation. The a full-bench ruling on the scope of subrogation of the National Health Insurance Corporation, which subrogates the claims for compensation for medical expenses against the perpetrator of the patient, changed the existing precedent that had taken the 'deduction method after offsetting negligence' and judged it as 'the method of offsetting negligence after deduction'. In addition, in the ruling on whether or not there was negligence, the court was not bound by the medical record appraisal result. Lastly, in relation to the National Health Insurance Service's disposition of reimbursement for medical care benefit costs, we reviewed the ruling that discretion should be exercised even when a non-medical person makes a refund to a medical institution opened by a non-medical person. And we also reviewed the ruling that the scope of reimbursement for medical institutions jointly using facilities and manpower specifically should be determined.

• Health Policy and Management
• /
• v.34 no.1
• /
• pp.78-86
• /
• 2024

Background: The purpose of this study was to determine the effectiveness of the specialty hospital system by comparing the medical use of inpatients who had artificial joint replacement surgery in specialty hospitals and non-specialty hospitals. Methods: This study utilized 2021-2022 healthcare benefit claims data provided by the Health Insurance Review and Assessment Service. The dependent variable is inpatient medical use which is measured in terms of charges per case and length of stay. The independent variable was whether the hospital was designated as a specialty hospital, and the control variables were patient-level variables (age, gender, insurer type, surgery type, and Charlson comorbidity index) and medical institution-level variables (establishment type, classification, location, number of orthopedic surgeons, and number of nurses). Results: The results of the multiple regression analysis between charges per case and whether a hospital is designated as a specialty hospital showed a statistically significant negative relationship between charges per case and whether a hospital is designated as a specialty hospital. This suggests a significant low in charges per case when a hospital is designated as a specialty hospital compared to a non-specialty hospital, indicating that there is a difference in medical use outcomes between specialty hospitals and non-specialty hospitals inpatients. Conclusion: The practical implications of this study are as follows. First, the criteria for designating specialty hospitals should be alleviated. In our study, the results show that specialty hospitals have significantly lower per-case costs than non-specialty hospitals. Despite the cost-effectiveness of specialty hospitals, the high barriers to be designated for specialty hospitals have gathered the specialty hospitals in metropolitan and major cities. To address the regional imbalance of specialty hospitals, it is believed that ease the criteria for designating specialty hospitals in non-metropolitan areas, such as introducing "semi-specialty hospitals (tentative name)," will lead to a reduction in health disparities between regions and reduce medical costs. Second, it is necessary to determine the appropriateness of the size of hospitals' medical staff. The study found that the number of orthopedic surgeons and nurses varied in charges per case. Therefore, it is believed that appropriately allocating hospital medical staff can maximize the cost-effectiveness of medical services and ultimately reduce medical costs.