• Journal of Preventive Medicine and Public Health
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• v.14 no.1
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• pp.53-58
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• 1981

In order to discover differences that may exist in quantity of medical care services, length of stay and hospital charges between insured and non-insured patients, records for primary Cesarean section patients discharged between July 1978 and June 1980 from a university hospital were examined. In addition, Cesarean section rates among the total deliveries for a two-year period between the two groups were studied. The results shelved that volume of services was greater and length of stay was longer among the insured, however, charges were higher among the non-insured. Cesarean section rates were statistically significantly different between insured and non-insured patients for every age group except the group of 35 or more.

• Journal of the Korean Operations Research and Management Science Society
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• v.15 no.1
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• pp.83-97
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• 1990

We consider an insured who wishes to determine his optimal reporting strategy over a given planning horizon, when he has option of reporting of not reporting his at-fault accidents. Assuming that the premium in future period is continually adjusted by the insured's loss experience, the insured would not report every loss incurred. Rather, considering the benefits and costs of each decision, the insured may want to seek a way of optimizing his interests over the planning horizon. The situation is modeled as a dynamic programming problem. We consider an insured's discounted expected cost minimization problem, where the premium increase in future period is affected by the size of the current claim. More specifically, we examine two cases ; (1) the premium increase in the next is a linear function (a constant fraction) of the current claim size; (2) the premium increase in the next period is a concave function of the current claim size. In each case, we derive the insured's optimal reporting strategy.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• v.71
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• pp.171-194
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• 2016

In the UK, the legal principle for the duty of disclosure established in Carter v Boehm case was codified in the Marine Insurance Act 1906("MIA"). The duty of disclosure under the MIA is the pre-contractual duty by the insured and therefore, the insured should disclose the every material circumstance that would influence a prudent insurer's judgement. If the insured violates the duty of disclosure, the insurer is entitled to avoid the insurance contract, regardless of whether there was the deliberate or reckless breach, which is unfavorable to the insured. The Law Commission reviewed the duty of disclosure under the MIA in detail and provided the Insurance Act 2015 for the purpose of enhancing the interests of the insured. The Insurance Act 2015("Act"),while the basic legal structure of the duty of disclosure under the MIA still remains, amends it in respect of non-consumer insurance and furthermore, integrate the duty of disclosure and the duty not to misrepresent into the duty of fair presentation of risk. And according to the Act, the insurer is required to more actively communicate with the insured before entering the contract with the result that, if the insured fails to disclose the material circumstance but provides the sufficient information to put the insurer on notice, the insurer should further inquire for the purpose of the insured's revealing the material circumstance. In addition, the Act details the insured's constructive knowledge of material circumstance by reviewing the current case law and introduces a new system for the insurer's proportionate remedy against the insured's breach of the duty of fair presentation of risk.

• Journal of Preventive Medicine and Public Health
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• v.16 no.1
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• pp.157-162
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• 1983

In order to determine the factors affecting the length of stay by pay status, a total of 961 in-patients medical records with appendectomy. cholecystectomy and Cesarean section discharged from the January 1979 to December 1981 from the University hospital were reviewed. Average length of stay showed no statistically significant difference by year between the insured and the non-insured patients, however multiple diagnoses and surgical complication were significantly different from single diagnosis and non-complicated cases. Surgical complication explained the length of stay mostly, and physician in discharge, multiple diagnoses, and accommodation in order for insured patients. Surgical complication, admission route, physician in charge and age in order explained the length of stay for non-insured patients.

• Journal of Society of Preventive Korean Medicine
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• v.17 no.2
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• pp.129-138
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• 2013

Objectives : The discussion of enlargement of Korean Medical insurance has been existed since 1987. But it had less effects. For better discussion, we compared insured herbal extracts and clinical prescriptions. Methods : The database of insured herbal extracts and clinical prescriptions bas set up to compare the ratios of herbal weight and analyze indications of insured herbal extracts and diagnosis and chief complain of clinical prescriptions. Results & Conclusions : The most frequent insured herbal extract is Bojungiki-tang. Analysis about indications of insured herbal extracts and diagnosis and chief complain of clinical prescriptions is that Bojungiki-tang is used frequently for gastrointestinal diseases, pulmonary diseases, and not for diseases. Bojungikgi-tang is also used for muscloskeletal dieases, hemorrhage, and ischemia.

• The Korean Society of Law and Medicine
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• v.15 no.1
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• pp.185-209
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• 2014

While the local health insurance and the employment-based insurance were integrated in July 2000, the insured is divided into employment-based insured and the local insured and the relevant premium has been applied to both groups. The health insurance premium having the feature of social solidarity has to be determined depending on income, that is, the ability to pay in accordance with the principles of social insurance. While employment-based insurance premium has been determined depending on the earned income, the local insurance premium for the local insured has been determined by scoring gross income(evaluated income), property and possession of automobiles. A variety of improvement approaches has been implemented including introduction of the employment-based insurance premium ceiling system (2002) and the change of property scoring system for the local insured (2006). However, the health insurance system which was merged in 2000 has been implemented up to now without significant change even though there were lots of socio-demographic change including increase of income level and the population structure such as low birth and aging. In other words, it is required to implement the premium rating system securing the income-based equity. Nevertheless, it was inevitable to apply the diverse rating standards in the early stage because it was very difficult to verify the income of the self-employed. Although the income verification rate was significantly increased from 23% in 1989 to 44% in 2010, the irrational standards including property, automobiles, living standard and activity rate have been still applied to the local insured because it is difficult to secure the validity of insurance premium rating system and it severely lacks of security. This paper investigated whether the current insurance premium rating system for the local insured imposing the premium on the basis of 'gender' and 'age' complies with the basic human rights secured by the current Constitution of the Republic of Korea with respect to the practical and theoretic irrationality of insurance premium rating system and standards for he local insured. In accordance with the analysis results, this paper proposed the approach to improve the system.

• Korea journal of population studies
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• v.21 no.1
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• pp.80-104
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• 1998

In order to examine differential mortality, the life tables for the insured persons in national pension scheme were estimated by sex and types of coverage(the insured in workplaces vs. the insured in rural areas). The averages of 1994-1996 data are used for insured in workplaces, but 1996 data are used for insured in rural areas. Life expectancies at the age of 18 are 59.5 years and 67.2 years each for insured males and females and thus 7.7 years longer for females than males in workplaces. Sex difference in mortality reduces as age increases, and more rapidly at younger ages than old ages. For insured in rural areas, life expectancies at the age of 18 are 51.4 years and 61.1 years each for insured males and females and thus sex difference is 9.7 years. The greater sex difference in mortality in rural areas can be explained by sex selective migration. The difference of life expectancy between insured in workplaces and insured in rural areas is 8.1 years for males, and 6.1 years for females. Because rural-urban difference in educational attainment is greater for males than females, the greater difference in life expectancy is observed for males than females.

• Health Policy and Management
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• v.3 no.2
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• pp.130-158
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• 1993

This study was written to discover the changes that may exist in the contents of medical services after introduction of health insurance system, and to identify the net-effect of health insurance system on medical services. Uncomplicated nornmal delivery and appendectomy patients were divided into 4 groups, the non-insured in pre-NHI periods(group A), the insured of health insurance for employees in pre-NHI periods(group B), the insured of regional health insurance for city residents in post-NHI periods(group C) and the insured of health insurance for employees in post-NHI periods(group D). The mehtod of matching was applied to control for major demographic differences among these 4 groups of each disease. In pre-NHI period, the medical services and the variation of medical services of the non-insured were compared with those of the insured. The difference between the change of medical services from group A to those of group C, and the change of medical services from group B to those group D is defined as the net-effect of health insurance. The results are as follows. First, in length of stay after delivery or operation, total length of stay, some laboratory examination, amount of several drugs used in appendectomy patients, frequency of sitz bath in delivery patients, there was net-effect of health insurance in increasing direction. Second, length of stay after delivery or operation, total length of stay, some laboratory examination, amount of several drugs used in appendectomy patients and frequency of sitz bath in delivery patients were significantly more in the insured than in the non-insured group in pre-NHI period. Third, the variation of medical services of post-NHI period was not less then those of pre-NHI period. Fourth, antenatal care on which the third party does not pay and the patient pays for all, was diffrerent by socioeconomic and educational level of patients.

• The Korean Journal of Health Service Management
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• v.8 no.2
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• pp.115-125
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• 2014

This study tries to investigate inequity in supplementary private health insurance insured in terms of the analysis of insurance insured general characteristics and to analyze the influence of supplementary private health insurance on their admission and their outpatient medical utilization behavior. As a result of the analysis of the general characteristics of supplementary private health insurances insured, it has turned out that men, persons at low ages, people with a spouse and chronic diseases, and persons with a high income have applied such insurances more. We can also tell that low-income classes have difficulty in applying private health insurances as people in the fifth income quintile have applied such insurances about 9 times as much as those in the first income quintile. The analysis of supplementary private health insurance insured health care utilization behavior has revealed that both male and female insured aged less than 55 and without chronic diseases have increases the number of their use of health care, their patient charge, and their medical cost per visit.

• Korea journal of population studies
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• v.11 no.1
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• pp.146-158
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• 1988

In order to examine differential mortality, the life tables for the insured persons in national pension scheme were estimated by sex and types of coverage(the insured in workplaces vs. the insured in rural areas). The averages of 1994-1996 data are used for insured in workplaces, but 1996 data are used for insured in rural areas. Life expectancies at the age of 18 are 59.5 years and 67.2 years each for insured males and females and thus 7.7 years longer for females than males in workplaces. Sex difference in mortality reduces as age increases, and more rapidly at younger ages than old ages. For insured in rural areas, life expectancies at the age of 18 are 51.4 years and 61.1 years each for insured males and females and thus sex difference is 9.7 years. The greater sex difference in mortality in rural areas can be explained by sex selective migration. The difference of life expectancy between insured in workplaces and insured in rural areas is 8.1 years for males, and 6.1 years for females. Because rural-urban difference in educational attainment is greater for males than females, the greater difference in life expectancy is observed for males than females.