• Journal of Preventive Medicine and Public Health
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• 제14권1호
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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.

• 한국경영과학회지
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• 제15권1호
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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.

• 무역상무연구
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• 제71권
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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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• 제16권1호
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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.

• 대한예방한의학회지
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• 제17권2호
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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.

• 의료법학
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• 제15권1호
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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.

• 한국인구학
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• 제21권1호
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• pp.80-104
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• 1998

국민연금가입자의 차별 사망력을 고찰하기 위하여 국민연금가입자의 성 및 가입종별(사업장가입자 및 지역가입자) 생명표를 작성하였다. 사업장가입자에 대해서는 1994-1996년 3년 평균자료를, 지역가입자에 대해서는 1996년 단년 자료를 활용하였다. 국민연금생명표의 최저연령인 18세에서 기대여명은 사업장가입자의 경우 남녀 각각 59.5년과 67.2년으로 여자가 남자보다 7.7년이 길었다. 남녀간의 사망률 차이는 연령이 증가함에 따라 줄어드는데, 연령증가에 따른 감소폭이 노년층에서보다 젊은층에서 큰 것으로 나타났다. 지역가입자의 경우 18세에서의 기대여명은 남녀 각각 51.4세와 61.1세로 그 차이는 사업장 가입자의 경우(7.7년)보다 큰 9.7년이었다. 지역가입자에서의 성별 사망률 차이가 사업장가입자에서보다 크게 나타난 것은 남녀의 지역간 차별 이동에 의한 결과이다. 사업장가입자와 지역가입자의 연령별 기대여명을 비교하여 보면 남자의 경우 18세에서 각각 59.5년과 51.4년으로 8.1년의 차이가 있었으며, 여자의 경우 각각 67.2년과 61.1년으로 6.1년의 차이가 나타났다. 남자 평균여명의 차이가 여자보다 더 큰 것은 도농간 교육정도 차이가 여자보다 남자에게서 더욱 뚜렷한데 그 원인을 찾을 수 있다.

• 보건행정학회지
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• 제3권2호
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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.

• 보건의료산업학회지
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• 제8권2호
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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.

• 한국인구학
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• 제11권1호
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• pp.146-158
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• 1988

국민연금가입자의 차별 사망력을 고찰하기 위하여 국민연금가입자의 성 및 가입종별(사업장가입자 및 지역가입자) 생명표를 작성하였다. 사업장가입자에 대해서는 1994-1996년 3년 평균자료를, 지역가입자에 대해서는 1996년 단년 자료를 활용하였다. 국민연금생명표의 최저연령인 18세에서 기대여명은 사업장가입자의 경우 남녀 각각 59.5년과 67.2년으로 여자가 남자보다 7.7년이 길었다. 남녀간의 사망률 차이는 연령이 증가함에 따라 줄어드는데, 연령증가에 따른 감소폭이 노년층에서보다 젊은층에서 큰 것으로 나타났다. 지역가입자의 경우 18세에서의 기대여명은 남녀 각각 51.4세와 61.1세로 그 차이는 사업장 가입자의 경우(7.7년)보다 큰 9.7년이었다. 지역가입자에서의 성별 사망률 차이가 사업장가입자에서보다 크게 나타난 것은 남녀의 지역간 차별 이동에 의한 결과이다. 사업장가입자와 지역가입자의 연령별 기대여명을 비교하여 보면 남자의 경우 18세에서 각각 59.5년과 51.4년으로 8.1년의 차이가 있었으며, 여자의 경우 각각 67.2년과 61.1년으로 6.1년의 차이가 나타났다. 남자 평균여명의 차이가 여자보다 더 큰 것은 도농간 교육정도 차이가 여자보다 남자에게서 더욱 뚜렷한데 그 원인을 찾을 수 있다.