• 보험의학회지
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• 제27권2호
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• pp.68-74
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• 2008

Medical verification of cancer diagnosis in insurance claims is a very important procedure in insurance administrations. Claims staffs are in need of medical experts' opinions about claim administration. This procedure is called medical claim review (MCR) and is composed of verification and advice. MCR verification evaluates the insured’s physical condition by medical records and compares it with product coverage. It is divided into assessment of living assurance benefit, verification of cancer, and assessment of the cause of death. Actually cancer verification of MCR is applicable to coding because the risk ratio in product development is usually coded data. There are some confusing neoplastic diseases in assessing the verification of cancer. This article reviews gastrointestinal stromal tumors (GIST) and mucosa-associated lymphoid tissue tumors (MALToma) of the stomach. The second most common group of stromal or mesenchymal neoplasms affecting the gastrointestinal tract is GIST. Nowadays there are many articles about the pathophysiology of GIST. However there are few confirmative theories except molecular cell biology of KIT mutation and some tyrosine kinase. Therefore, coding the GIST, which has previously been classified as an intermediate risk group according to NIH2001 criteria, for cancer verification of MCR is suitable for D37.1; neoplasm of uncertain or unknown behavior of digestive organs and the stomach. The gastrointestinal tract is the predominant site of extranodal non-Hodgkin's lymphomas. B-cell lymphomas of the MALT type, now called extranodal marginal zone B-cell lymphoma of MALT type in the REAL/WHO classification, are the most common primary gastric lymphomas worldwide. Its characteristics are as follows. First, it is different from traditional stomach cancers such as gastric adenocarcinoma. Second, the primary therapy of MALToma is the eradication of H. pylori by antibiotics and the remission rate is over 80%. Third, it has a different clinical course compared to traditional malignant lymphoma. Someone insisted that cancer verification is not possible for the above reasons. However, there have been findings on pathologic mechanism, and according to WHO classification, MALToma is classified into malignant B-cell lymphoma and it must be verified as malignancy in MCR.

• Asian Pacific Journal of Cancer Prevention
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• 제13권6호
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• pp.2717-2720
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• 2012

Background: The rates of breast cancer have increased over the past two decades, and this raises concern about physical, psychological and social well-being of women with breast cancer. Further, few women really want to do breast cancer screening. We here investigated the socio-demographic correlates of mammography participation among 400 asymptomatic Iranian women aged between 35 and 69. Methods: A cross-sectional survey was conducted at the four outpatient clinics of general hospitals in Tehran during the period from July through October, 2009. Bi-variate analyses and multi-variate binary logistic regression were employed to find the socio-demographic predictors of mammography utilization among participants. Results: The rate of mammography participation was 21.5% and relatively high because of access to general hospital services. More women who had undergone mammography were graduates from university or college, had full-time or part-time employment, were insured whether public or private, reported a positive family history of breast cancer, and were in the middle income level (all P<0.01).The largest number of participating women was in the age range of 41 to 50 years. The results of multivariate logistic regression further showed that education (95%CI: 0.131-0.622), monthly income (95%CI: 0.038-0.945), and family history of breast cancer (95%CI: 1.97-9.28) were significantly associated (all P<0.05) with mammography participation. Conclusions: The most important issue for a successful screening program is participation. Using a random sample, this study found that the potential predictor variables of mammography participation included a higher education level, a middle income level, and a positive family history of breast cancer for Iranian women, after adjusting for all other demographic variables in the model.

• 한국산학기술학회논문지
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• 제3권4호
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• pp.325-332
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• 2002

본 논문은 최적리콜보험계약의 설계와 관련된 논문의 survey이다. 리콜보험 뿐만이 아니라 최적보험계약을 만들기 위해서는 보험계약의 조건들이 내생적이라는 가정하에서 연구모형을 구축하고 분석의 과정에서는 보험구매를 위한 의사결정 원칙으로 기대효용이론, 비기대효용이론, 및 상태귀속적인 (state-dependent) 효용함수를 사용하였다. 어떠한 이론을 사용하더라도 최적보험의 조건들은 존재한다. 다만 계약조건에 관련되어서는 보험의 비용, 자기부담금, 보상한도액 등이 차이가 날 수 있다. 보험의 비용은 지급보험금과 선형, 오목형, 볼록형의 관계가 성립할 수 있으나 잠식비용과 고정비용의 존재를 인정하여야 한다. 이를 바탕으로 최적보험을 위한 비용 설계가 이루어져야 한다. 또한 전부보험이냐 일부보험이냐를 결정하는 자기부담금의 존재는 일률자기부담금형태와 점감식자기부담금형태가 가능하다. 자기부담금 수준의 결정과 관련하여 담보되는 모든 위험에 동일한 수준을 적용시킬 것인가 혹은 차별화시킬 것인가는 보험의 종류에 따라 달라질 수밖에 없다. 보상한도와 관련되어서는 특히 리콜보험에 있어서는 기업의 파산위험성이 상당히 존재하고 있으므로 계약당사자의 파산선고를 포함한 이익이 충분히 고려되어야 한다. 또한 제약조건으로는 불완전시장에 대한 이해를 필요로 하며 담보할 수 없는 배경위험의 존재에 대한 배려가 있어야 한다.

• 보험의학회지
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• 제4권1호
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• pp.101-109
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• 1987

The present study was undertaken to establish the standard body weight by height in Korean adults by using the actually measured heights and weights of a total of 5,496 insured persons who were examined medically at the Honam Medical Room of Dong Bang Life Insurance Company, Ltd. from January, 1983 to January, 1986. The results were as follows: 1. The linear regression equations to establish the standard body weight of Korean adults were as follows: In male, for $18{\sim}19$ age group, $y=7.272{\times}10^{-6}{\times}x^3+23.560$ for $20{\sim}29$ age group, $y=8.187{\times}10^{-6}{\times}x^3+22.031$ for $30{\sim}39$ age group, $y=8.627{\times}10^{-6}{\times}x^3+23.169$ for $40{\sim}49$ age group, $y=9.561{\times}10^{-6}{\times}x^3+20.994$ and for $50{\sim}59$ age group, $y=8.604{\times}10^{-6}{\times}x^3+23.801$ In female, for $18{\sim}19$ age group, $y=8.252{\times}10^{-6}{\times}x^3+18.920$ for $20{\sim}29$ age group, $y=7.715{\times}10^{-6}{\times}x^3+22.409$ for $30{\sim}39$ age group, $y=8.808{\times}10^{-6}{\times}x^3+21.439$ for $40{\sim}49$ age group, $y=9.691{\times}10^{-6}{\times}x^3+21.940$ and for $50{\sim}59$ age group, $y=12.500{\times}10^{-6}{\times}x^3+11.031$ 2. The standard age, height, and weight tables by author were presented with the aid of linear regression equations. 3. The values of standard body weight by height established by author reveal to be a little higher than those of other Korean reports through all age groups of both sexes, and reveal to be considerably similar, compared with those of the reports in Japan for fourth and sixth decade of female group.

• 보험의학회지
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• 제4권1호
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• pp.77-85
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• 1987

We'd performed the upper gastrointestinal study for a total of 1,033 insureds-male 630, female 403 persons-who were examined at medical dept. of Dae Han Kyoyuk Insurance Co., Ltd., from August, 1986 to January, 1987. The results on diverticulum were as follows; 1. The incidence rate of duodenal diverticulum is exceptionally higher than esophageal diverticulum. 2. In all of 53 insured who have duodenal diverticulum and esophageal diverticulum, there was little difference between male and female in the incidence rate of diverticulum; 5.08% in male, 5.21% in female. 3. The possessing rate of both diverticulums increased by age regardless of sex. ; 0.71% in 20yrs, 2.12% in 30yrs, 11.11% in 40yrs, 12.75% in 50yrs, 30.43% in 60yrs more. 4. The possessing rate of both diverticulums in male is 0% in 20yrs, 1.97% in 30yrs, 7.21% in 40yrs, 15.09% in 50yrs, 27.27% in 60yrs more and in female, 1.16% in 20yrs, 2.40% in 30yrs, 7.87% in 40yrs, 10.20% in 50yrs, 33.33% in 60yrs more. 5. Those who have duodenal diverticulum 47 insureds felt the following subjective symptoms; uncomfortable 8.51%, heartburn and tingling each 4.26%, sore throat 2.13%and esophageal diverticulum's heartburn 16.67%. 6. There occurred the following complications in 47 insureds with duodenal diverticulum-gastric polyp, erosive gastritis, antral gastritis, cascade stomach, fatty liver, polyp in GB and choledocholithiasis; each 2.13% and cholelithiasis 6.38% and cascade stomach. 7. All duodenal diverticulum occurred in duodenal inlet. 8. The number of lesion was single in all esophageal diverticulum, but there was each one case with 2 lesions and 3 lesions in duodenal diverticulum.

• Safety and Health at Work
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• 제2권1호
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• pp.52-56
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• 2011

Objectives: The occupational accident rate was officially reported to be 0.77 per 100 workers in 2001 and 0.70 in 2009. The stagnant decrease in accident rate raises a question about the effectiveness of prevention activity because there have been active prevention efforts in the past 10 years. It is also necessary to know the exact status of occupational injuries to direct a prevention strategy. Methods: The author re-analyzed occupational injury statistics to find the reason for stagnant decreases in occupational injuries. Compensated occupational injuries cases were used to calculate fatal and non-fatal injury rates. Injuries from commuting accidents and sports activities were excluded as well as occupational diseases. The number of workers was adjusted to that of full time equivalent employees. Results: The fatal injury rate excluding injuries associated with commuting accidents, sports activities, and occupational diseases decreased from 12.59 in 2001 to 8.20 in 2009. In 2007, 67.5% of accidents that involved being caught in objects, which are mostly caused by machines and equipment, occurred in the manufacturing industry; this type of incident has decreased since 2001. The fatal and non-fatal injury rates in the manufacturing industry have continuously decreased while the rates in the service industry have not changed from 2001 to 2009. Non-fatal injuries might not be reported in many cases. The number of insured workers was underestimated as long working hours were not adjusted for in the reporting system. Conclusion: The occupational fatal injury rate has decreased and the non-fatal injury rate might have decreased during the last 10 years, although the statistics show stagnancy. The decrease of the injury rate was countervailed by various factors. Hence, the current accident rate does not reflect the actual situation of accidents in Korea. Korea needs to develop an improved system to more accurately calculate occupational fatal and non-fatal injury rates.

• 혜화의학회지
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• 제14권2호
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• pp.93-105
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• 2005

Objective : We investigated the actual condition of oriental medical office in a public health center. Methods : We classified patients who visited an oriental medical office iin a public pealth center of Dalseong-gun, Daegu Metropolitan City during recent 3 years by KCPJMAIN(data processing system), according to location, age, time(month, year), sex, disease, insurance, etc. Results : As a local category, the residents in Hyeunpung-Myeon higher than 80% of the patients who visited the public health center. The patients aged over 60 occupied 80% of the patients. The frequency of the treatment was more than 10 in those patients aged over 60. The number of the patients was the highest in May when there was a change for the past 36months, whereafter the number has sustained decline for 3-5 months and repeated decreasing. As a gender category, the female inpatients were 10732(82%). This statistics shows that these musculoskeletal system disease occupied large part in them. As a heath insurance category, the patients who were insured by health care were 12454(96.30%). Conclusion : It should need to enable the rural residents who have difficulty benefitting from medical service to reach the service by making their access to the oriental medical office in public health center easier. Most of all, the support from both government and municipality should be urged to accomplish it. plus, it should be included not only boosting doctors' reliance but also improving the capability and services of doctors in public heath center. In conclusion, the treatment service in public health center should be diversified beyond musculoskeletal system disease and the identity transform of public health center should be needed to appeal to young generation.

• 한국직업건강간호학회지
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• 제9권1호
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• pp.18-29
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• 2000

Back injury is frequent in industry workers and is a common cause of productivity loss. It has been reported that the insured of industrial accident insurance tend to stay in hospital longer than that of other types of insurance. The purpose of this study was to identify factors affecting the length of hospital stay for the treatment of back injury in the workers under industrial accident insurance. The results of this study help insurers develop reasonable industrial accident insurance policy for back injury claims and prevention strategies of work-related back injury. A total of 2,949 patients whose industrial accident insurance claim has been approved for the treatment of work-related back injury from January to December 1999 were included in this study. Relationship between the length of hospital stay and characteristics of patient, work place, back injury, and hospital were assessed using ANOVA, t-test, simple linear regression and multiple resgression. The major findings of this study are as follows : 1. The average length of hospital stay(LOS) was 91.82 days, respectively. 2. Characteristics of Patient LOS of male patients was longer than that of female patients, there was positive correlation between age and LOS and between average wage and LOS. Working period was negatively correlated with LOS. Distance from resident to hospital was positively correlated with LOS and LOS was significantly different dependign on type of duty. 3. Characteristics of Work Place LOS was significantly different depending on types of industry and geographical region of work place. Size of work place was positively correlated with LOS. 4. Characteristics of Back Injury Occupational back pain required shorter LOS compared with back injury due to electric shock. Number of concomitant illnesses and severity of disability were positively correlated with LOS. 5. Characteristics of Hospital Patients treated in community hospitals required significantly longer LOS. Treatment in hospitals with rehabilitation program required decreased LOS. This was more prominent as number of physicians specialized in rehabilitation. 6. Multiple regression analysis revealed that distance form resident to hospital, geographical region of work place, size of work place, number of concomitant illnesses, severity of disability, and type of hospital were factors affecting LOS.

• 한국병원경영학회지
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• 제8권1호
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• pp.1-23
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• 2003

General drug prices involve three stages: shipment stage, wholesaler stage and retail stage. Policies on drug price differ from country to country. Shipment stage prices are tightly regulated in countries like France and Netherlands. They are free in only a minority of advanced countries, even if these include some major players such as the US, Germany and, in a very limited sense, Japan. The situation in the UK is very complex with a semi-free system, where drug companies are free to set their own prices but cannot exceed a predetermined profit ceiling. Mark-up at both wholesaler and retail stages is formally admitted in most countries observed. Apart from the general drug prices, reimbursement price of insured drugs has been major policy concerns. Most countries reviewed in this study has exerted some control over reimbursement prices, but differ both in the way how and in the extent to which prices are admitted or fixed. Price fixing has been used in France and Japan. Some countries have transformed their system over time, particularly to move to reference pricing in the last decade. This mechanism has empowered the customer, and improved price competition on the market. Referring to the drug price policies in the advanced countries, this study makes some suggestions for the redirection of Korean price policy for reimbursement drug in health insurance as follows: to match appropriate policy tools to each policy goal; to maximize market mechanism through effective reimbursement price fixing which admits mark-ups in wholesaler and retail prices; to introduce reference pricing system in order to redirect patient's demand with a financial incentive to choose the best-priced drugs and to save the finance of health insurance; and to strengthen surveillance and monitoring mechanism in the drug market.

• 재무관리연구
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• 제20권1호
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• pp.279-304
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• 2003

예금보험료는 각 금융기관의 위험정도에 상응해서 부과되어야 하지만 우리나라는 현재 금융 업종별로만 차등화되어 있고 같은 업종 금융기관간에는 동일 예금보험료율이 적용되고 있다. 고정예금 보험료율 부과방식에 비하여 변동예금 보험료율 부과방식은 논리적 타당성을 지니고 있지만 실제 적용가능한 객관적이고 측정이 용이한 기준마련이 어렵다. 본 연구에서는 옵션평가모형(option pricing model)을 이용하여 1995년부터 2001년까지 개별금융기관 및 전체 금융업종별로 예금보험료율을 추정하고 분석하였다. 금융업종별로 상호비교한 다음 연도별 추세분석과 분포분석을 하였다. 다음으로 추정 예금보험료율과 은행의 자본적정성, 수익성 및 자산건전성을 나타내는 관련 변수들과의 상관관계를 분석하였다. 연구 결과 개별 금융기관에 따라, 그리고 금융업종 및 표본기간에 따라 예금보험료율의 추정치가 상당한 차이를 보였다. 이는 금융업종에 따라 예금보험료율을 차등부과하고 개별은행의 위험을 반영하는 위험반영 차등 예금보험료율 제도의 타당성을 뒷받침한다고 할 수 있다. 은행보고자료와 감독기관의 검사자료가 지니고 있는 주관적 요소라는 단점을 극복하는 자료인 시장자료를 이용하는 본 연구의 추정결과는 예금보험료 부과에 보완적으로 사용할 수 있을 것이다.