• Title/Summary/Keyword: medical advice

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Typology of the medical claims review (의적클레임검토 유형론)

  • Lee, Sin-Hyung
    • The Journal of the Korean life insurance medical association
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    • v.26
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    • pp.41-53
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    • 2007
  • In the course of insurance claim administration, medical experts' opinions are called medical claim reviews. They are classified into two main categories: medical verification and counsel for claim staff. Medical verification compare between product coverage and the insured's physical condition. Medical counsel for claim staff is advice for claim staff when they have a question about medical knowledge to make a claim decision. A common example of medical verification is insurance coding of pituitary apoplexy. Some clinicians have insisted that the ICD coding of pituitary apoplexy is l63 of cerebral infarction, but the exclusion criteria of I code show that neoplasm is coded as C00 to D48. Thus, pituitary apoplexy must be coded as D33. An example of medical counsel for claim staff is interpretation of some medical conditions. It is divided into UCR(usual, customary, and reasonable) assessment, assessment of causality, and so on. Disability evaluation is another subject of medical counsel for claim staff. The final claim decision must be made by claim staff because only the claim staff have the authority of claim decision. Medical claims review is only an expert's opinion.

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Research on Job Recognition and Satisfaction of Medical Experts in Emergency Medical Information Center (응급의료정보센터 직원의 직무인식 및 만족도에 대한 연구)

  • Jang, Hyo-Kang;Lim, Jung-Do;Lee, Yong-Chul
    • The Journal of the Korea Contents Association
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    • v.9 no.6
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    • pp.275-288
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    • 2009
  • The research has been investigated to enhance job recognition and satisfaction in Emergency medical information center and to induce some positive suggestions to develop emergency medical information centers in Korea. As a result, the findings found that the tasks which the experts felt are most easily ones are the guidance, counseling, and advice of a patient, while the most difficult tasks are the advice on the first-aid treatment and the guidance of the hospitals. The research has found the findings that most employees feel that they perform their jobs quite well including the guidance and consultation of first-aide patients. They also feel that they are under stress in consulting patients, and in making decisions to visit emergency centers and to observe the patients in limited information without seeing patients in person. They are concerned about the identity of emergency information centers, feeling that it is difficult to construct smoothly the collaboration of such agencies as the administrative, emergency medical centers, 119 resue teams to treat first aide treatments, to provide transportation information, and hospital guidance.

Derivation of External Exposure Characteristics of Industrial Radiography Based on Empirical Evidence

  • Cho, Junik;Kim, Euidam;Kwon, Tae-Eun;Chung, Yoonsun
    • Journal of Radiation Protection and Research
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    • v.47 no.2
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    • pp.93-98
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    • 2022
  • Background: This study aims to derive the characteristics of each work type for industrial radiography based on empirical evidence through expert advice and a survey of radiation workers of various types of industrial radiography. Materials and Methods: According to a Korean report, work types of industrial radiography are classified into indoor tests, underground pipe tests, tests in a shielded room (radiographic testing [RT] room test), outdoor field tests, and outdoor large structure tests. For each work type, exposure geometry and radiation sources were mainly identified through the expert advice and workers' survey as reliable empirical evidence. Results and Discussion: The expert advice and survey results were consistent as the proportion of the work types were high in the order of RT room test, outdoor large structure test, underground pipe test, outdoor field test, and indoor test. The outdoor large structure test is the highest exposure risk work type in the industrial radiography. In most types of industrial radiography, radiation workers generally used 192Ir as the main source. In the results of the survey, the portion of sources was high in the order of 192Ir, X-ray generator, 60Co, and 75Se. As the exposure geometry, the antero-posterior geometry is dominant, and the rotational and isotropic geometry should be also considered with the work type. Conclusion: In this study, through expert advice and a survey, the external exposure characteristics for each work type of industrial radiography workers were derived. This information will be used in the reconstruction of organ dose for health effects assessment of Korean radiation workers.

The Perception Level of Seafarers for the Marine Telemedicine Assistance System (선박승무원들의 해양원격의료 지원 제도에 대한 인식도)

  • KIM, Jae-Ho;JEON, Yeong-Woo
    • Journal of Fisheries and Marine Sciences Education
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    • v.28 no.5
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    • pp.1508-1516
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    • 2016
  • This research intended to analyse the perception level of seafarers in order to propose enhancement of health management for seafarers and improvement of marine telemedicine assistance system. To this end, questionnaire survey was conducted for 422 seafarers in relation to current status of utilizing Emergency Medical Advice by radio(EMAR). By trading area, experience of benefiting EMAR by coastal seafarers was higher than that of ocean-going seafarers. By kinds of ships the rate of utilizing EMAR by fisherman was higher than that of seafarers of merchant ships. The level of satisfaction on the EMAR was 14.9% and regarded to be very low while the answering rate of necessity and urgency toward introducing marine telemedicine assistance system for the future through utilizing telemedicine equipment what is called U-helath including motion pictures information was very high. The answering rate of willingness to provide their personal health information positively when introducing marine telemedicine system was very high(97.4%). It is thus necessary to permit marine telemedicine service system, establish service model of marine telemedicine through conducting demonstration projects, promote marine telemedicine actively at the level of government, etc.

Factors associated with unexpected revisit to an emergency medical center (예고되지 않은 응급의료센터 재방문에 영향을 미치는 요인 분석)

  • Lim, Mi-Sun;Kang, Hye-Young;Sub, Gil-Joon;Hong, Joon-Hyun
    • Korea Journal of Hospital Management
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    • v.10 no.2
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    • pp.64-80
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    • 2005
  • The objectives of this study were to identify factors associated with unexpected revisit to an emergency medical center (EMC) located in Seoul and to examine reasons for revisit. During March, June, September and December, 2002, a total of 168 patients had unexpected revisits to the EMC within 48 hours of a previous discharge. As a 1:1 matched control, we included 136 patients who: discharged from the EMC during the same time period: did not return to the EMC; had the same diagnosis and age(${\pm}5$) with the case. In this study, factors associated with unexpected revisits were defined as characteristics of a previous discharge, which were classified into three: sociodemographic, EMC visit-related, and discharge management factors. Reasons for revisit were categorized into disease, physician, patients, and system-related factors. Data were collected by medical chart review with assistance from clinicians of the EMC. Logistic regression results showed that patients who headed home after discharge without follow-up schedule had a 27.6 times higher risk of revisiting EMC than those who were hospitalized following EMC visit. Patients discharged on his own will had a 5.9 times higher risk of revisiting than those discharged following physician's advice. Patients requiring continual observation at the time of discharge were more likely to revisit by 8.7 times than those discharged with improved condition. About 69.13% of the revisits were due to disease-related factors, followed by 13.90% due to patient-related factors, 8.64% due to system-related factors, and 8.34% due to physician-related factors. It appears that the most significant factors influencing revisits are discharge management factors such as patient's condition at discharge, whether the discharge was accorded with physician's advice, and whether returning home without follow-up schedule. Therefore, appropriate discharge management is necessary to prevent EMC revisit.

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Do We Really Need More Medical Schools or Doctors in Korea? (과연 의과대학 증원이 필요한가?)

  • Seog-Kyun Mun
    • The Korean Journal of Medicine
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    • v.99 no.1
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    • pp.1-3
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    • 2024
  • Recently, several social issues have raised public concerns about a deficiency of doctors. The government says it will solve the problem by increasing the number of doctors, saying essential medical service is collapsing. However, the medical community argues that there is a fundamental problem with Korea's health care delivery system. The government needs to take advice from the medical community to make policies in the right direction. And the press should no longer provide the public with misinformation that doctors and the public are opposed to. In this article, I would like to mention problems among current medical services and suggest healthcare policies for them.

Non-Pharmacological Treatments of Psoriasis in Persian Medicine a Narrative Review

  • Rasanan, Farshad Mohammadian;Kenari, Hoorieh Mohammadi;Ghassemi, Mohammadreza;Sabbagh, Ali Jabbari;Aliasl, Jale;Ghobadi, Ali
    • Journal of Pharmacopuncture
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    • v.25 no.1
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    • pp.1-6
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    • 2022
  • Psoriasis is a chronic disease that has no definitive cure. In this review study, the main sources of Persian Medicine (PM) such as the Canon of Medicine (by Avicenna) and Al-Havi (by Rhazes) were assessed to identify non-pharmacological treatments for psoriasis. Several treatments that are recommended for this disease include nutritional advice, lifestyle modifications, and manipulation therapy such as wet cupping (Hijamah), leech therapy, and phlebotomy (Fasd). These recommendations may help to prevent recurrence and be useful in improving psoriasis. The efficacy of PM recommendations to improve psoriasis should be evaluated in future studies.

Usefulness of medical review in the insurance claims

  • Lee, Eui-Kwan;Hwang, Jin-Sup;Lee, Sin-Hyung
    • The Journal of the Korean life insurance medical association
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    • v.28 no.1_2
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    • pp.31-35
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    • 2009
  • Background : Many of internists have been working for insurance industry. Insurance medicine is use of medical knowledge for insurance industry. There is social role of insurance medicine in terms of soundness of insurance administration. Recently social role of internists also have been being watched. Although theme of insurance medicine is medical risk selection, insurance claims administration also needs medical experts'opinion. There are not any corroborative study of medical consulting for insurance claims. Among insurance industry, someone called this medical review of insurance claims as 'medical claims review'. Aim : To investigate usefulness of medical review of insurance claims. Design : Questionnaire survey with claim staffs in one of insurance claim adjustment company in Korea. Methods : 265 claim staffs were divided into 4 groups and conducted survey using a questionnaire of 20 questions. Utility score, job satisfaction score, and difficult factors of claims administration were measured. Results : Utility score and job satisfaction score are highest in medical claims review group. The most difficult in claim administration to claim staffs was demonstrated to medical knowledge. Conclusion : Medical review of insurance claims is proved to be worthy. Document-based consulting method, namely medical claims review, is more useful than telephone-based simple query among claim staffs...Subjects of the medical claims review are medical record and it's principle is independent medical examination with evidence-based approach, it also has role of protecting fraud of insurance claims. Two main question types of medical claims review are verification and advice.

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Current status and improvement strategies of emergency medical counseling service for overseas koreans (재외국민 응급의료상담 서비스의 이용 실태 및 서비스 향상방안)

  • Hyeon-Jeong Ko;Eun-Sook Choi
    • The Korean Journal of Emergency Medical Services
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    • v.28 no.1
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    • pp.77-95
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    • 2024
  • Purpose: This study aimed to analyze the counseling status of overseas Koreans using emergency medical counseling services, identify frequently occurring types of diseases, explore approaches to emergency treatment guidance, and protect overseas Koreans from medical blind spots, thereby enhancing the quality of emergency medical counseling services. Methods: This study was approved by the Institutional Review Board of Kongju National University (KNU_IRB_2023-31), and data were collected and analyzed from 10,951 cases of emergency medical counseling services utilized by overseas Koreans from the National Fire Agency from 2018 to 2022. Results: Emergency medical consultation services for overseas Koreans included a majority of non-trauma patients, with medical consultations being predominant. Terrestrial patients commonly seek advice for internal medical symptoms, whereas maritime patients frequently present with trauma-related symptoms, with a higher incidence of cardiac arrest and altered consciousness cases at sea. The development of self-diagnostic tests based on internal medicine symptoms is necessary for terrestrial patients, whereas stakeholder education is required for maritime patients. Conclusion: Due to the different types of diseases occurring in terrestrial and maritime patients, emergency medical consultation services for overseas Koreans should be implemented according to the specific characteristics of each patient. Therefore, it is necessary to develop and disseminate response manuals that are tailored to medical and trauma-related symptoms.

A Study on the Quantitative Evaluation of Medical Images by Using the Technique of Image Processing - Determination and Validation of Features - (화상처리 기술을 응용한 의료용 화상의 정량적 평가에 관한 연구 -특징량 추출 및 그 타당성 검토 -)

  • 송재욱
    • Journal of the Korea Institute of Information and Communication Engineering
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    • v.2 no.4
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    • pp.619-626
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    • 1998
  • This paper presents the features for quantitative evaluation of medical images based on the technique of image processing. In consideration of advice from medical doctor, 1 derive three features seemed to be strongly correlated with the degree of disease's advance. From comparison between each feature and evaluation value by medical doctor, our research shows that three features can be a useful aids in quantitative evaluation of lung's disease on chest X-ray images.

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