• Journal of Preventive Medicine and Public Health
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• v.31 no.4 s.63
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• pp.814-827
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• 1998

In this study we analyzed the insurance claims data to investigate the medical care utilization pattern of tuberculosis patients in private sector. We selected the claims of principal or secondary diagnosis with tuberculosis from claims database of National federation of Medical Insurance, from December 1995 to November 1996. Both spell-based analysis and person-based analysis were carried out. In spell-based analysis, type and location of treatment facilities, distribution of diagnoses, number of outpatient/inpatient treatments were analyzed. Additionally in person-based analysis, number of tuberculosis patients, demographic characteristics, number of treatments per person, frequency and pattern of change in source of care were analyzed. The results were as follows 1. The number of treatments with tuberculosis was 863,641 from 1 December 1995 to 30 November 1996. The number of patients was 313.964. 2. Most of tuberculosis patients in private sector were treated in general hospital (45.8%) and clinics(42.2%) 3. About 77.7% of tuberculosis patients who were treated more than two times did not change the source of care. 18,9% of tuberculosis patients changed source of care only once. Even when we limited tuberculosis patient to those who were treated more than five times and whose treatment period were longer than six months, 94.7% of patients did not change source of care at all, or changed treatment facility only once. 4. The probability of change in source of rare was higher in pulmonary tuberculosis, in twenties, and in rural area respectively than other tuberculosis. In conclusion, healer shopping of tuberculosis patients was not serious as expected. However special attention is needed to pulmonary tuberculosis in twenties and rural area.

• Communications for Statistical Applications and Methods
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• v.24 no.3
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• pp.211-226
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• 2017

The chain-ladder method, for which run-off data is employed is popularly used in the rate-adjustment and loss-reserving practices of non-life-insurance and health-insurance companies. The method is applicable when the underlying assumption of a consistent development pattern is in regards to a cumulative loss payment after the occurrence of an insurance event. In this study, a modified chain-ladder algorithm is proposed for when the assumption is considered to be only partially appropriate for the given run-off data. The concept of a structural-change point in the run-off data and its reflection in the estimation of unpaid loss amounts are discussed with numerical illustrations. Experience data from private health insurance coverage in Korea were analyzed based on the suggested method. The performance in estimation of loss reserve was also compared with traditional approaches. We present evidence in this paper that shows that a reflection of a structural-change point in the chain-ladder method can improve the risk management of the relevant insurance products. The suggested method is expected to be utilized easily in actuarial practice as the algorithm is straightforward.

• Journal of agricultural medicine and community health
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• v.16 no.2
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• pp.179-194
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• 1991

Despite its universal coverage of health insurance, the rural health insurance program(RHIP) stands at the crossroads in Korea. The RHIP has weaknesses in stability of financing, problems of inequities in the provision of health services and has suffered from high cost of running the program. The author has analyzed these problems from the perspective of health insurance policy and presented several options for improvement. First of all, this study urged the importance of a firm Governmental commitment of RHIP with the 50% subsidization of contributions as the Government had promised, instead of the current 40%. This can be justified from the 20% subsidization by the Government for the contributions of private school teachers and their dependents, who belong to richer segments of the population. Second, various cost containment measures ought to be sought curbing the rising demand for medical through strengthening health education and increasing individual responsibility, and tightening the claim review process. Third, this study requires the Government to run a demonstration project on the introduction of case payment system for primary health care. Fourth introducing an income-related cost sharing scheme is another possibility. Reforming the cost sharing formula for large medical expenditures is recommendable for a beginning. This measure can take the form of tax credit for medical expenditures of the poor. Fifth, the degree of financial adjustment among health insurance plans should be levelled up for enhancing stability of RHIP and social solidarity. Sixth, health policy should be redirected toward development of rural health resources and higher priority should be put on relieving difficulties in access to care. Seventh. the insurance plan owned-hospital needs to be developed or provision of health services in the medically underserved areas, and the need of such facilities is particularly acute for geriatric care, rehabilitation and renal dialysis, etc. Eighth, more generous insurance benefits are required of the elderly who are suffering the most : elimination of the maximum 180 days of benefit period and provision of glasses and artificial dentures, etc. Ninth. the economies of scale principle is working for the operating expenses of regional self-employed insurance plan. Thus, measures should be instituted to pursue an optimum size of health insurance plans. Lastly, excessive dependence on exclusion items is an evil so that some radical remedies are urgently required to cut them.

• Korean Security Journal
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• no.32
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• pp.151-176
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• 2012

Government organizations (including police, prosecutor, and Financial Supervisory Service) and programs to uncover or prevent from insurance crime are not well developed. However, insurance crime are increasing among not only private insurances such as life insurance, indemnity insurance, and auto insurance but also public insurances including national health insurance and industrial accident compensation insurance. The damages of crimes are serious in both economical and ethical perspectives. Insurance crime deteriorates a current account of insurance companies and the leakages due to insurance fraud worsen loss ratio. Consequently, insurance crime increases customers' costs of insurance. For this reason, insurance companies stated to establish Special Investigation Unit(SIU) to detect insurance crime and fraud by themselves. However, organizational and operational efficiencies are limited. The purpose of this study is to examine the relationship between work environment factors, perception of insurance crime and job satisfaction among Special Investigation Units. Therefore, this study investigated the perception of work environments of Special Investigation Units. In addition, this study examined how their work environments and general perception of insurance crime influence their job satisfaction. In order test the purpose of this study, reliability test, exploratory factor analysis(EFA), multiple regression were employed. The results of this study suggested that clarity of insurance company, distress/difficulty of resolve, compensation, perception of work pressure are statistically significant on jab satisfaction among Special Investigation Unit in South Korea. This exploratory study expected to contribute to understanding of Special Investigation Unit, and their insurance crime prevention system. The results from this analysis will be examined in light of previous findings and policy implications discussed.

• Health Policy and Management
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• v.14 no.3
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• pp.20-44
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• 2004

The National Health Insurance Expenditure has been increased rapidly since the introduction of the separation of prescription and dispensing in 2000, and this trend of rapid growth in overall spendings rate has been observed predominantly among medical practitioners. This study was conducted to investigate the growth rate and distributional changes in private medical practitioners' expenses from 1999 to 2002 and its determinants using the National Health Insurance claims data. The total increasing rate of all medical practitioners' expenditure paid by the National Health Insurance between 1999 and 2002 was $41.71\%$, which exceeding that of general hospitals by $20\%$p. But the income distribution among each practitioner was improved as the changes in Gini coefficient(from 0.40 to 0.38) and decile distribution ratio(from 0.25 to 0.29) during the same period showed. However, this improvement in distributional patterns is not enough since even in 2002 it turned out that the highest $10\%$ income group earned 33times more than the lowest $10\%$ income group did. Also, higher Gini coefficient was observed in larger cities and some department like plastic surgery, obstetrics and gynecology. The major causes of this differentials in medical practitioners' expenses were factors related to medical demand like proportion of old population, residential economic status in a given area. In addition, providers' economic incentives also played an important role in determining their income distribution. The large income differentials among physicians may imply a skewed distribution of patients and thus long waiting time, inefficient utilization of resources and potential inadequate quality of care. In this sense, unreasonable distributional gaps should be reduced, so effective measures as well as ongoing monitoring would be necessary to correct current distributional problems.

• Journal of the Korean Dietetic Association
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• v.28 no.2
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• pp.67-84
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• 2022

This study aimed to explore the status of food service outsourcing behavior of long-term care institutions (LTCIs) through a cross-sectional survey using a questionnaire administered between July 16th and August 7th, 2020. The survey respondents were either dietitians or facility managers, who worked at 731 nursing homes, 477 group homes, and 673 day-care centers. Approximately 25.9% of nursing homes, 11.7% of group homes, and 33.1% of day-care centers used a managed-services company to operate their food service units. The main reason for outsourcing food service by nursing homes was related to the staffing of dietitians and cooks, whereas group homes and day-care centers outsourced food services due to factors relating to meal costs and the cooking process. Almost all the LTCIs entered into private contracts for outsourced food services. Only a few food service contracts included the types of meals, nutrition standards such as protein and calories per meal, and the parameter or ratio of food cost. Of the respondents, 84.5% from nursing homes, 87.5% from group homes, and 87.1% from day-care centers agreed that the quality of outsourced food services of the LTCIs should be regulated. Meals are essential for maintaining the health and functional status of LTCI users. As more LTCIs outsource their food services, we suggest the following: (1) Increasing the minimum dietitian staffing standards for LTCIs as per the Welfare of Senior Citizens Act and requiring at least one dietitian for every nursing home, (2) Making it mandatory to use a standard food service contract template when drafting food service contract, and (3) Developing realistic standards for food service operations considering the size and operation type of the LTCIs.

• Journal of the Korean Institute of Rural Architecture
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• v.9 no.1
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• pp.35-42
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• 2007

This study is the research of occupation distribution about citizen members of autonomy organization in Cheongju area. Investigation of autonomy organization members acting as local readers makes it possible to understand direction for community promotion. Result of this study sums up two type occupational categories. First, in urban area independently managers is above participation ratio in public affairs appeared. On the other hand, ratio of private organization, employee, and experts are low. In rural area, it shows the participation ratio of functional representatives and farmers highly. Second, with investigation of detailed occupation, most independent contractors and such as architecture, real-estate, whole and retail sales, restaurant, nursery, and private educational institute. And small number of insurance, news paper, car sales, gas station mangers participate in autonomy organization. Private organization consist of educational organization, social welfare corporate and district head council, as well as some teachers and farmers.

• Journal of Korean society of Dental Hygiene
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• v.13 no.4
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• pp.597-604
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• 2013

Objectives : The purpose of the study is to compare and investigate oral health status between Korean adults living in Korea and the US. Methods : Subjects were 1,785 persons including 399 Korean adults living in Virginia, US and those from the second year 2011 of the 5th National Health and Nutrition Survey. Darta were analyzed using SPSS 12.0 for frequency analysis, t-test, one-way ANOVA, and post-hoc Tukey. Results : 1. In general characteristics, adult living in Korea revealed higher DT and DMFT than those in the US. 2. In oral health status, adult living in Korea revealed higher DT and DMFT than those in the US. 3. The variables affecting oral health status in Korean adults in the US were age, private health insurance and number of tooth brushing. 4. The variables affecting oral health status in adults in Korea included gender, age, private health insurance, smoking, drinking, use of secondary oral hygienic products and number of tooth brushing. Conclusions : It is necessary to emphasize the importance of oral health care and to establish the oral health education in dental care agencies.

• Asian Oncology Nursing
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• v.8 no.2
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• pp.138-146
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• 2008

Purpose: This study was to investigate the cancer screening rates and influence factors in island residents. Methods: The participants were 1,223 Shinan gun island residents. Data were collected using structured questionnaires from June 23th to September 8th, 2007 and analyzed using the SAS win 12.0 program. Results: The cancer screening rate was 49.9%. There were significant differences for sex, age, living with family, economic level, smoking, exercise, private health insurance, familial history, health concern. The highest practice rate was of stomach cancer (55.9%), which is gastric endoscopic exam. The most common motivation of getting a screening test was the concern of health (40.8%), and many had no recommender of the screening test (30.0%). 58.4% of the subjects were satisfied with the screeing tests and the most frequent reason of the satisfaction was 'rapid result report' (33.1%). The msot common reason of unsatisfaction was 'long waiting time' (25.7%). Most participants agreed with the necessity of cancer screening (74.9%). More than half participants said they would participate in another cancer screening tests in the future (51.9%). Private health insurance, exercise, health concern and smoking showed significant predictors (20.6%) of obtaining cancer screening. Conclusion: The results suggest that health care professionals should give more attention to help the residents obtain cancer screening tests. A further study is necessary to develop any effective intervention for people who do not practice cancer screening tests.

• Korean Security Journal
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• no.6
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• pp.47-65
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• 2003

In Korea, Private security companies has steadily grown and amounts to 2,051 places as of November 30, 2002. Private security in korea is carrying out firm name role assignment to have held the police and public peace environment change factors for a standard faithfully, and protects social a little property that is a basic purpose, and it is spare no efforts in loss prevention. In spite of numeral increase of private security companies, private security companies have many problem. Moreover, they mostly did not have any remarkable in-house expertises in their own business under tough conditions. Under the unfavorable circumstances including insufficient investment and education in private security guard, there have been actually little further studies on private security business in practices. So this study mainly focused on addressing the installation security business managed by authorized companies, which amount to 96%(1,963 companies) of total 2,051 domestic security companies. Furthermore, the study formulated and modeled a series of business procedures in private security companies. A series of business procedures of private security companies can be modeled as follows : Setting of a business scope and aim market ${\Rightarrow}$ Marketing, Contact from customers(On-line or Off-line) ${\Rightarrow}$ Diagnosis of security target ${\Rightarrow}$ Submission of security operational plan ${\Rightarrow}$ Estimation of security operational plan ${\cdot}$ decision ${\Rightarrow}$ Contract ${\Rightarrow}$ Employment, selection of security guards ${\Rightarrow}$ Nomination of security guard instructors ${\Rightarrow}$ Education & training of security guards ${\Rightarrow}$ subscribe to insurance of damage liability ${\Rightarrow}$ Commitment and placement of security guards ${\Rightarrow}$ Establishment and preparation of security planning ${\Rightarrow}$ Field management and procurement of relevant security service.