• Title/Summary/Keyword: private insurance

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A Study on the Most Frequent Diseases of Health Insurance Program and the Primary Care Physicians in Korea (의료보험 다빈도 상병과 1차진료 의사에 관한 연구)

  • 김철환;문옥륜
    • Health Policy and Management
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    • v.3 no.1
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    • pp.124-145
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    • 1993
  • General practitioners, internists, pediatricians, and family physicians are classified as so-called primary care physicians in the United States. We carried out this study for the purpose of answering the following question; "Who are the primary care physicians in Korea\ulcorner" We analyzed the 663, 154 claims which were drawn from the health insurance processing file made during the period of one month, April 1992 on the basis of systemic random sampling technique. The 663, 154 cases were matched with the doctor's file registered at the National Federation Medical Insurance by using the indivisual physician code number and analyzed according to the kind of specialty. If we follow the Geyman's definition of primary care physician in the United States, this study shows that they can take care of 43.2% of the total private clinic's claims in Korea. Provided that general practitioners and family physicians are considered the same way as in the United Kingdom, they could with only 8.3% of the total claims in Korea. The most frequent diseases are those which rank first to 46th in the total private clinic's claims. The proportion of the most frequent diseases was highest for pediatricians(90.4%) and followed by internists(81.4%), otolaryngologists(78.7%) and family physicians(76.5%). The proportion of the most frequent diseases in the most common 46 diseases was highest for radiologists(80.4%) and the next was as follows : general practitioners(78.3%), family physicians(67.4%), and internists(67.4%). We classified the most common 20 diseases of each specialty into 17 categories of ICD-9 and compared it with those of general practitioners. The specialists who had managed a similar disease pattern to those of general practitioners were identified as anesthesiologists, family physicians, general surgeons, and internists. Some specialists practicing at private clinics managed the diseases which were not quite appropriate for their specialties. After we evaluated each specialty by the most common diseases, the most frequent diseases, and the most frequent 20 diseases of each specialty in terms of the 17 categories of ICD-9, a tentative assumption is made that the primary physicians in the Republic of Korea are general practitioners, anesthesiologists, family physicians, internists, and general surgeons. This study has concluded that the categories of the primary care physicians are so diverse that their roles and distributions are distorted accordingly. Vigorous health policy efforts in correcting the malcomposition need to be made for the better provision of primary health care in Korea. in Korea.

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Study on Privatization of First-aid Service Systems in Korea (우리나라 구급제도의 민영화 도입방안에 관한 연구)

  • Kong, Ha-Sung
    • Fire Science and Engineering
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    • v.22 no.2
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    • pp.108-115
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    • 2008
  • This research put the point on deducing problems of our first-aid system and proposing improvement program. Now first-aid system has lots of weakness, such as short of speciality, limitation to raise finance. To improve these first-aid infrastructure must be expanded and improved, and it also needs enough effort for improvement of quality and arrangement of emergency medical treatment speciality. We should introduce commission to first-aid system so raise fund and make use of speciality. And also we should organize private partnership with hospitals or insurance companies, so that we can construct united system of first-aid system.

The Effect of Income Transfer on Poverty Rate (소득이전의 빈곤완화 및 빈곤이행 효과에 관한 연구)

  • Kim, Kyo-Sung
    • Korean Journal of Social Welfare
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    • v.48
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    • pp.113-149
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    • 2002
  • The primary purpose of this study is to analyze the decreasing effect of public and private income transfers on poverty rate. Two year data of Korean Labor and Income Panel Study (KLIPS, 1998, 1999) are used for the analysis, and 1/2 of median income and 1/3 of mean income are adopted to measure poverty rate. Although private income transfer contributes more to reduce the rate than the public transfer, the main effect for decreasing poverty rate is forced by the wage. Statistically significant variables that affect to the exit of poverty based on the logistic regression analysis are number of family members(-), wage(+), property income(+), social insurance benefit(+), and the transfer income(+). Therefore, the future policy should be more related with the active labor market policy for developing better human resources among the poor family.

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Wealth Management Framework Experienced in Korean Financial Enterprises

  • Kim, Hak-Min
    • International Commerce and Information Review
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    • v.8 no.1
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    • pp.417-435
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    • 2006
  • A Systematic Wealth Management Framework (SWMF) was developed as a private banking management tool to enable more integrative personal finance management of personal wealth. It is a reference model that provides an unified framework for development, operation, and management and makes provision for personal financial services in today's complex financial environment. This study suggested some practical results from banks and insurance companies that have established SWMF as the differentiation business strategy for wealthy customers. The focus of this manuscript is on capturing the methodological approach most financial institutions in Korea adopted to execute new e-finance planning and implementation based on the SWMF. The alignment between the wealth management business goals and information system architecture at an organization constitutes the main theoretical basis of the study. Relevant discussions are made on the wealth management framework as a general business model for financial industry, on the functional relationship between new information systems and business organizations. Finally, lessons learned from the SWMF implementation are discussed.

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A Study on the Private Investigator System in U.S.A. (미국의 탐정제도에 관한 연구)

  • Kang, Young-Sook;Kim, Tae-Hwan
    • Korean Security Journal
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    • no.12
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    • pp.25-50
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    • 2006
  • Private detectives and investigators offer many services, including executive, corporate, and celebrity protection; pre-employment verification; and individual background profiles. They also investigate computer crimes, personal injury cases, insurance claims and fraud, child custody and protection cases, missing persons cases, and premarital screening. This paper focuses on a private detective or investigator system in most developed U.S.A, but it is not easy to describe that system. Licensing requirements vary in U.S.A. Some States have few requirements, and many other States have stringent regulations. A growing number of States are enacting mandatory training programs for private detectives and investigators. Employment and need of private detectives and investigators is expected to grow faster than the average for all occupations. Thus, it is reasonable that korean government should permit private investigation service find the way to minimize the side effects of private investigation service instead of banning the service totally.

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A Study on the characteristics of Chinese medical care consumers and choice of medical care providers (중국 현지 의료소비자의 특성 및 의료기관 선택 연구)

  • Kim, Ji Man;Lee, Sang Gyu;Shin, Jaeyong;Song, Joo Young;Lee, Ye Seol;Kim, Tae Hyun
    • Korea Journal of Hospital Management
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    • v.23 no.1
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    • pp.78-86
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    • 2018
  • Purposes: This study identifies local Chinese consumers' standard for selecting medical care provider and their standard for choosing medical staff, as well as their expectations and concerns regarding Korean medical care providers. Methodology: A survey was conducted in China, to identify Chinese medical care consumers' standards for selecting a medical provider and the factors that influence their use of general hospitals. A total of 1,500 people across three cities, between the ages 18 and 60 participated in the survey. Moreover, a multiple logistic regression analysis was used to analyze the factors that affect Chinese medical care consumers' use of general hospitals. Findings: A total of 75.5 percent respondents chose general hospitals as their most frequently-used medical provider. Those who have health insurance, visit general hospitals as outpatients or are hospitalized more frequently than those who do not have a health insurance. Furthermore, those who have private insurance visit general hospitals as outpatients or are hospitalized more frequently than those who are not signed up for private insurance. Major standards for selecting a hospital included: the doctor's skills, word-of-mouth regarding the hospital, and distance to the hospital from the respondents' home. Standards for choosing medical personnel included word-of-mouth regarding the medical team, recommendations from family members or acquaintances, and medical team's notoriety. Friends and neighbors, family members, television and other media outlets were the channels for acquiring information on a hospital. It was found that Chinese people mostly visit the cardiovascular department of Korean hospitals for treatment. For using Korean hospitals in China, the majority of respondents answered that they were concerned about the cost. Practical Implications: Backed by highly skilled medical experts and cutting-edge technology, Korean medical care providers are attempting to enter China's medical care market. To succeed in China's medical care market, it is vital to conduct a clear and precise analysis.

Accessible Strategy of the Registration & Management of Hypertension and Diabetes Mellitus Patients through the Public-Private Partnership: Policy Implications Fron the Hongcheon-gun Case (민관협력을 통한 고혈압.당뇨병 등록.관리사업의 접근 전략: 홍천군 사례의 정책적 함의)

  • Byun, Do-Hwa;Kim, Eun Jeong;Park, Myung-Bae;Son, Hyo-Rim;Park, Hye-Kyong;Kim, Chun-Bae
    • Korean Journal of Health Education and Promotion
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    • v.30 no.4
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    • pp.111-123
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    • 2013
  • Objectives: This study aimed to share with experiences of a demonstration program based on a community for prevention and management of hypertension and diabetes mellitus, and to supply the evidence of accessible strategies within the community through the public-private partnershipin the near future. Methods: This study case was "the program of registration and management of hypertension and diabetes mellitus patients" which was conducted in Hogncheon-gun in Gangwon-province, 2012. Results: The infrastructure of this center was constructed with the public-private sector partnership according to the basic model of demonstration program since November, 2012. So, the total registered rate of hypertension and diabetes mellitus patients were 26.6% in comparison with suspected patients (to the result of 2011 Korea National Health and Nutrition Examination Survey), 37.8% in comparison with the real number of outpatient (to the claims data of 2011 Branch Honcheon-gun, National Health Insurance Corporation), and 107.8% in comparison with the project goal, sequentially. To the patients who were not treated for 30 and 60 days among the registered patients, a recall service was conducted. Through this intervention, it was monitored that this program has enhanced the consecutive treatment rate of the registered patients. Conclusions: To improve the continuous management of hypertension and diabetes mellitus patients, we are gotten to know that the community need the joint participation and mutual cooperation with public-private sector partnership.

Application of the Terms and Conditions of English Law Related to the Duty of Utmost Good Faith under Marine Insurance Contract: Korean Supreme Court Decision 2018.10.25, Docket No.2017Da272103

  • Pak, Jee-Moon
    • Journal of Korea Trade
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    • v.24 no.6
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    • pp.19-36
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    • 2020
  • Purpose - This paper analyzes how to interpret the legal view of the precedents to the UK Insurance Act 2015, comparing it to the UK Marine Insurance Act (MIA) 1906 with a focus on the relationship between the duty of uberrimae fidei and the duty of disclosure. Furthermore, this study focuses on the judgment of the Korean Supreme Court in a case, that examined whether the legal nature of the duty of disclosure or duty of uberrimae fidei in insurance law can be considered as a matter related to the insurer's liability when the applicable terms of English law are incorporated under the insurance contract. Design/methodology - This paper belongs to the field of explanatory legal study, which aims to explain and test whether the choice of law is linked to the conditions that occur in the reality of judicial practice. The approach that is used toward this problem is the legal analytical normative approach. The juridical approach involves studying and examining theories, concepts, legal doctrines and legislation that are related to the problem. Findings - Regarding the requirements and effects of breach of the duty of disclosure, if English law and the Korean Commercial Act are handled differently from each other and Korean law is recognized as the applicable law outside of the insurer's liability, it may be whether the insurer's immunity under English law is contrary to s.633 of the Korean Commercial Act. In considering the breach of the duty of disclosure as a matter of the insurer's liability, even if English law is applied as a governing law, the question of how to interpret the agreement of the governing law in this case may also be raised in the interpretation of Korean International Private Law in relation to the applicable law that applies to the rest of the matter, excluding the matters of liability. Originality/value - According to the Korean Supreme Court judgement under the governing law of the MIA 1906, the basis for recognizing the assured's pre-and post-contractual duty of disclosure is separate, and the only important matters to be notified by the assured after the conclusion of the insurance contract are those that are "relevant" and "material circumstances" that are "relevant" to the matter in question after the conclusion of the insurance contract.

Chracteristics of Primary Health Practice and Diagnosis-Cluster Pattern in Health Insurance (의원의 특성에 따른 상병진단군의 분포에 대한 연구)

  • Yoon, Jong-Ryool;Moon, Ok-Ryun;Huh, Jung;Kim, Chang-Yup
    • Health Policy and Management
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    • v.3 no.2
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    • pp.100-129
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    • 1993
  • This study is designed to find out some intra-clinic factors affecting the content of practice provided by primary care physicians in Korea, and proposed factors in this study are characteristcs of each private clinc --- physician-related variables(age, sex, specialty), bfed-related variables for inpatient care, laboratory-related variables for precise diagnosis. We have tried to estimate the difference of disease entities cared by each primary care physician according to above factors by analyzin gdisease data claimed during one month(April, 1992) to National Federation of Medical Insurance. The diagnosis codes by ICD-9 in the research disease data were reclassified to 'diagnosis clusters' by virtue of clinical similarities for effective analyses. We have converted frequent-tsing ICD-9 codes to 86 diagnosis clusters, which incorporated 97.4 percents of all ambulatory visits to private clinics. This result means proposed diagnosis-cluster method is effective tool for analysis of the content of ambulatory medical care carried out by primary care physicians. Comparisons and analyses of multiple diagnosis-clusters made on the basis of presented factors were done and the results were as follows; - Major factors affecting the difference between diagnosis-cluster pattern by each variables were phyusician's age, sex, specialty and bed counts of each private clinic for inpatient care and the size of laboratories of each clinic. - Middle aged(30th to 40th) group physicians are providing more comprehensive care than 20th or above 50th aged groups. Male physicians are more adequate for comprehensive care than female physicians, because woman-doctors are providing narrow-spectrum care. The content of practice of obstetricians and gynecologists shows much difference from primary medical practice, and they cannot be included in primary care physician, this study suggested. Pediatricians are also providing short-spectum acre, and nearly all visits to pediatricians were incorporated only 2-3 diagnosis-clusters. General surgeons' practices are very similar to general practioners' or family physicians' practices, the means they are providing primary care rather than special surgical care. And small number of beds(under 5 beds) and only basic(2-3 sorts of)diagnostic apparatuses are sufficient for primary physicians' clinic to carry out primary care. In conclusion, to reinforce primary care department in Korea, there must be support with health policy to expand office-based primary care practice-- with small number of beds for inpatient care and only basic laboratories-- provided by general practitioner of family physician.

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Changes in factors on unmet dental scaling rate according to the National Health Insurance coverage (국민건강보험급여에 따른 스케일링 미수진율의 영향요인 변화)

  • Kim, Han-Nah;Kim, Chun-Bae;Kim, Nam-Hee
    • Journal of Korean society of Dental Hygiene
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    • v.17 no.3
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    • pp.539-551
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    • 2017
  • Objectives: The purpose of this study was to investigate the changes in factors on unmet dental scaling rate before and after the national health insurance. Methods: This study used the $2^{nd}$ data from the Community Health Survey. The study participants numbered 209,341 in 2011 and 219,517 in 2013.The average age was $51{\pm}17$ in 2011 and $52{\pm}17$ in 2013. Data were analyzed by descriptive statistics, chi -squared test and logistic regression using SPSS 23.0. Results: The scaling experienced rate of Korean adults has fallen by 3.5% from 66% to 69.5%. Logistic regression analysis showed that 2.7 times more 'people who were educated at elementary school level or lower' did not use dental scaling compared to higher educated children. Agriculture, forestry and fisheries workers did not use scaling at 2.0 times. Local residents with an income of less than one million won did not use 1.7times scaling. Local residents of 'no private insurance' did not use scaling at 1.5 times. In the case of the predisposing factors, the 20s had less than 1.8 times scaling compared to 50s. In the case of needs factor, local residents who experienced 'bad oral health status' and 'dental calculus' were treated scaling 1.3 times less compared to people with good oral health status and normal periodontal symptoms. Conclusions: In Korea, local residents are less frequently treated scaling due to enabling factors such as accessibility. In addition, predisposing factors such as age and sex, and oral health status and periodontal symptoms were related to not using the dental scaling. Therefore, the universality of health care services should be considered so that people who need periodontal care can use scaling.