• Title/Summary/Keyword: reimbursement system

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A Study of the Arbitration Issue on the KOREA and the U.S. FTA

  • Lee, Young Min
    • Journal of Arbitration Studies
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    • v.27 no.2
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    • pp.3-18
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    • 2017
  • International legal reviews on ISD, a procedure for resolving disputes under the Korea-US FTA, are examined from the perspective of law. If the ISD system does not exist, even if the investor suffers damage due to the illegal act of the host country, he or she must file a lawsuit through the court of the host country, which is unreasonable from the investor's point of view and makes it difficult to guarantee fairness and transparency. Some of the Koreans pointed out that there are some problems with the KORUS FTA dispute settlement regulations, and that the United States federal courts are taking a friendly attitude to the decisions made by the US Customs in determining the dispute by the KORUS FTA Agreement and the US Customs Act. In cases where the State does not violate international law but results in harmful consequences, the responsibility of one country is borne by the treaty. Foreign investment always comes with many challenges and risks. Therefore, the ISD system is a fair and universal arbitration system, which is considered to be a necessary system even for protecting the Korean companies investing abroad. In the investment treaty, compensation for the nationalization of foreign property and reimbursement under the laws of the host country were dissatisfied with foreign investors. In particular, some Koreans have pointed out that there are some problems in the KORUS FTA dispute resolution regulations and there is a need for further discussion and research. Based on the experiences and wisdoms gained in the course of Korea-US FTA negotiations, the dispute arbitration mechanism is urgently needed to reduce the possibility of disputes and to make amicable directions.

Developing a Real-time Cashflow Management System for National R&D Management (국가 연구 개발 프로젝트 실시간 자금 관리 시스템 개발에 관한 연구)

  • Han, Seung-Youp;Lee, Hyejung;Lee, Jungwoo
    • Journal of Information Technology Services
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    • v.13 no.3
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    • pp.343-357
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    • 2014
  • As science and technology infiltrates every aspects of modern society in terms of economic and social growth and development, funding for research and development (R&D) is growing rapidly. Republic of Korea is not an exception in this trend and the R&D funding in Korea has been grown about 10% every year, recently. However, as the scope and size of funding grows exponentially, need for monitoring and managing these R&D projects becoming more and more imminent. Though different types of project management systems were developed by a variety of agencies and departments and used in monitoring and managing, these systems were developed as standalone silo type systems. These systems are not connected to each other while the same researchers may involved in different projects across agencies and department. Also, these management systems are not linked to the banking systems in which real transactions of funding occurs, such as cost reimbursement and financial audit of each R&D accounts. Historically, a few fraud and malappropriation cases were found and indicted. However, as the number of these incidents grows along with the growth of R&D funding, a large scale integration/linking of project management systems and banking systems. Realizing the importance of systems integration among agencies as well as with the banking systems, situational requirements analyses were conducted concerning the current state of R&D management system. As a results, a Real-time Case Management System (RCMS) was proposed as a solution to current problems. In this paper, the collected systems requirements were documents with analyses of the situation, the architecture of the integrated systems with more user-friendly technological alternatives. This large scale linkage requires interface standardization as well as modularization of interfaces. Proposed systems architecture is introduced here with technical details of Jex Framework used,, followed by resulting technical and economic performance of the Realtime Cashflow Management System (RCMS).

Legal Standings of the Patient and the Doctor within the National Health Insurance - With its focus on the issue of arbitrary medical charge cover - (건강보험에 있어서 의사와 환자간의 법률관계 - 임의비급여 문제를 중심으로 -)

  • Hyun, Doo-Rhyun
    • The Korean Society of Law and Medicine
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    • v.8 no.2
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    • pp.69-118
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    • 2007
  • In providing general medical treatments, the medical service contract between the patient and the doctor is the mutually responsible onerous contract. However, the nature of the mutually assumed contract standings of the patient and the doctor has been changing since the implementation of the national health insurance program. For instance, besides the cases of beyond excessive medical charges and medical negligence, if the doctor charged for his/her medical treatments violating the post-treatment/nursing cover criteria, the overpaid medical charge, regardless of being collected with the patient's consent, has to be refunded back to the patient. Medically needed aspects, treatment results, and unfair benefits favoring the patient are not at all taken into consideration in the health insurance scheme. This makes it easier for patients to get refunds for their share of the medical payments by involving the Health Insurance Review & Assessment Service or the National Health Insurance Corporation, without engaging in civil law suits (for reimbursement claim) against doctors. In other words, the doctor's responsibility to provide medical treatments and the patient's responsibility to pay for the medical treatment provided within the contractual realm are being demolished by the administrational arbitration of the National Health Insurance system. The basic rights of medical service providers, and the patient's right to choose are as important constitutional rights, as the National Health Insurance program, which is essential in the social welfare system. Furthermore, the development of the medical fields should not be prevented by the National Health Insurance system. If the medical treatment services can be divided into necessary treatments, general treatments, and high quality treatments, the National Health Insurance is supposed to guarantee the necessary and general treatments to provide medical treatments equally to all the insured with limited financial resources. However, for the high quality treatments, it is recommended that they should not be interfered by the National Health Insurance system, and that they should be left to the private contract between the patient and the doctor.

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Present Situation of Korean Nursing (한국간호의 현재)

  • Choi, Euy-Soon
    • Women's Health Nursing
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    • v.10 no.3
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    • pp.190-199
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    • 2004
  • This thesis explores the actual circumstances of Korean nursing by investigating its present situations. Ultimately, the intent of this study aims to establish a future direction of Korean Nursing. As such, the current conditions of Korean nursing is analyzed in the following categories: education, practice, research, nursing policy, expansion of nursing field, and entrepreneurship. In the final conclusion, an appropriate orientation of the future of Korean nursing is discussed. There are two primary Nursing programs, a three-year(63) and a four-year(53), in Korean Nursing education. Master's programs are available at 32 nursing schools or 32 professional graduate schools. A total of 15 nursing schools have a doctoral program in Korea. The ratio of graduates between the three-year and four year programs is 76:24. Hence, it is highly encouraged to expand four-year nursing programs, because it will help raise the social status of nursing professionals as well as the quality of nursing. In the clinical nursing field, independency and self regulation are critical. As such, organizational change, implementation of a standardized nursing m information system, appropriate workforce, and improvement of the reimbursement system in nursing is recommended. In community nursing, the following should be resolved to provide better nursing services: improvement of working condition and benefits, establishment of a law enforcing the hiring of nurses, and providing continuing education. The number of nursing research has increased and nursing studies are in great quantity. However, research in practices and theories are more in demanded. Hence, research that integrates theories and practices are very significant. Ultimately, it is critical to support nursing studies that will influence nursing policy. The Korean Nurses Association(KNA) is an organization that supervises the nation's nursing policy. The primary focus of KNA is to combine the three and four year undergraduate education systems into 4 years and to establish the Nursing Practice Act. The Ministry of Health and Welfare has adapted a system to educate and certify nurse specialists in 10 nursing areas in 21 nursing graduate schools expecting high-quality nursing services and a decrease of cost. The government also allowed nurses to operate facilities for health management or welfare agencies.

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A Study on Improving the Legal System for the Expedited Preservation of Digital Evidence (디지털 증거의 긴급한 보전을 위한 법제 개선 연구)

  • Ro, Sohyong;Ji, Sungwoo
    • Journal of Information Technology Services
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    • v.19 no.3
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    • pp.57-73
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    • 2020
  • The proportion of digital evidence in criminal cases has increased, while at the same time, the spread of the Internet has made it easy to delete information that is stored in another place and thus, the Internet is being used to delete online criminal evidence. To respond quickly and effectively to cybercrime, 29 countries signed the Convention on Cybercrime in 2001 through the Council of Europe. Article 16 of the Convention relates to the expedited preservation of stored computer data and requires signatories to adopt legislative measures to enable its competent authorities to order expeditious preservation of specified computer data where there are grounds to believe that the data is particularly vulnerable to loss or modification. More than 60 countries have joined the Convention since 2001 and have made efforts to improve their legal system in line with it. The United States legislated 18 U.S.C. § 2703(f) to preserve electronic evidence pending the issuance of a court order. The German Code of Criminal Procedure §§ 94~95 allows prosecution authorities to seize evidence or issue production orders without court control in urgent circumstances. A custodian shall be obliged to surrender evidence upon a request that evidence be preserved, and non-compliance results in punishment. Japan legislated the Criminal Procedure Act § 197(3) and (4) to establish a legal base for requesting that electronic records that are stored by an ISP not be deleted. The Korean Criminal Procedure Act § 184 outlines procedures for the preservation of evidence but does not adequately address the expeditious preservation of digital evidence that may be vulnerable to deletion. This paper analyzes nine considerations, including request subjects, requirements, and cost reimbursement to establish directions to improve the legal system for the expedited preservation of digital evidence. A new method to preserve online digital evidence in urgent cases is necessary.

A study of Simulations on the Changes of Physician's Practice Patterns in University Hospitals after the Introduction of DRG in Obstetrics and Gynecology (산부인과 포괄수가제 도입에 따른 일개 대학병원의 진료행태 변화 모의실험 연구)

  • Shin, Sam-Chul;Kim, Jong-Soo
    • Journal of Digital Convergence
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    • v.11 no.6
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    • pp.289-298
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    • 2013
  • The objective of this study was to predict the changes in the duration of hospital stay, hospital admission fee, costs of drugs, changes in laboratory cost, material cost, total medical cost, adjusted amount of treatment and the efficacy of obstetrics and gynecology DRG system. The cost of drugs showed the greatest change and was followed by materials for medical examinations and the change in methods of medical examinations. In the analysis of the quantity of medical service the profit of medical examinations were influenced mostly by the duration of hospital stay. The results and data in this study could be used as a basis of future DRG system protocols and will be utilized so that hospitals can build a efficient medical system.

Implications of Price Setting Strategies for New Health Technologies from Five Countries (신의료기술에 대한 진료비 지불: 외국사례와 시사점)

  • Chung, Seol-hee;Kwon, Ohtak;Choi, Yeonmi;Moon, Kyeongjun;Chae, Jungmi;Lee, Ruri
    • Health Policy and Management
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    • v.30 no.2
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    • pp.164-177
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    • 2020
  • This study aims to compare the experience of selected countries in operating separate payment system for new healthcare technology and to find implications for price setting in Korea. We analyzed the related reports, papers, laws, regulations, and related agencies' online materials from five selected countries including the United States, Japan, Taiwan, Germany, and France. Each country has its own additional payment system for new technologies: transitional pass-through payment and new technology ambulatory payment classification for outpatient care and new technology add-on payment for inpatient care (USA), an extra payment for materials with new functions or new treatment (C1, C2; Japan), an additional payment system for new special treatment materials (Taiwan), a short-term extra funding for new diagnosis and treatment (NUB; Germany), and list of additional payments for new medical devices (France). The technology should be proven safe and effective in order to get approval for an additional payment. The price is determined by considering the actual cost of providing the technology and the cost of existing similar technologies listed in the benefits package. The revision cycle of the additional payment is 1 to 4 years. The cost or usage is monitored during that period and then integrated into the existing fee schedule or removed from the list. We conclude that it is important to set the explicit criteria to select services eligible for additional payment, to collect and analyze data to assess eligibility and to set the payment, to monitor the usage or cost, and to make follow-up measures in price setting for new health technologies in Korea.

Genetic counseling in Korean health care system (유전상담의 제도적인 고찰)

  • Kim, Hyon-J.
    • Journal of Genetic Medicine
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    • v.4 no.1
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    • pp.1-5
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    • 2007
  • Unprecedented amount of genetic information being generated from the result of Human Genome Project (HGP) and advances in genetic research is already forcing changes in the paradigm of health and disease. The ultimate goal of genetic medicine is to use genetic information and technology to develop new ways of treatment or even prevention of the disease on an individual level for 'personalized medicine'. Genetics is play ing an increasingly important role in the diagnosis, monitoring and management of common multifactorial diseases in addition to rare single-gene disorders. While wide range of genetic testing have provided benefits to patients and family, uncertainties surrounding test interpretation, the current lack of available medical options for the diseases, and risks for discrimination and social stigmatization may remain to be resolved. However an increasing number of genetic tests are becoming commercially available, including direct to consumer genetic testing, yet public is often unaw are of their clinical and social implications. The personal nature of information generated by a genetic test, its power to affect major life decisions and family members, and its potential misuse raise important ethical considerations. Therefore appropriate genetic counseling is needed for patient to be informed with the benefits, limitations and risks of genetic tests, prior to informed consent for the tests. Physician also should be familiar with the legal and ethical issues involved in genetic testing to tell patients how w ell a particular genetic risk factor relates with likelihood of disease, and be able to provide appropriate genetic counseling. Genetic counseling become a mandatory requirement as global standard for many genetic testing such as prenatal diagnosis, presymtomatic DNA diagnostic tests and cancer susceptibility gene test for familial cancer syndrome. In oder to meet the challenge of genetic medicine of 21 century in korean health care system, professional education program and certification board for medical genetics specialist including non-MD genetic counselors should be addressed by medical society and regulatory policy of national health insurance reimbursement for genetic counseling to be in place to promote the implementation of clinical genetic service including genetic counseling for proper genetic testing.

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Estimation of nursing costs for hospitalized patients using the resource-based relative value scale (상대가치(Resource-Based Relative Value)를 이용한 간호행위별 간호원가 산정)

  • Park, Jung-Ho;Song, Mi-Sook;Sung, Young-Hee;Cho, Jung-Sook;Sim, Won-Hee
    • Journal of Korean Academy of Nursing Administration
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    • v.5 no.2
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    • pp.253-280
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    • 1999
  • A cost analysis for hospitalized patients was performed based on the RBRVS in order to determine an appropriate nursing fee schedule. The study was conducted through three phases as follows: 1) Nursing activities provided for the inpatients currently in Korea were identified and classified using a taxonomy which was developed by our research team through the Delphi process. 2) The resource-based relative points for every nursing activity according to nursing time, mental effort and judgement, technical skill, physical effort and stress were determined through a survey of 300 clinical RNs working at 5 tertiary hospitals from May 25 to July 25. 1998. 3) The nursing cost of every nursing activity for hospitalized patients was estimated based on the RBRVS. As a result, 136 nursing activities were identified and classified by nursing processes and nursing domains. However, our classification system of nursing activities should continue to be refined, and all nursing practices should be standardized. The nursing activities were given resource-based relative points ranging from 100 to 400 points, then each nursing activity was assigned a value for the RBRVS, which was determined by the exponential function of 2resource-based relative point/100. Thus, a value of 2 was calculated for 100 points, 4 for 200 points, 8 for 300 points, and 16 for 400 points. Meanwhile, the unit cost of nursing was calculated as 170 Won. The nursing cost of 136 nursing activities was estimated using the RBRVS as shown in

    . A proper nursing fee schedule for a new reimbursement system based upon the results of the above study should be prepared in the near future.

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  • Health and Economic Burden of HPV-related Diseases in Singapore

    • Low, Jeffrey Jen Hui;Ko, Yu;Ilancheran, Arunachalam;Zhang, Xu Hao;Singhal, Puneet K.;Tay, Sun Kuie
      • Asian Pacific Journal of Cancer Prevention
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      • v.13 no.1
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      • pp.305-308
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      • 2012
    • Objective: To assess the health and economic burden of human papillomavirus (HPV)-related diseases (cervical cancer, cervical intraepithelial neoplasia (CIN) 1/2/3, and genital warts) in Singapore over a period of 25 years beginning in 2008. Methods: Incidence-based modeling was used to estimate the incidence cases and associated economic burden, with the assumption that age-stratified incidence rates will remain the same throughout the period of 25 years. The incidence rates in 2008 were projected based on data obtained from the National Cancer Registry for cervical cancer, and from a combination of published data and hospital registry review for CIN1/2/3 and genital warts. The population growth rate was factored into the projection of incidence cases over time. Direct cost data per cervical cancer and per CIN1/2/3 case were obtained from the financial database of large local hospitals while cost data for genital warts were obtained from the National Skin Center; these costs were multiplied by the number of incidence cases to produce an aggregate estimate of the economic burden over the 25-year period (in 2008 Singapore dollars) using a 3% discount rate. Results: The total number of incidence cases of HPV-disease over 25 years beginning in 2008 was estimated to be 60,183, including 8,078 for cervical cancer, 11,685 for CIN 2/3, 8,849 for CIN1, and 31,572 for genital warts. The estimated total direct cost was 83.2 million Singapore Dollars over 25 years: 57.6 million attributable to cervical cancer, 13.0 million to CIN2/3, 6.83 million to CIN1, and 5.70 million to genital warts. Conclusion: HPV-related diseases are expected to impose significant health and economic burden on the Singapore healthcare resources in the next 25 years.


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