Journal of Digital Convergence (디지털융복합연구)

The Society of Digital Policy and Management (한국디지털정책학회)
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A Study on the Online-based one-stop private health insurance claims

온라인 기반 원스톱 실손의료보험료 청구에 관한 연구

  • Received : 2016.03.01
  • Accepted : 2016.04.20
  • Published : 2016.04.28
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Abstract

The private health insurance covers areas that are not covered by the national health insurance to reinforce insurance guarantee. Realistically, however, many people renunciate small sum insurance claims because the inconvenient claim procedures require a certificate from the hospital for resubmission to the insurance company, which is very time consuming. Therefore, One-stop insurance payout claiming system that is capable of one stop processing of the issuance of e-page safer technology-based certification to claiming of insurance payout by utilizing authorized electronic address (#-mail) through the utilization of private information concealment technology and identification certification technology for the convenience of the subscribers and the simplification of operation was developed.

실손의료보험은 국민건강보험이 보장하지 않는 부분을 지원함으로써 보장성을 강화시키는 기능을 수행하고 있다. 그러나 까다로운 운영체계 및 절차로 보험가입자의 의료실손금액 청구가 어려운 실정이다. 이러한 현상을 해소하기 위하여 보험가입자가 진료비를 요양기관에 지급한 후 청구서류를 작성하여 보험금을 청구하는 체계로 운영(상환제)하고 있다. 그러나 상환제 운영도 여전히 보험가입자의 권익보호가 어렵고, 번거로운 청구 절차로 소액보험금의 청구를 포기하는 상황이다. 그래서 보험가입자의 편리와 운영의 간소화를 위하여 개인정보 은닉기술, 본인인증기술, e-page safer 기술 기반 증명서 발급에서 공인전자주소(#-mail)를 활용한 보험료 청구까지 한번에 처리할 수 있는 원스톱 보험 청구 시스템을 적용하였다. 이렇게 개발된 시스템은 번거로운 청구절차를 간소화함으로써 보험 청구율이 높아져 의료비의 부담을 줄일 수 있을 것이다.

Keywords

References

  1. Kim, H. Lee, Y. Park, Y, "A robust and flexible digital rights management system for home networks", The Journal of systems and software/ Vol. 83 No. 12, pp.2431-2440. 2010. https://doi.org/10.1016/j.jss.2010.04.064
  2. In Lib Beak, Hyunsoo Park, Sung-Soo Byun, "The Determinants and Medical Care Utilization Behavior of Private Health Insurance", Journal of korea contents Association, Vol. 12, No. 7, pp.295-305, 2012.
  3. Yong-Jae Lee,, "Effects of Private Health Insurance in National Health Care System", Journal of korea contents Association", Vol. 14, No. 1, pp.200-208, 2014.
  4. I. R. Baek, H. S. Park, S. S. Byun "The Determinants and Medical Care Utilization Behavior of Private Health Insurance", Journal of the Korea Contents Association, Vol. 12, No. 7, pp.295-305, 2012.
  5. D. N. Yang, I. Y. Choi, K. J. Kim, Y. D. Kwon, "Awareness and Purchase of the Private Dental Insurance among Dental Patients in the Capital Region", Journal of the Korea Contents Association, Vol. 13, No. 7, pp.322-332. 2013. https://doi.org/10.5392/JKCA.2013.13.07.322
  6. Y. K. Lee, "A Study on the Process of Decision-making for the Promotion of the Private Health Insurance", Journal of the Korea Contents Association, Vol. 26, pp.5-39, 2009.
  7. J. H. Park, "The Effect of Householder's Characteristics and Perceptions of the Korean National Health Insurance Coverage on Getting Private Medical Insurances", International journal of policy studies, Vol. 22, No. 1, pp.217-241, 2015.
  8. J. T. Lee, B, S, Ahn, "A Study on the way of using korea import insurance according its characteristics", Journal of Korea Trade, Vol. 37, No. 5, pp.253-274, 2012.
  9. Oh Young Soo, "A Study on New Relationship Between National and Private Health Insurance", KIDI, Vol.17, No.1, pp. 103-136, 2006.
  10. Yeon Hee Kim, Hee Sun Lee, "The Establishment Scheme of Medical Insurance System in Korea: An Issue Focused on Introduction of Private Medical Insurance", Korean Journal of Policy analysis and evaluation, Vol.16, No.1, 107-138, 2006.
  11. S. P. Hong, "Government regulations interventions applicable to private health insurance markets in selected countries", Korea Institute for Health and Social Affairs, pp.86-94, 2008.
  12. H. J. Jeon, "The Problems and Improvement Schemes of the Introduction of for-profit Medical Corporation and Private Health Insurance System to Korea", Journal of the Korean Industrial Economic Association", Vol. 20, No. 1, pp.415-440, 2007.
  13. H. J. Kin, J, H, Lee "Factors Associated with the Middle-aged or the Old-aged Koreans' Enrollment in Private Health Insurance", Journal of the Korea Contents Association, Vol. 12, No. 12, pp.683-693, 2012. https://doi.org/10.5392/JKCA.2012.12.12.683
  14. Lark Sang Kim, "Convergence of Information Technology and Corporate Strategy", Journal of the Korea Convergence Society, Vol. 6, No. 6, pp. 17-26, 2015. https://doi.org/10.15207/JKCS.2015.6.6.017
  15. Han-Kyoul Kim, Kyoung-Sook Lee, Kwang-Hwan Kim, Yong-Ha Kim, "A Study on Determinats of Cancer Patients's Length of Hospital Stay on Medical Charges Pattern", Journal of the Korea Convergence Society, Vol. 2, No. 4, pp. 53-58, 2011.
  16. N. Leavitt. "Internet Security under Attack: The Undermining of Digital Certificates, Computer Vol. 44, No. 12, pp.17-20, 2011. https://doi.org/10.1109/MC.2011.367
  17. Keun-Ho Lee, "A Method of Defense and Security Threats in U-Healthcare Service", Journal of the Korea Convergence Society, Vol. 3, No. 4, pp. 1-5, 2012.
  18. Weon Kim, Min-Ho Kim, Gyu-Beom Shim, Moon-Ju Shin, "A study on the satisfaction of Health Examination for National Health Insurance service -Target of medical examinee in Busan-", Journal of the Korea Convergence Society, Vol. 4, No. 2, pp. 1-8, 2013. https://doi.org/10.15207/JKCS.2013.4.2.001
  19. M. S. Kang, Y. G. Jung, K. H. Lee, "Development of On-line Based One-Stop Insurance Claim System between the Private Sector Medical Insurance and Hospital", International Institution Information, Vol. 18, No. 10, pp.4421-4426, 2015.
  20. Grunow, M. , Nuscheler, R., "Public and provate health insurance in Germany:The ignored risk selection problem",Health economics-chichester, Vol. 23, No. 6, pp.678-687, 2014.
  21. Parente, S. T., Feldman, R. "Microsimulation of Private Health Insurance and Medicaid Take-Up Following the U.S. Supreme Court Decision Upholding the Affordable Care Act", Health services research, Vol. 48, No. 2, pp.826-849, 2013. https://doi.org/10.1111/1475-6773.12036