• Korean Journal of Social Welfare
• /
• v.37
• /
• pp.307-326
• /
• 1999

The primary purpose of this study is to analyze changes, if any, in the financial status and the intensity of health care service utilization of the regional health insurance societies following the 1995 merger of some rural and urban regional health insurance societies. Ultimately, this study is aiming at providing an empirical basis for predicting the impact of the 1998 merger of the Regional Health Insurance Program and the Health Insurance Program for Government Employees and Teachers and, further, predicting the impact of the merger of the entire health insurance programs scheduled for the year 2000. The study results did not suggest that the 1995 merger had brought about notable changes in the rate of increase in the total expenditures or the insurance payment of the merged regional insurance societies in comparison to non-merged ones. Neither did it show that the merger had resulted in significant changes in the intensity of the use of health services. The study, however, found that the 1995 merger had reduced the rate of increase in the management and operational cost of the merged insurance societies. Based on these findings, some policy implications are discussed, and suggestions are made for the total merger plan scheduled for the year 2000.

• The Journal of Korean Institute for Practical Engineering Education
• /
• v.4 no.2
• /
• pp.144-149
• /
• 2012

This paper reviews the uncovered people of the Korean Employment Insurance System (EIS) and analyzes policy options for minimizing the dead zone of the EIS. There are several policy options such as subsidizing insurance premium to employers and employees of small companies, extending coverage of excluded groups, relaxing qualifications of unemployment benefits and increasing benefit period and level, introducing the unemployment assistance system, introducing the unemployment insurance savings account system, extending coverage to non-wage workers and individualizing package services. According to the survey to the specialists and comparative evaluation criteria, the best policy option to minimize the dead zone of the EIS was to activate individualizing package services of intensive consultation, job place services, tailored vocational training, income support, daycare services, etc. to cure complex employment barriers of job seekers.

• The Korean Society of Law and Medicine
• /
• v.16 no.2
• /
• pp.87-130
• /
• 2015

In a case in which National Health Insurance Corporation (NHIC) pays medical care expenses to a victim of a traffic accident resulting in injury or death and asks the assailant for compensation of its share in the medical care expenses, as the precedent treats the subrogation of a claim set by National Health Insurance Act the same as that set by Industrial Accident Compensation Insurance Act, it draws the range of its compensation from the range of deduction, according to the principle of deduction after offsetting and acknowledges the compensation of all medical care expenses borne by the NHIC, within the amount of compensation claimed by the victim. However, both the National Health Insurance Act and the Industrial Accident Compensation Insurance Act are laws that regulate social insurance, but medical care expenses in the National Health Insurance Act have a character of 'an underinsurance that fixes the ratio of indemnification,' while insurance benefit on the Industrial Accident Compensation Insurance Act has a character of full insurance, or focuses on helping the insured that suffered an industrial accident lead a life, approximate to that in the past, regardless of the amount of damages according to its character of social insurance. Therefore, there is no reason to treat the subrogation of a claim on the National Health Insurance Act the same as that on the Industrial Accident Compensation Insurance Act. Since the insured loses the right of claim acquired by the insurer by subrogation in return for receiving a receipt, there is no benefit from receiving insurance in the range. Thus, in a suit in which the insured seeks compensation for damages from the assailant, there is no room for the application of the legal principle of offset of profits and losses, and the range of subrogation of a claim or the amount of deduction from compensation should be decided by the contract between the persons directly involved or a related law. Therefore, it is not reasonable that the precedent draws the range of the NHIC's compensation from the principle of deduction after offsetting. To interpret Clause 1, Article 58 of the National Health Insurance Act that sets the range of the NHIC's compensation uniformly and systematically in combination with Clause 2 of the same article that sets the range of exemption, if the compensation is made first, it is reasonable to fix the range of the NHIC's compensation by multiplying the medical care expenses paid by the ratio of the assailant's liability. This is contrasted with the range of the Korea Labor Welfare Corporation's compensation which covers the total amount of the claim of the insured within the insurance benefit paid in the interpretation of Clauses 1 and 2, Article 87 of the Industrial Accident Compensation Insurance Act. In the meantime, there are doubts about why the profit should be deducted from the amount of compensation claimed, though it is enough for the principle of deduction after offsetting that the precedent took as the premise in judging the range of the NHIC's compensation to deduct the profit made by the victim from the amount of damages, so as to achieve the goal of not attributing profit more than the amount of damage to a victim; whether it is reasonable to attribute all the profit made by the victim to the assailant, while the damages suffered by the victim are distributed fairly; and whether there is concrete validity in actual cases. Therefore, the legal principle of the precedent concerning the range of the NHIC's compensation and the legal principle of the precedent following the principle of deduction after offsetting should be reconsidered.

• The Korean Society of Law and Medicine
• /
• v.20 no.3
• /
• pp.3-45
• /
• 2019

Health insurance is the main instrument to protect the people against sickness. To examine the task of in the future it would be necessary to extract and understand the components formed in its formation and development, benefit related and normative characteristics of the health insurance itself. The health insurance oriented itself to the universal coverage at a law level. Paradoxically this worked positively for the universal development of the health insurance. The task of the health insurance is on the one hand universal, positive and open. On the other hand it has to shape type of allowed method, art and content of the medical treatments into the regulation to ensure the equal benefit as well as the financial stability. That is, the health insurance should check the aberrant medical treatment, and at the same time should be compensated for the their necessity and effectiveness. However there are always some structural differences between both requirements. This article aims to restate and analyse the development of the health insurance, based on the characteristics formed hitherto show the way to reform the health insurance. The problem to enhance the coverage of health insurance, its institutional as well as financial crisis, its peculiar governance would be handled.

• Korean Business Review
• /
• v.19 no.1
• /
• pp.25-34
• /
• 2006

This research executed research that analyze construction cost and profitability through construction example of direction and subcontracting construction based on common private construction less than 3 billion. The results of this research, is summarized as follows. (1) Analyzed profitability about construction gross and operating profit of direction and subcontracting construction. The construction gross profit rate is 15.2% direction construction, subcontracting construction was analyzed by 1.3% high by 16.5% subcontracting construction, and the operating profit rate is 9.4% direction construction, subcontracting construction was construed by 2.3% high by 11.7% subcontracting construction. (2) Analyzed profitability about operating profit before and after deduction of 4 insurance cost of direction construction. The direction construction operating profit rate is 9.4% before deduction of 4 insurance cost, after deduction was construed that is 7.3% and operating profit rate difference after and before deduction was construed that is 2.1%. Therefore, subcontracting construction (operating profit rate 11.7%) was analyzed that last operating profitability after 4 insurance cost deduction produces more 4.4% about direction construction.

• The Journal of the Korean life insurance medical association
• /
• v.25
• /
• pp.49-62
• /
• 2006

생명공학의 시대로 일컬어 지고 있는 오늘날, 재생의학 분야에서는 난치성 질환 치료를 목적으로 활발한 연구가 진행되고 있다. 특히, 줄기세포를 이용한 세포 대체치료 관련 연구는 최근 국내 황우석 박사의 체세포 핵이식 배아세포주 확립에 이르기 까지 괄목할 만한 발전을 보여 주고 있다. 이와 관련해 생명보험산업에 적잖은 파장이 예상되며, 생명보험사 내부적으로 기존에 판매된 상품의 사차손 관리와 함께 급속도로 발전하는 줄기세포 연구에 직접적으로 대응하는 상품개발, 언더라이팅, 지급 심사 등 보험사 내외에서의 전방위적인 변화가 필요하다는 문제 제기가 있다. 줄기세포란 조직 분화 과정에서 볼 수 있는 세포이며 근육 뼈 뇌 피부 등 신체의 어떤 기관으로도 전환할 수 있는 만능세포로서, 간 폐 심장 등 구체적 장기를 형성하기 이전에 분화를 멈출 배아 단계의 세포를 말한다. 한편, 성체줄기세포는 조직이나 기관의 분화된 세포들 사이에서 발견되는 미분화 세포로써, 자기 스스로 증식할 수 있으며, 조직이나 기관의 특수한 기능을 가지고 있는 세포로 분화할 수 있는 능력을 가진 신체줄기세포를 말한다. 배아줄기세포와 생체줄기세포를 통한 장기이식 등 난치병 정복은 윤리적, 사회적으로 많은 논란이 예상되며, 기술적으로도 해결해야 할 문제점들이 산적해 있기 때문에 아직은 요원한 것이 사실이다. 현재 유럽 대부분의 나라와 미국에서는 인간 배아의 복제가 금지되어 있으며, 일본 정부는 연구용 배아 복제를 제한적으로 허용하고 있다. 하지만, 우리 나라의 경우 2005년 1월에 '생명윤리 및 안전에 관한 법'이 발효되었지만 정부는 관련 부작용에 대한 깊은 고찰 없이 전폭적인 지원들 약속하고 있는 실정이다. 줄기세포 연구의 발달로 인해 인류가 난치병 치료의 첫 장을 열었다고 하더라도 그 영향이 당장 보험사에 미친다고 할 수는 없다. 왜냐하면 앞으로 이러한 신기술이 실제 의료행위에 적용되기 위해서는 여러 단계의 안정화 작업과 임상시험이 필요한데 이러한 작업이 기술적으로 어렵고 그 시간도 만만치 않게 걸리기 때문이다. 또한, 보험사의 보장은 크게 사망/수술/입원/암/기타보장으로 구별할 수 있는데, 줄기세포 연구의 발달과 관련이 있는 보장이 제한되어 있어 보험사에 미치는 영향이 당장 우려할 만한 수준이라 할 수 없다. 하지만 만약 치료용 줄기세포 배양으로 인한 장기 기관의 이식이나 손상세포의 대체 등과 같은 의학신기술의 예상 외로 급격하게 발전한다면 보험사의 Risk 관리에 상당한 저해요인으로 작용할 것으로 판단된다. 특히 진단 입원 수술로 대표되는 생존보장에 대한 사차 Risk 및 사차손의 급증이나 역선택 증가는 보험사의 경영수지 악화를 유발하여 보험산업 전반에 위험으로 작용할 수도 있다. 따라서, 장기적인 안목으로 업계 공동의 대응이 필요하고, 각 사에서도 상품개발, 언더라이팅, 지급심사 간의 긴밀한 협조가 요구된다. 생명보험산업의 Risk 관리는 기존의 시장환경에 영향을 받는 비차, 이차중심에서 보험회사가 어느 정도 관리를 통해 적정규모를 유지할 수 있는 사차로 그 중심축이 이동하고 있다. 보험산업이 계속 활력을 갖고 성장하기 위해서는 체계적인 Risk나 관리가 핵심일 것이며, 보험사의 사차 Risk의 중요성이 더욱 커져 가고 있는 현실에서 거시적으로 의학신기술 발달 등 위험요인에 대해 미리 분석하고 이에 대한 대비책 마련이 필요할 것으로 판단된다.

• The Korean Society of Law and Medicine
• /
• v.13 no.1
• /
• pp.11-40
• /
• 2012

National Health Insurance Act has been enforced all over the People as part of the effort to assure the minimum constitutional human worth and dignity in the aspect of the right to pursue health for preventing misfortune that comes to death without even a chance to be received treatment for illness or injury. Meanwhile auto insurance is compulsory in certain parts in order to promote benefits of everyday life and the rapid recovery of the damage caused by traffic accident when one have negligently driven a car which has become the necessities in daily life. Any injured driver in a traffic accident can be treated by National Health Insurance without getting an auto insurance in various circumstances, but Article 3 paragraph 2 of Traffic Accident Act don't allow exception of criminal punishment when he has driven a car without license, drunken, or tresspassing the centerline, etc. When the injury occured by his own certain negligence is judged to 'when he has intentionally or through gross negligence caused a criminal conduct or intentionally contributed to the occurrence of an accident' of National Health Insurance Act, insurance benefits can be restricted. Such a restriction could harm the right to pursue happiness and health of People by depriving the poor, who cannot afford to pay, of chances to get treatment. Here we will see benefit restriction by 'gross negligence' of National Health Insurance Act Article 48 paragraph 1, which has largest portion of such restriction. It is desirable to delete 'gross negligence' clause from above paragraph and to interpret 'when' clause restrictively for diminishing confusion of interpreting and guaranteeing the right of health.

• Korean Journal of Social Welfare
• /
• v.64 no.4
• /
• pp.31-56
• /
• 2012

The main purpose of this study is to examine the rewards for "Family Care" from the Japanese Long-Term care policy, to investigate the effects of "The commodification of Family Care" after the introduction of "The Long-Term Care Insurance", and to find out the institutionalization of reward system for "Family Care". First of all, the socialization of "The Long-Term Care" is redefined to be the commodification of family care in this study. Based on this definition, the commodification of family care and the government's involvement are analyzed in conjunction with considering the role of family in the process of Long-Term Care supply, the social evaluation for family care, the family carers' home environment and the position in the labor market. In result, the commodification structure of family care in the Japanese Long-Term Care policy is found, and it helps to understand the reason why the cash payments was just partially introduced.

• Health Policy and Management
• /
• v.32 no.3
• /
• pp.323-329
• /
• 2022

Background: This study aimed to identify the characteristics of the referral and return of patients to clinics in the endocrinology and cardiology departments at the National Health Insurance Service Ilsan Hospital to evaluate the "referral and return of patients to clinics" program and reduce the rate of returning patients. Methods: From May 2018 to December 2020, we identified the number of visits to referral hospitals and hospital usage status at Ilsan Hospital after returning to clinics. We also identified the patients who returned to Ilsan Hospital within 6 months, defined as "failure to transport," among those recommended to be transported to clinics of the Medical Cooperation Center. Additionally, we evaluated the characteristics of the "failure to transport" patients. Results: Among the returning patients, the rate of visiting Ilsan Hospital within 6 months was higher in cardiology than in endocrinology (25.1% vs. 16.7%). Older age, more severe disease, and more number of visits to the department were associated with a high rate of failure to transport. The rate of failure to return was low in cases diagnosed with hyperlipidemia/lipoprotein metabolism disorder. With respect to diabetes, the rate of failure to transport differed according to each type of diagnosis of diabetes. Conclusion: The success rate of the "referral and return of patient to clinics" program differed based on each patient's characteristics, department of visit, and diagnosis. Individualizing according to the visit department and diagnosis is required to ensure successful transfers, and infrastructure expansion and institutional arrangements must be facilitated.

• Journal of Teachers' Pension
• /
• v.2
• /
• pp.11-46
• /
• 2017

이 연구는 사학재해보상제도의 개선방안을 제시하는 것을 목적으로 한다. 이를 위하여 사학재해보상제도의 제도 성격부터 시작하여 제도의 내용과 현황, 그리고 문제점을 산재보험과 공무원재해보상제도와의 비교를 통해서 살펴보고, 이를 바탕으로 제도 개선방안을 제시하였다. 지금까지 사학재해보상제도는 공무원재해보상제도를 준용하여 왔기 때문에 제도 개선에 대한 논의가 거의 이루어지지 않았으나, 공무원재해보상제도가 최근 들어 재해보상제도의 성격에서 벗어나서 보훈적 성격을 강화하면서 두 제도 사이의 괴리가 커지고 있다. 사학재해보상제도를 포함하는 사학연금은 정부로부터 재정지원을 받아왔기 때문에 독자적인 제도를 운영하지 못하고 공무원연금제도를 준용하여 왔으나, 퇴직연금이나 퇴직수당과 달리, 사학재해보상제도는 정부의 재정지원으로부터 벗어나 있다는 점에서 중장기적으로 제도의 독립을 고려할 필요가 있다. 구체적으로 본 연구에서는 다음과 같은 제도 개선 사항을 제시하였다. 휴업급여를 도입하여 요양중 소득손실에 대한 보상을 강화하고, 장해연금과 유족연금을 산재보험 수준으로 높이되, 유족보상금과 유족연금부가금을 폐지하고 장해연금과 퇴직연금 사이의 병급을 일부 조정하도록하며, 직무상 사망에 대한 사망조위금은 높이되 가족의 사망에 대한 사망조위금을 폐지하도록 한다.