• The Korean Society of Law and Medicine
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• v.18 no.2
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• pp.75-103
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• 2017

There are three types of benefits in the National Health Insurance Act of Korea. Those are the treatment benefit, statutory uninsured medical benefits and arbitrary uninsured medical benefits. Recently the Korea Supreme Court changed its past legal theory and permitted the arbitrary uninsured medical benefits under the strictly exceptional conditions. According to the Supreme Court's decision, the existence of procedural difficulty, the medical necessity and the patient's consent are necessarily required in order to allow the legal exceptions in arbitrary uninsured medical benefits. Among the three requirements, the doctor's explanation and the patient's fully informed consent are the most important essentials in this legal conflict. The requirement concerning the doctor's explanation and the patient's consent roles like a hole in the ice as a breathing hole in the arbitrary uninsured medical benefits. The most cases dismissed after Supreme Court Decision 2010DU27639, 27646 Decided June 18, 2012. were due to the defect of three requirements.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.6 no.1
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• pp.89-96
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• 2011

Objective : The purpose of this study is to evaluate the korean medical treatment for compressive neuropathy of radial nerve, especially chuna treatment of cervical vertebrae. Methods : Two patients were treated with acupuncture and moxibustion, herbal medication, chuna treatment on cervical vertebrae. To evaluate the wrist drop and numbness of hand, Coding Result of arbitrary values and manual muscle test(MMT), visual analogue scale(VAS) were used. Results : After 2 weeks-treatment(in case 1) & 5 weeks-treatment(in case 2), the movement and power of wrist were restored to nearly normal range, also the numbness of hands was removed. All cases show the improvement in the movement of wrist and the numbness of hands. Conclusions : Korean medical treatment including cervical manual therapy as chuna treatment is remarkably effective for radial nerve palsy. But further studies are required to concretely prove the effectiveness of chuna treatment on central vertebrae for peripheral neuropathy.

• Korean Journal of Psychosomatic Medicine
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• v.3 no.2
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• pp.214-221
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• 1995

There appears to be an increased incidence of anxiety symptoms in association with certain medical illness. It is usually assumed that certain medical disorders are directly associated with anxiety symptoms in that the pathophysilolgy of the medical illness somehow causes the anxiety symptoms. However, the pathophysilolgies of many such medical illnesses as well as anxiety are not known and no discrete group of medical illnesses is clearly more likely to produce anxiety symptoms than any other Moreover, anxiety symptoms may be the representation of other psychiatric symptoms, like depression and delirium. Though it is important to differentiate primary and other causes(secondary) of anxiety clinically, the clear differentiation is somewhat arbitrary, as the confusion of mind-body dichotomy. for the purpose of accurate treatment of anxiety symptoms relating medical illness, this review article focuses on those clinical features and mechanisms of anxiety that are potentially useful in differential diagnosis.

• 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.

• Communications for Statistical Applications and Methods
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• v.23 no.1
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• pp.1-20
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• 2016

Causal inference methodologies have been developed for the past decade to estimate the unconfounded effect of an exposure under several key assumptions. These assumptions include, but are not limited to, the stable unit treatment value assumption, the strong ignorability of treatment assignment assumption, and the assumption that propensity scores be bounded away from zero and one (the positivity assumption). Of these assumptions, the first two have received much attention in the literature. Yet the positivity assumption has been recently discussed in only a few papers. Propensity scores of zero or one are indicative of deterministic exposure so that causal effects cannot be defined for these subjects. Therefore, these subjects need to be removed because no comparable comparison groups can be found for such subjects. In this paper, using currently available causal inference methods, we evaluate the effect of arbitrary cutoffs in the distribution of propensity scores and the impact of those decisions on bias and efficiency. We propose a tree-based method that performs well in terms of bias reduction when the definition of positivity is based on a single confounder. This tree-based method can be easily implemented using the statistical software program, R. R code for the studies is available online.

• Journal of Acupuncture Research
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• v.26 no.6
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• pp.241-249
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• 2009

Objectives : The purpose of this study is to report the patients with compressive neuropathy of the radial nerve(Saturday Night Palsy), who was improved by acupuncture and Sweet Bee Venom(SBV) treatment. Methods & Results : The patients were hospitalized or outpatient in Dept. of Acupuncture & Moxibustion, traditional korean medical hospital, Sangji University from 1st, Dec. 2008 to 30th June 2009, and treated with acupuncture, SBV, electrical stimulation therapy and herbal medication therapy. To evaluate the wrist drop and numbness of fingers, coding result(Arbitrary values used to evaluate result) and digital infrared thermal image, which was well defined diagnostic tool estimating skin surface temperature difference, were used. As a result, patient symptoms were improved remarkably. Conclusions : Patients were treated during 6 weeks in average. 2 cases were excellent and 1 case was evaluated good result by the acupuncture, Sweet Bee Venom, electrical stimulation therapy.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.436-438
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• 2002

As the use of virtual simulation expands, digitally reconstructed radiographs (DRRs), which mimic conventional simulation films, play an increasingly important role as reference images in the verification of treatment fields. The purpose of our study is to develop an algorithm for computation of digitally reconstructed radiographs based on Monte Carlo simulation that take into account almost all possible physical processes by which photons interact with matter. The Monte Carlo simulation based DRRs have the following features. 1) Account has been taken of almost all possible physical processes of interaction of photons with matter, including a detector (film) response. In principle, this is equivalent to X-ray radiography. 2) Arbitrary photon energies (from diagnostic to therapeutic) can be used to produce DRRs. One can even use electrons as the source. 3) It is easy to produce a double exposure, which mimics the double exposure portal image and may have superior visual appeal for treatment field verification, with weighting within the treatment field.

• The Korean Society of Law and Medicine
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• v.5 no.2
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• pp.294-319
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• 2004

Because the treatment of a physician generally pertains to the intrusion into body of a patient, his/her consent is a must in order for such conduct to be justifiable. To ensure effective consent of a patient, the physician should fully inform him/her of kind and details of the disease and way of treatment and risks associated with it. The patient can, then, make a decision whether he/she should accept any treatment or operation, if necessary, on the basis of such information. The obligation of physicians to explain has since long been recognized as important in view of guaranteeing the rights of patients for self-decision and protecting them from arbitrary assessment of physicians for treatment. Progress has been made in this respect even to the extent that physicians treat patients on equal terms and think first of all much of establishing trustworthy relationships with patients. Lots of studies in Korea and foreign countries have tried to explore the issues concerning the obligation of physicians to explain in the meantime but seem to have failed to make concrete and versatile approaches from the standpoint of protecting the rights of patients. Wouldn't it be really possible for patients to perceive their own rights and cope actively with the medical treatments? If physicians have full understanding to the rights of patients, they will be put in a better situation to protect themselves and patients, in turn, can identify their own responsibility correctly, which will eventually contribute to fulfilling the goal of treatment. With this background, the present paper examines briefly the obligations of physicians for explanation based mainly on the preceding theories and judicial precedents in the first place and then deals with the status quo and contents of the German medical laws, with a focus on the treaty of European Law 1997 and its working document on the applications of genetics for health purposes that stipulate the detailed criteria on the medical treatment and rights of patients and Germany's $\ulcorner$Charter of Rights for Patients$\lrcorner$ promulgated in 2003.

• The Korean Society of Law and Medicine
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• v.16 no.2
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• pp.3-26
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• 2015

Recently, Practicing of ghost surgery and duty of informed consent of doctors have become a big issue in the medical dispute and lawsuits. The ground of admitting the informed consent and the agreement(self-determination of patients) can be based on the dignity of man and the right to pursue his happiness guaranteed under Article 10 of the constitution in theory. However there are no explicit legal regulations on the duty of the informed consent and there is no substantive legal enactment on the informed consent, but there is a collision between self-determination of patients and the discretionary power of doctors. If the discretionary power on the duty of the informed consent was extended it may result in the infringement of the right of surgical patients, so called arbitrary medical treatment. Relating to this issue, New Jersey Supreme Court held that a patient has the right to determine not only whether surgery is to be performed on him, but also who shall perform it. Moreover it held that a surgeon who operates without the patient's consent engages in the unauthorized touching of another and, thus, commits a battery'. But there are no ghost surgery cases adopting battery theory in Korea, and professional negligence has been considered rather than the battery, regarding an absence of hostile intent to injure patient. Supreme Court of Korea held that a doctor who operates a medical procedure without the patient's valid prior consent based on wrong diagnosis commits professional negligence resulting in injury, and the patient's invalid consent do not preclude wrongfulness'. However, if a health care provider conducts a completely non-consensual treatment or substitute surgeon without consent, the action should be plead in battery, not negligence, but if a health care provider violate his duty of care in obtaining the consent of the patient by failing to disclosure all relevant information (risks) that a reasonable person would deem significant in making a decision to have the procedure, the action should be plead in negligence, not battery. Therefore, the scope of patients' self-determination can be protected by stating clearly the scope of the duty of the informed consent and the exemption of the informed consent legislatively, it is considered that it is valid to legislate the limitation of the discretionary power.

• The Korean Society of Law and Medicine
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• v.12 no.1
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• pp.177-225
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• 2011

Verdicts related to major medical litigation given by the Seoul Central District Court, the Seoul High Court and the Supreme Court in 2010 were analyzed. It's shown that in cases of the medical negligence regarding the occurrence of neonatal cerebral palsy, the plaintiff claims were dismissed using criteria proposed by associations of Obstetrics and Gynecology and Pediatrics in US, and thereof the burden of plaintiffs to prove the medical negligence has increased. In addition, in case of that the expected survival period of infants gets longer, payments for treatment and nursing after survival period determined by judges are made and it was judged to compensate it as a periodical indemnity. In case for the explanation obligation the most frequently mentioned in the medical litigation, in addition to cases of invoking the existing theory of explanation obligation, verdicts to mention the instructions of theory regarding instruction explanation obligation and the possibility of compensation for damages on property are given. Particularly, in cases for a liability of reparation by exaggerating the effects and not disclosing the risks related to treatment with stem cells, even if the treatment not approved by Food and Drug Administration is in violation of the Pharmaceutical Affairs Law, it's not illegal as violation in Pharmaceutical Affairs Law itself. But there is a certain verdict to present the possibility of an extension of the theory of explanation obligation by acknowledging the liability of reparation caused by illegal acts with no explanations of effects and risks of treatment with stem cell by doctors and pharmaceutical companies. In an incident in which a mental patient fell and died through the opened door of the roof at the hospital, a liability of reparation was acknowledged due to defects in structure installation management and this verdict drew an attention since the overall management responsibility about patients including structures was acknowledged to the hospital besides the obligations on medical practice. In case of the verdict without giving the opportunity to state the opinion with respect to the main legal issues, the responsibility of the court was emphasized since the court did not fulfill the explanation obligations. There were some cases in which payments for nursing and caring to a patient in vegetative state during the plastic surgery was admitted. However, in dental-related incidents, the proportion of cases in which plaintiff won was low since the difficulty of proving may be reflected. In the area of administrative litigation, unlike the existing position regarding arbitrary medical charge cover collected from patients in hospital, the verdict to admit the legitimacy of collection of medical treatment was given and attracted the attention of people. Verdict in which the expression related to medical advertisement was not exaggerated disposed the original verdict and pointed out the problem of excessive regulations on medical advertisement. The effort to analyze the trend of verdicts of court through reviewing the decisions and to organize should be continued, but the full decision should be disclosed as a base, and people and systems to enable the all time monitoring should be prepared.