• Title/Summary/Keyword: Claim Management

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Impact of Selective Health Benefit on Medical Expenditure and Provider Behavior: Case of Gastric Cancer Surgery (선별급여 도입이 위암수술의 건강보험 진료비 및 진료행태에 미치는 영향)

  • Cho, Su-Jin;Ko, Jung-Ae;Choi, Yeonmi
    • Health Policy and Management
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    • v.26 no.1
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    • pp.63-70
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    • 2016
  • Background: Selective health benefit was introduced for decreasing economic burden of patients. Medical devices with economic uncertainty have been covered as selective health benefit by National Health Insurance since December 2013. We aimed to analyze impact of selective health benefit to medical expenditure and provider behavior focused on electrosurgery (ultrasonic shears, electrothermal bipolar vessel sealers) for gastric cancer patients covered since December 2014. Methods: We used the National Health Insurance claims data of 2,698 patients underwent gastric cancer surgery between August 2014 and March 2015. Medical cost and patient sharing per inpatient day were analyzed to verify that covering electrosurgery increased medical expenditure and changed provider behavior from open surgery to endoscopic or laparoscopic surgery. Additionally, we analyzed the claim rate of medical device or goods relating gastric endoscopic and laparoscopic surgery. Results: Medical cost and patient sharing per inpatient day were increased after covering electosurgery as selective health benefit (39,724/1,421 won). However, there were no medical expenditure increases after adjusting claim of electosurgery and patient sharing was decreased 1,057 won especially. The coverage of selective health benefit did not increase the claim rate of medical device or goods related endoscopic or laparoscopic surgery, either. Conclusion: Covering electosurgery decreased patient economic burden and did not change of provider behavior. Expanding selective health benefit is needed to decrease economic burden of severe patients. Further study should evaluate the long term effect with accumulated data.

Korean consumers' perceptions of health/functional food claims according to the strength of scientific evidence

  • Kim, Ji-Yeon;Kang, Eun-Jin;Kwon, O-Ran;Kim, Gun-Hee
    • Nutrition Research and Practice
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    • v.4 no.5
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    • pp.428-432
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    • 2010
  • In this study, we investigated that consumers could differentiate between levels of claims and clarify how a visual aid influences consumer understanding of the different claim levels. We interviewed 2,000 consumers in 13 shopping malls on their perception of and confidence in different levels of health claims using seven point scales. The average confidence scores given by participants were 4.17 for the probable level and 4.07 for the possible level; the score for the probable level was significantly higher than that for the possible level (P < 0.05). Scores for confidence in claims after reading labels with and without a visual aid were 5.27 and 4.43, respectively; the score for labeling with a visual aid was significantly higher than for labeling without a visual aid (P < 0.01). Our results provide compelling evidence that providing health claims with qualifying language differentiating levels of scientific evidence can help consumers understand the strength of scientific evidence behind those claims. Moreover, when a visual aid was included, consumers perceived the scientific levels more clearly and had greater confidence in their meanings than when a visual aid was not included. Although this result suggests that consumers react differently to different claim levels, it is not yet clear whether consumers understand the variations in the degree of scientific support.

Trends on the Curtailment of Drug Expenditure Before and After the Seperation between Prescription and Dispensing in General Hospitals By Drug Types (의약분업 전후 일부 종합병원의 약제종류별 약제비 삭감추이)

  • Lee, Sun-Hee;Jo, Heui-Sug;Lee, Hye-Jean
    • Korea Journal of Hospital Management
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    • v.8 no.2
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    • pp.93-110
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    • 2003
  • Fiscal crisis in the medical insurance has put the pressure upon hospitals by increasing the rate of curtailment, since the implementation of the separation between prescription and dispensing of Drug. The purpose of this study is to analyze the curtailment for antibiotics, injected drug and other drugs expenditure before and after the system of separation between prescribing and dispensing. Data were gathered from 13 general hospitals and used for analysis of trends on antibiotics and injected drug expenditure, and curtailment in 2000-2001 at three months intervals. The results were as follows; The curtailment rate of antibiotics expenditure has been increased in outpatient and inpatient since 2000. The curtailed antibiotics cost and injected drug cost in outpatient under the prescription within the hospital and in inpatient increased. The ratios of curtailment versus expenditure had increased in antibiotics, injected drugs, anticancer drugs, antiulcer drugs, albumine, antiinflammatory drugs. These results suggest that claim review system in social health insurance were over-focused mainly to control the cost and it might to impede the validity of claim review function in health insurance system. Therefore, it's needed to develope the scientific and reasonable parameter & criteria for claim review of drug expenditure.

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A Proposal of Improvement Devices for General Conditions of Contract in Claim-related Provisions (공사계약일반조건의 클레임 관련 조항의 개선방향)

  • paik, Hwa-Sook;Yang, Chang-Hyun;Yoon, Ja-Young;Kim, Kyung-Hwan;Kim, Jae-Jun
    • Proceedings of the Korean Institute Of Construction Engineering and Management
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    • 2007.11a
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    • pp.273-276
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    • 2007
  • Construction work has character which claim or dispute is frequently raised. This means that each construction project has it's own contract documents due to the difference of environment and time. Therefore to overcome the associated risks, domestic contract rules and acts should be reformed. Several well-recognized contract documents developed by FIDIC, AlA, CMAA and general conditions of the contract is investigated and analyzed. Based on the research outcomes the direction of reformation is suggested.

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Environment Dynamism and Strategic Technology Resource Protection: Claims of Priority of Korean High-tech Electronics Firms (환경 역동성과 전략적 기술자원의 보호: 한국 하이테크 전자기업의 우선권주장출원)

  • Kim, Doyoon;Shin, Dongyoub
    • Knowledge Management Research
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    • v.22 no.1
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    • pp.57-84
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    • 2021
  • In this paper, we explore market and environmental factors which affecting organization's priority claim application which is more powerful and prompt strategic method to protect technology from competitors under uncertain and volatile environments. This study empirically examines why organizations strategically choose the priority claim application which is more strong tactics to protect technology as the source of sustainable competitive advantage. We suggest that market and environmental factors, such as exogenous shock, volatility, and uncertainty, may also affect strategic decision that organization take patent application with claiming priority. The results of our analysis of priority claim application in the Korean high-tech electronics industry from 1994 to 2008 showed that these three strategic factors affected the technology protection decision and organization's status also moderate theses effects, as predicted in our hypotheses.

PRECISE LARGE DEVIATIONS FOR AGGREGATE LOSS PROCESS IN A MULTI-RISK MODEL

  • Tang, Fengqin;Bai, Jianming
    • Journal of the Korean Mathematical Society
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    • v.52 no.3
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    • pp.447-467
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    • 2015
  • In this paper, we consider a multi-risk model based on the policy entrance process with n independent policies. For each policy, the entrance process of the customer is a non-homogeneous Poisson process, and the claim process is a renewal process. The loss process of the single-risk model is a random sum of stochastic processes, and the actual individual claim sizes are described as extended upper negatively dependent (EUND) structure with heavy tails. We derive precise large deviations for the loss process of the multi-risk model after giving the precise large deviations of the single-risk model. Our results extend and improve the existing results in significant ways.

Case Study of Blasting Vibration and Noise in Public Resentment Area (민원발생시 발파진동.소음의 처리사례에 관한 연구)

  • 안명석;최영천;박종남;목연수
    • Explosives and Blasting
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    • v.17 no.3
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    • pp.13-22
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    • 1999
  • It Is indispensible to cause vibration, noise and dust to blasting and breaker operations. Since the control of these factors is supposed to be extremely difficult, the claim of compensation for material and mental damages are getting increased. Economically feasible blasting operation with controlling vibration and noise can be achieved by establishment of science-based plan, accurate operation and responsible inspection, and the application of efficient management system. It must also be remarked that the relevant applied without prejudice by the operator, and the law and regulation should be applied without prejudice by the authority concerned. In addition, the public claim against operators should be investigated in detail and the prosecution should be made under the careful onside-ration of scientific and reasonable conception. Finally, it is strongly suggested that the operations, public and authorities should make great efforts to develop higher technology in order to expand our construction market, to overseas.

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Planning and Scheduling using EOT Claim analysis (EOT 클레임 분석 기법을 활용한 공정관리)

  • Woo, Han Kil
    • Proceedings of the Korean Institute of Building Construction Conference
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    • 2021.11a
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    • pp.248-249
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    • 2021
  • Planning and Scheduling in Korean has been developed from Bar Chart to CPM, integrated management and EVM were attempted. As growing of overseas projects, Scheduler was also recognized as important one. However, the reality is that most Korean construction projects still remain in the preparation of construction plan and construction schedule in 1990s. The global Planning and Scheduling trend is EOT claims. I would like to understand the global trend of EOT claims and EOT analysis, and to find out Planning and Scheduling measures to successfully promote EOT claims.

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A Liquidated Damages Calculation Method Based on Owner's Substantial Loss (발주자 손실기반 지체상금 산정 개선방안)

  • Jang, Bong-Jo;Shim, Jae-Young;Koo, Jeong-San;Jung, Dae-Won;Koo, Kyo-Jin;Hyun, Chang-Taek
    • Korean Journal of Construction Engineering and Management
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    • v.8 no.1 s.35
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    • pp.150-158
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    • 2007
  • The delay of construction is one of the most frequent and complicated elements of the claim. And the liquidated damages cause many disputes during the judgement. The liquidated damages should be a compensation for owner's substantial loss, but actually be applied as a damage for breach of contract. These damages are different from owner's loss and give constructors a excessive burden. So we need a more reasonable system than a lump application system. In this study, we make a Improvement System, that based on owner's substantial loss, and suggest the new liquidated damages calculation method.

Tuning the Architecture of Neural Networks for Multi-Class Classification (다집단 분류 인공신경망 모형의 아키텍쳐 튜닝)

  • Jeong, Chulwoo;Min, Jae H.
    • Journal of the Korean Operations Research and Management Science Society
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    • v.38 no.1
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    • pp.139-152
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    • 2013
  • The purpose of this study is to claim the validity of tuning the architecture of neural network models for multi-class classification. A neural network model for multi-class classification is basically constructed by building a series of neural network models for binary classification. Building a neural network model, we are required to set the values of parameters such as number of hidden nodes and weight decay parameter in advance, which draws special attention as the performance of the model can be quite different by the values of the parameters. For better performance of the model, it is absolutely necessary to have a prior process of tuning the parameters every time the neural network model is built. Nonetheless, previous studies have not mentioned the necessity of the tuning process or proved its validity. In this study, we claim that we should tune the parameters every time we build the neural network model for multi-class classification. Through empirical analysis using wine data, we show that the performance of the model with the tuned parameters is superior to those of untuned models.