• Title/Summary/Keyword: Coverage criteria

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An Examination of the Exactitude of Legal Application behind the National Health Insurance Corporation's Practice of "Collection and Disbursement" of Paid Medical Expenses (With an Emphasis on Arbitrary Denial of Coverage) (국민건강보험공단의 요양급여비용 환수과정에 있어서 법적용 정밀성에 관한 검토 -특히 임의비급여를 중심으로-)

  • Song, Myung-Ho
    • The Korean Society of Law and Medicine
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    • v.13 no.2
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    • pp.45-72
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    • 2012
  • The National Health Insurance Corporation has been retrieving from health care providers the payments made to them by insured patients as a result of the health care providers' arbitrary denial of coverage under the National Health Insurance, and has been disbursing such retrieved monies back to the patients, pursuant to Article 57, Sections 1 and 4 of the National Health Insurance Act. However, such practice is an application of the law that lacks legal exactitude. Another problem with such practice is that there is no legal provision under any laws or notices that expressly prohibits arbitrary denial of coverage. A legislative solution, therefore, is called for to address these issues.

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Interpretability Comparison of Popular Decision Tree Algorithms (대표적인 의사결정나무 알고리즘의 해석력 비교)

  • Hong, Jung-Sik;Hwang, Geun-Seong
    • Journal of Korean Society of Industrial and Systems Engineering
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    • v.44 no.2
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    • pp.15-23
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    • 2021
  • Most of the open-source decision tree algorithms are based on three splitting criteria (Entropy, Gini Index, and Gain Ratio). Therefore, the advantages and disadvantages of these three popular algorithms need to be studied more thoroughly. Comparisons of the three algorithms were mainly performed with respect to the predictive performance. In this work, we conducted a comparative experiment on the splitting criteria of three decision trees, focusing on their interpretability. Depth, homogeneity, coverage, lift, and stability were used as indicators for measuring interpretability. To measure the stability of decision trees, we present a measure of the stability of the root node and the stability of the dominating rules based on a measure of the similarity of trees. Based on 10 data collected from UCI and Kaggle, we compare the interpretability of DT (Decision Tree) algorithms based on three splitting criteria. The results show that the GR (Gain Ratio) branch-based DT algorithm performs well in terms of lift and homogeneity, while the GINI (Gini Index) and ENT (Entropy) branch-based DT algorithms performs well in terms of coverage. With respect to stability, considering both the similarity of the dominating rule or the similarity of the root node, the DT algorithm according to the ENT splitting criterion shows the best results.

Overview of Risk-Sharing Schemes: Focusing on Anticancer Drugs (위험분담제도에 대한 고찰: 항암제 사례를 중심으로)

  • Sohn, Hyun Soon;Shin, Hyun Taek
    • Korean Journal of Clinical Pharmacy
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    • v.23 no.2
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    • pp.89-96
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    • 2013
  • This article aimed to introduce 'risk sharing' schemes for pharmaceuticals between drug manufacturers and healthcare payer. Published literature review was undertaken to summarize risk sharing concepts and collect information on existing scheme examples in other countries focusing on new anticancer drugs. Risk sharing schemes could be categorized into health outcomes-based and non-outcomes (financial) based ones. Outcome-based schemes could be broken down into performance-linked reimbursement and conditional coverage. Performance-linked reimbursement can be further broken into outcomes guarantee and pattern or process of care and conditional coverage included coverage with evidence development and conditional treatment continuation schemes. Non-outcome based schemes included market share and price volume at population level, and utilization caps and manufacturer funded treatment initiation at patient level. We reviewed the fifteen examples for anticancer drugs that risk sharing agreements in response to the inherent uncertainties and increased costs of eleven anticancer drugs. Of them, eight cases were coverage with evidence development schemes. The anticancer drugs except bevacizumab and cetuximab were all listed on the national health insurance formulary in Korea, with reimbursement criteria defined on the basis of approved indications and administrations. Risk sharing approach may be a useful tool to ensure values for drug expenditure, but there are a number of concerns such as high administration costs, lack of transparency and conflicts of interest, especially for performance-based health outcomes reimbursement schemes.

Evaluation of Moxibustion -related Health Information on Korean Internet News Coverage (한국 인터넷 신문기사에서 뜸 관련 의료정보 평가)

  • Kang, O-Seok;Park, Hi-Joon;Kim, Song-Yi;Lee, Hye-Jung;Chae, Youn-Byoung
    • Journal of Acupuncture Research
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    • v.26 no.2
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    • pp.189-199
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    • 2009
  • Objectives : Despite the substantial amount of newspaper coverage related to complementary and alternative medicine on the internet in recent years, little is know about the quality of the health information. To evaluate health information of the newspaper articles on moxibustion available in Korea through Korean language search engines and Web sites. Methods : We searched 454 news stories about moxibustion between 1 January 2006 and 31 December 2008. Among them, 34 internet news coverage related to health information on moxibustion were selected and rated against eight categories by two individuals. Results : The inter-rater reliability of the two reviewers was assessed as 0.69, indicating a moderately high level of agreement. The overall rating score for 34 articles was 35.7${\pm}$17.2 for the statement criteria and 12.9${\pm}$17.0 for the satisfaction criteria. Overall, although they might be improving recently, the scores remain generally low. There was a statistically significant difference in the score of the newspaper coverage according to the type of evidence sources, including anecdotes. Conclusions : There is substantial variability in news reporting practices about moxibustion. It is urgently needed to enhance the information related to CAM including moxibustion through the news media in Korea.

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Automated Test Data Generation for Dynamic Branch Coverage (동적 분기 커버리지를 위한 테스트 데이터 자동 생성)

  • Chung, In Sang
    • KIPS Transactions on Software and Data Engineering
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    • v.2 no.7
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    • pp.451-460
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    • 2013
  • In order to achieve high test coverage, it is usual to generate test data using various techniques including symbolic execution, data flow analysis or constraints solving. Recently, a technique for automated test data generation that fulfills high coverage effectively without those sophisticated means has been proposed. However, the technique shows its weakness in the generation of test data that leads to high coverage for programs having branch conditions where different memory locations are binded during execution. For certain programs with flag conditions, in particular, high coverage can not be achieved because specific branches are not executed. To address the problem, this paper presents dynamic branch coverage criteria and a test data generation technique based on the notion of dynamic branch. It is shown that the proposed technique compared to the previous approach is more effective by conducting experiments involving programs with flag conditions.

Development of Suit-tops Size-system for Abdomen-obese Adult Males (복부비만 성인 남성의 상의류 치수체계 제안)

  • Lim, Jiyoung
    • Fashion & Textile Research Journal
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    • v.22 no.1
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    • pp.94-101
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    • 2020
  • This helps plus-size consumers purchase ready-made clothes and improves fitness by analyzing the upper body shapes of abdomen-obese adult males; in addition, it creates a size system based on each size interval of obesity shapes. The criteria for the 572 male subjects surveyed were over 25 kg/㎡ of the BMI, over 90 cm of waist, and over 0.85 waist hip ratio. The results were as follows. First, the higher the age group, the higher the degree of abdominal obesity in each age group. The degree of obesity decreases age increase; however, was the risk of abdominal obesity increased. Second, Compared to standard body types, the average body size of Abdomen-obese males is significantly larger, especially in the waist area than in the chest area. Third, to propose a size system for abdominal obese adult males, 16 sections with a final 2% rate of appearance were finally adopted as suit-tops size system for abdominal obese adult males by applying a 3 cm dimension gap between each designation as specified in the KS standard. The coverage ratio for the 16 sections was 72.6% and the coverage effienciency was 4.5%. The results of this study can be used in a various clothes; in addition, the activation and segmentation of the plus-size market are also believed to be significant.

A Prioritizing for the Evidence-Based Nursing Practice Guidelines Development (국내 근거기반 임상간호실무지침 주제의 우선순위 결정)

  • Gu, Mee Ock;Cho, Myoung Sook;Cho, Yong Ae;Jeong, Jae Sim;Eun, Young;Jeong, Ihn Sook;Park, Jeong Sook;Kim, Hea Jeong
    • Journal of Korean Clinical Nursing Research
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    • v.18 no.1
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    • pp.39-51
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    • 2012
  • Purpose: Thisstudy was conducted with an aim to get a kind of prioritiesin developing the evidence-based nursing practice guidelines in fields. Methods: This study utilized a two-round Delphi surveys from November to December, 2010 with self-administered questionnaires which had a scale ranged from 0 to 9. A total of 95 head nurses working at the forty different general hospitals was asked to evaluate the priorities in four criteria; patient coverage, certainty, improvement in patient outcome and in nursing practice (first round) and 65 head nurses were asked to decide the importance of the criteria afterwards (second round). Results: The relative importance of 4 criteria was 22.3% in patient coverage, 26.5% in certainty, 23.5% in improvement of patient outcome, and 27.7% in improvement of nursing practice as the results of the 1st round and 20.6%, 26.6%, 24.8%, and 28.0% for the 2nd round, respectively. Top five nursing practices showed high scores after considering the relative importances of the 4 criteria were medication, intravenous therapy, checking vital sign, pain management, and diagnostic test or procedures care. Conclusion: It is recommended to take into account of the priorities that were found in this study when someone intends to develop a evidence-based nursing practice guideline.

A Study on Evaluation Standard for Revegetation Method through Monitoring of Vegetation on the Slope of Expressway (고속도로 비탈면 식생 모니터링을 통한 녹화공법 평가기준 연구)

  • Kim, Kyung-Hoon;Jeon, Gi-Seong;Hur, Young-Jin;Park, Jong-Chul;Joo, Baek;Kang, Dae-In
    • Journal of the Korean Society of Environmental Restoration Technology
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    • v.23 no.6
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    • pp.57-73
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    • 2020
  • A study was conducted to present the criteria for evaluating the revegetation method of the slope of the expressway. The results of comparative analysis between 2019-2020 field survey and existing research data (2015-2016) are as follows. Soil is a very important factor at the beginning of revegetation work. However, after the plant has settled, the importance of the soil composition diminishes. Among the plants used, the number of plants sown at the beginning gradually decreases. And it changes as it competes with invading plants. Among the plants used for sowing, it was found to affect the vegetation composition in the order of exotic grass > native herb and wildflower > native tree. Plant coverage is continuously evaluated as an important factor regardless of the time. The vegetation structure on the slope will change continuously over time. New items need to be evaluated in situations where a lot of time has elapsed since the application of revegetation work. It is desirable to use the current evaluation standard only to perform the evaluation within 1 to 2 years. In the long run, it is necessary to establish a new evaluation standard that adjusts the weights of each item.

A Simple Scoring Method to Calculate the Homogeneity and Coverage Indices of Dose Volume Histogram (DVH를 이용한 선량 균등률 및 덮임률 지수에 관한 연구)

  • Yoon Myong-Geun;Park Sung-Yong;Shin Dong-Ho;Park Jung-Hun;Lee Se-Byeong;Kim Dae-Yong;Kim Joo-Young;Cho Kwan-Ho
    • Progress in Medical Physics
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    • v.17 no.1
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    • pp.6-16
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    • 2006
  • The goal of this study was to develop new indices for effectively evaluating the dose coverage and homogeneity based on the target-volume dose-volume histogram (TV-DVH) of intensity-modulated radio-therapy treatment plans. A new coverage Index and a new homogeneity index were developed by integrating a modified TV-DVH and by fitting a TV-DVH with a modified step function, respectively. The coverage index, named the l-index, indicates whether the dose coverage for the target volume is adequate based on user-defined criteria. A lower l-index indicates higher dose coverage of the tumor volume. The index for assessing dose homogeneity in a target volume, named the n-index, is more accurate than the conventional method in evaluating the dose homogeneity in a tumor volume. The baseline treatment plan for a target volume coverage and homogeneity is discussed. The proposed simple indices have been demonstrated to be effective in evaluating the dose coverage and homogeneity for TV-DVHs.

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Basic Study on Enhancement of Recreational Forest Designation Criteria - A Case Study of Gwangju-si, Gyeonggi-do - (자연휴양림 지정평가기준의 개선방향도출을 위한 기초연구 - 경기도 광주시의 사례를 중심으로 -)

  • Lim, Eun-Hee;Yeom, Sung-Jin
    • Journal of Environmental Science International
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    • v.29 no.6
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    • pp.643-658
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    • 2020
  • Recent economic and income growth in Korea has caused people to seek healthier and happier lives. Forests are seen as spaces that provide tourism and recreation. The Korea forest service and local governments are developing and designating recreational forests but previous studies on the subject have only covered customer satisfaction and how forests are used. As such, the current study aims to find issues with designation criteria for recreational forests used by Gwangju city in Gyeonggi province and suggest improvements to the system. Site E was deemed the most adequate in evaluations of five candidate site. The criteria used in the evaluations were problematic due to (1) a lack of differentiating power in evaluation items, (2) blanket coverage of score ranges, (3) a lack of additional points for special sites, and (4) unclear evaluation indices. Based on the identified issues, the current study suggests introducing additional points and clearly detailing evaluation indices and items to enhance the evaluation of recreational forest candidate sites.