• Korean Journal of Clinical Pharmacy
• /
• v.29 no.3
• /
• pp.147-155
• /
• 2019

Objectives: The purpose of this study was to investigate the association between fracture risk and proton pump inhibitor (PPI) use to establish evidence for defining high-risk groups of fracture among PPI users. Methods: A case-control study was performed using the National Health Insurance Sample Cohort Database from January 2002 to December 2013. The cases included all incidences of major fractures identified from January 2011 to December 2013, and up to four controls were matched to each case by age, gender, osteoporosis, and Charlson comorbidity index. Conditional logistic regression was used to calculate the adjusted odds ratio (aOR) and associated 95% confidence interval (CI). Results: Overall, 14,295 cases were identified, and 63,435 controls were matched to the cases. The aOR of fractures related to the use of PPIs was 1.06 (95% CI: 1.01-1.11). There was a statistically significant association between fracture and PPI use within 3 months of the last dose, and a trend of increasing fracture risk with increasing cumulative PPI dose. The risk of fracture was significantly higher in patients who took PPIs for more than 1 year during the 2-year observation period. Conclusion: Patients who have been using PPIs for more than 1 year should be warned about the risk of fracture during or at least 3 months after discontinuing the PPI.

• Korean Journal of Clinical Pharmacy
• /
• v.31 no.1
• /
• pp.27-34
• /
• 2021

Objective: To analyze osteoporosis treatment patterns and teriparatide prescription-associated factors in Korea by using a national health insurance claims database. Methods: We utilized the Health Insurance Review & Assessment Service National Patients Sample claims database to identify patients (aged ≥50 years) with at least one osteoporosis claim (International Classification of Disease 10th revision code: M80, M81, M82) and at least one prescription for osteoporosis medication (antiresorptive agents: bisphosphonates, selective estrogen receptor modulators, denosumab, and calcitonin; bone-forming agent: teriparatide) in 2018. Demographic characteristics and healthcare utilization patterns were analyzed. Factors associated with teriparatide prescriptions were assessed using a multivariate logistic regression model. Results: Records showed that 44,815 patients were prescribed osteoporosis medications in 2018; the percentage of patients prescribed each treatment was as follows: 86.6% bisphosphonates, 13.9% selective estrogen receptor modulators, 3.1% calcitonin, 2.1% denosumab, and 0.7% teriparatide. A greater proportion of patients prescribed teriparatide were ≥75 years (53.4% vs. 33.8%) and had fractures (63.9% vs. 12.8%) compared to the same for antiresorptives (p<0.001). Patients prescribed teriparatide had higher Charlson comorbidity index values (1.2±1.3 vs. 0.9±1.2) and were more frequently hospitalized (0.8±1.3 vs. 0.1±0.5) than those prescribed antiresorptives (p<0.001). Elderly patients (≥75 years old; adjusted OR=1.66; 95% CI 1.16-2.38) and those with fractures (adjusted OR=6.23; 95% CI 4.76-8.14) were more likely to be prescribed teriparatide than antiresorptives. Conclusion: Patients prescribed teriparatide were older and more likely to have severe osteoporosis than those prescribed antiresorptives.

• Journal of Service Research and Studies
• /
• v.6 no.2
• /
• pp.99-116
• /
• 2016

The purpose of this paper is to see what the problem is and what the direction of the strategy of asset management after this study has analyzed asset management status of domestic life insurance companies according to interest rate trends, analyzing in time series management asset lists, asset distribution state, and securities list of life insurance companies during 2000~2014. It has carried correlation analysis and regression analysis between yield and bond interest KOSPI index. As the study result, life insurance companies have managed assets in stability than profitability. The correlation coefficient between interest rate and performance rates of total asset, management asset and securities is highly plus, correlation of management asset performance rate is higher than that of total asset performance rate, and the correlation of securities performance rate is higher than that of management asset performance rate. The correlation coefficient of KOSPI and performance rate shows minus. The suggestion is that the change of asset management is required as the interest decline rises up a reverse margin risk because of the asset management of stability.

• KDI Journal of Economic Policy
• /
• v.36 no.4
• /
• pp.135-169
• /
• 2014

This study empirically analyzes changes in production patterns of farmers by agricultural disaster insurance. The aim of this project is to achieve stability of farm management by paying insurance in case of a natural disaster. However, it causes farmers to change production patterns in the direction of increasing production, and leads the crop price to drop. This can be explained by producers' risk reduction through the disaster insurance. The empirical analysis is based on IV approach with using two stage least squares method. The first stage estimates by difference-in-differences methodology indicate that the production of insurable crops increases more about 80,000ton on average than that of non-insurable crops. In addition, to solve the endogeneity problem caused by general supply and demand model, I use the first stage estimates and find that the price index of the crops drops about 2.3% according to the production increase by 10,000ton. The credibility of these results is also attained by various robustness checks. These findings suggest that it is necessary for government to analyze the whole economy which consists of producer and consumer welfare when it determines the policy. Besides, it implies that it is essential to develop a new market to cope with the unintended effect.

• Journal of Acupuncture Research
• /
• v.33 no.3
• /
• pp.67-73
• /
• 2016

Objectives : The objective of this study is to discuss problems and potential improvements of national health insurance fees associated with miniscalpel acupuncture according to Korean medical doctors' workload, material cost and degree of risk. Methods : We researched the change of relative value points, national health insurance fees, the acupuncture process, and Korean medicine doctors' workload related to Miniscalpel acupuncture, as compared to general meridian point acupuncture. We also examined material cost by surveying pharmacies, internet shopping malls and medical appliance shops. Results : Relative value point for Miniscalpel acupuncture decreased from 2010 to 2012, and remained the same from 2012 to 2016. National health insurance fees for Miniscalpel acupuncture increased by a small margin annually for rise of equivalent index. There was no reporting on workload related to Miniscalpel acupuncture. Material cost of Miniscalpel acupuncture was 18.2~20.7 times higher than actual cost of procedure. There were few studies examining medical accidents related to Miniscalpel acupuncture, and thus we could not evaluate degree of risk. Conclusion : We suggest revaluating Korean medical doctors' workload related to including Miniscalpel acupuncture, to consider the material costs of Miniscalpel acupuncture, and investigate its degree of risk by researching medical accidents.

• Journal of Obesity & Metabolic Syndrome
• /
• v.26 no.1
• /
• pp.23-27
• /
• 2017

Background: In Korea, the prevalence of obesity has steadily increased, and the socioeconomic burden of obesity has increased along with it. In 2015, the National Health Insurance Service (NHIS) signed a memorandum of understanding with the Korean Society for the Study of Obesity (KSSO), providing limited open access to its databases so that the status of obesity and obesity management could be investigated. Methods: Using NHIS databases, we analyzed nationwide population-based studies for obesity using the definition of obesity (body mass index ${\geq}25kg/m^2$) in subjects over the age of 20. Age and sex standardization were used for all data. Results: The KSSO released the 'Obesity Fact Sheet 2016' using the 2006-2015 NHIS Health Checkup database. The prevalence of obesity steadily increased from 28.7% in 2006 to 32.4% in 2015, and the prevalence of abdominal obesity also steadily increased from 18.4% in 2009 to 20.8% in 2015. The prevalence of class II obesity steadily increased from 2006 to 2015, such that the total prevalence was 4.8% in 2015 (5.6% in men and 4.0% in women). The highest prevalence of obesity was found in Jeju Island, while the lowest prevalence was found in Daegu City. The highest prevalence of abdominal obesity was also found in Jeju Island, while the lowest prevalence was found in Gwangju City. Conclusion: Based on the Obesity Fact Sheet 2016, a strategy for reducing the prevalence of obesity is needed, especially in Korean men.

• Quality Improvement in Health Care
• /
• v.28 no.2
• /
• pp.30-38
• /
• 2022

Purpose: The Health Insurance Review and Assessment Service (HIRA) in South Korea initiated a quality assessment (QA) program for blood transfusion healthcare services in 2020 to ensure patient safety and appropriate blood use. This study examines the quality of blood transfusion services since the first national QA program for blood transfusion services in Korea. Methods: We analyzed HIRA claims and QA investigation data based on inpatient medical records from all tertiary, general, and primary hospitals between October 2020 and March 2021. The target population was patients aged 18 years and older who received either total knee arthroplasty or red blood cell transfusion. The QA indicators for transfusion healthcare service consisted of four quality indicators and four monitoring indicators. Results: We analyzed the results of QA indicators for transfusion service from the medical records of 189,668 patients from 1,171hospitals and expressed indicators as proportions. The average results for evaluation indicators were as follows: transfusion checklist presence, 64.8%; irregular antibody tests, 61.8%; transfusions in which the hemoglobin levels before transfusion met the transfusion guidelines for patients undergoing total knee arthroplasty, 20.6%, and transfusions in patients undergoing total knee arthroplasty, 59.3%. The average results for monitoring indicators were as follows: transfusion management implementation in medical institutions, 56.9%; preoperative anemia management in anemia patients undergoing total knee arthroplasty, 43.9%; one-unit transfusions, 82.5%; and the transfusion index. Conclusion: The quality of blood transfusion healthcare varied and the assessment revealed that there is scope for improvement. Hospitals require more effective blood transfusion management and this can be facilitated by providing feedback on the QA results about blood transfusion healthcare services to medical institutions, and by disclosing the results to the public.

• Korean Journal of Social Welfare Studies
• /
• v.42 no.1
• /
• pp.31-54
• /
• 2011

This study investigates the nature of the welfare state under the Kim Dae Jung and Roh Moo Hyun regime focusing on participatory democracy in the policy decision making procedure for the National Health Insurance. Participatory democracy was introduced not for the qualitative development of Korean democracy but for securing political legitimacy to change the Korean economic structure after the IMF financial crisis. Although participatory democracy played the positive role in winning higher benefit level in National Health Insurance. an index for the development of the welfare state, in 2007 A policy of higher benefit level ended in failure because of the pursuit of the neoliberal ideology, lack of government's responsibility for public finance, and thwarting policy holders' substantial participation in the decision-making process. Like those of past welfare systems, participatory democracy under the Kim Dae Jung and Roh Moo Hyun regime was introduced for securing political legitimacy. But it was managed under restrictions imposed by pro-economic-growth ideology. Nevertheless, the Kim Dae Jung and Roh Moo Hyun governments are different from the former welfare states because of the fact that participatory democracy system is not 'service' system but 'political structure' and the fact that the grant of powers by participatory democracy played positive roles in the development of welfare state through request of higher benefit level policy.

• The Korean Journal of Applied Statistics
• /
• v.29 no.1
• /
• pp.41-59
• /
• 2016

There have been continuous improvements in human life expectancy. Life expectancy is as a key factor in an aging population and can wreak severe damage on the financial integrity of pension providers. Hence, the projection of the accurate future mortality is a critical point to prevent possible losses to pension providers. However, improvements in future mortality would be overestimated by a typical mortality projection method using the Lee-Carter model since it underestimates the mortality index ${\kappa}_t$. This paper suggests a mortality projection based on the projection of the skewness of the mortality versus the typical mortality projection of the Lee-Carter model based on the projection of the mortality index, ${\kappa}_t$. The paper shows how to indirectly estimate future t trend with the skewness of the mortality and compares the results under each estimation method of the mortality index, ${\kappa}_t$. The analysis of the results shows that mortality projection based on the skewness presents less improved mortality at an elderly ages than the original projection.

• Journal of the Korean Data and Information Science Society
• /
• v.22 no.2
• /
• pp.335-351
• /
• 2011

In order to resolve data scarcity problem related to crisis, Oh and Kim (2007) proposed to use stability oriented approach which focuses a base period of financial market, fits asymptotic stationary autoregressive model to the base period and then compares the fitted model with the current market situation. Based on such approach, they developed financial market instability index. However, since neural network, their major tool, depends on the base period too heavily, their instability index tends to suffer from inaccuracy. In this study, we consider linear asymptotic stationary autoregressive model and neural network to fit the base period and produce two instability indexes independently. Then the two indexes are combined into one integrated instability index via newly proposed combining method. It turns out that the combined instability performs reliably well.