• 보험의학회지
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• 제2권1호
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• pp.245-252
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• 1985

Ultrasonographic examination in the obstetrics not only makes easy of the diagnosis of Hydrocephalus, placenta previa, anencephalus and ectopic pregnancy, etc, but also guaranteed its excellence in the diagnosis of women gynecology disease. Especially in case that it doesn't affect radiation hazard on the embryo, its efficiency keeps increasing and it is spotlighted to many clinic doctors. Even though in general hospital we often observe congenital hydrocephalus in Med. Dept. which entirly undergoes the medical examination to the insured, we don't observe even the women delivered with child and it is very difficult to find a rare congenital hydrocephlus throughout other present insurance companies. We inspected a congenital hydrocephalus, which other medical equipments of present insurance companies have many difficulties in the medical examination, accompanied by meningoencephalocele by ultrasonic diagnosis. We analyzed and compared the data by ultrasonic diagnosis with that of surgical diagnosis and the results are follows; 1) We could correctly describe meningoencephalocele by ultrasonic diagnosis. 2) It was able to be diagnosed in LMP 22 weeks. 3) BPD has about 10 mm higher than normal value in LMP 22 weeks. 4) Dilatation of lateral ventricle was observed in LMP 22 weeks. 5) As paralled with ultrasonic diagnosis in pregnancy medical examination, accepting declines including the risk rate can be restrained.

• 융합보안논문지
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• 제15권6_2호
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• pp.79-87
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• 2015

최근 허위입원을 이용한 보험범죄가 증가하여 사회문제화 되고 있다. 급격하게 증가하고 있는 허위 과다입원을 통한 보험범죄에 민간보험회사가 대응하는 데에는 한계가 있고, 실제 적발하기에 어려움이 있다. 보험범죄의 증가는 보험회사의 경영악화 뿐만 아니라 보험계약자의 손해를 야기하고, 결국 국가 전체적인 피해로 귀결된다. 보험범죄의 위법성을 분명하게 인식시키기 위해서는 현행법에서 보험범죄에 대한 규정을 명시하는 것이 바람직하다. 일반 사기죄의 구성요건과 차별화된 '보험사기죄'를 신설하고, 보험범죄의 행위태양이나 조직적 가담의 정도 등에 따른 차별화가 요구된다. 또한 민사제재의 도입과 조직적 보험범죄에 대한 가중처벌 규정의 신설이 요구된다. 중복보험사실을 생명보험 가입시에 고지하도록 법규의 개정이 요구된다. 그리고 불필요한 장기입원을 제한할 수 있는 입원기준 마련이 필요하다. 아울러 보험회사 조사요원에게도 조사권을 부여하는 방안으로 민간조사원 제도의 도입이 필요하다. 또한 보험회사와 수사기관 등 유관기관 사이의 정보공유관련법을 마련하고 보험범죄 적발이 가능한 정보 데이터베이스를 구축하며, 보험범죄인지시스템에 SNA기법을 도입하여 조직적 공모사기를 찾아낼 수 있도록 해야 할 것이다.

• 한국전자거래학회지
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• 제19권3호
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• pp.1-21
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• 2014

개인정보는 금융거래의 성립조건이며 금융회사의 핵심자산이다. 그러나 정보사회의 부작용으로써 나타난 개인정보 침해사고는 중대한 사회적 위험이 되고 있으며, 이러한 위험은 개인과 회사의 실제적 피해로써 현실화되고 있다. 본 연구는 소비자의 손실 측면에서 개인정보 침해 사고로 인해 금융 분야에서 발생한 금전적, 정신적 손해 현황을 분석하고, 이러한 실제 손해를 최소화하기 위한 위험전가의 수단으로써 보험의 유용성을 제시하였다. 그리고 개인 정보 침해 사고 보상보험의 구성요소와 보험료의 산정원리를 검토하고 최종적으로 이러한 보험 제도를 활성화하기 위한 정책을 제안하였다. 위험관리의 한 방법으로써 보험은 소비자 보호와 회사의 재무적 건전성을 동시에 확보할 수 있는 유용한 수단이며, IT 리스크의 계량적 측정을 위한 기반을 제공할 수 있다.

• 아태비즈니스연구
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• 제3권1호
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• pp.39-47
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• 2012

Organizations pursue a CRM strategy for the purpose of increasing business performance and value. However, firms face a multitude of organizational challenges associated with this endeavor. To reduce their risk of failure, it is suggested that firms undertake a deep analysis of organizational readiness prior to committing to a CRM initiative. Insurance sector is no exception to this fact. There is an increased need to concentrate on the various challenges thrown open by the public insurance firms in implementing CRM. Many insurance firms have invested into customer driven CRM but research indicates varying outcomes (Schmith 2004). While it is clear that there are significant issues involved in the CRM implementation and success and environment faced by the public sector. It is clear that business should have an easier time in applying CRM systems is the strategic value for public sector. With customers demanding more service and accessibility from administrators, public sector CRM software technologies have to offer best solutions for achieving process and cost objectives (Souder 2001). With results which go far beyond improved service delivery and include sustained cost reductions, increased customer knowledge and better employee morale, CRM software implementation and post product environments offer great upside value. Although there are material differences in public sector use of CRM strategy, they share at least one glaring similarity - they have much to gain from proven CRM software technology. As business methods cross over in the public sector, many government bodies are investigating how they can adopt and adapt various CRM models (Bleyer 2003). There is a need to understand the similarities and differences in public sector CRM to foster shared knowledge, business processes and planning functions to integrate disparate technologies and software platforms and then, of course, the organizational culture to support knowledge sharing (Peters 1997). For the public sector, there are clearly identified CRM processes which have resulted in increased profits and improved efficiency. These have focused on sales, marketing and customer service activities, which often operate along fundamentally different lines in various public sector insurance companies. Thus the present research paper makes an attempt to explore how public sector CRM methods can be adopted and subsequently adapted.

• 한국지능정보시스템학회:학술대회논문집
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• 한국지능정보시스템학회 2000년도 춘계정기학술대회 e-Business를 위한 지능형 정보기술 / 한국지능정보시스템학회
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• pp.365-373
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• 2000

Data Envelopment Analysis (DEA), a non-parametric productivity analysis tool, has become an accepted approach for assessing efficiency in a wide range of fields. Despite of its extensive applications and merits, some features of DEA remain bothersome. DEA offers no guideline about to which direction relatively inefficient DMUs improve since a reference set of an inefficient DMU, several efficient DMUs, hardly provides a stepwise path for improving the efficiency of the inefficient DMU.In this paper, we aim to show that DEA can be used to evaluate the efficiency of life insurance companies while overcoming its limitation with the aids of machine learning methods.

• 한국정보시스템학회지:정보시스템연구
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• 제22권1호
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• pp.181-200
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• 2013

Electronic channel of automobile insurance has emerged as an attractive way of lowering costs and saving time to do the transaction for customers. Electronic channel refers to using web sites to find useful information on insurance products, buy automobile insurance, and ask for services related to the insurance. This study suggests a modified model of the UTAUT and examines the factors influencing intention to use electronic channel in the transaction of automobile insurance. Based on 203 responses from potential automobile insurance buyers, the results showed that performance expectancy, effort expectancy, social influence, service expectancy, and security risk are significantly related to intention to use electronic channel. The results also showed that age as a moderator influences the effects of performance expectancy and effort expectancy on intention to use electronic channel. The study results would improve the understanding of the factors to which managers of insurance companies should pay attention in order to increase their sales through electronic channel.

• 한국컴퓨터정보학회논문지
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• 제24권1호
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• pp.207-215
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• 2019

The insurance system is indispensable to our society. However in recent years, there have been a lot of insurance fraud crimes, such as the abuse of these valuable insurance system and the cheating the insurance proceeds. These insurance frauds make the insurance companies harder to manage, and as a result, the insurance premiums have risen, which has caused a lot of damaging good policyholders. However, the damage caused by insurance fraud has been continuously increasing due to the punishment of cotton stick. Therefore, after the long discussion, the 'The Act for Prevention of Insurance Fraud', which is a special law recently has been enacted. However, within two years of the enactment of this law, which was enacted after much anticipation and long waiting, there is already debate about its effectiveness. The reason for this is that even though the law was enacted and enforced, insurance fraud continues to increase and even punishment for these crimes is not strengthened, and now it is time to look for specific problems and resolutions for these crimes see. So in this paper the author dealt with the problems of the law, first, related regulation of insurance payment, second, right to terminate insurance contract and return of insurance proceeds, third, regulation on notification of investigations, fourth, regulations on the adequacy of hospitalization. Of course, since this law has just been enacted, there are many other problems besides these problems, but I tried to present a fresh resolution based on the problems that have been mainly discussed since the legislative period.

• East Asian mathematical journal
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• 제38권5호
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• pp.617-641
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• 2022

In this study, we first present a brief overview of the Korean general insurance market. We then explore the characteristics of the loss ratios of the Korean general insurance industry and apply Markov regime-switching methodology to model the loss ratios of these insurance companies by line of business based on changes in economic regimes. This study applies a number of confirmatory tests such as Zivot-Andrews test (2002), the Chow (1960) test and the Bai and Perron (1998) to confirm the presence of structural breaks in the time series of the loss ratios by line of business. Then, we employ Markov regime-switching methodology to model these loss ratios. We find empirical evidence that the loss ratios reported by insurance companies in Korea is characterized by two distinct regimes; a regime with high volatility and a regime with low volatility, except for vehicle insurance. Our analyses suggest that macro-economic conditions have significant explanatory effect on loss ratios but the direction of effect differs based on the line of business and the regime. Unlike previous studies that have applied linear regressions or divided the samples into different periods and then apply linear regressions to model loss ratios, we argue for the application of Markov regime-switching methodology, which are able to automatically distinguish the different regimes that may be associated with the movements of loss ratios based on differing economic conditions and regulatory upheavals. This study provides a more in depth understanding of loss ratios in the general insurance industry and will be of value to insurance practitioners in modelling the loss ratios associated with their businesses to aid in their decision making. The results may also provide a basis for further studies in other markets apart from Korea as well as for shaping policy decisions related to loss ratios.

• 시큐리티연구
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• 제32호
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• pp.151-176
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• 2012

현재 보험범죄는 해마다 증가하고 있으나 정부차원에서 보험범죄를 적발하거나 방지하기 위한 전문조직은 미비한 실정이다. 이러한 보험범죄로 인한 피해는 인명과 국민경제 측면에서 매우 심각한 실정이다. 보험범죄는 보험회사의 경영수지를 악화시키는 것은 물론이고, 보험금의 부정유출로 인해 보험사의 손해율을 악화시킴으로써 보험사 부실의 원인이 될 수 있다. 이는 결국 보험사의 보험료 인상으로 이어져 결국, 보험가입자의 보험료 인상이라는 문제를 야기시킨다. 이러한 이유로 1996년부터 보험회사들은 보상조직 내에 보험사기를 전문적으로 조사하기 위한 보험범죄특별조사팀(Special Investigation Unit, SIU)을 구성하기 시작하였다. 하지만 현재의 SIU는 보험범죄의 예방을 위한 다양한 업무를 효율적으로 수행하기에는 아직 그 인력과 재원이 부족한 수준이다. 따라서 본 연구는 갈수록 심각한 사회문제로 주목받고 있는 보험범죄를 실제 현장에서 담당하고 있는 SIU 구성원을 대상으로 현재의 근무환경과 보험범죄에 대한 일반적 인식이 그들의 직무만족에 미치는 영향에 대하여 알아보았다. 본 연구는 이러한 현장조사 분석을 바탕으로 현재 SIU 구성원들의 보험범죄 인식 및 근무 환경을 분석하고, 직무만족 향상을 통하여 구축할 수 있는 효과적인 보험범죄 대응 방안을 마련하는 데에 목적이 있다.

• 대한치과의사협회지
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• 제48권6호
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• pp.459-468
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• 2010

International Classification of Disease (ICD-10) is widely used as a crucial reference not only in the medical diagnosis of diseases but also within the health insurance system. It makes possible for medical personnel to make decisions systematically and for the people working in the health insurance or public health industries to better understand medical issues. However, this classification is often not enough or acceptable in a clinical setting. Many countries amend in their own way to make it more appropriate for their people. Korean Classification of Disease (KCD-5) was made by adding a 5 digit code for some diseases to clarify the conditions of the patients. The authors found problems of KCD-5 in temporomandibular disorders and several related medical problems. Medical treatment for these problems had not been covered even by public health insurance until 2000 in Korea. For the last decade, private insurance companies have introduced new items for reimbursement of the treatment fees the patients actually pay. The authors assumed that many patients with these medical problems encountered difficulties in the reimbursement from private insurance companies because KCD-5 did not classify these medical conditions appropriately. An overview of KCD-5 and suggestions for improvement are introduced in this study.