• Journal of Society of Preventive Korean Medicine
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• v.12 no.3
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• pp.21-34
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• 2008

Objectives : This paper analysed the alternative methods of calculating conversion factor for oriental medicine in the National Health Insurance and estimated the conversion factor(reimbursing price level) of the oriental medical services, based on health insurance claims data and macro economic data. Methods : Comparing cost accounting method, SGR model, and index model to estimate conversion factor in the national health insurance, six empirical models were derived depending on the scope of revenue considered in financial indicators. Classifications of data and sources used in the analysis were identified as officially released by the government. Results and Conclusion : Cost accounting analysis and SGR model showed a two digit decrease in the physician fee schedule of oriental medical services in the national health insurance, while index model indicated a positive increase in the fee reimbursed. As expected, SGR model measured an overall trend of health expenditures rather than an individual financial status of medical institutions, and index model properly estimated the level of payments to oriental medical doctors. Upon a declining share of health expenditures on oriental medicine, a global budget system fixed to a flat rate of total budget could be an opportunity as well as a challenge.

• Communications for Statistical Applications and Methods
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• v.28 no.5
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• pp.447-462
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• 2021

In insurance, the surrender rate is an important variable that threatens the sustainability of insurers and determines the profitability of the contract. Unlike other actuarial assumptions that determine the cash flow of an insurance contract, however, it is characterized by endogenous variables such as people's economic, social, and subjective decisions. Therefore, a microscopic approach is required to identify and analyze the factors that determine the lapse rate. Specifically, micro-level characteristics including the individual, demographic, microeconomic, and household characteristics of policyholders are necessary for the analysis. In this study, we select panel survey data of Korean Retirement Income Study (KReIS) with many diverse dimensions to determine which variables have a decisive effect on the lapse and apply the lasso regularized regression model to analyze it empirically. As the data contain many missing values, they are imputed using the random forest method. Among the household variables, we find that the non-existence of old dependents, the existence of young dependents, and employed family members increase the surrender rate. Among the individual variables, divorce, non-urban residential areas, apartment type of housing, non-ownership of homes, and bad relationship with siblings increase the lapse rate. Finally, among the financial variables, low income, low expenditure, the existence of children that incur child care expenditure, not expecting to bequest from spouse, not holding public health insurance, and expecting to benefit from a retirement pension increase the lapse rate. Some of these findings are consistent with those in the literature.

• Journal of Periodontal and Implant Science
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• v.49 no.4
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• pp.248-257
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• 2019

Purpose: The purpose of this retrospective study was to investigate the relationships of types of dental insurance coverage in Korea with sociodemographic characteristics and the prevalence of systemic and oral diseases, as well as to evaluate the socioeconomic impact of Korean dental insurance policies. Methods: Sample cohort data from 2006 to 2015 were obtained from the National Health Insurance Service. Patients were divided into 2 groups. The exposed group comprised patients who received insurance benefits for complete dentures, removable partial dentures, and implant care, while the control group comprised patients who did not receive these benefits. The type of insurance coverage and the prevalence of systemic and oral diseases were compared between the 2 groups. Results: Patients who received benefits in the form of complete dentures, removable partial dentures, and implants had similar sociodemographic characteristics in terms of sex, age, income quintile, and type of insurance coverage to the control group. The prevalence of hypertension, anemia, renal disease, rheumatoid arthritis, osteoporosis, asthma, and cerebral infarction was higher in the exposed group than in the control group (P<0.05). The prevalence of periodontal diseases and dental caries was also higher in the exposed group. Conclusions: Korean dental health insurance policy has been beneficial for the medical expenses of low-income and elderly people suffering from a cost burden due to systemic diseases. However, since there is a tendency to avoid invasive interventions in older patients due to the high risk of systemic diseases, insurance coverage of dentures may be more helpful from a socioeconomic perspective than coverage of dental implant treatments.

• Health Policy and Management
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• v.4 no.1
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• pp.77-106
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• 1994

This study attempts to evaluate the beneficial equity and operational efficiency of the three Korean medical insurance programmes and thereby suggest directions for their policy improvement. Concepts of the equity and effciency were reviewed to develop indicators for comparative analysis. For the analysis, statistical and financial accounting data for 1991, issued by the National Federation of Medical Insurance and the Korea Medical Insurance Corporation, on the operational status and performances of the programmes, were collected and rearranged to be suited to the purpose of the study. The analysis reveals that beneficial inequity exists between self-employed and employee programs. and that operational inefficiency is prominent in both programms for self-employeds and for Government employees and private school teachers. In order to improve the beneficial inequity of the self-employed program, it is suggested that policies be formulated and implimented toward increasing the program revenue through increasing subsidies from the Government, and through inter- program finance adiustment. For the operational inefficiency of the two programs, it is judged that, toghether with the administrative support and control from the Government and the insurance society bodies, self- efforts be initiated to improve the internal mangement styles and systems of the insurance societies. Finally, from the viewpoint of the structural efficiency, expansion of the preventive insurance benefits by the insurance soceties is recommended both for beneficial equity and operational efficiency.

• Journal of Service Research and Studies
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• v.9 no.3
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• pp.39-60
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• 2019

The purpose of this study is to analyze the determinants of insurance product cross selling performance. For the study, 11 insurance managers and 2 sales managers belonging to A insurance agency were selected and in-depth interviews were conducted. The analysis of the research data was done by the open coding method suggested by Strauss & Corbin(2001). As a result, 84 concepts, 28 subcategories and 10 categories were derived. The ten categories that were determinants of insurance product cross-selling performance were personal characteristics, consultation method, cross-selling ratio, sales culture, education, customer change, customer DB provision, satisfaction, business support system, and customer service. In order to verify the qualitative results, quantitative analysis was emplyed to the actual performance data of insurance planners belonging to A insurance agency during April 2016~March 2019. As a result of the analysis, the age, position, and the number of months worked in the insurance company had a statistically significant effect on the number of life insurance contracts in total insurance contracts and life insurance contracts in total insurance contracts. In addition, the age, position, and the number of months worked in the insurance company had a statistically significant negative impact on the number of non-life insurance contracts in the total number of insurance contracts and the total amount of insurance contracts in total insurance contracts. The result of this study can be an important basic data for the development of educational programs and job support systems for the training of insurance planners. Insurance companies should refer to ten categories derived from qualitative research in order to increase the performance of insurance planners and to promote long-term service. Especially, it is necessary to develop specialized education programs and job support systems so that cross sales that increase the proportion of life insurance sales increase.

• Journal of the Korean Data and Information Science Society
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• v.19 no.4
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• pp.1007-1018
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• 2008

The purpose of this case study is to demonstrate database-marketing management. First, we explore original variables for insurance customer's data, modify them if necessary, and go through variable selection process before analysis. Then, we develop churn prediction models using logistic regression, neural network and SVM analysis. We also compare these three data mining models in terms of misclassification rate.

• Health Policy and Management
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• v.23 no.4
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• pp.387-396
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• 2013

Background: The purpose of this study was to analyze the association between areas of Korea Train Express (KTX) region and external medical service use in Korean society using spatial statistical model. Methods: The data which was used in this study was extracted from 2011 regional health care utilization statistics and health insurance key statistics from National Health Insurance Corporation. A total spatial units of 229 districts (si-gun-gu) were included in this study and spatial area was all parts of the country excepted Jeju, Ulleungdo island. We conducted Kruskal-Wallis test, correlation, Moran's I and hot-spot analysis. And after, ordinary linear regression, spatial lag, spatial error analysis was performed in order to find factors which were associated with external medical service use. The data was processed by SAS ver. 9.1 and Geoda095i (windows). Results: Moran's I of health insurance patients' external medical service use was 0.644. Also, population density, Seoul region, doctor factors positively associated with health insurance patients' external medical service. In contrast, average age, health care organization per 100 thousand were negatively associated with health insurance patients' external medical service use. Conclusion: The finding of this study suggested that health insurance patient's external medical service use correlated for seoul region in korea. The study results imply the need for more attention medical needs in the region (si-gun-gu unit) for health insurance patients of seoul region. It is important to adapt strategy to activation of primary health care as well as enhancing public health institution for prevent leakage of patients to other areas.

• Journal of Korean Medical Science
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• v.33 no.44
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• pp.276.1-276.10
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• 2018

Background: The National Health Insurance Service (NHIS) established a healthcare claim database for all Korean citizens. This study aimed to analyze the NHIS data and investigate the patterns of breast cancer treatments. Methods: We constructed a retrospective female breast cancer cohort by analyzing annual incident cases. The annual number of newly diagnosed female breast cancer was compared between the NHIS data and Korea National Cancer Incidence Database (KNCIDB). The annual treatment patterns including surgery, chemotherapy, radiation therapy, endocrine therapy and targeted therapy were analyzed. Results: A total of 148,322 women with newly diagnosed invasive breast cancer during 2006-2014 was identified. The numbers of newly diagnosed invasive breast cancer cases were similar between the NHIS data and KNCIDB, which demonstrated a strong correlation (r = 0.995; P < 0.001). The age distribution of the breast cancer cases in the NHIS data and KNCIDB also showed a strong correlation (r = 1.000; P < 0.001). About 85% of newly diagnosed breast cancer patients underwent operations. Although the proportions of chemotherapy use have not changed during 2006-2014, the total number of chemotherapy prescriptions sharply increased during this period. The proportions of radiotherapy and anti-hormonal therapy increased. Among the anti-hormonal agents, tamoxifen was the most frequently prescribed medication, and letrozole was the most preferred endocrine treatment in patients aged ${\geq}50$ years. Conclusion: Along with the increased breast cancer incidence in Korea, the frequencies of breast cancer treatments have increased. The NHIS data can be a feasible data source for future research.

• Korea Journal of Hospital Management
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• v.19 no.3
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• pp.1-10
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• 2014

The purpose of this study was to present base data for an efficient management of medical expenses at the hospital management by doing grasp of status of medical expenses from seamen's insurance by voluntary agreements. A Object of study is analyzing the data of medical expenses occurred from the total number of 2,699(inpatients 507, outpatients 2,192)cases who were covered by seamen's insurance at a general hospital which is located in Pusan Metropolitan City during 48 months from January 1, 2009 to Dec 31, 2012. The main results of this study are as follows: accrual medical expenses are the ship management companies member of P&I insurance is the most highest but share of receivables are the Korean ocean-going companies member of P&I insurance is the most highest, therefore, Korean ocean-going companies focus strictly than the payments from accounts receivable management should be considered to reduce the occurrence and concerning the turn around period of medical receivables are 4 months to 6 months during a research period. Therefore, it will be needed for managers of hospitals to prepare differentiated management based on the characteristics of each in insurer and to have recovery strategies of uncollected medical expenses.

• The Journal of Asian Finance, Economics and Business
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• v.7 no.6
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• pp.297-304
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• 2020

This paper applies the Data Envelopment Analysis (DEA) to compute the managerial efficiency of 30 insurance companies listed on the Saudi stock exchange for the duration of four years from 2015 to 2018. The companies taken as a sample of study included both conventional and Takaful insurance companies. The insurance sector of KSA is one of the largest sectors in the country, contributing a substantial percentage in the non-oil economy. Efficiency measurement and evaluation will provide a venue to introspect and benchmark frontiers to the sector. In the present study, we have utilized the basic Banker Charnes Cooper and Charnes Copper Rhodes models of DEA. Two inputs, namely, general & administrative expenses and policy & acquisition costs, and two outputs (Net premium earned and Investment Income & other incomes) were taken for efficiency calculations. The final outcomes of the study reveal that a good number of insurance companies operating in KSA are found to be efficient on managerial efficiency scale. Three firms remain the leader on the frontier of the managerial efficiency. And no company found with zero (0) efficiency or a negative efficiency. It is expected that the outcome of the study will provide benchmarks to managers and a road map to further improvement.