• Title/Summary/Keyword: Insurance medicine

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A Case of Benign Metastasizing Pulmonary Leiomyoma (양성 전이성 폐 평활근종 1예)

  • Kang, Shin Ae;Choi, Sang In;Kim, Yeon-A;Kim, Chong Ju;Yang, Dong Gyoo;Kang, Jeong Han;Kie, Jeong Hae;Hong, Yong Kook;Lee, Sun-Min
    • Tuberculosis and Respiratory Diseases
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    • v.58 no.6
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    • pp.614-618
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    • 2005
  • A benign metastasizing pulmonary leiomyoma (BMPL) is a rare disease that usually occurs in women with a prior or coincident history of uterine leiomyoma. Although leiomyoma is histologically benign, it has the potential to metastasize to a distant site such as the lung. A 35 year old woman who had undergone a hysterectomy due to uterine leiomyoma 5 years prior was admitted for an investigation of multiple pulmonary nodules on a routine chest roentgenogram. An open lung biopsy was taken to make a pathological diagnosis. The microscopic finding of the nodules was leiomyoma and was similar to those of the uterine leiomyoma that had been resected 5 years ago. The woman underwent wedge resections of all pulmonary nodules. This is the first case of BMPL in Korea, which was treated with wedge resections of all multiple pulmonary nodules.

Survey on the Preference Formula for the Improvement of Oriental Herbal Medicine Insurance (한약건강보험에 대한 일반인의 한약제형 선호도 조사)

  • Kim, Yong-Ho;Kim, Se-Hyun;Chang, Hye-Jung;Park, Jae-Kyung;Jeong, Mi-Young;Park, Yoo-Seon
    • The Korea Journal of Herbology
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    • v.24 no.4
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    • pp.17-23
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    • 2009
  • Objectives : This study aimed to provide basic data for future policies regarding the expansion of health insurance, through investigating the current status of Oriental herbal medicine insurance as perceived by the public. Methods : Questionnaire was developed through literature searches, in-depth interviews, item generation and item reduction. The questionnaires were further refined by a focus group. 221 surveys were retrieved from the general public. Results : The in-depth interviews, reveal that the public is aware of the various forms of Oriental herbal medicine formulas, except for the use of mixture of which are soluble granules covered by insurance. The public awareness of the soluble granules turned out to be so low that enhanced awareness of it is required. The public identified decoctions as the most preferred formula as well as the most effective formulas out of all Oriental herbal medical formulas. They also suggested that it should be the first to be included when the insurance policy expands in the future. The public had frequent experienced not choosing Oriental herbal prescription due to the high cost. Insurance coverage of Oriental herbal prescription is much needed. The public indicated that they will make frequent visits to the KMD if the insurance covers Oriental herbal prescriptions. Conclusions : The current status quo of Oriental herbal medicine insurance showed that the public identified decoctions as the most preferred, most effective and the top priority to be covered by insurance.

A Comparative Analysis of the Systems Related to the Production, Authorization, and Listing for Insurance of Herbal Medicine Products in South Korea and Taiwan (국내와 대만의 전통약제제 생산.허가.보험등재 관련 제도)

  • Son, Chi-Hyoung;Lim, Sabina;Lee, Eun-Kyoung;Kim, Dong-Su;Kim, Yun-Gi;Cheng, Huan-Chiang;Kim, Yong-Ho
    • The Journal of Korean Medicine
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    • v.33 no.3
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    • pp.147-159
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    • 2012
  • Objectives: Systems related to the production, authorization, and listing for insurance of herbal medicine products were compared between South Korea and Taiwan to illuminate herbal medicine products system issues in South Korea. Methods: Papers, and laws and policies related to the production, authorization, and listing for insurance of herbal medicine products in South Korea and Taiwan are analyzed to create the primary documents. The documents from South Korea were screened with the advice of a specialist, while those from Taiwan have been verified through local investigation and with the help of a related specialist. The screened documents were then compared and analyzed in the order of the systems related to the production, authorization, and listing for insurance of herbal medicine products. Results: The systems related to the production of herbal medicine products satisfy GMP requirements in both countries, while Taiwan has more specialized systems related to the production of herbal medicine products and a more strict authorization program as compared to South Korea. While South Korea has most of the herbal medicine products classified as non-prescription drugs, Taiwan has them as prescription drugs. And while South Korea does not allow new herbal medicine products to be listed for insurance, Taiwan allows for once-a-year application toward listing for insurance. Conclusions: In order to ensure the safe and effective use of herbal medicine products, systems related to the production, authorization, and listing for insurance of herbal medicine products are to be established, while the categorization of medicine products principally used by Korean medicine doctors should be prepared. Furthermore, prescription by a Korean medicine doctor for new drugs made with natural products and their listing for insurance need to be encouraged.

Single-Center Retrospective Study on the Status of Korean Medicine Automobile Insurance Treatment and Usage of Main Pharmacopuncture (단일 한의원 교통사고 환자 258례에 대한 한방치료 효과 후향적 연구)

  • Hwang, Ji Hye;Jung, Chul
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.33 no.3
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    • pp.181-190
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    • 2019
  • In South Korea, traffic accident patients can be treated under automobile insurance coverage. This study investigated the status of Korean medicine (KM) Automobile insurance system and usage status of main pharmacopuncture in KM clinic which reported that the largest number of automobile insurance fee claims among medical institutions. We surveyed 258 traffic accident patients who were treated at Namsangcheon KM clinic from 2014 to 2018 according to medical chart. The majority of the patients were male and thirties. In traffic accident situation, the highest distribution was car to car crash with 85.66% and 66.67% of the patients visited in the most acute phase. The most frequent treatment period was within 4 weeks and the number of treatments was 10 or less with 72.87%. In total results of treatment, the distribution was exellent with 10.08%, good with 46.90%, fair with 27.13% and poor with 15.89%, and the effective rate was 84.11%. The most frequent treatment period was within 4 weeks with 64.73% and the number of treatments was 10 or less with 72.87%. Of the 242 patients who received pharmacopunture, 91.5% were treated with HO, which was named after Honghwaja and TA, which was named after traffic accidents, and there were significant differences in the number of treatments and symptom improvement between the two groups. In this study, we confirmed the status of automobile insurance treatment and usage of main pharmacopuncture of single KM clinic with symptom improvement. This study can be regarded as one of the basis of KM treatment for the rapidly growing automobile insurance market.

Role of the medical claims review (의적클레임검토의 역할 및 기능)

  • Lee, Sin-Hyung
    • The Journal of the Korean life insurance medical association
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    • v.26
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    • pp.31-39
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    • 2007
  • Background and main issue: In the Korean insurance market, an outstanding issue is the decrease of margin of risk ratio. This affects the solvency and profitability of insurance companies. Insurance medicine, which has been developed in Western countries, is so-called medical risk selection or medical underwriting. Medical risk selection is based on clinical follow-up study and mortality analysis methodology. Unfortunately, there have been few clinical follow-up studies, and no intercompany disease analysis system is available in the Korean insurance market. In practice, we use underwriting guidelines, which were developed by some global reinsurance companies. However, these guidelines were developed under clinical follow-up studies performed abroad. So, we cannot rule out underestimation of excess mortality factors such as mortality ratio, excess death rate, and life expectancy. It is necessary to perform medical assessment in claims administration. Comparing the insured's statement by medical records with products' benefit according to this procedure, we can make sound claim decisions and participate in the role of sound underwriting. We can call this scientific procedure as the verification of medical claims review. Another area of medical claims review is medical counsel for claims staff. Result: There is another insurance medicine in addition to medical risk selection. Independent medical assessment by medical records of insured is medical claims review. Medical claims review is composed of verification and counsel.

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Overview of Exercise electrocardiogram in terms of insurance medicine (운동부하 검사의 보험의학적 이해와 의의)

  • Hyun, Hyeyun
    • The Journal of the Korean life insurance medical association
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    • v.32 no.1
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    • pp.15-20
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    • 2013
  • The exercise ECG test is a well-established, inexpensive, and non-invasive procedure for answering important clinical questions related to heart problems. The heart disease is directly led to mortality and serious issue to insurance medicine. Here is some evidence for interpretation of exercise ECG test results can determine prognosis of the heart disease.

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Trend analysis of financial balance of Korean medicine clinics during 20years(1987~2007) (20년간(1987년~2007년) 한의원 경영수지의 경향 연구)

  • Kim, Dae-Hun;Lim, Byung-Mook
    • Journal of Society of Preventive Korean Medicine
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    • v.16 no.2
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    • pp.41-52
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    • 2012
  • Objectives : This study aimed to analyze the trend of financial balance of Korean medicine clinics during 20 years, and to provide basic information for adjusting the fee schedule of Korean medicine procedures in national health insurance(NHI). Methods : We collected 6 financial analysis reports for Korean medicine clinics from the Association of Korean Oriental Medicine(AKOM). The data on incomes, costs and EBIT(earning before interests and taxes) of subject clinics were abstracted, and their long-term trends were evaluated. Results : The proportion of insurance income in total income increased from 23% to 56% during 20 years. Among 5 treatment groups, 'non-insurance medication' took up 65~67% of total incomes in 1997, but its proportion decreased to 42.4% in 2007. 'medical procedure, physical therapy and others' increased from 12.4% in 1987 to 29.2% in 2007. The labor cost was major part of total cost and its proportion maintained from 52% to 54%. Cost of 'non-insurance medication' was on the decline from 41% in 1996 to 31.6% in 2007. EBIT were -17.4 million won in 1996, and 18.4 million won in 2007. Conclusions : Financial balance of Korean medicine clinics improved until early 2000, but it became worse in 2007. Though deficits from NHI procedures has been covered up by profit from 'non-insurance medication', health insurance became a major source of income during last two decades.