• 한국보건간호학회지
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• 제2권2호
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• pp.21-44
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• 1988

In Korea, fee-for service reimbursement has been adopted from the begining of medical insurance system in 1977, and the importance of the relative value unit is currently being investigated. The purpose of this study was to find out the level of propriety of the difference in the fees for different surgical services, and the appropriateness of the classification of the insurance fee schedule. For the purpose of this study, specific subjects and the procedural methodology is shown as follows: 1. The propriety of the Relative Price System(RPS). 1) Choice of sample operations. In this study, sample operations were selected and classified by specialists in general surgery, and the number of items they classified were 32. For the same group of operations the Insurance Fee Schedule(IFS) classified the operations into 24 separate items. In order to investigate the propriety of the RPS, one of the purpose of this study, was to examine the 24 items classified by the IFS. 2) Evaluation of the complexity of surgery. The data used in this study was collected The data used in this study was collected from 94 specialists in general surgery by mail survey from November I to 15, 1986. Several independent variables (age, location, number of bed, university hospital, whether the medical institution adopt residents or not) were also investigated for analysis of the characteristics of surgical complexity. 3) Complexity and time calculations. Time data was collected from the records of the Seoul National University' Hospital, and the cost per operation was calculated through cost finding methods. 4) Analysis of the propriety of the Relative Price System of the Insurance Fee Schedule. The Relative Price System of the sample operation was regressed on the cost, time, comlexity relative ,value system (RVS) separately. The coefficient of determination indicates the degree of variation in the RPS of the Insurance Fee Schedule explained by the cost, time, complexity RVS separately. 2. The appropriateness of the classification of the Insurance Fee Schedule. 1) Choice of sample operations. The items which differed between the classification of the specialist and the classification of medical, Insurance Fee Schedule were chosen. 2) Comparisons of cost, time and complexity between the items were done to evaluate which classification was more appropriate. The findings of the study can be summarized as follows: 1. The coefficient of determination of the regression of the RPS on-cost RVS was 0.58, on time RVS was 0.65, and on complexity RVS was 0.72. This means that the RPS of Insurance Fee Schedule is improper with respect to the cost, time, complexity separately. Thus this indicates that RPS must be re-shaped according to the standard element. In this study, the correlation coefficients of cost, time, complexity Relative Value System were very high, and this suggests that RPS could be reshaped I according to anyone standard element. Considering of measurement, time was thought to be the most I appropriate. 2. The classifications of specialist and of the Insurance Fee Schedule were compared with respect to cost, time, and complexity separately. For complexity, ANOVA was done and the others were compared to the different values of different classifications. The result was that the classification of specialist was more reasonable and that the classification of Insurance Fee Schedule grouped inappropriately several into one price unit.

• 한국전문물리치료학회지
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• 제29권2호
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• pp.94-105
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• 2022

Background: As South Korea enters an aged society, the government has emphasized the need for a soft landing of the older adults into the community after the acute and recovery periods under a national policy of "community care." However, the institutionalization of community rehabilitation services to implement this is insufficient. Japan had already entered an aged society when the Long-Term Care Insurance System was introduced in 2000. Thus, the case of Japan's institutionalization of the system is expected to have implications for us in supplementing a suitable system for the aged society. Objects: This study compared the institutionalization process of the Long-Term Care Insurance System in South Korea and Japan and the services currently being implemented in each country. Methods: To examine the institutionalization process and services of the system, related legal rules and regulations, government reports, and articles were reviewed. To examine the operation status of the system, statistical data provided by each country's government were analyzed. Results: Japan recognized the importance of community rehabilitation even before the enactment of Long-Term Care Insurance. Thus, community rehabilitation services, such as home-visit rehabilitation and health facilities, were already stipulated in the law. Under such institutional legacy, Long-Term Care Insurance was able to establish a service system, which balanced welfare and health-related services, including various types of services with enhanced rehabilitation functions. In South Korea, rehabilitation policies were not much considered in the process of institutionalizing the system; thus, it was composed mainly of services focusing on care and recuperation. Conclusion: In order to realize community care, rehabilitation services need to be developed in Long-Term Care Insurance System in various forms such as home-visit services, daily services, short stay, and facility services.

• 보험의학회지
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• 제30권2호
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• pp.8-11
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• 2011

Insurance medicine has been known to medical risk selection. The role of insurance medicine is sound maintenance of insurance system. So it's function is medical underwriting of life risks. However, emerging market has insufficient medical epidemiological research that is necessary for estimation of extra-risk and such market is usually lack of full understanding of life insurance among insurance customers. This problem makes difficult of performing the medical underwriting, as an original insurance medicine. Medical contributions at the stage of claims adjudication comparing the coverage provided in the product, with the information provided in the claims, based on medical records and the agreement between them. This is called medical verification. The insurance doctors can also use their medical knowledge to help the claims staff with informing claimants about the medical basis of claims decisions.

• 한국전자거래학회지
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• 제12권1호
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• pp.99-122
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• 2007

규칙 기반 시스템은 업무 담당자의 비즈니스 노하우 및 전문 지식에 대한 처리는 물론, 기업의 비즈니스 로직까지 처리하여 새로운 비즈니스 모델 변화와 개선요구에 대해 즉각적으로 대응할 수 있는 규칙 기반 추론 엔진으로, 최근 다양한 산업으로의 적용이 시도되고 있다. 이에 이 논문에서는 규칙 기반 시스템 적용 사례의 일환으로, 다양한 소비자 니즈, 수많은 종류의 상품, 그리고 시시각각 변하는 대내외 환경에 민감하게 영향을 받는 보험 산업에서의 효율적인 보험 상품 추천과 설계를 위한 규칙 기반의 보험 상품 추천 및 설계 시스템을 설계하고 구현하고자 한다. 개발된 시스템은 퍼지추론 과정을 통해 고객의 개인정보와 기존 가입고객의 가입정보를 이용하여 보험상품 설계를 원하는 고객에게 맞춤형 보험상품을 추천하고 설계하고자 한다. 이러한 시도는 향후 보험 산업에 있어서 상품에 대한 다양한 고객들의 니즈를 즉각적으로 판단하고 대응하여 보다 정확하고, 고객 개개인의 욕구에 맞는 맞춤형 상품추천 및 설계를 위한 핵심 기술로서 자리 잡을 수 있을 것으로 기대된다.

• 대한한의학회지
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• 제28권3호통권71호
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• pp.244-260
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• 2007

Objectives : The purpose of this study was to provide lawmakers with basic data for the purpose of establishing a policy on health insurance for packed herbal medicine. Methods : To properly execute an insurance system for packed herbal medicine, we surveyed the following questions from May 1st to June 15th, 2006: (1)the way to pay the insurance benefits (2)specific impression (disease) names as related to insurance (3)the range of insurance coverage. We obtained answers from 304 Korea traditional doctors. Results : 89.4% respondents were agreed on execution of health insurance for packed herbal medicine. 93.86% respondents answered that the way to pay insurance benefits and the range of insurance coverage have to be changed properly. Most respondents answered that the coverage should be based on a specific disease being treated, not the current symptoms method which relates to the prescription. The execution of health insurance for packed herbal medicine is expected to increase the number of patients and make the Korean medical system more popular. Conclusion : The findings are expected to make it easier for the general public to get treatment by providing basic data with policy makers that will cover packed herbal medicine in insurance. Also, a proper Korea traditional health insurance program should be set up as soon as possible to widen the choice of medicine for the general public.

• 한국콘텐츠학회논문지
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• 제14권1호
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• pp.200-208
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• 2014

본 연구는 민간의료보험이 국민보건의료에 미친 영향과 관련된 오랜 논쟁에 관한 기존연구들을 분석하고, 논의가 부족했던 의료서비스 이용만족에 대한 영향을 확인하여 민간의료보험의 발전적 역할설정에 기여하는 데 목적이 있다. 선행연구 고찰을 통해 민간의료보험이 국민보건의료에 미친 영향을 확인한 결과 민간의 료보험 활성화가 저소득층과 건강상태가 좋지 않은 국민을 배제시키는 국민양극화를 초래할 가능성이 있고, 민간의료보험에 가입한 가입자의 의료이용량이 많아서 건강보험 추가재정지출을 유발할 가능성이 있었다. 그러나 민간의료보험이 의료서비스 질 개선과 의료소비자 만족에 기여하는지는 더 많은 연구가 필요한 상황이었다. 문헌고찰에서 연구가 미진한 것으로 확인된 민간의료보험이 소비자의 의료서비스 만족에 미치는 영향을 국민건강영양조사 자료를 통하여 확인한 결과 민간의료보험가입여부에 따라서 외래의료이용과 입원의료이용에 대한 의료서비스 만족도의 차이가 없었으며, 통계적으로 유의미한 영향관계도 없었다. 즉, 민간의료보험가입이 의료서비스 만족에 영향을 미치지 않는 것이다. 이러한 분석결과에 따라 향후 우리나라의 민간의료보험은 비급여 보충형으로 운영하는 것이 바람직할 것이다.

• 보건행정학회지
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• 제33권4호
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• pp.379-388
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• 2023

This study aims to propose the implementation of innovative payment models in Korea in order to promote the financial sustainability of the national health insurance system by reviewing the current status of the payment system in Korea and examining other countries' experiences with various innovative payment models. Korea primarily uses a fee-for-service payment system and additionally uses various payment systems such as case payment, per diem, and pay-for-performance. However, each payment system has its limitations. Many OECD (Organization for Economic Cooperation and Development) countries have pointed out the limitations of existing payment systems and have been attempting various innovative payment models (e.g., add-on payment, bundled payment, and population-based payment). Therefore, it is essential for Korea to consider innovative payment models, such as a mixed payment model that takes into account the strengths and weaknesses of each payment system, and to design and pilot these models. This process requires stakeholders to work together to build a social consensus on the implementation of innovative payment systems and to refine legal and systematic aspects, develop an integrated health information system, and establish dedicated organizations and committees. These efforts towards innovative payment models will contribute to developing a sustainable health insurance system that ensures the public's health and well-being in Korea.

• 노동경제논집
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• 제26권2호
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• pp.31-59
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• 2003

본고는 실업보험과 연금을 통합시켜 실직자가 실업급여 이외에 자신의 미래 연금을 담보로 대출을 받게 되는 통합실업보험제의 후생효과를 분석하고 있다. 특히 본고에서는 통합실업보헙제가 기존 실업보험제에 비해 후생을 증가시키는 경우를 제시하고 구체적으로 이 제도하에서 실업급여와 연금담보대출의 적정수준을 결정하는 요인을 분석하였다. 일반적으로 통합실업보험제가 기존 실업보험제에 비해 후생적으로우월하고 실업급여 수준은 근로자 위험기피도, 구직유인의 중요성 그리고 실업기간의 상대적 크기에 따라 달라짐을 보이고 있다. 그밖에 본고에서는 같은 원리에 의해 연금을 실업보험 뿐아니라 다른 사회보험과도 동시에 통합하는 것이 후생적으로 바람직함을 강조하고 있다.

• Journal of Korea Trade
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• 제23권5호
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• pp.87-101
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• 2019

Purpose - This paper examines the effectiveness of the foreign exchange risk insurance system in the promotion of SME exports in Korea. The purpose of this study is to analyze the short-term and long-term responses of SME exports to foreign exchange risk insurance support policies. Based on these empirical studies, we would like to present some operational improvements to the operation of the foreign exchange risk insurance system. Design/methodology - In order to analyze the effect of exchange risk insurance on the exports of SMEs, a VAR model consisting of foreign exchange risk insurance underwriting values, export relative price, and domestic demand pressure, including export volume, was established. The study began with tests of the stationarity of time series data. The unit root tests showed that all concerned variables were non-stationary. Accordingly, the results of the cointegration test showed that the tested variables are not cointegrated. Finally, an impulse response function and variance decomposition analysis were conducted to analyze the impulse of foreign exchange risk insurance on exports of SMEs. Findings - As a result of estimating the VAR (1) model, foreign exchange risk insurance was found to be significant at a 1% significance level for SME' export promotion. In the impulse response analysis, SMEs' export response to the impulse of foreign exchange risk insurance showed that exports gradually increased until the third quarter, and then slowed down. However, the impulse did not disappear, and appeared continuously. Originality/value - This study analyzed the effect of foreign exchange insurance on exports of SMEs by applying the VAR model. In particular, this study is the first to analyze the short-term and long-term effects of foreign exchange risk insurance on exports of SMEs. The empirical evidence in the current study have a policy implication for the policy authority to support and promote the foreign exchange risk insurance in the effect of exchange rate volatility on Korea' export SMEs.

• 무역상무연구
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• 제61권
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• pp.139-163
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• 2014

Recently with making of 'The Consumer Insurance (Disclosure and Representations) Act 2012(hereunder CIA)', the UK revised the duty of disclosure especially with the consumer insurance contract. According to the CIA, if the misrepresentation was careless, the insurer may have the three options based upon what the insurer would have done had the consumer taken care to answer the question accurately; a compensatory remedy, avoidance of the insurance contract or, amendment of the contract. I realized that the establishment of CIA has been exposed to pro-actively relieve the breach of Warranty and Disclosure, Representations as far as required by the Global Insurance market. It was found that it is expected to bring significant changes in UK Insurance Act system of the 21st century, and prepares competition from neighboring countries. On the other hand, in the common law system, countries under MIA(1906) are trying to address the breach of warranty and Disclosure, Representations, except the UK cannot completely adhere with a positive attitude.