• Health Policy and Management
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• 제34권2호
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• pp.163-177
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• 2024

Background: This study aims to examine changes in fraudulent claim counts and total reimbursements before and after enhancements in counterfeit claim controls and monitoring of provider claim patterns under the "Proactive self-audit pilot program of fraudulent claims." Methods: This study used the claims data and hospital information (July 2021-February 2022) of the Health Insurance Review and Assessment Service. The data was collected from 1,129 hospitals assigned to the pilot program, selected from the providers who filed a claim for reimbursement for intravenous injections. Paired and independent t-tests, along with regression analysis, were utilized to analyze changing patterns and factors influencing claim behaviors. Results: This program led to a reduction in the number of fraudulent claims and the total amount of reimbursements across all levels of hospitals in the experimental groups (except for physicians below 40 years old). In the control group, general hospitals and hospitals demonstrated some significant decreases based on the duration since opening, while clinics showed significant reductions in specified subjects. Additionally, a notable increase was observed among male physicians over the age of 50 years. Overall, claims and reimbursements significantly declined after the intervention. Furthermore, a positive correlation was found between hospital opening duration and claim numbers, suggesting longer-established hospitals were more likely to file claims. Conclusion: The results indicate that the pilot program successfully encouraged providers to autonomously minimize fraudulent claims. Therefore, it is advised to extend further support, including promotional activities, training, seminars, and continuous monitoring, to nonparticipating hospitals to facilitate independent improvements in their claim practices.

• Archives of design research
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• 제19권1호
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• pp.253-262
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• 2006

Research of color has been developed and also has raised consumer desire through changing from a tool to pursue curiosity or beauty to a tool creating effects in the 20th century. People have been interested in colors as a dynamic expression of results since the color TV appeared. The meaning of colors has been recently diversified as the roles of colors became important to the emotional aspects of design. While auto colors have developed along with such changes of the times, black led the color trend during the first half of the 20th century from 1900 to 1950, a transitional period of economic growth and world war. Since then, automobile production has increased apace with the rapid economic growth throughout the world and automobiles became the most expensive item out of the goods that people use. Accordingly, increasing production induced facility investment in mass production and a technology leveling was achieved. Auto manufacturing processes are very complicated, auto makers gradually recognized that software changes such as to colors or materials was an easier way for the improvement of brand identity as opposed to hardware changes such as the mechanical or design components of the body. Color planning and development systems were segmented in various aspects. In the segmentation issue, pigment technology and painting methods are important elements that have an influence on body colors and have a higher technical correlation with colors than in other industries. In other words, the advanced mixture of pigments is creating new body colors that have not existed previously. This diversifies the painting structure and methods and so maximizes the transparency and depth of body colors. Thus, body colors that are closely related to technical factors will increase in the future and research on color preferences by region have been systemized to cope with global competition due to the expansion and change of auto export regions.