• 한국병원경영학회지
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• 제25권4호
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• pp.38-47
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• 2020

Purposes: The problem in the recent immigration policy and social policy changes for foreigners is that the preliminary analysis or research on the actual impact of the influx of foreigners has not been done enough in Korea yet.. This study is to examine the impact of the Korean health insurance finances on the influx of foreigners. Approach: This study analyzed the health insurance statistics for foreigners and overseas Koreans of the Health Insurance Corporation from 2013 to 2017. The data is the "Status of Health Insurance Premiums for Nationals, Foreigners, and Overseas Koreans from 2013 to 2017" submitted by the National Health Insurance Service to the Health and Welfare Committee during the 2018 National Audit Period. Findings: To summarize the analysis, first, the proportion of foreigners was only 1% of all subscribers (1.7% at work, 1.9% in regions) until 2017. Second, employees at work have a lower pay-to-pay ratio, and local subscribers have a higher pay-to-pay rate, regardless of nationality. Third, as immigrants are mostly concentrated in younger ages, they are healthy and use of hospitals is relatively low. Fourth, in terms of gender distribution, there are many women of childbearing age due to marriage immigration among foreign local subscribers, and more men use hospitals than workers who have a high proportion of males due to childbirth. In conclusion, the impact of immigration on health insurance finances is not large, and has a positive effect on finances. Practical Implications: If we simply consider the financial aspect, encouraging foreigners to subscribe to health insurance has a positive effect on finances. In particular, the more foreign workers are enrolled, the greater the financial gain. In particular, increasing the employment of foreign women through language education, vocational training, and employment support will help finance health insurance. One of the reasons foreign subscribers have a positive impact on health insurance finance is the low medical utilization rate. It can be said that young and healthy foreigners use fewer hospitals and clinics, but another aspect means that foreigners have difficulty using health insurance for various reasons. Therefore, various supports must be accompanied so that foreign subscribers can use medical services when necessary.

• 해양환경안전학회:학술대회논문집
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• 해양환경안전학회 2017년도 공동학술발표회
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• pp.243-243
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• 2017

• Perspectives in Nursing Science
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• 제7권1호
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• pp.23-35
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• 2010

Purpose: The purpose of this paper is to analyze the demand and supply of advanced practice nurses and suggest alternative benefit strategies in the Korean national health insurance. Methods: A revised demand & supply model was used to estimate the excess supply of APNs, and policy making process and key actors in the Korean health insurance were considered to develop a political approach to the APN issue. Results: The social demand for APNs is currently estimated to be less than 50% of its supply and the APN education program fell into difficulties in recruits. No reimbursement mechanism for APN's services in the national health insurance has given no economic incentive to hospital managers who have monopsony power in nursing labor market, which has caused the demand shortage of APNs in hospital industry. Payment for APN's services recognized as one of the most significant strategies to booster the social demand for APN's services should be carefully designed and implemented in the national health insurance. In line with this, key actors in health insurance policy decision-making include government, national assembly, labor unions, NGOs, civic groups, medical associations, and academia. Conclusion: The basic researches for APN's activities and cost-effectiveness analysis in clinical settings are required to support the strategies aforementioned. Constructing a policy network among key actors is able to make the payment strategy feasible, which will increase the socal demand for APNs.

• Journal of Preventive Medicine and Public Health
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• 제39권5호
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• pp.438-446
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• 2006

Objectives: We developed the predictive model for the incidence of colon cancer by utilizing the health screening data of the National Health Insurance in Korea. We also explored the characteristics of the high risk group for colon cancer. Methods: The predictive model was used to determine those people who have a high risk for colon cancer within 2 years of their NHI health screening, and we excluded the people who had already been treated for cancer or who were cancer patient. The study population is the insured of the NHI, aged 40 or over and they had undergone health screening from the year 2000 to 2004, according to NHI health screening formula. We performed logistic regression analysis and used SAS Enterprise Miner 4.1. Results: This study shows that there exists a higher rate of colon cancer in males than females. Also, for the population in their 60s, the incidence rate of colon cancer is much higher by 5.36 times than that for those people in their 40s. Amongst the behavioral factors, heavy drinking is the most important determinant of the colon cancer incidence (7.39 times in males and 21.51 times in females). Conclusions: Our study confirms that the major influencing factors for the incidence of colon cancer are drinking, lack of exercise, a medical history of colon polypus and a family history of colon cancer. As a result, we can choose the group that is at a high risk for colon cancer and provide customized medical information and selective management services according to their characteristics.

• 대한한의학방제학회지
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• 제18권1호
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• pp.43-56
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• 2010

Objective : There is a growing need to expand or adjust insurance coverage of herbal prescriptions in National Health Insurance. The purpose of this study was to provide basic data for expansions or adjustments of 56 herbal prescriptions in the National Health Insurance. Method : We surveyed lists of 56 insurance-covered herbal prescriptions, non-covered company-produced herbal medicines and self-prepared herbal medicines in 531 traditional korean medical clinics by mail from 6/1/2008 to 12/9/2008. Result : Among the 56 Prescriptions, Ojeok-san was stocked in 66.7% of clinics (1st), Samso-eum ranked 2nd, Socheongnyong-tang ranked 3rd, Gumiganghwal-tang was 4th, Hyangsapyeongwi-san ranked 5th. Among the non-covered company-produced herbal medicines, Danggwisu-san ranked 1st, Gwakyangjeonggi-san ranked 2nd, Oryeong-san was 3rd, Bangpungtongseong-san was 4th, Maengmundong-tang ranked 5th. Among the self-prepared herbal medicines, Gongjin-dan ranked 1st, Soche-hwan was 2nd, Gyejibongnyeong-hwan was 3rd, Yeongsin-hwan was 4th, Palmi-hwan ranked 5th. Conclusions : It is reasonable to select frequently used company-produced or self-prepared herbal prescriptions in this stock rate survey for improvement of National Health Insurance coverage.

• 보건행정학회지
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• 제9권4호
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• pp.1-14
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• 1999

The purpose of this study was to estimate the magnitude of patient's actual cost-sharing for hospital services in the National Health Insurance which has been estimated with only a few hospitals or limited number of patients. Also we aimed at analysis of factors influencing the magnitude. Sources of analyzed data were two databases. 1997 medical benefits record of the National Federation of Medical Insurance and 1997 Statistics for Hospital Management from the Korea Institute of Health Services Management(KIHM). We merged two databases and related records for 224 hospitals. based on the identification details of each hospital. The average percent of patients' cost-sharing was 51.7% of total hospital revenues from the insurance. with 40.3% of revenue in inpatient and 67.4% in outpatient. respectively. The contributing hospital factors to the magnitude of cost-sharing were size of hospitals. teaching status. location. number of employed physicians. etc. Larger and university hospital. urban location. and with more physicians were positively correlated with higher level of cost-sharing. Additionally, the higher the expenses of inpatient's treatment was, the higher the size of patient's cost-sharing was. These findings suggest that present level of patients' cost-sharing is quitely high and it is urgent to reduce the patient's cost-sharing to the reasonable level. It would be necessary to extend the coverage of insurance benefits and to develop policies focusing on larger hospitals and inpatient services.

• 대한치과의료관리학회지
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• 제8권1호
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• pp.37-40
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• 2020

The background of this study is the observation that there is an increase in the number of elderly persons and the decrease in fertility rates, which may be related to the increase in the average age of the Korean people; accordingly, the national health insurance system changes every year following this pattern. However, this study investigates whether these changes are reflected in the dental hygiene curriculum. Data from the national health insurance system is reviewed for the last three years, and the recently published dental hygiene curriculum is selected, compared, and analyzed using a literature survey. The study is divided into two parts: information that is reflected in the dental hygiene curriculum and information that is not reflected in the dental hygiene curriculum, but which it is believed should be included. In addition, as the part reflected in the dental hygiene curriculum, it was stated in three subjects of dental implantology, dental prosthesis, and conservative dentistry, and there were four cases. Therefore, efforts should be made to ensure that the curriculum for dental hygiene students should reflect the changes in the national health insurance system so that students can more easily understand dental insurance claim processes.

• Journal of Preventive Medicine and Public Health
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• 제28권2호
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• pp.450-461
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• 1995

This paper tested by using Micro TSP, an empirical econometric analysis to approve officially a hypothesis of price elasticity of the demand for medical care services in Korean national medical insurance and the economic effect of health care delivery system with time-series datas of Medical Insurance Statistical Yearbook$(1981\sim1993)$. The results suggest that the Korean medical insurance system shows moral hazard due to the change of coinsurance and the economic effect according to intervention of the health care delivery system, but it is different by insurers regardless of the same structure of the medical insurance scheme.

• Asia pacific journal of information systems
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• 제32권3호
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• pp.496-513
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• 2022

Artificial intelligence or big data technologies can benefit finance companies such as those in the insurance sector. With artificial intelligence, companies can develop better customer segmentation methods and eventually improve the quality of customer relationship management. However, the application of AI-based customer segmentation in the insurance industry seems to have been unsuccessful. Findings from our interviews with sales agents and customer service managers indicate that current customer segmentation in the Korean insurance company relies upon individual agents' heuristic decisions rather than a generalizable data-based method. We propose guidelines for AI-based customer segmentation for the insurance industry, based on the CRISP-DM standard data mining project framework. Our proposed guideline provides new insights for studies on AI-based technology implementation and has practical implications for companies that deploy algorithm-based customer relationship management systems.

• 한국융합학회논문지
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• 제9권5호
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• pp.157-169
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• 2018

본 연구는 보험소비자의 자발적 구매동기가 보험소비만족에 어떠한 영향을 주는지 확인하고자 하였다. 심리학의 자기결정성 이론에 근거하여 자발적인 구매동기를 유발하는 소비자의 심리적 욕구를 포함하여 보험소비만족에 대한 직 간접적 영향을 파악하고자 하였다. 보험소비자 1,225명 대상의 온라인 설문조사 자료를 이용하여 구조방정식 분석을 통해 연구 가설과 모형을 증명하였다. 연구결과, 소비자가 구매의 필요성을 스스로 인지하는 자발적인 구매동기에 의한 구매시 보험소비만족이 높아지고, 보험소비자율성과 보험소비환경에 대한 긍정적 인지는 자발적 구매동기를 높이며, 이를 매개로 소비만족에 기여하는 것으로 나타났다. 본 연구를 통하여 보험회사의 과도한 마케팅과 보험소비자의 자기과신은 보험소비만족을 저해할 수 있으며, 보험소비자의 자율적권리와 책임 인식을 높이는 금융소비자의 소비태도 교육이 필요하다는 시사점이 도출되었다.