• Women's Health Nursing
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• v.17 no.4
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• pp.328-336
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• 2011

Purpose: The purpose of this study is to develop the optimal nursing fee for nurse-midwifery center (MC) in the national health insurance system. Methods: The three methodologies used to calculate the conversion factors for the MCs in the national health insurance include cost accounting method, sustainable growth rate (SGR) model, and index model. In this study, the macro-economic indicators and the national statistics were used to estimate the conversion factors for the MCs. Results: The optimal nursing fee for the MCs in 2011 was estimated to be an increase of 57.7% by cost accounting analysis, a decrease of 17.1% by SGR model, and a decrease of 16.1% by index model. The results from SGR model and index model could had been biased due to the upswing of medical spendings in the short-term period (2008~2009). A sensitivity analysis of pre-delivery subsidy program for OB & GYN hospitals and clinics showed that the program has substantially diminished the demand for the MC services. Conclusion: More reliable methodologies to estimate nursing fees precisely are required to prove the value of nurses' services and a government subsidy program for the MC services should be followed from a social perspective.

• Health Policy and Management
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• v.19 no.4
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• pp.33-52
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• 2009

Health promotion policies have needed to assess in detailed and evidence-based work to set a policy goal and clear future directions of health promotion in Korea. To identify the major factors related with health promotion, we assessed the associations between public health outcome (potential years of life loss, PYLL) and national health determinants. For this purpose, we used a pooled cross sectional time-series regression analysis with corrected fixed effect models involving sixteen member countries of the Organisation for Economic Cooperation and Development during the period 1970 to 2001. The PYLL was positively associated with tobacco and alcohol consumption (model 1 and 2) and calories intake (model 2 and 3) while the PYLL was negatively associated with GDP, fruit and vegetable intake (model 2), number of doctors (model 3), coverage rates of health care security, and elderly population rates (model 4). In conclusion, health behaviors related with tobacco, alcohol, and nutrition were significant health determinants for health outcome. Overall analysis results of this study will provide a guidance toward improved macro- and micro-policy development for future health promotion policy in Korea.

• Health Policy and Management
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• v.28 no.4
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• pp.378-391
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• 2018

Background: People who were born in different years, that is, different birth cohorts, grow in varying socio-historical and dynamic contexts, which result in differences in social dispositions and physical abilities. Methods: This study used age-period-cohort analysis method to establish explanatory models on healthcare expenditure in Korea reflecting birth cohort factor using intrinsic estimator. Based on these models, we tried to investigate the effects of ageing population on future healthcare expenditure through simulation by scenarios. Results: Coefficient of cohort effect was not as high as that of age effect, but greater than that of period effect. The cohort effect can be interpreted to show 'healthy ageing' phenomenon. Healthy ageing effect shows annual average decrease of -1.74% to 1.57% in healthcare expenditure. Controlling age, period, and birth cohort effects, pure demographic effect of population ageing due to increase in life expectancy shows annual average increase of 1.61%-1.80% in healthcare expenditure. Conclusion: First, since the influence of population factor itself on healthcare expenditure increase is not as big as expected. Second, 'healthy ageing effect' suggests that there is a need of paradigm shift to prevention centered-healthcare services. Third, forecasting of health expenditure needs to reflect social change factors by considering birth cohort effect.

• Journal of Pharmacopuncture
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• v.24 no.3
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• pp.122-137
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• 2021

Objectives: In South Korea, traffic accident victims can be treated under automobile insurance coverage. Korean medicine (KM) clinics have reported the largest number of automobile insurance fee claims among medical institutions. This study investigated the status of the KM automobile insurance system in a single KM clinic. Methods: We retrospectively surveyed the medical charts of 342 traffic accident patients treated at the Jisung KM clinic between January 2009 and June 2017. Results: Most of the patients were men and in their 30s. The most common method of locating the clinic was an internet search. The most common traffic accident type was collision between vehicles (83.63%), with 70.76% of patients visiting during the most acute phase. The major disease codes included S434, M4836, F072, S0600, and S3350. The most frequent treatment period was within 1 month of the accident, and most patients received 10 or fewer treatments. The mean treatment duration and number of treatments were 37.68 ± 45.11 days and 11.68 ± 10.63 treatments, respectively. The initial pain numerical rating scale (NRS), 7.32 ± 0.96, decreased to 3.57 ± 1.40 at the end of treatment, with a symptom improvement score of 1.87 ± 0.60. Regarding sex, age, disease duration, location at the time of the accident, presence of additional and psychological symptoms, and chuna, there were statistically significant differences in treatment duration and number of treatments. A higher number of treatments and the longer treatment duration was associated with a higher initial NRS, lower post-treatment NRS, and better improvement score. Since the introduction of traffic accident (TA) pharmacopuncture, the rate of use of a single type of pharmacopuncture increased; however, no significant differences in treatment duration and number, NRS before and after treatment, and improvement score were observed between treatment groups before and after TA pharmacopuncture. No adverse reactions were observed for any treatment. Conclusion: This study confirmed the previous findings of a high treatment effect of KM under automobile insurance. We also observed significant correlations based on a detailed medical status, which may explain the increasing use of KM in the automobile insurance system. Additional multi-center studies in different regions are needed.

• Korea Journal of Hospital Management
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• v.29 no.2
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• pp.37-47
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• 2024

Purpose: This study aimed to determine the effect of adjusted out-of-pocket maximum rules in the 'differential co-payment ceiling', which means having a higher burden of co-payment, that expanded to the entire ceiling level in long-stay admission patients in long-term care hospitals(LTCH). Methodology: We used health insurance claim data between January 1, 2022, and December 31, 2022 received from the National Health Insurance Service. The study populations were inpatients in long-term care hospitals more than 1 days during the study period. We performed the difference in characteristics of the LTCH patient of the differential and general ceiling by the chi-square test. We estimated the change of the population, cost, and co-payments per person under the assumption of restructuring. Finding: Based on adjusted out-of-pocket maximum rules in 2023, it was expected that the number of benefits decreases at the high-income level while increasing at the low-income level. The burden of health expenditure after reimbursement of co-payment ceiling, is expected to increase by 65.1% in the highest medical necessity, whereas the low medical necessity would decreases compared to 2022. Practical Implications: The results demonstrate that the current out-of-pocket maximum rules do not reflect the needs of medical necessity. This study suggested the need to reflect the medical necessity in LTCH on the out-of-pocket maximum rules in the future.

• Journal of Preventive Medicine and Public Health
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• v.42 no.1
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• pp.5-11
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• 2009

Objectives : This study was conducted to estimate the socioeconomic cost of injuries in South Korea. Methods : We matched claims data from national health insurance, automobile insurance and industrial accident compensation insurance(IACI), and mortality data obtained from the national statistical office from 2001 to 2003 by patients unique identifier. Socioeconomic cost included both direct cost and indirect cost: the direct cost was injury-related medical expenditure and the indirect cost included loss of productivity due to healthcare utilization and premature death. Results : The socioeconomic cost of injuries in Korea was approximately 1.9% of the GDP from 2001 to 2003. That is, 12.1 trillion KRW(Korean Won) in 2001, 12.3 trillion KRW in 2002, and 13.7 trillion KRW in 2003. In 2003, direct medical costs were 24.6%(3.4 trillion KRW), the costs for loss of productivity by healthcare utilization were 13.0%(1.8 trillion KRW), and the costs for loss of productivity by premature death were 62.4%(8.6 trillion KRW). Conclusions : In this study, the socioeconomic cost of injuries in Korea between 2001 and 2003 was estimated by using not only health insurance claims data, but also automobile insurance, IACI claims and mortality data. We conclude that social efforts are required to reduce the socioeconomic cost of injuries in Korea, which represented approximately 1.9% of the GDP for the time period specified.

• The Korean Journal of Applied Statistics
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• v.26 no.6
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• pp.857-871
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• 2013

Export credit insurance is a policy tool for export growth. In the era of free trade under the governance of WTO, export credit insurance is still allowed as one of the few instruments to increase exports. This paper, using data on short-term export insurance contracts issued to foreign subsidiaries of Korean companies, calculates the expected loss per exposure by combining the effect of risk factors (credit rate of foreign importers, size of mother company, and payment period) on loss frequency and loss severity in different levels. We, applying generalized linear models (GLM), first fit loss frequency and loss severity to negative binomial and lognormal distribution, respectively, and then estimate the loss frequency rate per contract and the ratio of loss severity to coverage amount. Finally, we calculate the expected loss per exposure for each level of risk factors by combining these two rates. Based on the result of statistical analysis, we present the implication for the current premium rate of export insurance.

• Communications for Statistical Applications and Methods
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• v.17 no.5
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• pp.697-712
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• 2010

This paper is concerned with the statistical analysis and development of stochastic models for the demand for life insurance policy loans. For these, firstly the characteristics of the regression trend, periodicity and dependence of the monthly demand for life insurance policy loans are investigated by a statistical analysis of the monthly demand data for the years 1999 through 2008. Secondly, the causal relationships between the demand for life insurance policy loans and the economic variables including unemployment rate and inflation rate for the period are investigated. The results show that inflation rate is main factor influencing policy loan demands. The overall evidence, however, failed to establish unidirectional causality relationships between the demand series and the other variables under study. Finally, based on these, univariate time series model and transfer function model where the demand series is related to one input series are derived, respectively, for the prediction of the demand for life insurance policy loans. A statistical procedure for using the model to predict the demand for life insurance policy loans is also proposed.

• Journal of Society of Occupational Therapy for the Aged and Dementia
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• v.12 no.2
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• pp.67-74
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• 2018

Objective : The purpose of this study is to quantitatively analyze the role of occupational therapy in long - term care insurance for the elderly using text mining, one of the big data analysis techniques. Method : For the analysis of newspaper articles, "Long - Term Care Insurance for the Elderly + Occupational Therapy for the Elderly" was collected after the period from 2007 to 208. Naver, which has a high share of the domestic search engine, utilized the database of Naver News by utilizing Textom, a web crawling tool. After collecting the article title and original text of 510 news data from the collection of the elderly long term care insurance + occupational therapy search, we analyzed the article frequency and key words by year. Result : In terms of the frequency of articles published by year, the number of articles published in 2015 and 2017 was the highest with 70 articles (13.7%), and the top 10 terms of the key word analysis showed the highest frequency of 'dementia' (344) In terms of key words, dementia, treatment, hospital, health, service, rehabilitation, facilities, institution, grade, elderly, professional, salary, industrial complex and people are related. Conclusion : In this study, it is meaningful that the textual mining technique was used to more objectively confirm the social needs and the role of the occupational therapist for the dementia and rehabilitation in the related key keywords based on the media reporting trend of the elderly long - term care insurance for 11 years. Based on the results of this study, future research should expand research field and period and supplement the research methodology through various analysis methods according to the year.

• The Journal of the Korean life insurance medical association
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• v.2 no.1
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• pp.218-232
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• 1985

Congenital hereditary disease is in devided into Infantile type and Adult type, Adult type is hidden for many years and keeps normal renal function till middle age. Cyst is stimultaneously made in both sides and becomes lowered in renal function in 30's to 40's. Infantile type is generally born with the big kidneys, renal failure, undergrowth of intrahepatic bile duct. Both infantile and childhood type have ureteral dilatation and portal hypertension In infantile type, it is mostly developed into renal failure, but generally faces death as a result of hepatic disease. The reason of death is that an abnormal condition of recessive autosome affects the liver and kidneys. While the incidence of infantile type is rare as $0.017{\sim}0.07%$ and it is autosomal recessive heredity, Adult type can rarely exist in infantile period. Though it exists in middle period, 50% of patients can live for 2-4 years after the first symptom incidence and 25% can less than 2 years. It is hard to cure completely in medicine and surgery. Three difficulties in familial incidence are comparative decrease of the donor who have no affection on renal transplantation. For another consideration it is to show the family history for several generations. We, the Med. Dept. of Dae Han Kyouk Life Insurance Co. Ltd., used the ultrasonic apparatus in diagnosing the one case of adult type bilateral polycystic kidney and then doubted the family history. As a result of inspecting the family we experienced bilateral polycystic kidney from 3 persons out of 4 who can be inspected. The results are as follows: 1) We could confirm the polycystic kidney from 3 persons out of 4(75%). 2) Then when they came for check up, chief complaint was the pain in all 3 cases(100%). 3) Accompanying disease was hypertension in 2 cases(67%). 4) In early disease incidence, we couldn't observe the specific change in pathological opinion. 5) All 3 cases are not accompanied with cystic lesion in liver, spleen, pancreas.