• 아태비즈니스연구
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• 제3권1호
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• pp.39-47
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• 2012

Organizations pursue a CRM strategy for the purpose of increasing business performance and value. However, firms face a multitude of organizational challenges associated with this endeavor. To reduce their risk of failure, it is suggested that firms undertake a deep analysis of organizational readiness prior to committing to a CRM initiative. Insurance sector is no exception to this fact. There is an increased need to concentrate on the various challenges thrown open by the public insurance firms in implementing CRM. Many insurance firms have invested into customer driven CRM but research indicates varying outcomes (Schmith 2004). While it is clear that there are significant issues involved in the CRM implementation and success and environment faced by the public sector. It is clear that business should have an easier time in applying CRM systems is the strategic value for public sector. With customers demanding more service and accessibility from administrators, public sector CRM software technologies have to offer best solutions for achieving process and cost objectives (Souder 2001). With results which go far beyond improved service delivery and include sustained cost reductions, increased customer knowledge and better employee morale, CRM software implementation and post product environments offer great upside value. Although there are material differences in public sector use of CRM strategy, they share at least one glaring similarity - they have much to gain from proven CRM software technology. As business methods cross over in the public sector, many government bodies are investigating how they can adopt and adapt various CRM models (Bleyer 2003). There is a need to understand the similarities and differences in public sector CRM to foster shared knowledge, business processes and planning functions to integrate disparate technologies and software platforms and then, of course, the organizational culture to support knowledge sharing (Peters 1997). For the public sector, there are clearly identified CRM processes which have resulted in increased profits and improved efficiency. These have focused on sales, marketing and customer service activities, which often operate along fundamentally different lines in various public sector insurance companies. Thus the present research paper makes an attempt to explore how public sector CRM methods can be adopted and subsequently adapted.

• Journal of the Korean Data and Information Science Society
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• 제20권4호
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• pp.673-684
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• 2009

텔레마케팅의 영업특성상 전화 응대를 한 고객에게 초기 적절한 상품을 추천하여 보험가입을 유치하는 것이 가장 중요하다. 따라서 고객의 선호상품 및 선호시간을 고려한 고객 선별과 타겟팅을 어떻게 진행하느냐에 따라 거수보험료 차이가 발생한다. 본 연구는 데이터마이닝 기법 중 로지스틱회귀모형을 이용하여 생명보험사 아웃바운드 텔레마케팅 영업을 지원하는데 있어서 그 효과를 검증하고자 하였다. 기존의 가입상품에 대한 고객반응정보와 L생명보험사 영업 전략에 따라 연령을 구간화하고 가족사랑보험, 상해보험, 암보험 상품에 대한 모델링을 진행하였다. 설정된 모델을 바탕으로 캠페인 진행시 기존 마케팅 방식과 모델방식으로 고객을 추출하고 실행결과를 통해 모델의 우수성을 입증하였다. 또한 시간이 지남에 따라 설정한 모델이 노후화되고 영업이익이 줄어듦에 따라 지속적으로 영업이익을 극대화 할 수 있도록 모델갱신주기를 도출하였다.

• 대한치과의사협회지
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• 제48권6호
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• pp.459-468
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• 2010

International Classification of Disease (ICD-10) is widely used as a crucial reference not only in the medical diagnosis of diseases but also within the health insurance system. It makes possible for medical personnel to make decisions systematically and for the people working in the health insurance or public health industries to better understand medical issues. However, this classification is often not enough or acceptable in a clinical setting. Many countries amend in their own way to make it more appropriate for their people. Korean Classification of Disease (KCD-5) was made by adding a 5 digit code for some diseases to clarify the conditions of the patients. The authors found problems of KCD-5 in temporomandibular disorders and several related medical problems. Medical treatment for these problems had not been covered even by public health insurance until 2000 in Korea. For the last decade, private insurance companies have introduced new items for reimbursement of the treatment fees the patients actually pay. The authors assumed that many patients with these medical problems encountered difficulties in the reimbursement from private insurance companies because KCD-5 did not classify these medical conditions appropriately. An overview of KCD-5 and suggestions for improvement are introduced in this study.

• KDI Journal of Economic Policy
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• 제30권2호
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• pp.99-128
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• 2008

민간보험은 공적보험과 보완적인 관계를 형성함에도 불구하고 우리나라의 민간보험은 소득계층에 따른 접근성 차이로 인한 사회적 불평등, 도덕적 해이로 인한 공적보험 재정악화 등의 우려를 낳고 있다. 그러나 이에 관한 실증적 분석은 그간 이루어지지 못하여 정책적인 방향을 정립하는 데 장애가 되어 왔다. 본 연구는 건강보험공단, 심사평가원, 민간보험사, 행정자치부 주민등록세대정보 등의 관련 정보를 종합하여 이에 대한 실증분석을 시도했다. 그 결과, 우리나라의 민간보험 가입률은 전 국민의 64%에 달하고 있으며, 고소득층과 저소득층 간에 민간보험 가입률의 차이가 나타나지 않았다. 이는 공적보험의 보장성이 미흡한 상황에서 저소득층 역시 갑작스런 의료지출에 대비하고 있으며, 민간보험이 의료접근성의 계층화를 초래하지 않고 있다는 것을 시사한다. 또한 민간보험 가입자는 평균적으로 미가입자에 비해 의료이용량이 높지 않았으며, Two-Part Model을 통해 다양한 변수를 통제했을 경우에도 동일한 결과가 나타났다. 연령대에 따른 차이로 미루어 이러한 결과는 노동시장과 연관된 한시적인 성격일 것으로 추측되나, 현재로서는 민간보험 가입에 따른 도덕적 해이가 강하게 나타나고 있다는 근거는 발견되지 않았다.

• 의료법학
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• 제10권2호
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• pp.37-82
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• 2009

Korea has gained the much more performances in the fields of pubic health laws and related policies on the basis of the substantial economic achievements. In 1977, the social medical insurance was established for companies with more than 500 employees, and in 1989, Korea successfully achieved the national medical insurance system covering the total population within only 12 years beginning with multiple insurers. There remained some problems, however, to be improved such as both the low level of contribution rates and benefit packages due to the inefficiency in utilizing limited medical resources. In 2000, all insurers were unified into a single insurer (National Health Insurance Corporation), and special independent Health Insurance Review & Assessment Service (HIRA) was also established. From the origin of medical insurance system in 1977, the Korean reimbursement system has been fee-for-service system, and after the establishment of HIRA, it has been providing objective and expert medical cost review services and health quality assessment services.

• 대한본초학회지
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• 제27권2호
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• pp.1-16
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• 2012

Objective : To investigate the current status of prescription drugs in Oriental medical institutes and to draw up a future plan for the revitalization of Oriental medical health insurance, this survey has been performed. Method : The survey has been made with 321 doctors working at Oriental medical institutes in Daegu and Kyungbuk areas for a period of 3 month from June 1, 2010 until September 1, 2010. Result : 1. When it comes to the current status of the use of herbal drugs in Oriental Health insurance, most of doctors surveyed prescribe insurance drugs, and they prescribe insurance drugs to patients, who are less than 20% of total patients visiting their clinics. 2. The awareness of Herbal Health Care Drugs is investigated. When it comes to the understanding of the difference between insurance drugs(powder type drugs) and granular type drugs, doctors admit that they differ only in one aspect, whether or not their being covered by health insurance. Based on the survey results on the understanding of insurance coverage of granular type drugs, doctors, even though they long for granular type drugs to be accepted as insurance drugs, are worrying whether the number of outpatients might dwindle due to increased insurance co-payments. They also point out that the biggest obstacles in the expansion of the granular type drugs as insurance drugs are the lack of understanding of the government and the objection of the Health Insurance Review and Assesment service (HIRA) for fear of increased insurance claims. 3. Upon investigation on Oriental medicine doctors' understandings of herbal pharmaceutical industry, it is found that doctors' responses on pharmaceutical industry are not all positive ones('new product development and neglect of R&D infrastructure' and 'smallness of industry'). When it is investigated what area needs the greatest improvement in herbal pharmaceutical industry, 'securing sufficient capital, good manufacturing, and strengthening quality control', is the highest. 4. When it is asked what are the most needed in order to improve herbal health insurance medicine, responses such as 'the increase in the accessibility to and the utilization of Oriental medical clinics through the diversification of the means of prescriptions', 'the improvement of insurance benefits(cap adjustments)', 'increase the proportion of high quality medicinal plants', 'the ceiling of co-payments(deductible) at 20,000 won or more', 'expansion of the choices of formulations', 'formulational expansions of tablets and pills', and finally 'admittance and expansion of granular type drug as insurance drug' are the highest. 5. Upon investigating the general characteristics of the current status of the usage of Oriental health care herbal drugs, the followings are observed. First, the frequency of use of health insurance drugs by the doctors who use health insurance with general characteristics shows similar differences in case of total monthly sales amount (p<0.001), average number of daily patients (p<0.05). Secondly, as to the willingness of the expanded usage of insurance drugs, similar differences are observed in case of total monthly sales amount (p<0.05). 6. Upon investigating the general characteristics of the perception of Herbal health care drugs, the followings are observed. First, inspecting general characteristics and insurance claims due to increased co-payments(deductible amount) reveals similar differences in case of working period (p<0.01) and in case of total monthly sales amount (p <0.01). Secondly, inspecting general characteristics and the obstacles that hinder granular type drugs from being accepted as health care insurance drugs shows similar differences in case of working period (p<0.05). 7. Upon investigating the general characteristics of the understanding of Oriental Herbal pharmaceutical companies, the followings are observed. First, opinions on the general characteristics of pharmaceutical companies, when examined with variance analysis, shows similar differences in case of total monthly sales amount (p<0.05). Secondly, when opinions are examined on general characteristics and the problems of herbal pharmaceutical companies, similar differences are found in case of working period (p<0.01) and in case of total monthly sales amount (p<0.001). Lastly, opinions on the general characteristics and reforms of pharmaceutical companies, similar differences are observed in case of working period (p<0.001). 8. Upon investigating the general characteristics of the improvement of insurance Herbal drugs, the followings are observed. First, regarding general characteristics and insurance benefits, similar differences are observed in case of working period (p<0.05), in case of total monthly sales amount (p<0.05), and in case of average number of daily patients (p<0.01). Secondly, opinions on the general characteristics and the needs for the improvement of Herbal insurance drugs are examined in 5 different aspects, which are the approval of granular type drugs as insurance drugs, the expanded practices of the number of prescription insurance drugs, the needs of a variety of formulations, the needs of TFT of which numbers of Oriental medical doctors are members for the revision of the existing system, and the needs of adjusting the current ceiling of the fixed amount and the fixed rate. When processed by the analysis of variance, the results show similar differences in case of average number of daily patients (p<0.01). Conclusion : From the results of this study the first measures to take are, to reform overall insurance benefit system, including insurance co-payment system(fixed rate cap adjustment), to expand the number of the herbal drugs to be prescribed matching with insurance benefit accordingly, and to revitalize herbal medicine insurance system through the change of various formulations. In addition, it is recommended to improve the effectiveness of herbal medicine by making plans to enhance the efficacy of herbal medicine and by enabling small pharmaceutical companies to outgrow themselves.

• 한국산학기술학회논문지
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• 제7권3호
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• pp.483-493
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• 2006

본 연구는 보험감독규정과 보험회계준칙의 분리계정(구분계리 포함) 관련 규정을 개선하기 위한 대안을 제시하기 위해 수행되었다. 구분계리, 포괄적으로는 분리계정은 회계의 투명성을 증가시키고 보험회사의 주주와 보험계약자 사이의 이익 배분의 공정성을 높이는데 기여할 수 있다. 구분계리의 유용성을 높이기 위해서는 국제회계기준의 변화된 내용, 보험상품별 성과 구분, 보험상품별 경제적 실질이 반영될 수 있어야 한다. 분리계정이 성공적으로 정착된다면 보험계약자에 대한 공정한 이익배분 뿐만 아니라 생명보험회사 상장시의 보험계약자 이익 보호와 관련된 논쟁의 해결에도 기여할 것이다.

• 한국건설관리학회논문집
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• 제15권5호
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• pp.94-102
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• 2014

본 연구에서는 건설공사보험 확대의 당위성을 분석하고 확대를 위한 예산소요를 추정하였다. 건설공사 손해배상보험은 국가계약법, 지방계약법 등 관련법규에서 의무화하고 있으며, 건설공사의 수행 중에 발생하는 예기치 못한 사고로 인한 사업목적물이나 재산상 손해의 배상을 위하여 가입하고 있다. 현재 200억 이상 PQ공사 및 대형공사만을 의무가입대상으로 공공발주자가 보험료를 지원하고 있다. 의무가입 대상 공사의 경우 발주자가 보험료를 부담하지만, 200억 미만 공공공사의 경우 업체가 자기부담으로 손해를 배상해야 하는 형평성문제가 발생한다. 비의무대상 공사라도 많은 경우가 자기비용으로 보험을 가입하고 있으며, 민간 공사의 경우도 건설공사보험 가입이 많은 것으로 나타난다. 건설공사보험을 가입하면 건설업체의 부족한 사고관리능력을 보험회사로부터 지원받아 안정적인 조업이 가능하게 된다. 따라서 중소업체에 대한 보호와 중소규모 공사의 조업안정성을 위해 200억 이상 공공공사에만 의무화 되어 있는 현재 규제를 개선하여 중소 규모 공사까지 가입 범위를 확대시킬 필요가 있다. 비의무가입 공사의 최근 3년 평균 비중은 46%이며, 보험사의 보험료율에 근거한 원가반영율은 0.2%로 산출된다. 여기에 공종별 위험도를 감안하면 비의무가입 공사의 원가반영율은 0.13%로 추정된다. 이에 따라 향후 200억 이하 공사에 대한 보험 가입을 위해 공공공사 발주가 35조원 규모라면 209억원, 40조원이라면 239억원의 예산이 추가로 필요할 것으로 추정된다.

• 시큐리티연구
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• 제32호
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• pp.151-176
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• 2012

현재 보험범죄는 해마다 증가하고 있으나 정부차원에서 보험범죄를 적발하거나 방지하기 위한 전문조직은 미비한 실정이다. 이러한 보험범죄로 인한 피해는 인명과 국민경제 측면에서 매우 심각한 실정이다. 보험범죄는 보험회사의 경영수지를 악화시키는 것은 물론이고, 보험금의 부정유출로 인해 보험사의 손해율을 악화시킴으로써 보험사 부실의 원인이 될 수 있다. 이는 결국 보험사의 보험료 인상으로 이어져 결국, 보험가입자의 보험료 인상이라는 문제를 야기시킨다. 이러한 이유로 1996년부터 보험회사들은 보상조직 내에 보험사기를 전문적으로 조사하기 위한 보험범죄특별조사팀(Special Investigation Unit, SIU)을 구성하기 시작하였다. 하지만 현재의 SIU는 보험범죄의 예방을 위한 다양한 업무를 효율적으로 수행하기에는 아직 그 인력과 재원이 부족한 수준이다. 따라서 본 연구는 갈수록 심각한 사회문제로 주목받고 있는 보험범죄를 실제 현장에서 담당하고 있는 SIU 구성원을 대상으로 현재의 근무환경과 보험범죄에 대한 일반적 인식이 그들의 직무만족에 미치는 영향에 대하여 알아보았다. 본 연구는 이러한 현장조사 분석을 바탕으로 현재 SIU 구성원들의 보험범죄 인식 및 근무 환경을 분석하고, 직무만족 향상을 통하여 구축할 수 있는 효과적인 보험범죄 대응 방안을 마련하는 데에 목적이 있다.

• 한국안전학회지
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• 제34권1호
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• pp.115-121
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• 2019

Background: Due to the diversification and advancement of research, researchers have become to deal with a variety of chemical and biological harmful materials in the laboratories of universities and research institutes and the risk has increased as well. Therefore, it is necessary to strengthen the social safety net for laboratory accidents by strengthening the compensation to the level comparable to that of Korean Workers' Compensation & Welfare Service, when the researchers become physically disabled by laboratory accidents. The purpose of this study is to secure researchers' health rights and to create a research environment where researchers can work with confidence by strengthening the compensation to the level comparable to that of Korean Workers' Compensation & Welfare Service. Method: We analyzed the laboratory accidents by year, injury type, severity of accident and disability grade with the 6 year data from 2011 to 2016, provided by Laboratory Safety Insurance. Based on the analysis result, we predicted the financial impact on Laboratory Safety Insurance if we introduce a compensation annuity by disability grade which is similar to Injury-Disease Compensation Annuity of Korean Workers' Compensation & Welfare Service. Result :As of 2011, the insured number of Laboratory Safety Insurance was approximately 700,000. The Average premium per insured was KRW 3,339 and there were 158 claims. Total claim amount was KRW 130 million, whereas the premium was about KRW 2.3 billion. The loss ratio was very low at 5.75%. If we introduce a compensation annuity by disability grade similar to Injury-Disease Compensation Annuity of Korean Workers' Compensation & Welfare Service, the expected benefit amount for 1 case of disability grade 1 would be KRW 1.6 billion, assuming 2% of interest rate. Given current premium, the loss ratio, the ratio of premium income to claim payment, is expected 41.4% in 2017 and 151.6% in 2026. The increased loss ratio due to the introduce of the compensation annuity by disability grade is estimated to be 11.0% in 2017 and 40.4% in 2026. Conclusion: Currently, laboratories can purchase insurance companies' laboratory safety insurance that meets the standards prescribed by Act on the Establishment of Safe Laboratory Environment. However, if a compensation annuity is introduced, it would be difficult for insurance companies to operate the laboratory safety insurance due to financial losses from a large-scale accident. Therefore, it is desirable that one or designated entities operate laboratory safety insurance. We think that it is more desirable for laboratory safety insurance to be operated by a public entity rather than private entities.