• Journal of Digestive Cancer Research
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• 제9권2호
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• pp.43-49
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• 2021

Background/Aims: Colonic stenting as a bridge to elective surgery is an alternative for emergency surgery in patients with acute malignant colonic obstruction. However, since its benefits are uncertain, we aimed to establish whether it has better clinical outcomes. Methods: The patients with acute malignant left-sided colon obstruction enrolled from January 2009 to December 2018 in National Health Insurance Service Ilsan Hospital. The patients were enrolled to undergo colonic stenting as a bridge to elective surgery or emergency surgery. The following oncological outcomes were assessed: incidence of complete remission, disease progression, local recurrence, and systemic recurrence. Results: Out of 40 patients, 33 received self-expanding metallic stent (SEMS) as a bridge-to-surgery, and 7 underwent emergency surgery. More stoma was made in case of emergency surgery with statistical significance (p < 0.001). There were no significant differences in complete remission rate in curable left-sided malignant colonic obstruction between SEMS as a bridge-to-surgery and emergency surgery. Complete remission was achieved for 3 patients (42.9%) in the non-stent group and 27 patients (81.8%) in the stent group. There was no statistically significant difference in oncologic outcomes between the two groups (p = 0.069). According to multi-variate analysis, advanced TNM stage, Adjuvant chemotherapy, and SEMS bridge-to-surgery were significantly associated with disease-free survival. Disease-free survival rate differed significantly between the two groups (p = 0.024). Conclusions: SEMS as a bridge-to-surgery might be an effective strategy and reduce stoma formation in acute malignant left-sided colon obstruction.

• 대한간호
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• 제32권5호
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• pp.78-92
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• 1994

The purposes of this study were to evaluate the results of the hospital self inspection with the medical insurance and to offer basic materials to the medical insurance inspection and the education of medical insurance. The study was undertaken with 4,730 cases among the total 13,810 medical insurance in patients from Jan. 1990 to Dec. 1990 at one university hospital in Pusan. The major contents of the inspection were the omission of diagnosis and medical fee, curtailment, application mistake, the rates of inclusion, subtraction and total accumulation. The data were collected using patients charts and bills. The results of the paper analysis were as follows. 1. From the pre-discharge hospital self inspection, major omission were treatment and material fee but medication fee were moderately high and high curtailment was operation fee. 2. Decreasing order of operation fee adjustment were digestive(22.4%) muscular(22%) and neuro system operation(21.4%). Majority of the medication fee adjustments were injection form of medication(95.7%). 50% of the treatment fee adjustments were composed of injection fee(27.9%) and dressing or post-operative dressing fee(22.3%). 74.7% of material costs were composed of oxygen(30.6%), blood and the blood composed materials(44.1%). 3. Pre-discharge inspection showed 6% adjustment rate, 4.3% addition and 2.1% curtailment rate. Most of the adjustment were omission(66.1%). 4. Omission were divided by event omission(92.6%)and application mistake(7.4%). The decreasing order of omission fee were operation(21.84%), treatment(18.71 %) diagnosis(18.68%), medication (14.53%) and material costs(10.84%). So operation and treatment part were the major part of the total omission fee(40.55%). 5. The average omission of diagnosis were 1,800 per month.

• 한국화재소방학회논문지
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• 제15권1호
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• pp.55-65
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• 2001

본 논문은 민간의 자율성과 책임에 입각한 자율예방체계를 현행 관주도의 소방예방체계의 대안적 틀로서 제시하고, 그 구체적인 정책적 함의를 도출한 후 자율예방체계의 구축을 위한 조건 내지는 과제로서, 화재보험으로 대표되는 보험시장의 문제점과 개선방안을 제시하고자 한다. 자율예방체계는 당사자가 책임을 지고 화제 등의 예방과 관련된 조치를 자발적으로 취하는 가운데서 국가적 소방예방체계가 구축되는 소방예방의 큰 틀로서 자기책임의 원칙, 공공재로서의 소방서비스, 자기결정주의로 구성된다. 이러한 원칙에 입각하여 현행 소방예방행정제도의 개선방안을 제시하면 자체점검업 시장의 합리화 및 자체점검 유예제도 도입, 화재보험의 제도와 기능의 활용, 예방검사의 유예와 강호 및 탄력적인 운용, 경방조사 위주의 소방검사, 정보수집과 전파를 위한 특별조사의 선용, 소방시스템평가제도의 도입, 건축허가 동의 절차의 실질화, 소방감리제도의 실질화, 화재원인조사를 위한 연구개발역량 확충, 소방안전대상/소방안전마크/모범 방화관리가 시상제도 등의 도입을 들 수 있다. 그러나 이러한 대안들중에서 핵심적인 역할이 기대되는 화재보험제도는 우리나라의 경우 l장에서 결정되는 보험요율이 실질적인 경쟁가격이 아니라는 점에서 큰 한계를 안고 있다. 하지만 장기적으로 보험시장이 개방되고 국내 손해보험업계의 과점성이 완화되면, 보험이 자율예방체계에서 차지하는 비중은 상당히 커질 것으로 기대한다.

• 한국경영과학회:학술대회논문집
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• 대한산업공학회/한국경영과학회 1992년도 춘계공동학술대회 발표논문 및 초록집; 울산대학교, 울산; 01월 02일 May 1992
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• pp.403-412
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• 1992

This note examines a situation where a risk-neutral insurer and a risk-averse individual (prospective insured) negotiate to reach an arbitration point of the price of insurance over the terms of an insurance contract in order to maximize their respective self-interests. The situation is modeled as a Nash bargaining problem. We analyze the dependence of the price of insurance, which is determined by the Nash solution, on the parameters such as the size of insured loss, the probability of a loss, the degree of risk-aversion of the insured, and the riskiness of loss distribution.

• 한국치위생학회지
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• 제16권4호
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• pp.539-548
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• 2016

Objectives: The purpose of the study is to investigate the awareness and attitude toward health insurance coverage extension to scaling in dental service consumers. Methods: A self-reported questionnaire was completed by 349 adults in Jeonbuk from May 4 to 15, 2015. The questionnaire consisted of general characteristics of the subjects (7 items), Awareness of the dental health insurance system(8 items), Health insurance system coverage extension to scaling(8 items), Self-perception of oral health(7 items), Recognition toward yearly scaling benefit(10 items). Results: There were significant differences according to age in opinions on the appropriateness of the frequency of yearly scaling benefit, and the respondents who were in their 20s, who were unmarried and who brushed their teeth three times a day had significantly different opinions on the appropriateness of the fee of yearly scaling benefit. Their opinions on the expansion of scaling benefit was significantly affected by age. It implies that scaling should be added to the coverage list of the national health insurance in every age group since there is an increase in periodontal diseases with age. Concerning awareness of dental health insurance policy, the better-educated respondents took a better view of this system as they showed a more positive interest in its policies and shifts. Conclusions: It is desirable to provide more precise information as to eligible age, frequency and cost through public promotion of health coverage of scaling, and the effort to improve the health insurance coverage policy should be made in order to extend the scope of health coverage of scaling in the near future.

• 보건교육건강증진학회지
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• 제6권2호
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• pp.23-39
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• 1989

There have been a lot of considerable. discussion and debate surrounding the management model in the health insurance management system and opinions regarding the management operating cost. It is a well known fact that there have always been dissenting opinions and debates surrounding the issue. The management operating cost varies according to the scale of the management organization and component members characteristics of the insurance carrier. Therefore, it is necessary to examine and compare the management operating cost to the simulated management models developed to cover those eligible for the health insurance scheme in this country. Since the management operating cost can vary according to the different models of management, four alternative management models have been established based on the critical evaluation of existing theories concerned, as well as on the basis of the survey results and simulation attempts. The first alternative model is the Unique Insurance Carrier Model(Ⅰ) ; desigened to cover all of the people with no classification of insurance qualifications and finances from the source of contribution of the insured, nationwide. The second is the Management Model of Large-scale District Insurance Carrier(Ⅱ) ; this means the Korean society would be divided into 21 large districts; each having its own insurance carrier that would cover the people in that particular district with no classification of insurance qualifications arid finances as in Model I. The third is the Management Model of Insurance Carrier Divided by Area and Classified with Occupation if Largescale (Ⅲ) ; to serve the self-employed in the 21 districts divided as in Model Ⅱ. It would serve the employees and their dependents by separate insurance carriers in large-scale similar to the area of the district-scale for the self-employed, so that the insurance qualifications and finances would be classified with each of the insurance carriers: The last is the Management Model of the Multi - insurance Carrier (Ⅳ) based on the Si. Gun. Gu area which will cover their own self- employed people in the area with more than 150 additional insurance carriers covering the employees and their dependents. The manpower necessary to provide services to all of the people according to the four models is calculated through simulation trials. It indicates that the Management Model of Large-scale District Insurance Carrier requires the most manpower among the four alternative models. The unit management operating costs per the insured individuals and covered persons are leveled with several intervals based on the insurance recipients. in their characteristics. The interval levels derived from the regression analysis reveal that the larger the scale of the insurance carriers is in the number of those insured and covered. the more the unit management operating cost decreases. significantly. Moreover. the result of the quadratic functional formula also shows the U-shape significantly. The management operating costs derived from the simulated calculation. on the basis of the average salary and related cost per staff- member of the Health Insurance Societies for Occupational Labours and Korean Medical Insurance Corporation for the Official Servants and Private School Teachers in 1987 fiscal year. show that the Model of Multi-insurance Carrier warrants the highest management operating cost. Meanwhile the least expensive management operating cost is the Management Model of Unique Insurance Carrier. Insurance Carrier Divided by Area and Classified with Occupation in Large-scale. and Large-scale District Insurance Carrier. in order. Therefore. it is feasible to select the Unique Insurance Carrier Model among the four alternatives from the viewpoint of the management operating cost and in the sense of the flexibility in promoting the productivity of manpower in the human services field. However. the choice of the management model for health insurance systems and its application should be examined further utilizing the operation research analysis for such areas as the administrative efficiency and factors related to computer cost etc.

• 대한소화기학회지
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• 제72권5호
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• pp.262-266
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• 2018

Surgery has been the standard treatment for perforated duodenal ulcers, with mostly good results. However, the resolution of postoperative leakage after primary repair of perforated duodenal ulcer remains challenging. There are several choices for re-operation required in persistent leakage from perforated duodenal ulcers. However, many of these choices are complicated surgical procedures requiring prolonged general anesthesia that may increase the chances of morbidity and mortality. Several recent reports have demonstrated postoperative leakage after primary repair of a perforated duodenal ulcer treated with endoscopic insertion using a covered self-expandable metallic stent, with good clinical results. We report a case with postoperative leakage after primary repair of a perforated duodenal ulcer treated using a covered self-expandable metallic stent.

• Journal of Preventive Medicine and Public Health
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• 제28권1호
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• pp.153-174
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• 1995

This study was conducted to examine the determinant factors for expenditure of the medical insurance program for self-employeds based on the analysis of 1991 'The Medical Insurance Program for Self-Employeds Statistical Yearbook', and also similar yearbooks in the metropolitan and other provinces. The major findings are as follows : We have divided benefits into these four components such as the utilization rate for out-patients, expenses per claim for out-patients as paid by the insurer, utilization rate for in-patients, and the expenses per claim for in-patients as paid by the insurer, in order to examine the determinant factors for it. The results of the study revealed the following findings, in urban areas, the supply of medical care had more influence on the benefits than other demographic and economic variables, while, in county areas, both the supply of medical care and the rate of those aged over 65 affected the provision of benefits. The determinant factors for financial balance of the medical insurance program for self-employeds are, first, the determinant factor for administrative expenses was the number of households. The more the number of households, the less the administrative expenses per the insured. This shows that the economy of scale is being. And so, the administrative district must be taken into consideration in the incorporation of small regional medical societies and should be re-organized for more efficient management. Second, in urban areas, the supply of medical care had more influence on utilization rate and expenses per claim as paid by insurer, and therefore it is necessary to control it. In county areas, the supply of medical care and the rate of those aged over 65 raised the utilization rate and expenses per claim as paid by insurer. For the financial stability of county areas, a common fund for medical care for the aged and expansion of finance stabilization fund would be necessary. But, in county areas, it would be unnecessary to control the supply of medical care because it was much more insufficient than in urban areas. The vitalization of public health facilities must be carried out in county areas, for they reduced benefits. Sice the more insured in a single household, the less the utilization of the medical insurance program, benefits for habilitation at home should be given consideration. The law of majority and the economy of scale were applied here, and therefore the incorporation of regional medical societies must be taken into consideration. In integrating regional medical societies, it would be absolutely necessary to review the structural differences among all regional medical societies, the medical demand of each region, and also the local characteristics of each region.

• 한국치위생학회지
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• 제15권6호
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• pp.1107-1116
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• 2015

Objectives: The purpose of this study was to examine awareness and satisfaction toward health insurance coverage of scaling. Methods: A self-reported questionnaire was completed by 221 patients receiving scaling service from July to August, 2014. The informed consent was approved after the explanation of purpose of the study. The questionnaire consisted of general characteristics of the subjects, awareness toward health insurance coverage of scaling, scaling service covered by health insurance, and satisfaction with health insurance service. Results: Those recognizing the health insurance service extension accounted for 87.3 percent and 67.4 percent answered that the appropriate coverage age would be 20 years old. The recommendable frequency of scaling was once a year and this accounted for 49.3 percent. Fifty percent of the subjects thought health insurance coverage of scaling would be reasonable and 34.8 percent acquired the information from mass media. The most common service providers were dental hygienists and the length of service was from 20 to 30 minutes. The contents of service included scaling service, toothbrushing method, and oral care. The satisfaction was 4.39 points. Conclusions: The health insurance coverage of scaling will improve the oral health and quality of life in Korean adults. So the government should try to extend the scaling coverage by health insurance and the frequency of scaling.

• 대한치과기공학회지
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• 제34권4호
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• pp.423-431
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• 2012

Purpose: The purpose of this study was to examine the recognition of dental technician's about including denture into the coverage of the national health insurance. Methods: This study carried out self-administered questionnaire survey from June 10, 2012 to June 20 by having research subjects as 230 dental technician. Except 22 copies with incomplete response, 208 copies were used as the materials of final analysis. Results: The recognition of dental technician on the national health insurance of denture was 48%, but there was a low recognition on the details. The rates of dental technician who approved of the inclusion of denture into the coverage of the health insurance respectively stood at 59%. Conclusion: The coverage of the health insurance should be extended to dental medicine in a manner to satisfy dental technicians, dental service providers and receivers. Also, further studies for the extending coverage of the details are needed.