• Communications for Statistical Applications and Methods
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• v.28 no.5
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• pp.447-462
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• 2021

In insurance, the surrender rate is an important variable that threatens the sustainability of insurers and determines the profitability of the contract. Unlike other actuarial assumptions that determine the cash flow of an insurance contract, however, it is characterized by endogenous variables such as people's economic, social, and subjective decisions. Therefore, a microscopic approach is required to identify and analyze the factors that determine the lapse rate. Specifically, micro-level characteristics including the individual, demographic, microeconomic, and household characteristics of policyholders are necessary for the analysis. In this study, we select panel survey data of Korean Retirement Income Study (KReIS) with many diverse dimensions to determine which variables have a decisive effect on the lapse and apply the lasso regularized regression model to analyze it empirically. As the data contain many missing values, they are imputed using the random forest method. Among the household variables, we find that the non-existence of old dependents, the existence of young dependents, and employed family members increase the surrender rate. Among the individual variables, divorce, non-urban residential areas, apartment type of housing, non-ownership of homes, and bad relationship with siblings increase the lapse rate. Finally, among the financial variables, low income, low expenditure, the existence of children that incur child care expenditure, not expecting to bequest from spouse, not holding public health insurance, and expecting to benefit from a retirement pension increase the lapse rate. Some of these findings are consistent with those in the literature.

• Journal of Society of Preventive Korean Medicine
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• v.28 no.1
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• pp.69-87
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• 2024

Objectives : This study is to investigate the current National Health Insurance Database cohort studies related to complications of Parkinson's Disease (PD) and suggest the design of Korean medical epidemiological studies of PD. Methods : Nationwide longitudinal studies of PD patients in South Korea were collected through Pubmed and the Korea Citation Index (KCI). We selected cohort studies that used the National Health Insurance Database in Korea and targeted Parkinson's disease patients. Studies published before February 2024 were categorized according to study designs. We examined variables and covariates, enroll dates and matching methods. Results : Of a total of 536 studies, 18 studies met the inclusion criteria. All studies used the National Health Insurance (NHI) Research Database and among them, 5 used sample data and one senior database. Studies can be classified into two types. 11 cohort studies were comparing PD patients and non-PD patients. Another type was 4 PD patients cohort studies. Most studies used two diagnostic codes (G20 and V124) for inclusion criteria. Enroll periods were from 2002 to 2017, and follow-up periods were from 7 to 14 years. 16 studies considered age and sex as covariates. 15 studies used the propensity score matching method to increase the level of causality. There was only one study related to the Korean medical treatment. Conclusion : In future cohort studies on Korean medical treatment, more attempts should be made to reveal the effect of the treatments on PD patients by defining inclusion criteria for patient groups, covariates, exposure variables, and assessment indicators more operatively.

• Journal of Korean Foot and Ankle Society
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• v.16 no.3
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• pp.175-180
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• 2012

Purpose: To evaluate the radiological and clinical results after open reduction and internal fixation with calcaneal F plate and locking calcaneal plate using lateral extensile approach in the treatment of intra-articular calcaneal fracture Materials and Methods: This study included 34 cases of 33 patients followed up for at least 6 months postoperatively. F plate was applied in 18 cases (Group 1), locking plate was used in 16 cases (Group 2) and compared radiological and clinical results between two groups. Results: Radiollogically, the mean Bohler angle was improved from $5.5^{\circ}$ preoperatively to $20.1^{\circ}$ postoperatively and $18.8^{\circ}$ at the last follow up in group 1 and $8.6^{\circ}$ preoperatively, $21.4^{\circ}$ postoperatively and $20.3^{\circ}$ at last follow up in group 2. Bone union was observed in all cases and 4 cases of screw loosening were noted in Group 1 with extended fracture to anterior process. At the last follow up, both groups showed clinical results in American orthopedic foot and ankle society ankle hindfoot score, 76(77 in Sanders type II and 75 in type III) in group 1 and 72(73 in type II and 70 in type III) in group 2. Conclusion: F plate and locking plate showed firm fixation and satisfactory clinical results in the treatment of intra-articular calcaneal fracture. We suggest applying locking plate in cases with extended fracture to anterior process, considering screw loosenings in those who were treated with F plate fixation.

• Journal of the Korean Society of Safety
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• v.34 no.1
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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.

• Korean Journal of Clinical Pharmacy
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• v.26 no.2
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• pp.128-136
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• 2016

Objective: This study was to explore the association between having a usual source of care and adherence to medicines in patient with chronic diseases. Methods: The 2012 Korea Health Panel was used as a data source. We analyzed 4,418 respondents that were diagnosed with chronic diseases and utilized health care services. Non-adherence to medication, a dependent variable, was defined as "not taking the medicines that were prescribed for treating chronic disease" or "not following the direction for medication". Whether having a usual source of care or not was used as a key independent variable, which was defined as having a regular site or a regular doctor for medical test, treatment, and consultation. Sex, age, education level, marital status, income, the type of health insurance, the number of chronic disease and CCI (Charlson Comorbidity Index) were included as covariates in the analysis. We conducted a multivariate logistic regression. Results: Totally, 30 percent of respondents reported to experience non-adherence to medication. Having a usual source of care was significantly associated with lower non-adherence to medication regardless its type, which is a regular doctor (OR=0.61, 95% CI=0.53-0.70) or a regular site (OR=0.67, 95% CI=0.58-0.78). Furthermore, having a usual source of care was associated with both of medication persistence (OR=0.66, 95% CI=0.54-0.81) and compliance (OR=0.65, 95% CI=0.56-0.76). Conclusion: Our results showed the possibility that usual source of care is able to conduct a positive role in improving adherence to medication with better management of chronic disease.

• Journal of Preventive Medicine and Public Health
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• v.56 no.2
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• pp.180-189
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• 2023

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has led to a global shortage of medical resources; therefore, we investigated whether COVID-19 impacted the quality of non-COVID-19 hospital care in Korea by comparing hospital standardized mortality rates (HSMRs) before and during the pandemic. Methods: This retrospective cohort study analyzed Korean National Health Insurance discharge claim data obtained from January to June in 2017, 2018, 2019, and 2020. Patients' in-hospital deaths were classified according to the most responsible diagnosis categories. The HSMR is calculated as the ratio of expected deaths to actual deaths. The time trend in the overall HSMR was analyzed by region and hospital type. Results: The final analysis included 2 252 824 patients. In 2020, the HSMR increased nationwide (HSMR, 99.3; 95% confidence interval [CI], 97.7 to 101.0) in comparison to 2019 (HSMR, 97.3; 95% CI, 95.8 to 98.8). In the COVID-19 pandemic zone, the HSMR increased significantly in 2020 (HSMR, 112.7; 95% CI, 107.0 to 118.7) compared to 2019 (HSMR, 101.7; 95% CI, 96.9 to 106.6). The HSMR in all general hospitals increased significantly in 2020 (HSMR, 106.4; 95% CI, 104.3 to 108.5) compared to 2019 (HSMR, 100.3; 95% CI, 98.4 to 102.2). Hospitals participating in the COVID-19 response had a lower HSMR (HSMR, 95.6; 95% CI, 93.9 to 97.4) than hospitals not participating in the COVID-19 response (HSMR, 124.3; 95% CI, 119.3 to 129.4). Conclusions: This study suggests that the COVID-19 pandemic may have negatively impacted the quality of care in hospitals, especially general hospitals with relatively few beds. In light of the COVID-19 pandemic, it is necessary to prevent excessive workloads in hospitals and to properly employ and coordinate the workforce.

• Health Policy and Management
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• v.30 no.1
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• pp.82-91
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• 2020

Background: This study investigates the influence factors of medical service variations using medical charge and the length of stay (LOS) for urinary incontinence surgery and uterine polypectomy. Methods: The National Health Insurance claims data and Medical Resource Report by the Health Insurance Review & Assessment Service in 2016 were used. Frequency analysis, one-way analysis of variance, and Bonferroni post-hoc tests were executed for each surgery. A multilevel analysis was executed to assess the factors to the medical charge and LOS for each surgery in patient, doctor, and hospital level. Results: Fifty-two point eight percent of urinary incontinence surgery and 87.1% of uterine polypectomy were distributed in general and tertiary hospitals. Among three levels, the patient level variation was 61.5% or 77.2% in medical charge and 93.9% or 96.3% in LOS, respectively. The doctor level variation was 29.6% or 22.6% in medical charge and 0.6% or 0.0% in LOS, respectively. The institution level variation was 8.9% or 0.2% in medical charge and 5.5% or 3.7% in LOS, respectively. Number of other disease and organizational type were main factors that affected the charge and LOS for urinary incontinence surgery and uterine polypectomy. Conclusion: Medical service variations of the urinary incontinence surgery and uterine polypectomy were the largest for the patient level, followed by doctor level for the medical charge, and the institution level for the LOS.

• Journal of muscle and joint health
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• v.29 no.1
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• pp.41-49
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• 2022

Purpose: The purpose of this study was to assess the influence of nurses staffing level on patient health outcomes in intensive care units (ICUs) in Korea. Methods: The study was retrospective in nature. Information on patients and their outcomes, as well as nurse cohort data, were obtained from Korea's National Health Insurance Service Database. The observation period was from January 1, 2008 to December 31, 2018, and data for 2,964,991 patients were analyzed. Independent variables included patient' age and sex and hospital type, intensivist, and nurses staffing level. Results: The mortality rate in ICUs was significantly higher at tertiary hospitals with a level 3~4 (HR, 1.21; 95% confidence interval, 1.19~1.22) or level 5~9 nurse staffing (HR, 1.31; 95% confidence interval, 1.27~1.34) compare to that of tertiary hospitals with a 1~2 level. 28-day mortality rate was also higher at general hospitals with a level 3~4 (HR, 1.13; 95% confidence interval, 1.12~1.14), level 5~6 (HR. 1.34; 95% confidence interval, 1.32~1.36), level 7~9 nurse staffing (HR, 1.38; 95% confidence interval, 1.38~1.42), using level 1~2 as reference. Conclusion: Nurses staffing level is a key determinant of healthcare-associated mortality in critically ICUs patients. Policies to achieve adequate nurse staffing levels are therefore required to enhance patient outcomes.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.5
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• pp.607-614
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• 2020

This secondary analysis study used the 2015 Korea Health Panel data to identify the difference of factors affecting the quality of life (QoL) of Korean adults with diabetes mellitus (DM). The data from 1,343 subjects who met the criteria for screening was analyzed by multiple linear regression and quantile regression analyses. As a result, the average QoL of the subjects was .86 (±.14). The factors affecting the QoL of the subjects were age, gender, education level, spouse, economic activity, type of health insurance, and regular physical activity (all p<.05). However, there were differences of the results when dividing the subjects into three groups according to their QoL level. The factors for the lower 25% group were age, gender, education level, spouse, economic activity, type of health insurance, and regular physical activity, and those factors for the middle 50% group were age, gender, education level, spouse, type of health insurance, and regular physical activity, and those factors for the top 75% group were spouse, economic activity, household income, type of health insurance, and duration of DM. Based on these results, it is important to develop and provide a differentiated intervention strategy that considers the influential factors in order to improve the QoL of Korean adults with DM.

• Journal of the korean academy of Pediatric Dentistry
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• v.50 no.3
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• pp.292-306
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• 2023

Antibiotics are used for the prevention and treatment of infections. This study aimed to investigate the patterns of dental antibiotic prescription in children and adolescents. The Health Insurance Review and Assessment Service provided data on patients who visited medical institutions. It was categorized according to year, sex, age, insurance type, dental institution, and region. Chi-square tests, Fisher's exact tests, and one-way analyses of variance were performed. Statistical analyses were performed using SAS software (ver. 9.2; SAS Institute, Cary, NC, USA). Amoxicillin and cephalosporins, the most commonly used antibiotics, accounted for approximately 96% of the prescriptions. The younger the child, the more antibiotics were prescribed for trauma, pulpitis, and dental abscesses. However, closer to adolescence, the antibiotics were primarily prescribed to manage impacted teeth and periodontal problems. Antibiotics were prescribed for 3.13 days on average. There were significant differences in the prescription rates according to age, sex, type of insurance, type of medical institution, and region (p < 0.05). This study suggested that antibiotic prescriptions should be closely monitored to ensure appropriate usage of antibiotics.