• 대한안전경영과학회지
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• 제12권3호
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• pp.257-262
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• 2010

The study investigates the various Acceptance Control Charts (ACCs) based on the factors that include process independence, data weighting scheme, subgrouping, and use of control charts. USL - LSL > $6{\sigma}$ that used in the good condition processes in the ACCs are designed by considering user's perspective, producer's perspective and both perspectives. ACCs developed from the research is efficiently applied by using the simple control limit unified with APL (Acceptable Process Level), RLP (Rejectable Process Level), Type I Error $\alpha$, and Type II Error $\beta$. Sampling interval of subgroup examines i.i.d. (Identically and Independent Distributed) or auto-correlated processes. Three types of weight schemes according to the reliability of data include Shewhart, Moving Average(MA) and Exponentially Weighted Moving Average (EWMA) which are considered when designing ACCs. Two types of control charts by the purpose of improvement are also presented. Overall, $\alpha$, $\beta$ and APL for nonconforming proportion and RPL of claim proportion can be designed by practioners who emphasize productivity and claim defense cost.

• 논리연구
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• 제11권2호
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• pp.93-125
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• 2008

원초적 확률주의자들은 명제가 경험을 표상한다는 것을 거부한다. 그러나 경험의 영향은 다른 믿음에 전파되고, 다른 사람과 소통될 수 있어야 하기 때문에 명제와 다른 방식으로 경험, 혹은 경험의 영향을 표상할 수 있는 대안을 찾아야 한다. 그들이 제안하는 경험의 영향을 표상하는 유력한 대안은 베이즈 인수이다. 왜냐하면 베이즈 인수는 사전확률의 영향을 제외하고 있으며, 교환성 역시 성립하기 때문이다. 본 논문은 베이즈 인수만이 그런 역할을 하는 것이 아니라고 주장한다. 즉 베이즈 인수의 대안으로 제시된 q(E|$N_p$) 역시 사전확률의 영향이 제외되어 있으며, 교환성 또한 성립한다는 것을 보인다. 그리고 더 나아가 q(E|$N_p$)는 베이즈 인수가 결여한 프래그마틱한 장점을 가진다고 주장한다.

• 한국치위생학회지
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• 제11권3호
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• pp.325-341
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• 2011

Objectives : This research has investigated the reality of the education of the claim and the degree of the education for the claimed of the dentistry recuperation organization in the Daejeon and Chuncheong are for the improvement of the problem in the medical expenses. Methods : It use as a basic data for the vitalizations of the education and performed the survey in the dentistry recuperation organization in the Daejeon and ChungCheong Nam BukDo which are registered in the evaluating organization for judging the health insurance in the present May 2010, and concluded just like the below. Results : 1. The education of the claim in the requirer in the dentistry recuperation organization, and the education of the claim was especially lacking when the dentist was studying in the university, and the dental hygienist had the similar educational experience in the school and the clinic (p<0.05) 2. Most of the requirer in the dental recuperation organization was hoping to get the education related to the claim work, but the dentist and the nurse's aid was relatively low (p<0.05) 3. For fixing the error of the claim, the participation and the extension of the judging standard of the insurance was the highest among the university subordinate dental hospital/dental hospital, but the health center was relatively low (p<0.05). 4. The dentist feels the economic burden in employing the special employee because the raising of the special judging people, compared to others, but the staffs such as the dental hygienist preferred it as one of ways to fix the error of the claim of the dental insurance (p<0.05) 5. Both dentists and the dental hygienist said proper time to teach the insurance was all needed in the school, and the clinic, but other workers relatively believed it should be held in the clinic (p<0.05). 6. The important factors to decide the participation of the lecture was in order of the contents of the lecture, the place of the lecture, the amount for the lecture, the superintendent of the lecture, whether it has gone through the educational score, and whether it has passed the conserving educational score was relatively less important in the university subordinate dentist/dentist, but the medical center was very effective as 4.50 (p<0.05) 7. Health Insurance Review and assessment service was very high as the managing department for supplying the lecture and the information, 70.5%, and the next was the Korean Dental Association/ Korean dental hygiene association, but dentists were preferring the association to manage in than the Health Insurance Review and assessment service to manage (p<0.05) 8. In preferring lecture for the inquiring the insurance, periodontal surgery was the highest as 4.51, the diagnosis standard for injection was high in the university subordinate hospital/dentists, and the more the year of the insurance inquiry, the less the doctor who was hoping for the lecture about the basic treatment. Conclusions : Taken together, it is decided that the inquiry education about the medical expense in the dentist, so the consistent and systematic education should be held to the related people, and from this, it is thought to reduce the problem of the inquiry of the medical expenses by fostering the knowledge and supplying the information which are related to the inquiry of the dentists.

• 보건행정학회지
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• 제34권2호
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• pp.163-177
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• 2024

연구배경: 본 연구는 부당청구 예방형 자율점검제 시범사업의 "개선요청 통보 및 모니터링" 중재활동이 의료기관의 중재 실시 전과 후 청구건수와 청구총진료비 청구행태에 있어서의 변화를 검증하고자 하였다. 방법: 자료는 건강보험심사평가원의 2021년 7월부터 2022년 2월까지 시범사업 항목인 '정맥 내 일시주사(KK020)'를 청구한 기관 중 예방형 자율점검제 대상기관으로 선정된 1,129개 의료기관의 청구자료와 신고 현황자료를 활용하였다. 비교 대상을 선정하기 위해 1:3 비율로 성향점수매칭을 사용하였고, 청구행태 변화를 검증하기 위해 대응표본 t-검정과 t-검정을 실시하였다. 또한 청구행태 변화에 차이가 있는 경우 이에 영향을 미치는 요인분석을 위하여 회귀분석을 시행하였다. 결과: 중재 실시 전과 후의 청구행태는 실험군의 모든 의료기관 종별에서 청구건수와 청구총진료비가 유의하게 감소하였고, 의원의 대조군에서는 유의한 증가를 보였다. 의료기관 및 의사 특성에 따른 중재 실시 전·후 청구행태는 실험군은 의원의 의사 연령 40세 미만을 제외하고 모든 종별에서 유의하게 감소하였다. 대조군은 종합병원과 병원은 개원기간에서, 의원은 표시과목에서 일부 유의한 감소가 있었고, 의사 50세 이상 남성에서 유의하게 증가한 것으로 나타났다. 실험군 대상 의료기관의 청구행태에 변화에 대한 회귀분석 결과, 모든 종별에서 중재 실시 전과 후에 청구건수와 청구총진료비가 유의하게 감소하였다. 또한 의료기관과 의사 특성에서 병원은 개원기간이 길수록 유의한 증가를 나타났고, 의원은 소재지역과 표시과목(기타)에서 유의한 감소를 보였다. 결론: 실험군의 부당청구 예방형 자율점검제의 중재 실시 이후 청구경향의 변화가 연구가설대로 감소하는 경향을 보였다. 이는 제도 시행 직후에 의료기관 스스로 청구행태를 개선하고, 교정하는 사전예방적 활동의 효과가 존재하는 것으로 나타났다. 또한 대조군에서도 통보 대상기관 위주의 제도운영방식에도 불구하고 일부 유의한 감소가 나타난 것은 예방형 자율점검제의 간접적인 효과로 볼 수 있다. 따라서 비대상기관에도 청구행태 개선활동이 이루어질 수 있도록 적극적인 홍보와 교육, 간담회 등의 추가적인 지원과 지속적인 모니터링이 필요하다. 이를 통해 부당청구가 감소될 수 있도록 예방형 자율점검제를 확대하는 것이 바람직하다.

• 한국보건간호학회지
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• 제28권3호
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• pp.522-535
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• 2014

Purpose: This study was constructed in order to examine factors that influence work-related musculoskeletal disease (WMSD) approvals and current status according to the company size. Method: This is a descriptive study that utilized Industrial Accident Compensation Claim Data. Workplaces with over 35,811 workers derived from the 2012 claim data, which comprised approximately 91.5%, were selected for this study. Then workplaces were divided into three groups according to the number of workers: less than 5, 5~299, and 300 and over. Results: Since 2008, the number of small sized workplaces has increased. The 2012 data showed that 32.5% of workers at small sized workplace had WMSD. However, workplaces with 5~299 workers showed WMSD approval rate of 60%. Of note most WMSD approved workers were employed by manufacturing and construction companies, regardless of the workplace size. Most of them were engaged in elementary tasks. The days of medical treatment at OPD and IPD were most prevalent among workers at the largest workplaces. Conclusions: It is certain from this study that WMSD has been polarized by the company size. More policy attention should be paid to the WMSD status of workers at small sized workplaces which usually do not have their own health office.

• 보험의학회지
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• 제27권2호
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• pp.96-106
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• 2008

다음은 위의 모든 결과를 바탕으로 디스크 질환의 입원기간이 길어지고 재발이 일어날 수 있는 나쁜 조건 (NEGATIVE)과 그 반대인 좋은 조건(Positive)을 table로 정리하였다. 좋은 조건은 같은 추간판 탈출 기왕력자라고 하더라도 예후에 긍정적인 가능성을 주는 조건이다. 따라서 심사할 때 table를 토대로 고지내용이 좋은 조건인지, 나쁜 조건인지 판단 할 수 있고 추가 질문사항을 요청하는데 도움이 될 수 있을 것이다. 만약 입원을 했더라도 며칠을 입원했는지. 재수술을 하였다면 어떻게 했는지, 직장인의 경우 현재 어떤 조건인지, 수술을 했다면 구체적으로 수술명이 무엇인지, 수술 후 술, 담배를 하였는지, 수술 후 현재 상태가 어떤지에 따라 인수 여부를 결정하는데 도움이 될 것이라고 생각한다.

• 의료법학
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• 제8권1호
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• pp.137-177
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• 2007

The medical expenses review system in Korea has developed under fee-for-service system with its own unique structure. The importance of reviewing medical expenses has been emphasized, as the size of medical expenditures moving through the health insurance legal context and its weight in the national economy have increased very rapidly. It is, however, analyzed that the feuds and arguments continue among the stakeholders for the lack of laws supporting the medical expenses review system. The medical expenses review is a series of administrative procedures, deciding whether claims from medical care institutions to the insurer are legal and valid or not. It mainly controls the increase of unnecessarily excessive health insurance claim and prevents fraudulent claim and abuse and checks the less use or unsuitable use of medical resources. It also works a function guarantees medical benefits for the appropriate treatment according to the object of health insurance system as a social insurance scheme. The dispute on legal base of the medical expenses review is about the source of law in the medical expenses review. There are the Health Insurance Act and administrative laws as jus scriptum and the guidelines of review as administrative orders. The medical expenses review should reflect various factors, such as the development of medical healthcare technologies, the health expenditures distribution, the financial situation of the health insurance, and the evaluation on the level of appropriate benefits. It is also likely to adapt to the traits of characters of medicine, and trends and transition, Besides it should judge the legality and the validity of medical benefits expenditures by synthesizing these all factors. And the evaluation system of appropriateness of medical benefits was administrative procedure which was consecutive with reviewing the medical expenses system and it was intended to make up for the result of reviewing the medical expenses in more comprehensive levels.

• 보건행정학회지
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• 제16권2호
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• pp.49-76
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• 2006

The aim of this study was to explore the effects of a computerized review program which was introduced in August 1, 2003, using claims data for acute respiratory infection related diseases. National Health Insurance (NHI) claims data on respiratory infection related diseases before and after the introduction, with six month intervals respectively, were used for the analysis. Clinic was the unit of observation, and clinics with only one physician whose specialty was internal medicine, pediatrics, otorhinolaryngology and family medicine and clinics with a general practitioner were selected. The final sample had 7,637 clinics in total. Indices used to measure practice pattern was prescription rates of antibiotics, prescription rates of injection drug per visit, treatment costs per claim, and total costs per claim. Changes in the number of claims for major disease categories and upcoding index for disease categories were used to measure claiming behavior. Data were analysed using descriptive analysis, t-test for indices changes before and after the introduction, analysis of variance (ANOVA) for practice pattern change for major disease categories, and multiple regression analysis to identify whether new system influenced on provider' practice patterns or not. Prescription of antibiotics, prescription rates of injection drug, treatment costs per claim, and total costs per claim decreased significantly. Results from multiple regression analysis showed that a computerized review system had effects on all the indices measuring behavior. Introduction of the new system had the spillover effects on the provider's behavior in the related disease categories in addition to the effects in the target diseases, but the magnitude of the effects were bigger among the target diseases. Rates of claims for computerized review over total claims for respiratory diseases significantly decreased after the introduction of a computerized review system and rates of claims for non target diseases increased, which was also statistically significant. Distribution of the number of claims by disease categories after the introduction of a computerized review system changed so as to increase the costs per claims. Analysis of upcoding index showed index for 'other acute lower respiratory infection (J20-22)', which was included in the review target, decreased and 'otitis media (H65, H66)', which was not included in the review target, increase. Factors affecting provider's practice patterns should be taken into consideration when policies on claims review method and behavior changes. It is critical to include strategies to decrease the variations among providers.

• 한국융합학회논문지
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• 제12권10호
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• pp.137-144
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• 2021

이 연구는 치과 종사자들의 치과 건강보험 교육경험 및 교육요구도와 산정기준에 대한 지식수준에 미치는 요인을 분석하는 것을 목적으로 한다. 대구·경북 지역의 치과 종사자들을 연구대상으로 하였으며, 구글 설문지를 활용한 온라인 조사를 실시하였다. 연구대상자의 일반적 특성, 교육 경험, 교육 경험 및 교육요구도에 따른 지식수준을 알아보기 위하여 빈도분석과 교차분석 및 ANOVA분석을 사용하였다. 분석 결과, 치과 건강보험에 대한 지식수준 조사에서 청구 프로그램에서 자동으로 처리를 해주거나 오류창으로 알려주는 경우의 산정기준에 대한 오답률이 높았다. 근무경력이 많고 치과에서 보험청구를 하고 있거나 최근 6개월 동안 치과보험 교육 경험이 있는 대상자들에서 산정기준에 대한 지식수준이 높았다. 결론적으로, 정기적인 치과 건강보험 교육을 통해 변경되는 산정기준을 숙지하도록 해야만 정확하고 올바른 보험청구가 가능하다고 보여진다. 이 연구는 치과 종사자들의 전문적인 치과 보험청구를 위한 교육체계 마련에 기초자료를 제공할 것으로 기대한다.

• 영어어문교육
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• 제12권2호
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• pp.19-40
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• 2006

This paper deals with a part-specific analysis of grammatical errors in the production of the English passive in writing. The purpose of the study is dual: to explore common error types in forming the passive; and to provide plausible sources of the errors, with special attention to the role of the native language. To this end, this study obtained a large amount of data from Korean EFL university students using an essay writing task. The results show that in forming the passive sentence, errors were made in various ways and that the most common problem was the formation of the be-auxiliary, in particular, the proper use of tense and S-V agreement. Another important finding was that the global errors found in this study were not necessarily those with the greatest frequency. Also corroborated was the general claim that many factors work together to account for errors. In many cases, interlingual and intralingual factors were shown to interact with each other to explain the passive errors made by Korean students. On the basis of the results, suggestions are made for effective and well-formed use of the passive sentence.