• Journal of Korean Public Health Nursing
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• v.31 no.1
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• pp.5-18
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• 2017

Purpose: This study was conducted to suggest a method for financial projection of health insurance expenditures that reflects future changes in demographic structure. Methods: Using data associated with the number of patients and health insurance cost per patient, generalized linear models (GLM) were fitted with demographic explanatory variables. Models were constructed separately for individual medical departments, types of medical service, and types of public health insurance. Goodness-of-fit of most of the applied GLM models was quite satisfactory. By combining estimates of frequency and severity from the constructed models and results of the population projection, total annual health insurance expenditures were projected through year 2060. Results: Expenditures for medical departments associated with diseases that are more frequent in elderly peoples are expected to increase steeply, leading to considerable increases in overall health insurance expenditures. The suggested method can contribute to improvement of the accuracy of financial projection. Conclusion: The overall demands for medical service, medical personnel, and relevant facilities in the future are expected to increase as the proportion of elderly people increases. Application of a more reasonable estimation method reflecting changes in demographic structure will help develop health policies relevant to above mentioned resources.

• The Journal of Asian Finance, Economics and Business
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• v.6 no.1
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• pp.241-248
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• 2019

The purpose of this study is to investigate empirical evidences of productivity of life insurance institutions in Malaysia. Therefore, this study attempts to explore the productivity of the life insurance institutions in Malaysia. The overall findings show that the total factor productivity (TFP) has progressed by 2.5% per year during the study period from 2012 to 2016 in the Malaysian insurance industry. However, TFP change has declined from 2012 to 2015 and observed a negative growth in 2015-16 (3.3%). The highest productivity progress was documented during 2012-13 at a rate of 11.7% while the minimum productivity progress was during 2014-15 (only 0.2%). The results also indicate that the decomposition of TFP found that overall progress could mainly be attributed to technological change (TC). However, technical efficiency change (TEC) and pure technical efficiency change (PTE) have negative impact on TFP. The findings also show that most of the insurance companies have a steady growth. Therefore, this study will contribute new insights for the policy makers and insurance institutions to take appropriate steps in developing relevant policies for increasing productivity of insurance institutions in Malaysia.

• Korea Trade Review
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• v.44 no.3
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• pp.137-154
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• 2019

This study analyzes the major provisions of the UK Insurance Act 2015 and Marine Insurance Act 1906 on the duty of disclosure under the doctrine of utmost good faith. Marine insurance contracts are based on "utmost good faith" and one aspect of this is that MIA 1906 imposes a duty on prospective policy holders to disclose all material facts. In the Insurance Act 2015 of the United Kingdom, the contents of the precedent were enacted such that we have borrowed the legal principles of common law until now. The insurer is required to more actively communicate with the insurer rather than passively underwriting and asking questions of the insured. The Act details the insured's constructive knowledge of the material circumstance by reviewing the current case law and introduces a new system for the insurer's proportionate remedy against the insured's breach of the duty of fair presentation of risk. This is a default regime, which may be altered by agreement between the parties.

• Health Policy and Management
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• v.28 no.3
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• pp.263-271
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• 2018

Health technology assessment (HTA) is defined as multidisciplinary policy analysis to look into the medical, economic, social, and ethical implications of the development, distribution, and use of health technology. Following the recent changes in the social environment, there are increasing needs to improve Korea's healthcare environment by, inter alia, assessing health technologies in an organized, timely manner in accordance with the government's strategies to ensure that citizens' medical expenses are kept at a stable level. Dedicated to HTA and research, the National Evidence-based Healthcare Collaborating Agency (NECA) analyzes and provides grounds on the clinical safety, efficacy, and economic feasibility of health technologies. HTA offers the most suitable grounds for decision making not only by healthcare professionals but also by policy makers and citizens as seen in a case in 2009 where research revealed that glucosamine lacked preventive and treatment effects for osteoarthritis and glucosamine was subsequently excluded from the National Health Insurance's benefit list to stop the insurance scheme from suffering financial losses and citizens from paying unnecessary medical expenses. For the development of HTA in Korea, the NECA will continue exerting itself to accomplish its mission of providing policy support by health technology reassessment, promoting the establishment and use of big data and HTA platforms for public interest, and developing a new value-based HTA system.

• Journal of Intelligence and Information Systems
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• v.6 no.1
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• pp.73-82
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• 2000

This study examined the characteristicso f the knowledge discovery and data mining algorithms to demonstrate how they can be used to predict health outcomes and provide policy information for hypertension management using the Korea Medical Insurance Corporation database. Specifically this study validated the predictive power of data mining algorithms by comparing the performance of logistic regression and two decision tree algorithms CHAID (Chi-squared Automatic Interaction Detection) and C5.0 (a variant of C4.5) since logistic regression has assumed a major position in the healthcare field as a method for predicting or classifying health outcomes based on the specific characteristics of each individual case. This comparison was performed using the test set of 4,588 beneficiaries and the training set of 13,689 beneficiaries that were used to develop the models. On the contrary to the previous study CHAID algorithm performed better than logistic regression in predicting hypertension but C5.0 had the lowest predictive power. In addition CHAID algorithm and association rule also provided the segment characteristics for the risk factors that may be used in developing hypertension management programs. This showed that data mining approach can be a useful analytic tool for predicting and classifying health outcomes data.

• Korean Journal of Clinical Pharmacy
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• v.27 no.3
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• pp.186-194
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• 2017

Objectives: A significant concern has been raised about the emerging resistance that is largely caused by the excessive or inappropriate use of antibacterial agents for viral respiratory infections. This study investigated the trend of respiratory tract infections (RTIs) and the use of antibiotics. Methods: Utilizing the national level health insurance claims data from 2005 to 2008, we examined encounter days, antibiotic use, and the prescription rate for respiratory tract infections including upper respiratory tract infections (URTIs), lower respiratory tract infections (LRTIs), and otitis media in outpatient settings. The antibiotic use was measured as defined daily dose per 1,000 patients per day (DDD/1,000 patients/day). Results: The visit for URTI increased from 141,693,465 in 2005 to 120,717,966 in 2008 and the visit for LRTI decreased from 61,778,718 to 66,930,122. For RTIs, prescription rates of antibiotics decreased from 65.2% to 58.5% for URTIs and 76.9% to 68.3% for LRTIs from 2005 to 2008. The antibiotic use decreased to 20.85 DDD/1,000 patients/day after a significant increase of 22.01 DDD/1,000 patients/day in 2006. Among antibiotics, J01CR had the highest use- 7.93 DDD/1,000 patients/day followed by J01DC of 3.71 DDD/1,000 patients/day and J01FA of 3.2 DDD/1,000 patients/day. One notable trend is that J01FA presented a continuous increase in antibiotic use from 2.3 in 2005 to 3.26 DDD/1,000 patients/day in 2008. Conclusion: The use of antibiotics had poor compliance to guidelines for RTIs. Despite decrease in the use of antibiotics, prescription rates for URTIs were still about 50% indicating that the delayed prescribing antibiotics (or wait-and-see) were not observed.

• Journal of Society of Preventive Korean Medicine
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• v.10 no.2
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• pp.147-158
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• 2006

The purpose of this paper is to review the empirical study results of conversion factors(unit prices) for relative values of health care services in the national health insurance system and establish optimal classification of health care institutions for feasible contract of conversion factors between National Health Insurance Corporation(NHIC) and provider groups, based on legal backgrounds and types of health care service delivery system. some empirical research evidences shows the validity of applying multiple conversion factors to annual contract for reimbursement in the national health insurance. Policy recommendations suggest that clinic, hospital, general hospital, tertiary hospital, dental clinic, oriental medical clinic, pharmacy, and public health centers would be a basic category of provider groups for a meaningful price contract between the NHIC and providers.

• Journal of Preventive Medicine and Public Health
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• v.12 no.1
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• pp.99-106
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• 1979

Accessibility to medical facilities and personnels has been known as one of important determinants of medical care utilization. This study attempted to identify the effects of medical accessibility in terms of geographical distance and occupational opportunity to the medical utilizations. Two-year-experiences of Yonsei University Health Insurance Cooperatives were used as the sources of data. Out patient utilization patterns of 713 members sampled from 4,352 members of Health Insurance Cooperatives were analyzed in order to identify the effects of medical accessibilities. Findings: 1 Average clinic visit rate of Yonsei Health Insurance is 1.66 per person per year. 2. The utilization rates of geographically more accessible group were 33% higher than that of less accessible group. 3. No marked difference in clinic visit rate were observed between medical and non-medical personnel and their family members. 4. Clinic visit rates among occupationally accessible group were slightly higher than those of less accessible. The utilization rate was more sensitively changed by the insurance policy changes in occupationally accessible group.

• Journal of Korean society of Dental Hygiene
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• v.12 no.4
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• pp.751-758
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• 2012

Objectives : This study aimed to seek the national health insurance coverage and the efficient direction of toothbrushing instruction and to contribute to establishing policy as auxiliary data, targeting 373 dental hygienists who are working in some areas of Jeonnam. Methods : A research method was questionnaire survey by individually self-administration method. Results : It was indicated to agree to the national health insurance coverage of toothbrushing instruction in the better understanding and cooperation level with toothbrushing instruction, in case of carrying out toothbrushing instruction, and in the higher age group. Conclusions : There will be a need of allowing the national health insurance coverage to be formed in the direction at which the dental service providers and the dental service consumers can be satisfied, by being performed a comprehensive and sufficient research for this.

• Proceedings of the Safety Management and Science Conference
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• 2013.04a
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• pp.557-564
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• 2013

This study investigates the delay declaration of the traffic insurance accident which is focused on a business truck causing the traffic insurance accident. The type of the delay declaration is classified as 15 types and it differs in level of payment of insurance money. It is most important that the support policy of government and the self-help of related business to reduce the delay declaration and pursue progressive solution. Moreover, it is essential not only introducing the strict regulation system but also adapting the various victim protection system.