• Title/Summary/Keyword: public claim

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Determinant Factors for Expenditure of the Medical Insurance Program for Self-Employeds (지역의료보험(地域醫療保險) 재정지출(財政支出)의 결정요인(決定要因))

  • Kam, Sin;Park, Jae-Yong;Yeh, Min-Hae
    • Journal of Preventive Medicine and Public Health
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    • v.28 no.1 s.49
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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.

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A Study on Limitation of Public Performance Right for Library Service (도서관에서의 공연권 제한에 관한 연구)

  • Lee, Ho-Sin
    • Journal of the Korean Society for Library and Information Science
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    • v.47 no.1
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    • pp.249-268
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    • 2013
  • Public Performance in Copyright Law is a wider concept, which people generally think. It includes the presentation of a work to the public by acting, musical playing, singing, narrating as well as even the act of mechanical playing phonogram and cinematographic work. Article 29 in Korean Copyright Act is the restriction of an author's public performance right. It shall be permissible to perform publicly or broadcast a work already made public for nonprofit purposes and without charging any fees to audience, spectators, or third parties, provided that the performers concerned are not paid any remuneration for such performances. Commercial phonograms or cinematographic works may be played back for the public, if no fee is charged to the audience or spectators, except in cases as set forth by Presidential Decree. In recent year, public performance in libraries became a major issue of the Copyright Law. It is a claim that watching cinematographic works in libraries is one of the act that should apply public performance right, thus to use commercial cinematographic works before six months, which was published, need permission to copyright owners. But this claim is unfair because it can make impossible normal library service. Thus there is a need to revise the Copyright Law to understand the difference between act of viewing and public performance in libraries.

Impacts of DRG Payment System on Behavior of Medical Insurance Claimants (DRG 지불제도 도입에 따른 의료보험청구 행태 변화)

  • Kang, Gil-Won;Park, Hyoung-Keun;Kim, Chang-Yup;Kim, Yong-Ik;Ha, Beom-Man
    • Journal of Preventive Medicine and Public Health
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    • v.33 no.4
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    • pp.393-401
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    • 2000
  • Objectives : To evaluate the impacts of the DRG payment system on the behavior of medical insurance claimants. Specifically, we evaluated the case-mix index, the numbers of diagnosis and procedure codes utilized, and the corresponding rate of diagnosis codes before, during and after implementation of the DRG payment system. Methods : In order to evaluate the case-mix index, the number of diagnosis and procedure codes utilized, we used medical insurance claim data from all medical facilities that participated in the DRG-based Prospective Payment Demonstration Program. This medical insurance claim data consisted of both pre-demonstration program data (fee-for-service, from November, 1998 to January, 1999) and post-demonstration program data (DRG-based Prospective Payment, from February, 1999 to April, 1999). And in order to evaluate the corresponding rate of diagnosis codes utilized, we reviewed 820 medical records from 20 medical institutes that were selected by random sampling methods. Results : The case-mix index rate decreased after the DRG-based Prospective Payment Demonstration Program was introduced. The average numbers of different claim diagnosis codes used decreased (new DRGs from 2.22 to 1.24, and previous DRGs from 1.69 to 1.21), as did the average number of claim procedure codes used (new DRGs from 3.02 to 2.16, and previous DRGs from 2.97 to 2.43). With respect to the time of participation in the program, the change in number of claim procedure codes was significant, but the change in number of claim diagnosis codes was not. The corresponding rate of claim diagnosis codes increased (from 57.5% to 82.6%), as did the exclusion rate of claim diagnosis codes (from 16.5% to 25.1%). Conclusions : After the implementation of the DRG payment system, the corresponding rate of insurance claim codes and the corresponding exclusion rate of claim diagnosis codes both increased, because the inducement system for entering the codes for claim review was changed.

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Estimation of a Nationwide Statistics of Hernia Operation Applying Data Mining Technique to the National Health Insurance Database (데이터마이닝 기법을 이용한 건강보험공단의 수술 통계량 근사치 추정 -허니아 수술을 중심으로-)

  • Kang, Sung-Hong;Seo, Seok-Kyung;Yang, Yeong-Ja;Lee, Ae-Kyung;Bae, Jong-Myon
    • Journal of Preventive Medicine and Public Health
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    • v.39 no.5
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    • pp.433-437
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    • 2006
  • Objectives: The aim of this study is to develop a methodology for estimating a nationwide statistic for hernia operations with using the claim database of the Korea Health Insurance Cooperation (KHIC). Methods: According to the insurance claim procedures, the claim database was divided into the electronic data interchange database (EDI_DB) and the sheet database (Paper_DB). Although the EDI_DB has operation and management codes showing the facts and kinds of operations, the Paper_DB doesn't. Using the hernia matched management code in the EDI_DB, the cases of hernia surgery were extracted. For drawing the potential cases from the Paper_DB, which doesn't have the code, the predictive model was developed using the data mining technique called SEMMA. The claim sheets of the cases that showed a predictive probability of an operation over the threshold, as was decided by the ROC curve, were identified in order to get the positive predictive value as an index of usefulness for the predictive model. Results: Of the claim databases in 2004, 14,386 cases had hernia related management codes with using the EDI system. For fitting the models with applying the data mining technique, logistic regression was chosen rather than the neural network method or the decision tree method. From the Paper_DB, 1,019 cases were extracted as potential cases. Direct review of the sheets of the extracted cases showed that the positive predictive value was 95.3%. Conclusions: The results suggested that applying the data mining technique to the claim database in the KHIC for estimating the nationwide surgical statistics would be useful from the aspect of execution and cost-effectiveness.

Exploratory Insight into the (Un)intended Effects of Trade Policy in Public Diplomacy

  • Albertoni, Nicolas
    • Journal of Public Diplomacy
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    • v.2 no.1
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    • pp.28-42
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    • 2022
  • The aim of this article is to rethink the role of international trade as a public diplomacy tool by considering the uncertainties that stem from political tensions. The main contribution made in this article is theoretical rather than statistical. However, we analyze trade and public opinion data to study the relationship between both factors. Using Latinobarometer, a cross-sectional survey that collects public opinion data from Latin America, this article analyses public opinion toward the United States and China. One of the main takeaways from this study is that, despite its potential to showcase political stability, public diplomacy undervalues 'unintended consequences' of international trade relations. This article takes up international trade as an unintended, but arguably effective, resource to be developed for the practice of public diplomacy. Findings presented in this article do not claim causation between trade and opinion, something that can be explored by further research, but rather introduce new questions for further research on the public diplomacy of trade relations.

Building Linked Big Data for Stroke in Korea: Linkage of Stroke Registry and National Health Insurance Claims Data

  • Kim, Tae Jung;Lee, Ji Sung;Kim, Ji-Woo;Oh, Mi Sun;Mo, Heejung;Lee, Chan-Hyuk;Jeong, Han-Young;Jung, Keun-Hwa;Lim, Jae-Sung;Ko, Sang-Bae;Yu, Kyung-Ho;Lee, Byung-Chul;Yoon, Byung-Woo
    • Journal of Korean Medical Science
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    • v.33 no.53
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    • pp.343.1-343.8
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    • 2018
  • Background: Linkage of public healthcare data is useful in stroke research because patients may visit different sectors of the health system before, during, and after stroke. Therefore, we aimed to establish high-quality big data on stroke in Korea by linking acute stroke registry and national health claim databases. Methods: Acute stroke patients (n = 65,311) with claim data suitable for linkage were included in the Clinical Research Center for Stroke (CRCS) registry during 2006-2014. We linked the CRCS registry with national health claim databases in the Health Insurance Review and Assessment Service (HIRA). Linkage was performed using 6 common variables: birth date, gender, provider identification, receiving year and number, and statement serial number in the benefit claim statement. For matched records, linkage accuracy was evaluated using differences between hospital visiting date in the CRCS registry and the commencement date for health insurance care in HIRA. Results: Of 65,311 CRCS cases, 64,634 were matched to HIRA cases (match rate, 99.0%). The proportion of true matches was 94.4% (n = 61,017) in the matched data. Among true matches (mean age 66.4 years; men 58.4%), the median National Institutes of Health Stroke Scale score was 3 (interquartile range 1-7). When comparing baseline characteristics between true matches and false matches, no substantial difference was observed for any variable. Conclusion: We could establish big data on stroke by linking CRCS registry and HIRA records, using claims data without personal identifiers. We plan to conduct national stroke research and improve stroke care using the linked big database.

Adjusting for Confounders in Outcome Studies Using the Korea National Health Insurance Claim Database: A Review of Methods and Applications

  • Seung Jin Han;Kyoung Hoon Kim
    • Journal of Preventive Medicine and Public Health
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    • v.57 no.1
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    • pp.1-7
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    • 2024
  • Objectives: Adjusting for potential confounders is crucial for producing valuable evidence in outcome studies. Although numerous studies have been published using the Korea National Health Insurance Claim Database, no study has critically reviewed the methods used to adjust for confounders. This study aimed to review these studies and suggest methods and applications to adjust for confounders. Methods: We conducted a literature search of electronic databases, including PubMed and Embase, from January 1, 2021 to December 31, 2022. In total, 278 studies were retrieved. Eligibility criteria were published in English and outcome studies. A literature search and article screening were independently performed by 2 authors and finally, 173 of 278 studies were included. Results: Thirty-nine studies used matching at the study design stage, and 171 adjusted for confounders using regression analysis or propensity scores at the analysis stage. Of these, 125 conducted regression analyses based on the study questions. Propensity score matching was the most common method involving propensity scores. A total of 171 studies included age and/or sex as confounders. Comorbidities and healthcare utilization, including medications and procedures, were used as confounders in 146 and 82 studies, respectively. Conclusions: This is the first review to address the methods and applications used to adjust for confounders in recently published studies. Our results indicate that all studies adjusted for confounders with appropriate study designs and statistical methodologies; however, a thorough understanding and careful application of confounding variables are required to avoid erroneous results.

Consumers' Ad Responses towards Marketing Motives and Ad Appeals in Hotels' Green Advertising

  • Yoon, Donghwan;Kim, Byeong-Yong
    • Culinary science and hospitality research
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    • v.23 no.6
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    • pp.99-109
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    • 2017
  • This study aims to investigate the impacts of marketing motive (public- vs. firm-interest) and ad appeal (soft- vs. hard-sell) types on consumers' ad attitudes and behavioral intention in hotels' green advertising. From 711 US respondents, a multivariate analysis of covariance (MANCOVA) was employed to test main effects of marketing motive and ad appeal types on ad recipients' affective and cognitive ad attitudes, while controlling their environmental consciousness. Further, the study conducted a multiple regressions analysis to examine the influence of ad attitudes on respondents' intention to visit the hotel. The study found that a public-serving claim can yield more positive affective ad attitude than a firm-interested claim, regardless of ad image type (soft- or hard-sell image). The result also revealed that a soft-sell ad image can elicit more positive affective ad attitude than a hard-sell one. On the other hand, the study showed that consumers' affective and cognitive ad attitudes are significant predictors of behavioral intention (i.e., visit intention). The study provided theoretical and managerial implications for hospitality researchers and hotel marketers to effectively design hotels' green advertising to ultimately increase consumers' visit intention.

What Factors Cause a Complete Examination of Infant Health Checkup? (영유아 건강검진 완전수검 여부 관련 요인)

  • Kang, Seungjin;Chung, Woojin;Kim, Heejin;Lee, Sunmi
    • Health Policy and Management
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    • v.24 no.3
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    • pp.261-270
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    • 2014
  • Background: This study examined what factors affected a complete examination of infant health checkup. Methods: We used Korean national health insurance claim data of 2,936,650 infants, taking examination in 2012. These claim data included enrollment status of householders and records of infant health checkup from 2008 to 2013. Results: Our results shows that for infant characteristics, the likelihood of complete examination of infant health checkup is significantly lower in female, older aged, and handicapped ones. For householder characteristics, the likelihood of complete examination of infant health checkup is also significantly lower in female, older group and self-employed ones. For household characteristics, the likelihood of complete examination is also significantly lower in single-parent families, multi-cultural families, parent with unexperienced health checkup and lower monthly premiums. Conclusion: It is necessary to support an additional use-guide and follow-up management services to improve incomplete examination of infant health checkup.