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KMID : 1170320150210030033
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Korean Journal of Health Economics and Policy
2015 Volume.21 No. 3 p.33 ~ p.54
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How to Revise National Health Insurance Investigation
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Jun Byung-Wook
Choi Eu-Gene
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Abstract
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Using privately collected data, this study analyzes the selection model for “false qualification” policyholders (sole proprietors) of the National Health Insurance. The regression results of this study shows that explanation variables of the best selection model should include whether to be its representative, whether to be enlisted representatively, whether to be relatively elderly, whether to be optionally ongoing, and etc., while the selection model might be much improved with policyholders’ financial data which this study can’t make use of. Based on above results, this study suggests practical plans to revise the National Health Insurance to improve its finance and equity. First, investigation right of the National Health Insurance Service should be reinforced by introducing criminal charge, fine and penalty. Second, various investigation techniques, including tax investigation skills, should be developed to detect false qualification cases effectively. Third, once selection model is decided, its validity should be ascertained to improve the model with gathering and mining financial data. Last, thorough sharing of policyholders’ data with the National Tax Service should be enacted in the long run, while imbalanced current data sharing should be improved for the present.
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KEYWORD
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National Health Insurance, Investigation, False Qualification, Selection Model, Data Mining
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