|
KMID : 1170320200260010041
|
|
Korean Journal of Health Economics and Policy
2020 Volume.26 No. 1 p.41 ~ p.68
|
|
|
A Detection Model of Industrial Accident Related Disease in the National Health Insurance
|
|
Park Il-Su
Yim Eun-Shil
Lee Kyoung-A
Kim Jin-Hyun
|
|
|
Abstract
|
|
|
|
Industrial workers who were injured during work tend to get medical treatment through the national health insurance instead of industrial accident compensation insurance, which causes serious problems in the social security system and industrial worker's health. This study aims to develop a more efficient and sophisticated model to detect the patients with industrial accident, who used the national health insurance. We used the national health insurance claims data for injury disease from March 1st, 2015 to August 31st, 2018. A logistic regression model that identifies whether the disease is related with industrial accident or not was adopted to develop a standard score card for detecting the individual accident concealment. The patients’ demographic and social characteristics, medical service utilization, and workplace factors were included in independent variables. It was estimated that the detection rate of the model was as high as four times than the current detection rate. The results can be applied to detect the inappropriate reimbursement to industrial accident related disease and then to prevent financial leaks in the national health insurance.
|
|
|
KEYWORD
|
|
|
Industrial Accident, Under Reporting, Concealment, National Health Insurance
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
|