Earticle

본 연구의 목적은 국내 의료기관에서 외래진료 시 경구용 혈당강하제를 투약 받는 사람들의 특성과 복약순응도와의 연관성을 확인하기 위함이다. 연구방법은 2016년 한 해 동안 건강보험심사평가원 청구데이터에 주상병이나 부상병에 E11을 포함하는 제2형 당뇨병 환자표본자료를 이용한 단면연구로 당뇨약제 109개 주성분코드로 분석하였다. 연구결과 복약순응도는 성별에서 유의한 차이가 있었고, 남성이 여성에 비해 높았다. 복약순응도는 보험유형 간에 유의한 차이가 있었으며, 건강보험, 의료급여에 비해 보훈(무료)이 가장 높았다. 보훈(무료)이 타 보험유형에 비해 복약순응도가 높은 것은 자기부담이 적어 의료접근성이 높은 이유로 해석된다. 본 연구의 결과가 건강보험 외래 본인부담에 대한 정책적 기초자료로 활용될 것을 기대한다. 또한, 제2형 당뇨병 환자와 같은 만성질환자의 외래 본인부담률을 줄일 수 있는 적정방안을 추가연구로 제안한다.

The purpose of this study was to analyse the relationship between the characteristics of the patients who received oral antihyperglycemic drugs and their medical adherence in Korea. The study method was a cross-sectional study using the patient sample data of the Health Insurance Review and Assessment Service for 2016, and it was analyzed with 109 major components of diabetes drug. The medical adherence was slightly higher in male than female. The patriots & veterans(free) type had the highest medication adherence because they have low self burden to access medical institutions compared to other insurance types. It is expect that this study result will be used as a basic data to understand the burden of outpatients with health insurance and establish a policy to reduce of the self outpatients' burden with chronic diseases such as type 2 diabetes.

Purpose: This study investigated differences in the use of life-sustaining treatments during the last six months of life between older adults covered by the National Health Insurance (NHI) and those enrolled in the Medical Aid (MA) program. Methods: A retrospective cohort design was applied using national claims data from the National Health Insurance Service. The study population included individuals aged ≥65 years who died in 2023, with 286,319 decedents (247,935 with NHI and 38,384 with MA) analyzed. We compared hospitalization frequency and duration, intensive care unit (ICU) stays, and the use of life-sustaining treatments, including cardiopulmonary resuscitation, mechanical ventilation, hemodialysis, chemotherapy, transfusions, and vasopressors, between NHI and MA groups. Logistic regression analyses were conducted with adjustments for age, sex, comorbidities, place of death, and advance care planning status. Results: Completion rates of advance directives and physician orders for life-sustaining treatment were lower in MA than in NHI decedents. MA decedents had fewer admissions but significantly longer hospital and ICU stays than NHI decedents. They were less likely to receive mechanical ventilation, chemotherapy, transfusion, and vasopressors but more likely to undergo hemodialysis. Conclusion: Substantial disparities exist in end-of-life care by insurance type, suggesting that socioeconomic inequalities and reimbursement structures influence patterns of intensive care near the end of life. Targeted interventions are needed to ensure equitable, patient-centered end-of-life care for socioeconomically vulnerable older adults.

지식서비스는 현대에서 중요한 국가경쟁력의 원천이 되었다. 그리고 지식서비스의 수출도 중요한 상황이다. 원래 수출보험제도는 수출기업이 물품을 수출하고 수출대금을 받지 못하거나, 수출금융을 제공한 금융기관이 대출금을 회수하지 못하는 손실을 보상해주는 정책보험제도로, 신용위험과 비상위험을 보장한다. 신용위험은 수입자의 신용 악화, 파산, 대금지급 거절 등으로 인한 수출 불능 또는 수출대금 미회수 위험을 말하며, 비상위험은 수입국에서의 전쟁·혁명·내란, 수입국 정부의 수입거래·외환거래 제한, 수입국 모라토리움 선언 등을 말한다. 2010년 수출보험법이 무역보험법으로 바뀌고 수출보험도 수입을 포함한다는 의미에서 무역보험으로 용어가 변경되었다. 더불어 한국수출보험공사도 한국무역보험공사로 명칭이 변경되었다. 오늘날 영화 한 편의 제작으로 거두어들일 수 있는 부가효과는 일반 제조물보다도 클 수 있다. 원래 문화수출보험은 수출계약이 체결된 영화의 제작과 관련한 투자 및 대출거래에서 발생하는 손실을 보상하는 제도이었다. 그런데 이 문화수출보험이 이제는 서비스종합보험에 의하여 운용이 되고 있다. 우리나라가 처한 상황을 보건데, 무역보험을 통한 수출지원이 매우 중요하다. 그런데 제조물의 수출도 중요하지만 현재의 무형자산이 강조되는 시대에는 영화, 특허 등 지식재산권을 포함하는 문화콘텐츠의 수출도 매우 중요한 비중을 차지하고 있다. 한국은 지식재산권분야의 강국이기도 하다. 그런데 이러한 문화콘텐츠의 수출을 지원할 수 있는 무역보험은 서비스종합보험(일시결제방식), 서비스종합보험(기성고․연불방식)만이 존재하여 한계가 있다. 이들 보험은 지식서비스를 수출하고 대금을 받지 못하거나 지출비용 또는 확인대가를 회수하지 못함으로써 입게 되는 손실을 보상하는 것이다. 그리하여 이들 무역보험종목을 문화컨텐츠, 지식재산권에 특화하는 방향으로 재조정하는 것이 필요하다. 특히 지식재산의 분쟁이 급증하고 있는 오늘날에 있어서는 그 소송으로 인한 비용을 보전해주는 내용을 명시적으로 서비스종합보험에서 보전하여 주도록 상품을 재구성 하는 조치가 필요하다. 한편 서비스종합보험의 약관에는 문제점이 있다. 우선 약관상 완전한 수동적 답변의무화가 아니어서 완전히 수동답변의무화하는 쪽으로 개정을 요한다. 그리고 보험료미납에 대하여 보험자인 공사가 한번 명시적으로 독촉을 하는 것을 요구할 필요가 있다. 중소기업들이 보험료를 내는 것을 잊을 수도 있기 때문이다. 또한 중복보험 통지의무를 규정하고 있으나 위험변경・증가의 통지의무에 대하여는 포괄규정을 두고 있지 아니하다. 다만 이행내역 통지 후 수출대금, 결제조건(결제기일 포함) 등을 변경하였을 경우 보험계약자는 당해 내용변경일부터 10영업일 이내에 그 사실을 서면으로 공사에 통지하도록 하고 있다(약관 제15조 제1항). 그런데 수출보험에도 보험의 원리가 적용되고, 약관에 정해져 있지 않은 사항에 대해서는 대한민국 법령이 정하는 바에 따르도록 하고 있다(약관 제27조)는 점에서 결국은 상법의 보험계약법 내용이 준용될 수 있을 것이다. 그리고 계약해지와 관련하여 중복보험을 든 경우 고의중과실이 있으면 계약해지가 가능한 것으로 규정(약관 제8조와 제7조의 연계)하고 있다. 그런데 일반보험의 경우에는 중복보험통지의무위반의 효과를 법에서 규정을 하고 있지 아니하다. 그리고 판례는 중복보험을 통지하지 아니하였다고 하여 고의・중과실을 거의 인정하지 아니하여 계약의 해지를 허용하지 않는 입장을 취하고 있다는 점에서 이점은 재고를 요한다. 즉 일반보험의 경우에 중복보험을 들었다고 하여 바로 제재를 가하지 아니하는 점을 고려하여 연대비례보상의 취지로써 보상을 하는 방식을 취하여야 할 것이다.

Nowadays, the culture contents play very important role in national and trade economy. For the export promotion, the most countries operate export credit insurance. But not only export, but also import is very important for the economy of one country. The export can not exist alone. The import should support getting needed materials for the export. Therefore, the export credit insurance was reformed to trade insurance in the year of 2010. This is international trend. Japan has also reformed to the trade insurance long time ago. The service comprehensive insurance recover the obligation outstanding out of culture export. One of service comprehensive insurance is type of lump sum payment. Another is service comprehensive insurance(type of amount of work completed and deferred payment). One of the important sector of the culture contents is intellectual property right. Copyright, design, trademark, patent, utility model are its main sectors. There are many disputes in regard of intellectual property right. The cost arising from the disputes is also rising. Therefore, the service comprehensive insurance should recover the costs arising from disputes related to intellectual property right. The standard contract terms of service comprehensive insurance(type of lump sum payment) regulates the detailed contents of this insurance. But in view of general insurance contract law and principle, there are many things to be improved. First, the international trend is passive answer system or calling for notice in regard of duty of disclosure. But in the standard terms of service comprehensive insurance(type of lump sum payment), the passive answer system is not realized perfectly. And when the insured does not pay insurance premium, the insurer should urge its payment. But in the standard terms of service comprehensive insurance(type of lump sum payment), it is not regulated. Furthermore, the duty of notice of double insurance and its violation effects are regulated in standard terms of service comprehensive insurance(type of lump sum payment). But the sanction is too heavy. In general insurance principle, the solidarity proportion indemnification is accepted in the case of double insurance. And the contract cancellation is not allowed even in the case of violation of the duty of notice of double insurance. It should be therefor reformed. We should try for getting better contents and standard contract terms of service comprehensive insurance(type of lump sum payment) in the future. Then our service and culture export can extend. It is obligation of scholars and lawmakers.

보험은 위험보장이라는 본래의 기능으로 세법에서 다른 금융상품보다 우대되어 왔다. 그러나 최근의 보험상품은 위험보장 뿐만 아니라 투자기능 및 저축기능이 결합된 다양한 방식으로 출시되고 있다. 더욱이 보험사의 판매방식이 절세전략, 조세회피 등과 관련된 컨설팅 등을 포함하고 있어 저축성 보험차익의 비과세와 관련된 조세정책에 비판이 제기되어 왔다. 이에 정부는 고액자산가의 조세회피방지와 타금융상품 간의 형평성 등을 위하여 2013년 소득세법 시행령 제25조를 개정하였지만 여전히 많은 문제점이 존재하고 있다. 본 연구에서는 저축성 보험차익에 대한 조세정책의 타당성을 2013년에 개정된 소득세법 시행령을 중심으로 살펴보고 이에 대한 개선방안을 도출하고자 하였다.

Insurance has been preferential treatment than other financial products for risk ensure as a original function in tax law. However, the recent insurance products is being released in a variety of ways combined with investment and savings, as well as risk ensure. In addition, as the insurer's sales approach including to tax avoidance, tax saving strategies, tax policy associated with the tax-free savings-type insurance has been criticized. The government amended Article 25 of the Enforcement Decree of the Income Tax Act 2013 in order to prevent tax avoidance and equity among other financial instruments, but there are still many problems exist. this study looks for the validity of the tax policies of savings-type insurance In terms of the Enforcement Decree of the Income Tax Act as amended in 2013, and derived for ways to improve.

본 연구는 2018년 최저임금의 급격한 인상이 저소득층의 소득과 보장성보험 소비에 미친 영향을 재정패널조사 자료(제7~12차)를 이용하여 개인 및 가구 단위에서 분석하였다. 인과적 식별을 위해 이중차분법(DID), 사건사 분석, 합성이중차분법(SDID)을 적용하였다. 분석 결과, 최저임금 인상은 수혜 근로자의 근로소득과 가구소득을 유의하게 증가시켰다. 보험 소비와 관련하여 개인 단위 분석에서는 신규 가입 확대 효과가 확인되지 않았으나, 기존 가입자의 보험료 지출은 유의하게 증가하였다. 가구 단위 분석에서는 가구내 최저임금 소득 의존도가 높은 취약 가구를 중심으로 무보험 가구의 보험시장 신규진입이 확대되는 것으로 나타났다. 이러한 결과는 저소득층의 강한 예비적 동기를 반영하는 한편, 보험료 산출 체계에 내재할 수 있는 소득 역진적 재분배 가능성을 점검하고이를 완화하기 위한 제도적 보완의 필요성을 시사한다.

This paper examines the effects of the sharp increase in Korea’s minimum wage in 2018 on income and protection-type insurance consumption among low-wage workers, using panel data from waves 7?12 of the National Survey of Tax and Benefit. To identify causal effects, I employ a difference-in-differences(DID) framework, complemented by event-study specifications and synthetic difference-in-differences (SDID) estimators. The results show that the minimum wage hike significantly increased both individual labor income and total household income among affected workers. At the individual level, there is no evidence of a significant expansion in new insurance enrollment; however, existing policyholders exhibit a statistically significant rise in premium payments, indicating an intensification of coverage. At the household level, the reform led to a meaningful rise in insurance market entry among previously uninsured households, particularly those with a high share of minimum-wage income. These findings suggest that income gains from the minimum wage increase were partly allocated toward strengthening private risk protection, consistent with a precautionary motive among low-wage workers. At the same time, the results raise concerns about potential regressive redistribution embedded in insurance pricing structures, highlighting the need to incorporate distributional considerations into insurance product design and regulatory frameworks.

Purpose: We analyzed the characteristics and differences in patients’ medical benefits and health insurance based on disease severity classification. Methods: We examined 29,139 patients who visited the emergency medical center of K Hospital from January 1,2016 to December 31, 2016. Survey items included the Korean Triage and Acuity Scale (KTAS) classification of emergency and non-emergency situations ratio and type of insurance. Results: According to KTAS classification, 76.2% of patients exhibited an emergency condition and 23.8% exhibited a non-emergency condition. Emergency patients exhibited more trauma than non-emergency patients. According to the type of insurance coverage, the duration of stay in the emergency room was longer for patients with medical care than for patients with health insurance. Additionally, 119 ambulances use was significantly higher among patients with medical care. Conclusion: Policy discussions should address alternative ways to replace the 119 ambulances used by patients in this study. Additionally, health care administrators should identify alternative care agencies as potential alternatives to emergency room visits.

본 연구는 자동차보험 이용환자들의 효율적 관리방안을 모색하는데 필요한 기초정보를 제공하고자 보건의 료빅데이터개방시스템에 등록된 2016년부터 2020년까지 5개년 자동차보험 진료비 심사자료를 대상으로 분석하 였다. 분석결과, 자동차보험 입원진료비 내역 구성비율 1순위는 상급종합병원은 처치 및 수술료, 종합병원․병원․의 원은 입원료, 한방의료기관(한방병원, 한의원)은 처치 및 수술료, 치과병원은 처치 및 수술료 이었다. 외래진료비 내역 구성비율 1순위는 양방의료기관(상급종합병원, 종합병원, 병원, 의원)은 진찰료, 한방의료기관(한방병원, 한의 원)과 치과의료기관(치과병원, 치과의원)은 처치 및 수술료 이었다. 자동차보험 입원 건당 진료비에는 투약료, 마취 료, 특수장비 비율이 영향요인이었으며, 외래 건당 진료비에는 이학요법료 비율이 영향요인으로 확인되었다.

This study aims to provide basic information necessary to find an efficient management plan for patients using auto insurance. The analysis was conducted on the five-year auto insurance medical expenses review data registered in the health care bigdata Hub from 2016 to 2020. As a result of the analysis, the number one composition ratio of auto insurance inpatient treatment expenses was treatment and surgery fees for Certified tertiary hospitals, hospitalization fees for general hospitals, hospitals and clinics, and treatment and surgery fees for oriental medical institutions and dental hospitals. outpatient treatment expenses was doctor's fee for medical institution, treatment and surgery fees for oriental medical institutions and dental hospitals. The ratio of medication, anesthesia, and special equipment significantly affected the cost of inpatient. And the ratio of physical therapy significantly affected the cost of outpatient.

This study was performed to provide efficient fund managing plans for hospitals by looking into the management of medical fees for accident insurance. Car insurance, industrial accident insurance and seamen's insurance at a general hospital which is located in Busan during 29 months from January 1, 2009 to May 31, 2011 were assessed. The research data is the total number of 6,293 cases, including 2,251 car insurance cases, 2,350 industrial accident insurance cases, and 1,692 seamen's insurance cases. There were some significant differences found, as car insurance and seamen's insurance, including accident insurance, are types of insurance for which employers or traffic accidents offenders shall be the final premium payer. In addition, medical examination fees or premium payers are applied under their respective related laws. The findings suggest that it is necessary for managers of hospitals to prepare differentiated management schemes based on the characteristics of each insurer and schemes to ensure proper recovery strategies of uncollected medical account receivables.

Purpose: The purpose of this study is to analyze occupational accident compensation insurance coverage and occupational accidents incidence for special-type delivery workers. Methods: The data for occupational accident compensation insurance coverage and occupational accidents from 2012 to 2017 were analyzed through descriptive statistics. Results: Rates of occupational accident compensation insurance coverage of special-type delivery workers decreased gradually from 43.4% in 2012 to 28.5% in 2016, and 29.0% in 2017. Rates of occupational illnesses death per ten thousand workers increased gradually from 2.1? in 2013 to 3.1? in 2016, and 8.6? in 2017. All occupational illness deaths were due to cerebro-cardiovascular diseases. Road traffic accidents and slips accounted for the largest proportion of occupational accidents. Conclusion: Special-type delivery workers have a high risk of industrial accidents, so it is necessary to raise industrial accident insurance coverage and provide professional and systematic occupational safety and health services.

본 연구는 죽음 현저성과 종신보험광고 메시지 유형이 소비자의 종신보험 가입의도에 미치는 영향에 대해 살펴보았다. 구체적으로 죽음 현저성 상황에 따른 종신보험의 가입의도와 죽음 현저성 상황과 종신보험광고에서 제시되는 메시지 유형에 따른 종신보험의 가입의도를 실증적으로 밝히고자 하였다. 이를 위해 2(죽음 현저성 유형: 고 vs 저) x 2 (메시지 유형: 사회적 지지 메시지 vs 자기결정 메시지) 요인설계(2×2 Factorial Design) 방안을 적용하여 실험을 실시하였다. 가설로 세운 결과들은 지지되었으며, 다음과 같이 요약할 수 있다. 첫째, 높은 죽음 현저성 상황이 낮은 죽음 현저성 상황보다 종신보험의 가입의도가 높았다, 둘째, 높은 죽음 현저성 상황에서 소비자의 종신보험 가입의도는 종신보험광고의 자기결정 메시지 제시보다 사회적지지 메시지 제시 일 때 더 높았다. 마지막으로 낮은 죽음 현저성 상황에서 소비자의 종신보험 가입의도는 종신보험광고의 자기결정 메시지 제시와 사회적지지 메시지 제시에 따른 차이가 없었다. 본 연구의 결과는 죽음 현저성 연구와 종신보험 연구를 연결하였으며, 더 나아가 죽음 현저성의 연구와 종신보험광고의 메시지 차별화 전략 연구를 연결하여 살펴보았다는 것에서 학문적 의의를 찾을 수 있다. 또한 종신보험의 가입의도를 높일 수 있는 상황과 종신보험광고에서 효과적인 메시지의 유형을 파악할 수 있다는 것에서 실무적인 의의를 찾을 수 있을 것이다.

This study examined the effect of mortality salience and advertising message type on consumers' intention of life insurance. This study hypothesizes that for the intention life insurance would be higher in high mortality salience than in the low mortality salience. In addition, in high mortality salience, the social support message of the life insurance advertising would have higher intention of life insurance than the self-determination message, and in the low mortality salience, there would be no difference in message type. Suggested and tested in an experimental situation with 2x2(mortality salience: high vs. low) X (message type: social support message vs self-determination message). The result of the study is as follows. The intention life insurance was higher in high mortality salience than in the low mortality salience. In addition, in high mortality salience, the social support message of the life insurance advertising would have higher intention of life insurance than the self-determination message, and in the low mortality salience, there was no difference in message type. Finally, the academic and practical implications were discussed based on the findings.

Objectives : The aim of the study is to investigate the actual condition of the occurrence and recovery of medical expenses in seafarers insurance and to provide basic data to be helpful to establish efficient management strategies for medical expenses of insurance companies depending on type of seafarers insurance for hospital management. Methods : Three general hospitals located in Busan, Korea were selected and seafarers insurance claim data collected from January 1, 2012 to December 31, 2013(24 months) were analyzed. There were total 5,490 cases. Results : There was a significant difference in distribution of the incidence of disease, accrued medical expenses, payback of medical expenses and the actual condition of medical receivables depending on insurance companies. Conclusions : Therefore, differentiated payback strategies for medical expenses are needed to consider various seafarers insurance companies and treatment characteristics in seafarers insurance.

본 연구는 주요 OECD 9개국(핀란드, 스웨덴, 덴마크, 독일, 오스트리아, 프랑스, 스페인, 이탈리아, 한국)의 자영업자 실업보험제도에 대해, 가입 접근성(accessibility), 적용 포괄성(eligibility), 급여 관대성(generosity)으로 구성된 주요한 제도적 속성을 바탕으로, 퍼지셋이상형분석(Fuzzy-Set Ideal Type Analysis)을 통한 비교연구를 진행하였다. 본 연구는 먼저 자영업자를 위한 실업보장체제의 변화에 대한 기존 논의를 검토 및 비전형적 노동형태의 확대에 따른 국가별 사회보장제도의 대응을 논의하였다. 이를 바탕으로, 가입 접근성, 적용 포괄성, 급여 관대성의 세 가지로 주요 속성으로 국가별 자영업자 대상 실업보험제도를 개념화하고, 각국의 자영업자 대상 실업보험체제에 대한 비교사례연구를 실시하였다. 분석 결과, 9개 국가의 실업보험은 5개의 유형으로 나뉘었는데, ‘자영업자에게 모든 차원이 보장된실업보험’ 유형에는 덴마크와 스웨덴이, ‘자영업자의 가입 접근성과 급여 관대성은 높지만 적용 포괄성은 낮은 실업보험’ 유형으로는 핀란드가, 그리고 ‘자영업자의 적용 포괄성만 보장된 실업보험’ 유형으로 독일과 오스트리아가 속했다. 다음으로 ‘자영업자의 가입 접근성만 보장된 실업보험’ 유형에는프랑스, 스페인, 이탈리아가 속했고, 마지막으로, 한국은 ‘자영업자에게 모든 차원이 부실한 실업보험’ 유형에 속했다. 자영업자의 비율이 높은 한국의 실업보험에 대한 분석결과는, 자영업자 실업보장의 사각지대와 함께 불안정한 자영업자의 확대를 의미하는데, 이는 실업보험 기여금은 축소시키는 반면, 급여가 필요한 수급자는 증가시킬 수 있어 실업보험 개혁과 정부의 재정적 부담 간 딜레마가 예상되었다. 본 연구는, 한국의 경우 자영업자의 실업보험 가입 접근성을 높여나가는 경로를 제안하였다. 마지막으로는, 자영업자를 포함한 비전형적인 노동형태를 포괄하기 위해 비자발적 실업 제재 완화 및 부분실업 보장을 통한 실업보험의 적용 포괄성뿐만 아니라 급여 관대성도 높여야 하는 제도적 개혁과제를제시하였다.

This study conducted comparative analysis of self-employed unemployment insurance systems in nine OECD countries, Finland, Sweden, Denmark, Germany, Austria, France, Spain, Italy, and Korea, focusing on major institutional conditions consisting of accessibility, eligibility, and generosity, through fuzzy-set ideal type analysis. Based on recent studies, this study reviewed the changes in the composition and nature of self-employed workers after de-industrialization, discussed institutional reforms of national social security systems toward the expansion of non-standard forms of work, and reviewed existing discussions on changes in the self-employed unemployment security system. The main institutional categories that can reflect the institutionalization of unemployment insurance for self-employed workers in each country were composed of accessibility, eligibility, and generosity. Fuzzy-set ideal type analysis was conducted and as a result, Denmark and Sweden were classified as “the type with a high level of unemployment security for self-employed at all levels,” Finland as “the type with high generosity but low eligibility,” and Germany and Austria as “the type with high generosity but low accessibility.” France, Spain, and Italy were “the type with high accessibility only”. Here, Korea is “the type with a low level of unemployment security for self-employed businesses at all levels.” The analysis results for Korea, where the proportion of the self-employed are high, indicate an expansion of the precarious self-employed w ith large blind spots of unemployment insurance for the self-employed. Overall, it is necessary to ease involuntary unemployment sanctions and guarantee partial unemployment, as well as strengthen eligibility and generosity at the same level as employees to cover non-standard forms of work, including self-employed workers. Based on the analysis of the institutional similarity and difference in unemployment insurance of self-employed w orkers in nine OECD countries, the policy implications for the Korean labour market and unemployment insurance of self-employed workers were discussed.

Background: Diabetes is associated with cancer risk in the aging population. Observational studies have indicated the beneficial effects of metformin against breast cancer, making studies on the anticancer potential of antidiabetic drugs worthwhile. This study investigated cancer incidence in patients on antidiabetic monotherapy. Methods: Using National Health Insurance Service data (2002-2013), a retrospective cohort study that included type 2 diabetes mellitus (T2DM) patients was conducted. Study subjects were enrolled if they were ≥30 years old, on monotherapy for diabetes, and cancer-free. They were followed up for cancer occurrence or death, until December 31st, 2013. A Cox proportional hazard model analysis was conducted between metformin and sulfonylurea (including meglitinide) users, to determine cancer risk, with adjustment for age, gender, comorbidity index, dyslipidemia, hypertension, and T2DM duration. Results: The number of antidiabetic monotherapy-treated T2DM patients without a history of cancer was 9,554 (metformin, n = 5,825; sulfonylurea, n = 3,225; others, n = 504). During the follow-up period (mean, 2.04; IQR, 3.18 years), the cancer incidence rate was 5.48/100 and 5.45/100 patient-years for metformin and sulfonylurea, respectively. The hazard ratio (HR) for risk of cancer incidence in the metformin group was 0.74 (95% confidence interval [CI], 0.66-0.83; p < 0.0001), compared with sulfonylurea. Additionally, the HRs for risks of lung, liver, and stomach cancer were respectively 0.46 (95% CI, 0.31- 0.66; p < 0.0001), 0.41 (95% CI, 0.31-0.54; p < 0.0001), and 0.51 (95% CI, 0.35-0.73; p = 0.0003). Conclusion: Antidiabetic therapy with metformin reduces cancer risk by 26%, specifically for lung, liver, and stomach cancer.

Purpose: This study aimed to identify the prevalence of chronic diabetic complications in patients with type 2 diabetes mellitus. Methods: Data for adults aged over 30 years, who were diagnosed with type 2 diabetes mellitus and who had at least one claim for the prescription of antidiabetic medication were extracted from the National Health Insurance Service-National Health Screening Cohort in Korea from 2002 to 2015. Statistical analyses were performed using R version 3.5.1. Results: In total, 1,407 patients with type 2 diabetes mellitus without complications were extracted from the database. Patients were observed for an average of 10.43 years. The prevalence of chronic diabetic complications was 84.7% and was significantly higher for patients who were older women, who lived in the capital, and had diabetes mellitus for a longer time. The prevalence of eye disease was the highest at 42.4%, and cerebrovascular disease was the lowest at 15.1%. Cardiovascular disease, peripheral vascular disease, neuropathy, and foot ulcers often occurred between two and four years, and eye disease and nephropathy often occurred over eight years after the diagnosis of diabetes. Prior to the occurrence of nephropathy, microvascular complications such as neuropathy, peripheral vascular disease, and eye disease occurred. Conclusion: These findings provide compelling evidence of the prevalence of chronic diabetic complications based on a national database. Since a high incidence of diabetic complications occurs within a short period of time after the diagnosis of diabetes, aggressive interventions are required to prevent diabetic complications in the early stages after diagnosis.

연구목적: 노년기 삶의 양상이 빠르게 변화함에 따라, 노인장기요양보험 수급 노인의 부양환경과 인지기능 간의 연관성을 살펴볼 필요성이 제기된다. 이에 본 연구는 노인장기요양보험 재가급여 수급자의 독거여부와 인지기능의 관계에서 수발자 유형에 따른 조절효과를 확인하고자 한다. 연구방법: 본 연구는 국민건강보험공단 노인코호트DB의 노인장기요양DB을 활용하여, 2019년에 등급판정을 받은 재가 노인 25,420명을 분석하였다. 수급자들의 부양환경을 파악하기 위해 독거여부(동거, 독거)와 수발자 유형(무수발, 비공식적 수발, 공식적 수발)을 포함하였으며, 인지기능은 인지환산점수를 사용하였다. 연구결과: 첫째, 동거노인은 독거노인에 비해 인지기능이 낮았으며(β = -.07, p < .001), 비공식적 수발은 각각 무수발(β = -.04, p < .01)과 공식적 수발(β = -.02, p < .01) 보다 인지기능이 낮았다. 즉, 독거노인과 무수발 및 공식적 수발을 받는 노인은 상대적으로 인지기능이 양호한 것으로 해석된다. 둘째, 독거여부와 공식적 수발 간의 상호작용항은 유의한 것으로 나타났다(β = -.01, p < .05). 공식적 수발을 받는 경우 독거여부와 인지기능 간의 관계가 더 강하게 나타났으며, 독거이면서 공식적 수발을 받는 노인의 인지기능이 가장 양호하였다. 반면, 비공식적 수발 집단에서는 독거여부에 따른 인지기능의 차이가 상대적으로 완만하였다. 결론: 본 연구는 독거노인이 공식적 수발을 받는 경우 인지기능과 긍정적인 관련성이 있음을 보여준다. 이는 노인의 Aging in Place에 대한 선호가 증가하고 관련 정책이 강화되는 현시점에서, 노인장기요양보험 재가급여 수급자의 직접적인 부양환경과 인지기능 간의 관련성을 파악했다는 의의가 있다.

Objective: As living contexts in later life evolve, it is increasingly important to examine the association between care environments and cognitive function among older adults receiving long-term care. This study examines the moderating effect of caregiver type on the relationship between living arrangement and cognitive function among home-based long-term care beneficiaries under the Korean Long-Term Care Insurance (LTCI) system. Methods: Using the Long-Term Care Database of the National Health Insurance Service (NHIS) Elderly Cohort, we analyzed 25,420 older adults who were certified for long-term care benefits and received home-based services in 2019. Living arrangement (living alone, living with others) and caregiver type (no caregiver, informal caregiver, and formal caregiver) were included to capture care environments. Cognitive function was measured using the standardized cognitive score. Results: First, older adults living with others showed lower levels of cognitive function than those living alone (β = -.07, p < .001). Compared with older adults without a caregiver (β = -.04, p < .01) and those receiving formal care (β = -.02, p < .01), those receiving informal care showed lower cognitive function. This suggests that older adults living alone and those receiving no or formal care tend to have relatively better cognitive function. Second, a significant interaction effect between living arrangement and formal caregiving was identified (β = -.01, p < .05). Among those receiving formal care, differences in cognitive function according to living arrangement were more pronounced, with older adults living alone and receiving formal care exhibiting the highest cognitive function. In contrast, among those receiving informal care, differences by living arrangement were relatively attenuated. Conclusion: The findings suggest that living alone with formal caregiving is positively associated with cognitive function among home-based LTCI beneficiaries. Given the growing preference for Aging in Place and the strengthening policy support for community-based care, this study contributes to the literature by identifying the immediate caregiving environment of home-based long-term care beneficiaries.

Purpose: This study was performed to identify factors related to the occurrence and number of chronic diabetic complications in patients with type 2 diabetes mellitus. Methods: Data were extracted from the Korean National Health Insurance Service-National Health Screening Cohort from 2002 to 2015. Adults 30 years of age or older diagnosed with type 2 diabetes mellitus and prescribed at least one diabetes medication were included. Statistical data analyses were performed using R version 3.5.1. Results: A total of 1,406 subjects were analysed in this study, of which 15.3% did not develop chronic diabetic complications. The most common first complications were eye (17.6%), peripheral vascular (16.7%), neuropathy (15.1%), and cardiovascular disease (13.6%). Multivariable Cox regression analyses showed that female, older age, and higher body mass index were consistently associated with an increased risk of chronic diabetic complications. There were significant differences in gender, age, residential area, duration of diabetes, body mass index, smoking, and alcohol consumption according to the number of chronic diabetic complications. Conclusion: Female gender, older age, higher body mass index were consistently and significantly associated with the occurrence and number of chronic diabetic complications. Efforts to screen high risk patients and to manage the weight of type 2 diabetes patients are required. Future studies are needed to elucidate the relationship between chronic diabetic complications and recommended physical activity for weight management.

Objectives: This study aimed to provide basic data for policies related to the classification of long-term care hospitals admitting the elderly, according to receipt or otherwise of specialized rehabilitation treatment, and to analyze the status and characteristics of medical use. Methods: The Health Insurance Review and Assessment Service 2018 Elderly Patient Data was used to analyze 33,821 inpatients who had applied for the daily flat-rate system for long-term care hospitals. Results: The ratio of the paralysis group, cerebrovascular disease group, and musculo-skeletal system group was higher for the rehabilitative long-term care hospital, and the ratios of medical high, medical middle, physical function low, fee-for-service, and medical low groups were also higher than those of general long-term care hospitals. The long-term hospitalization rates were low for patients admitted to rehabilitative long-term care hospitals. Conclusions: It is necessary to establish policies so that patients in need of specialized rehabilitation treatment are not admitted to general long-term care hospitals, which delays their recovery.

This study explored socioeconomic disparities in Korea using health insurance type as a proxy during the ongoing coronavirus disease 2019 (COVID-19) pandemic. METHODS: We conducted a retrospective cohort study using Korea’s nationwide healthcare database, which contained all individuals who received a diagnostic test for COVID-19 (n=232,390) as of May 15, 2020. We classified our cohort by health insurance type into beneficiaries of the National Health Insurance (NHI) or Medicaid programs. Our study outcomes were infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19-related outcomes, a composite of all-cause death, intensive care unit admission, and mechanical ventilation use. We estimated age-, sex-, and Charlson comorbidity index score?adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a multivariable logistic regression analysis. RESULTS: Of the 218,070 NHI and 14,320 Medicaid beneficiaries who received COVID-19 tests, 7,777 and 738 tested positive, respectively. The Medicaid beneficiaries were older (mean age, 57.5 vs. 47.8 years), more likely to be males (47.2 vs. 40.2%), and had a higher comorbidity burden (mean CCI, 2.0 vs. 1.7) than NHI beneficiaries. Compared to NHI beneficiaries, Medicaid beneficiaries had a 22% increased risk of SARS-CoV-2 infection (aOR, 1.22; 95% CI, 1.09 to 1.38), but had no significantly elevated risk of COVID-19-related outcomes (aOR 1.10, 95% CI 0.77 to 1.57); the individual events of the composite outcome yielded similar findings. CONCLUSIONS: As socioeconomic factors, with health insurance as a proxy, could serve as determinants during the current pandemic, pre-emptive support is needed for high-risk groups to slow its spread.

Objectives: This study was conducted to analyze the utilization status of the National Long-Term Care Insurance system, which was introduced to address the surging demand for elderly care due to rapid population aging, and to seek sustainable development strategies. Methods: The analysis was performed using the National Health Insurance Corporation's Senior Cohort 2.0 database from 2008 to 2019. Results: The incidence rate of long-term care certification has been continuously increasing since 2011, reaching 1,346 for men and 2,117 for women per 100,000 population in 2019. The rate for women was notably higher than for men, and the gap widened over the study period. The monthly average utilization rate of long-term care benefits peaked in 2013 (90.5% for men and 93.0% for women) but maintained an overall increasing trend. Home-visit care accounted for the highest proportion, with a utilization rate of 41.6% for men and 42.8% for women in 2019. Furthermore, the monthly average usage days for facilities (29.1 days for men and 29.5 days for women) and nursing hospitals (27.1 days for men and 27.9 days for women) remained consistently high, while the usage days for day and night care services showed a steady increase, reaching 28.3 days per month for men by 2019. Conclusions: To address the increase in long-term care demand, it is essential to improve the equity of the grade system, reduce out-of-pocket costs, and integrate related services such as those from nursing hospitals. Additionally, it is necessary to foster a workforce with practical caregiving skills and ensure a stable working environment to enhance professionalism and reduce turnover.

ObjectivesThe current study aimed to investigate whether pregnancy outcomes are affected by maternal rhesus (Rh) status bycomparing the primigravida pregnancy outcomes of Rh-negative women with those of Rh-positive women. MethodsThe study data were collected from the Korea National Health Insurance Claims Database and the National HealthScreening Program for Infants and Children. In total, 1,664,882 primigravida women who gave birth between January1, 2007 and December 31, 2014, were enrolled in this study. As the risk and severity of sensitization response increaseswith each subsequent pregnancy, only primigravida women were enrolled. The patients were divided into 2 groupsaccording to Rh status, and the pregnancy outcomes were compared. ResultsIn total, 1,661,320 women in the Rh-positive group and 3,290 in the Rh-negative group were assessed. With regardto adverse pregnancy outcomes, there was no statistically significant difference between the 2 groups in terms ofthe prevalence of preeclampsia, postpartum hemorrhage, abruptio placenta, placenta previa, and uterine arteryembolization. A univariate analysis revealed that none of the adverse pregnancy outcomes were significantlycorrelated to Rh status (preeclampsia: odds ratio [OR], 1.00, 95% confidence interval [CI], 0.81?1.23; postpartumhemorrhage: OR, 1.10, 95% CI, 0.98?1.24; abruptio placenta: OR, 0.80, 95% CI, 0.46?1.37; and placenta previa: OR, 1.08,95% CI, 0.78?1.42). The adjusted ORs of postpartum hemorrhage and preterm birth did not significantly differ. ConclusionMaternal Rh status is not associated with adverse outcomes in primigravida women.