Recent trend of precedents for National Health Insurance

This paper introduces the major issues related to the Health Insurance Act and the core content of recent precedents, in order to prevent health insurance arguments and to contribute to health insurance-related administrative litigation. The basis of Korea's health insurance system is the National Health Insurance Act. After providing medical services, the medical cost is covered by the National Health Insurance Corporation (NHIC). If the doctor was paid deceptively or improperly, then the NHIC will seize the entire payment, and the Minister of Health and Welfare will order the doctor to suspension practice or, similarly, fine the doctor for five times the original payment. In addition, doctors who have used deception will have their license suspended. If the doctor has any objection against this administrative measure, he or she can file an administrative lawsuit. So far, if the action was illegal, the court has generally made principle-based judgments, regardless of whether the behavior was intentional or negligent; however, recently, especially in cases related to the court of first instance (only a few cases), the court has made a judgment clearly cancelling the measure under the condition that the measure was beyond the level by analyzing the reason why the practitioner committed an offense. From the practitioners' point of view, it is encouraging that the judges have started to understand the reality of the medical field. Further, this paper argues that judges should increase their understanding the medical field and specific validity. This article reviews the litigation process related to the National Health Insurance Act and recent trends in its precedents. From now on, these judgments should support the arguments of practitioners. Con-clusively, these judgments were the result of legal actions; therefore, doctors should avoid taking an attitude of annoyance toward lawsuits or being intimidated by the organization, and as a result, respond passively by simply paying out the lawsuit settlements.

Factors Affecting the Designation of Cerebrovascular Diseases as Work-Related in Administrative Litigation

The purpose of this study was to identify factors that could be used as standardized criteria for evaluating occupational diseases in initial assessments or requests for examination. Using 100 administrative litigation cases on the work-relatedness of cerebrovascular diseases (CVDs) by the Seoul Branch of the Korea Labor Welfare Corporation (KLWC) from 1997 to 2002, we estimated the relationship between the investigated variables and designation of the work-relatedness of the CVD. As for the age, the odds ratio of the acceptance rate of a case as work-related in subjects over 60 yr of age was 0.08 (95% CI, 0.01-0.75), which was compared to subjects under 30 yr of age. Regarding working hours, the odds ratio of the acceptance rate of a case as work-related in CVDs in those over 56 hr was 9.50 (95% CI, 1.92-47.10) when compared to those less than 56 hr. As for the benefit type, the odds ratio of the acceptance rate of a case as work-related in medical benefits was 5.74 (95% CI, 1.29-25.54), compared to survivor benefits. As for the criteria for defining situations as work overload, the odds ratio of the acceptance rate of a case as work-related in injured workers was 12.06 (95% CI, 3.12-46.62), compared to that in non-injured workers. Our findings show that the criteria for defining situations of work overload played an important role in assessing the work-relatedness of CVDs in administrative litigation, and it is necessary to make the scientific evidence on judgement of workrelatedness on overwork.