Much policy attention has been directed to the concentration of patients in large hospitals, especially in tertiary care hospitals. In order to address the problem, the government has enforced referral requirement for accessing care in tertiary care hospitals by denying insurance benefits to the patients who do not observe the requirement. This approach somehow has failed to produce expected effects although it still exists in theory. The concentration of patients in a certain type of providers results in the distortion of functional differentiation among various types of providers and vice versa. Thus the approaches for the alleviation of the problem should be directed to both patients and providers. However, policy approaches has so far focused on ways of directly affecting patients' choice of a provider neglecting the effects of providers. Based upon the observation, this paper has reviewed selected issues that should be considered in agenda setting for policies concerned with the concentration of patients in large hospitals or the distortion of functional differentiation among health care providers. A brief discussion of each of the issues suggests three general guidelines for the formulation and implementation of policies intended to address the problem. First, attention should be directed to both patients and providers. Secondly, it is necessary to employ diverse measures including regulation, incentives and administrative supports. Thirdly, some of the approaches should be planned from a long range perspective, for it often takes a long time to change some aspects of health care utilization and provision.

This study was conducted to investigate the changes in patterns of Daegu- and Gyeongbuk-based patients' use of medical care facilities located in Seoul. The 'Patient Survey' data issued by the Ministry of Health and Welfare for 2002, 2005, and 2008 were used. Among all discharged patients residing in Daegu and Gyeongbuk, 133,456 who used medical facilities in Daegu, Gyeongbuk, and Seoul were selected. Among patients residing in Daegu, 2.2% used medical facilities in Seoul in 2002, 3.7% in 2005, and 3.5% in 2008. The corresponding rates among patients living in Gyeongbuk were 5.6%(2002), 7.1%(2005), and 7.3%(2008). Regarding the ICD-10 disease groups, the use of medical facilities in Seoul by patients residing in either Daegu or Gyeongbuk increased in 2005 right after the introduction of the KTX high-speed train service, covering various disease groups, but decreased again in 2008. 'Neoplasm' cases, however, showed a progressive rising trend during the years studied. Multivariate data analysis for the three years showed that sex, age, payment type, hospital type, residence, year, and disease groups were all significantly associated with the utilization of medical facilities in Seoul. The major results are : First, use of medical facilities in Seoul by Gyeongbuk patients was 2.4-fold higher than that by Daegu patients, but with respect to 2005 and 2008 vs. 2002, use of medical facilities in Seoul by Daegu resident patients' showed a larger increase than that by Gyeongbuk's patients. Second, for patients residing in the two regions, use of medical facilities in Seoul was highest for 'congenital malformations, deformations and chromosomal abnormalities', followed by 'neoplasms'. Third, for patients residing in the two regions, general hospitals comprise the primary factor in the use of medical facilities in Seoul. The study shows that local medical facilities should individually exert more efforts to improve the quality of their medical services. Relevant authorities should likewise help these facilities develop their own unique services and respective specialization.

Background : If different cost efficiency indexes were informed to the same clinic depending on the inclusion or exclusion of pharmacy cost, it may impair the reliability of provider-profiling system. This study aimed to investigate whether the omission of pharmacy cost affects cost-efficiency rankings in medical clinics. Methods : Data for ambulatory care cost at 23,112 medical clinics were collected from the claims database, which was constructed after review by the Health Insurance Review and Assessment Service (HIRA) of Korea in April 2007. We calculated two types of cost efficiency indexes by inclusion or exclusion of pharmacy cost for a medical clinic. The agreement between the decile rankings of the two indexes was also assessed using the weighted kappa statistic of Landis and Koch. Results : When the cost efficiency index for total cost including pharmacy cost was compared with the index for total cost excluding it, the agreement between the two indexes was only 55%. The agreements between the two indexes were relatively low within specialties which have larger pharmacy volume of total cost and lower correlation between total cost with or without pharmacy cost included than the average level of all the specialties. Conclusion : These results suggest that the omission of pharmacy cost may result in contradictory outcomes that may be confusing to a medical institution and may impair the reliability of provider-profiling systems. It is very important to standardize profiling criteria for the reliability of provider profiling system.

Background : Cancer is a disease that not only places a significant burden on patients clinically but also requires significant expense for diagnosis and treatment. Although the cancer coverage of health insurance has recently been expended, the need for financial assistance among cancer patients and their families is still expected to be significant. In this study, cancer patients' need for financial assistance in Korea was examined and its influence factors were analyzed. Methods : Target study subjects were those who are over 18 years of age and were diagnosed with cancer more than four months prior at the National Cancer Center and 9 Regional Cancer Centers in Korea during the period from July to August of 2008. Quarter sampling was conducted according to the ratio of the type of each cancer. A face to face interview survey was conducted. A total of 2,661 cancer patients finished the survey. Medical charts were reviewed in order to obtain the cancer type and SEER stage of cancer patients. An ordered logistic regression model was used to examine the level of need for financial assistance according to the demographical, clinical, and socio-economic variables of cancer patients. Result : The percentage of cancer patients who needed financial assistance was 69.0%, and 36.9% needed significant financial assistance. The need for financial assistance was perceived to be greater in males, younger age group, low income group, low education group, medical aid recipients, those who were diagnosed recently, those with a low level of quality of life measured through EQ5D, and those with decreased income after cancer diagnosis. Conclusion : In spite of the current policy to increase health insurance coverage, the majority of cancer patients and their families in Korea still need financial assistance due to cancer. In particular, there were more vulnerable groups, such as the low income, or low education group. In the future, policies that focus on the disadvantaged, which strengthen social security, should be considered for achievement of a substantially better quality of life for cancer patients and their families.

The purpose of this empirical study is to evaluate efficiency of the regional public hospitals, using DEA(Data Envelopment Analysis). to do this, we design a DEA-AR/AHP Hybrid model to evaluate efficiency of 34 Regional Public Hospitals. the proposed model is developed by adding Acceptance Region(AR). using analytical hierarchy process(AHP). this model is compared with those of typical DEA models. Financial data used in this study were obtained from Database of the Korea Association Regional Public Hospital and analyzed using DEA model. As a result of analysis, This study found that the DEA-AR/AHP Hybrid model was superior to those typical DEA models in determining the priority among efficient hospitals. the result of this study can provide helpful information to evaluate the efficiency of public hospitals for efficient operational management, to develop more precise measurement for the priority of the efficient hospitals.

The purpose of this study was to analyze the relationship between the locational characteristics of areas surrounding oriental medicine hospitals and the number of patients who visited study hospitals. Administrative data collected from the annual report of 5 ward offices in Daejeon used to assess the geographical attributes. Two oriental medicine hospitals operated in Daejeon provided data for the number of inpatient and outpatient. Number of patients who visited study hospitals was calculated in each Dong which is the smallest administrative district. The geographical attributes of Daejeon were evaluated by the demographic and economic factors which were assumed to influence the health care demand. Each criterion was measured from each Dong. Weights of factors was calculated by Analytic Hierarchy Process (AHP) method. Evaluation scores which representing the geographical attributes of Dong was computed by multiplying the eight factors and weights. Results showed positive correlation coefficients between the evaluation scores of Dong and the number of patients. One hospital which was more closely located to areas with high evaluation scores had higher number of patients than that of the other hospital. Buffering analysis with varying size support the analysis results. This finding proposed the importance of location for the management of oriental medicine hospitals in a metropolitan city. Applying study model to other cities will enhance the validity of study results.

Objectives : This study investigates the determinants of contingent workers' ratio in public health centers. Since the economic crisis in 1997, there have been many studies on contingent workers in Korea. But, previous studies have been not conducted focusing on public health center. Methods : This study used 253 public health centers, installed and operated since December 31, 2008. in Korea as units of analysis. To examine the determinants of contingent workers' ratio, this study uses Pearson correlation and multiple regression analysis. Results : The following appeared as significant variable affecting contingent workers' ratio in public health centers; degree of the local government's financial independence(p<0.001), rate of increase/decrease in ages 65 and over(p<0.001), rate of increase/decrease in basic livelihood security recipients(p<0.01) and rate of increase/decrease in registered disabled persons(p<0.01). In contrast, internal organizational environment characteristics related variables were not statistically significant. Conclusions : Contingent workers' ratio in public health center is significantly affected by financial vulnerability of the local government and increase in demand of health care services.

Objectives : The purpose of this study is to evaluate the effects of assistive products usage on activity of daily living for the beneficiary older adults people in Korean long-term care insurance system. The study subjects were divided to assistive products users and non-users among the beneficiary older adults based on Korean long-term care insurance system to compare function improvement of the activity of daily living. Methods : In national wide 12 community elderly care center enrolled the National Health Insurance Corporation, The numbers of 281 beneficiary older adults(long-term care Grade I: 66, Grade II: 58, Grade III: 157) participated in this study. This survey assessment tool for activity of daily living was used the long-term care assessment instrument of the physical functions in the law of Korean long-term care insurance. The function items of Activity of daily living were included in clothing, washing, tooth brushing, bathing, eating, posture converting, stand sitting, move sitting, out of room, using toilet, controlling of stool, controlling of urine, washing hair. According to independence to complete dependence functioning level, remarks pointed 1 to 3 points. The data were analyzed by chi-square, two-way anova using SPSS V. 12.0. Results : The results appeared that the mean score of the functions in activity of daily living of assistive products users was a 27.60, and that of non-users was a 30.66. Assistive products were not effected in Grade I and II recipients, but that effected in Grade III recipients. Conclusion : Preparing for activation of assistive products based Korean long-term care insurance system, the result application as follows is possible. The usage of assistive products could improve the function of daily living activity in older adults. Related to Grade III beneficiary elderly people were improved function in activity of daily living by using assistive products, it is necessary to extend coverage the non-eligible elderly people in Korean long-term care insurance system.

The purpose of this study is to compare accreditation criteria of environmentally-friendly hospitals in the USA, UK and Australia and find out the implications for Korean hospitals. The comparison was made in terms of 11 categories : sustainable site, water efficiency, energy & atmosphere, transportation, indoor environmental quality, health, material & resources, management, waste, innovation, and regional priority. Literature review of the study revealed that most of the environmentally-friendly hospitals have experienced such positive effects as cost saving, health promotion of patients & employees and good reputation etc. The study result implies that the following factors are so critical to settle environmentally-friendly hospitals in Korea: 1) CEO's interest & support, 2) education for employees, 3) efficient renovation of existing facility and 4) data accumulation on the effectiveness of environmentally- friendly hospitals by scientific methods.