• 보건행정학회지
• /
• 제23권4호
• /
• pp.349-357
• /
• 2013

Background: Although interferon-gamma release assay (IGRA) is now available alternatives to tuberculin skin test (TST) for detection of latent tuberculosis infection (LTBI), the cost of IGRA test is much higher than TST. So economic analysis of LTBI screening strategies have been done in many countries, but there are few reports in Korea. This study examined cost analysis of LTBI screening strategies in Korea. Methods: The economic outcomes were evaluated by five strategies. These were 1) TST alone, 2) IGRA alone, 3) combination of TST and IGRA (TST followed by IGRA) and 4) no testing no prevention, 5) no testing all prevention. Last two strategies were added to compare with three main LTBI screening strategies. Decision analysis model were used to perform economic analysis. A cohort study of Korean Institute of Tuberculosis and the data of published literatures were used to estimate the cost analysis. Results: In a base-case scenario which was assumed that TST specificity was 80%, TST alone was the least expensive strategy. In a alternative scenario which was assumed that TST specificity was 97%, the combination of TST and IGRA was the least expensive strategy. Sensitivity analysis shows that patients adherent rate to LTBI treatment, TST sensitivity, IGRA sensitivity and IGRA specificity did not have a significant impact on the outcomes. Conclusion: In Korea, for the diagnosis of LTBI at the time of child and adolescent, TST alone reduces medical costs compared with IGRA alone or combination of TST and IGRA.

• 보건행정학회지
• /
• 제26권3호
• /
• pp.226-232
• /
• 2016

Background: This study was conducted to analyze the influence of socioeconomic characteristics of community on the food insecurity under the control of personal socioeconomic factors which may be influence to the food security. Methods: Food insecurity and individual socioeconomic characteristics were obtained from 2012 community health survey. Socioeconomic characteristics of communities were extracted from the data of Statistics Korea and local governments. Personal socioeconomic factors were sex, age, educational status, job, and monthly family income. Socioeconomic characteristics of communities were administrative district (urban vs. rural), senior population rate, degree of financial self reliance, degree of financial independence, portion of welfare budget, number of welfare facilities, and unemployment rate. We analysed the relationships between the food insecurity and socioeconomic characteristics of community using multi-level analysis under the control of personal characteristics. Results: On personal level age, sex, education status, and monthly family income were related with food insecurity. On community level administrative district (urban vs. rural), degree of financial independence, unemployment rate, and proportion of welfare budget among local general government accounts were related to individual food insecurity. Rural area, district with low levels of financial independence, low portion of welfare budget, and greater unemployment rate showed a higher level of food insecurity. Conclusion: To reduce the level of food insecurity in a community it is necessary to decrease the unemployment rate, in addition to providing support from the central government by increasing the proportion of the welfare budget so that both factors contribute to raising the degree of financial independence.

• 보건행정학회지
• /
• 제21권4호
• /
• pp.493-510
• /
• 2011

Objectives : This study aims to explore how social support and social network are related with health behavior. Methods : The target population was 12,449 people in Chungcheongbuk-do. The sample was accrued for the period of 3 months in 2008 by face to face interview of direct visiting from systematic sampling method. The instruments used in this study were social support, social network and health behavior. Results : There was significant difference in the level of social support and social network by sex, age, educational level, occupation, and monthly income(p<0.05). There was significant difference in the level of social support by alcohol drinking, physical exercise. There was significant difference in the level of social network by smoking, alcohol drinking, physical exercise, obesity(p<0.05). Multivarite analysis shows significant difference in the level of social instrumental support by smoking, physical exercise. It shows significant difference in the level of social emotional support by smoking. It also shows significant difference in the level of social network by smoking, physical exercise. Conclusion : These results suggest that social support and social network may be associated with health behavior. Because this study was cross sectional research, the order was not found between social support, social network and health behavior. Through a study on monitoring, we will obtain more information for relationship.

• 보건행정학회지
• /
• 제16권1호
• /
• pp.17-40
• /
• 2006

With the prospect of rapidly growing health insurance expenditures, particularly spending for ambulatory care, the introduction of a case-based payment method is discussed as an alternative to the current fee-for-service based method. A system to measure case mixes of providers is a core component of such payment systems. The objective of this study were to develop a classification system for ambulatory care, Korean Ambulatory Patient Group (KAPG) based on the U.S. APG version 2.0 and to evaluate the classification accuracy of the system. A database of 64,258,386 records was constructed from insurance claims submitted to the Health Insurance Review Agency (HIRA) during three months from August 2002. A total of 41,347,307 records with a single visit was used for the development and 7% random sample of the database was used for the evaluation. Additional groups were defined to include both physician and hospital fees in the classification, age splits were added to classify the entire population as well as the population older than 65, and the definition of medical groups used by the HIRA was adopted. The variance reduction in charges achieved by KAPGs was computed to evaluate the accuracy of classification. A total of 474 KAPGs was defined compare to 290 groups in the U.S. APG. The variance reduction for charges of all visits ranged from 20% to 37% depending on the type of provider, and ranged from 22% to 42% for non-outliers, that were better than those achieved by the system currently used by the .HIRA for its internal review purpose. Although further study is required to improve the classification for complicated care in larger hospitals, the results indicated that KAPGs could be used for better management of costs for ambulatory care.

• 기술혁신학회지
• /
• 제15권2호
• /
• pp.369-399
• /
• 2012

목적: 본 연구는 보건의료분야 연구주제 중 암유전자 분야의 지식지도를 구축하고 국내외 연구주제 네트워크를 시계열적으로 비교 분석함에 의해 국내 연구동향을 파악하고 향후 암유전자 분야에서 활발하게 연구될 영역을 확인하고자 하였다. 방법: 자료는 PubMed 데이터베이스의 Medical Subject Headings(MeSH) 검색기능을 이용하여 'Oncogene'을 주제로 하는 논문을 추출하였고, 교신저자 소속이 한국인인 논문을 분리한 후 추출된 논문의 키워드를 대상으로 하였다. 분석방법은 사회네트워크 분석 기법 중 가중치가 부여된 연결정도 중심성을 적용하여 연구주제 네트워크를 구축하였으며, 이를 시기별로 나누어 연구주제 변화를 확인하였다. 결과: 암유전자의 경우 국내외 모두 'Genes, ras'와 'Apoptosis', 'Signal Transdction' 등이 연결정도 중심성이 가장 높은 키워드였으며, 시기별로는 국내외 모두 'antineoplastic Agents', 'Prognosis', 'Tumor Markers, Biological' 등 암유전자를 대상으로 치료 및 진단, 예후와 관련된 연구가 활발해졌다. 결론: 암유전자 연구주제 네트워크 분석 결과 시기별로 연구주제에 대한 일정한 흐름이 있었다. 따라서 다양한 연구주제 네트워크 분석으로 각 질환별 연구단계가 확인된다면 다음 단계의 연구진행을 예측할 수 있을 것이며 그에 따른 연구개발 지원을 위한 전략을 수립할 수 있을 것이다.

• Journal of health informatics and statistics
• /
• 제43권4호
• /
• pp.329-335
• /
• 2018

Objectives: In recent years, there has been an increased need for a way to extract desired information from multiple medical literatures at once. This study was conducted to confirm the usefulness of unstructured data analysis using previously published medical literatures to search for new indications. Methods: The new indications were searched through text mining, network analysis, and topic modeling analysis using 5,057 articles of atorvastatin, a treatment for hyperlipidemia, from 1990 to 2017. Results: The extracted keywords was 273. In the frequency of text mining and network analysis, the existing indications of atorvastatin were extracted in top level. The novel indications by Term Frequency-Inverse Document Frequency (TF-IDF) were atrial fibrillation, heart failure, breast cancer, rheumatoid arthritis, combined hyperlipidemia, arrhythmias, multiple sclerosis, non-alcoholic fatty liver disease, contrast-induced acute kidney injury and prostate cancer. Conclusions: Unstructured data analysis for discovering new indications from massive medical literature is expected to be used in drug repositioning industries.

• 보건행정학회지
• /
• 제28권4호
• /
• pp.352-359
• /
• 2018

Background: The purpose of this study is to propose an analysis of trends and characteristics of high-cost patients who take over 40% of total national health insurance medical expenses. Methods: It has been analyzed the tendency of high-cost patients by open data based on the medical history information of 1 million people among national health insurance subscriber from 2002 to 2015. To conduct detailed study of characteristics of high-cost patients, multiple regression has been performed by sex, age, residence, main provider, and admission status based on the top 5% group. Results: The amount of medical expenses and the number of high-cost patients have gradually increased in decades. The number of high-cost patients for Korean won (KRW) 5,000,000 category has increased by 7.6 times, KRW 10,000,000 category has increased by 14.1 times in comparing of year 2002 and 2015. Top 5% medical expenses have increased by 4.6 times. In consideration of the characteristics of patients, the incidence of high medical expenses has been higher in female patients than male ones, the older patients than in the younger. Patients residence in Gyeonsang or Jeonla province have had a high incidence of medical expenses than other area. The disease including dementia, cerebral infarction, and cerebrovascular disease for high-cost patients has been also increased. Conclusion: The major increase factor for high medical expenses is the aging of population. The elderly population receiving inpatient care residing in the province that increases high medical costs have to management. There is an urgent need to develop a mechanism for predicting and managing the cost of high-cost medical expenses for patients who have a heavy financial burden.

• 디지털융복합연구
• /
• 제16권12호
• /
• pp.533-540
• /
• 2018

이 연구는 건강보험 심사평가원 자료를 이용하여 동일 환자의 동일 질환에 대하여 서로 다른 의료기관이 부여하는 질병 코딩의 불일치성을 분석하여 국가 보건 통계 질 향상을 위한 기초 자료로 활용하고자 시행하였다. 건강보험심사평가원 2014년 전체 환자 데이터셋(HIRA-NPS)에서 9,976,826건의 진료비 명세서를 연구 대상으로 하였다. 연구결과 의료기관의 이동 경로에 따라서 질병 코딩 불일치의 차이가 존재 하였고 불일치율은 보건기관 이외의 타 의료기관에서 보건기관으로 이동하였을 때 높아지는 경향이 발견되었고, 상급종합병원 간 이동하였을 때는 불일치율이 현저하게 낮았다. 본 연구의 의료기관 간 질병 코딩 불일치 현황 분석은 국내 의료기관에서 일관성 있는 질병 코딩이 이루어지기 위한 제도적 보완의 필요성을 시사하고 있다.

• 보건행정학회지
• /
• 제32권2호
• /
• pp.154-163
• /
• 2022

Background: The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit. Methods: We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. Results: In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated. Conclusion: High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.

• Journal of Nutrition and Health
• /
• 제7권3호
• /
• pp.27-44
• /
• 1974

A general survey of 82 perschool children and 473 school children (from 1st to 3rd grade) residing in the Dongnae area of Shindong Myun, choonseoung Gun, Kangwon Province was conducted from June 12 to 21, 1973, to obtain information concerning nutritional status, especially the protein and iron nutrition of preschool and school children in a rural area of Korea. A sample of 58 children 2 to 9 years old was selected from these 555 children for hematological, biochemical and parasitological tests. The results of these tests are presented below, 1) Both the mean body height and mean body weight of these children were higher and heavier than the averages in the Korean Physical Standards. About 39 per cent were above the 90 th percentile of the Korean Physical Standards of height and 35 per cent were above the 90th percentile of the Korean Physical Standards of weight. 2) The rate of infestation by helminthes was 67.6 per cent and there were no cases of hookworm infestation Among the ascaris-infected children, 61.6 per cent fell within an Ascaris E.P.G. count range of $501{\sim}2,000$. This was considered a rather mild intensify of ascaris infection. Nutrient loss due to helminthes was also estimated to be low. 3) The mean hemoglobin level was 11.3gm% $({\pm}0.94)$, and 68.4 per cent of the children were anemic (less than 11gm% among those 5 years old or less, less than l2gm% among those 6 years old or more). The average hematocrit value was 36.1% $({\pm}2.36)$, and only 3.5 per cent showed more than 34% on the M.C.H.C. test. These results showed that the incidence of anemia, in these rural children was high, and that in general it displayed hypochromic characteristics. 4) The average serum iron level was $78.2{\mu}g%$\;({\pm}29.8). The Proportion of the children showing less than $50{\mu}g% in the serum iron level was 5.6 per cent, while 41.8 percent revealed $450{\mu}g% or more in the TIBC determination. Transferrin saturation was below 15% in 71.4 percent of the preschool children, and in 28.6 percent of the school children. Those who had a serum iron level of $50{\mu}g% or less and a TIBC of more than $450{\mu}g% constituted 11.9 percent of the children examined. From these results, it was concluded that especially preschool children were low in iron nutrition, and that most of the anemia might be iron-deficiency anemia. 5) The mean values of total serum protein and albumin were 6.98gm% and 4.99gm% respectively. Especially in serum albumin, all children stowed more than 4 gm%. 6) The mean urinary urea nitrogen Per creatinine ratio was 11.5 $({\pm}4.2)$, and 21.8 percent had a ratio of more than 15. Considering these results, it was suggested that protein nutrition in these children was relatively good.