• Korean Journal of Clinical Pharmacy
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• v.21 no.2
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• pp.156-160
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• 2011

서론: 본 연구는 불필요한 소화기관용 약제의 처방이 한국에서의 처방전 당 약물 개수를 증가시키는 것과의 연관성을 검토하고자 수행되었다. 연구방법: 연구를 위한 자료로 건강보험심사평가원의 처방전 데이터와 환자의 기타 모든 의료보험 청구데이터를 이용하였고, 두 데이터셋을 연결하여 처방전들을 소화기관용 약제의 필요성에 따라 소화기관질환 그룹, 관절염질환 그룹,소화기관용 약제 처방이 불필요할 것으로 그 외 질환 그룹으로 구분, 분리하였다. 결과: 처방전 당 약물의 평균 개수의 분포는 세 그룹에서 비슷한 양상을 보였는데, 관절염질환 그룹과 그 외 질환 그룹의 거의 절반 이상은 한 개의 소화기관용 약제를 포함하였다. 세 그룹 모두 처방전 당 약물 개수와 처방전 당소화기관용 약제의 개수가 1차 선형관계를 보였다. 그 외 질환 그룹에서는 처방전 당 전체 약물이 평균 6개를 넘는 경우, 적어도 한 개의 소화기관용 약제가 포함되었다. 본 연구는 불필요한 소화기관용 약제를 처방하는 것은 다제처방의 매우 유의한 예측인자임을 보였다. 결론: 향후, 약제 처방전의 질을 향상시키기 위해서는 각각의 약물을, 특히 소화기관용 약제를, 처방 시 약제의 불가피한 필요성에 대해 판단할 수 있어야 할 것이다.

• Korean Journal of Clinical Pharmacy
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• v.21 no.3
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• pp.249-255
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• 2011

Objective: To examine the drug use (prescribing) pattern of serious drug-drug interactions (DDIs, contraindicated drug interactions) using real world data. Prescription patterns were examined in terms of dispensing types. Method: Retrospective drug utilization review (DUR) study was performed. One hundred and six datasets of serious DDIs (DDI pairs) were determined among DDI datasets that Ministry of Health & Welfare announced for the DUR system from 2004 to 2005. Electronically transacted ambulatory patients' prescription database to Health Insurance Assessment and Review Services (HIRA) from July, 2005 to June, 2006 was collected with personal information deidentified and analyzed in terms of types of dispensing as a contributing factor. Results: After prescription data analysis per each patient, total number of DDI cases using 95 DDI pairs was 5,511, which accounted for 2.6 cases per patients. DDI cases between two drugs from each of community pharmacy dispensing- type prescription were considerable (63% vs. 24% in those from each of in-institutional dispensing-type prescription and vs. 13% in those from a community pharmacy dispensing-type prescription and an in-institutional dispensingtype prescription). Conclusions: DDI cases from different prescribers were found to be significant. Thus, the concurrent DUR process between prescriptions from different physicians and institutions should be implemented for the safe drug use.

• Journal of the Korean Data and Information Science Society
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• v.28 no.1
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• pp.75-86
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• 2017

The facial palsy is one of the most common illness in Western-Korean collaborative treatment (hereinafter "collaborative treatment"). The purpose of this study is to analyze facial palsy patients'collaborative treatment use patterns. By analysing the 2014 National Health Insurance Review and Assessment Patient Sample Data (NPS 2014) with the episode of care unit, we have found the following results. First, the collaborative treatment is preferred by patients over 50 years old and female. Second, western medicine mainly focuses on diagnosis and medical examination while korean medicine and collaborative treatment focus more on treatment activity. Third, western medicine showed the shortest treatment period, followed by korean medicine and collaborative treatment. However, the cost of medical treatment per day is highest in western medicine. The analysis of the use patterns of collaborative treatment shown in the study is expected to provide a direction for the development of clinical practice guidelines and the establishment of medical policies in the future.

• Journal of the Korea Convergence Society
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• v.8 no.12
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• pp.149-157
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• 2017

Unnecessary readmissions could be the result of the inadequate and unnecessary treatments. Adequate quality indicators for readmission are important because they can identify inadequate spending by inpatients as well as quality screening. This study attempted to estimate the cost incurred by unnecessary readmissions. The Health Insurance Claims Data of 18 years or older who were admitted in the tertiary hospitals in 2014 were analyzed. Admissions and readmissions were sorted and readmissions were classified into planned and unplanned readmissions. We adopted 28 days as a criteria for the classification of the readmission. Proportion of the patients were higher in readmissions among cancer, accompanied diseases, and special rehabilitation patients. Cost of the readmissions were 50% of the total cost of the admission among the patients of same diseases, same departments, and same hospitals. Almost 1,000billion Won were used by the unnecessary readmissions. We need to reduce the readmissions in regions, departments, and diseases studying the pattern of the readmissions. National level efforts are required to improve quality of care and reduce cost by the unnecessary readmissions.

• The Korean Society of Law and Medicine
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• v.18 no.2
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• pp.195-218
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• 2017

The increase in medical expenses for convalescent hospitals is increasing abnormally, which puts enormous burden on the National health insurance finances. This is a phenomenon that has been associated with the social phenomenon of rapid aging. The fact that the convalescent hospitals are paid the fixed amount per day for hospitalization became the incentive for some hospitals to use the patients as means of making money. And these hospitals intend to get regular care or take medicines at other hospitals in order to reduce medical expenses, even when the medical fee is paid. In order to prevent such financial leaks, the Health Insurance Review and Assessment Service adjusted the patient group for inpatients in a hospital with the above behavior, and then cut the cost of medical care benefits. However, Above decision was canceled by the court on the grounds that there was no basis rule. However, based on the above case, I think that it can be an opportunity to draw up the problem and to improve of the Medical Fee System of hospital. The modified medical fee system can strengthen the medical function of the convalescent hospital. In addition, it seems reasonable to exclude admission for "physically disabled group". Even if admission is allowed for the physically disabled group due to social needs, it should be excluded from the National health insurance for the fianacial soundness and the sustainability of the system.

• Journal of Society of Preventive Korean Medicine
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• v.19 no.2
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• pp.51-56
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• 2015

Objective : We analyzed present condition of cooperative medical care using claims data of HEALTH INSURANCE REVIEW & ASSESSMENT SERVICE form patients treated by Korean-Western cooperative medicine. The study aimed to offer guidelines in selecting disease-related research in developing Korean-Western convergence technology. Method : Based on the patients using Korean medical service, we analyzed claims data of patients using Korean medical service and western medical service from January 2012 to December 2013. We were assigned to the server remotely. With the concept of 'episode of care', we rebuilt claims data and analyzed present condition of cooperative medical usage. Results : We analyzed present condition of cooperative medical care per episode of care. Among outpatients, Low back pain, lumbar region(M5456) was the highest number. Among inpatients, Sciatica due to intervertebral disc disorder(M511) was the highest number. Conclusion : Based on the claims data provided by HEALTH INSURANCE REVIEW & ASSESSMENT SERVICE, we have derived a list of multy frequently disease frequently treated by cooperative medical care by analyzing present condition.

• Korean Journal of Clinical Pharmacy
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• v.20 no.3
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• pp.262-267
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• 2010

Therapeutic duplication of prescriptions is the most frequently reported inappropriate drug use in Korea. To prevent significant problems during drug prescribing and dispensing, prospectively, development of standard including drug lists considered as therapeutic duplications for the prioritized drug classes first would be necessary. This study was aimed to analyze frequent drug classes of therapeutic duplications by healthcare providers in clinical practice settings. National health claims data for drug review and reimbursement (1,426,065 prescriptions dated March 19, 2008) were analyzed. Therapeutic duplication was defined as the prescription including more than 2 ingredients belonging to the same KFDA drug classification numbers that considered to have therapeutic similarities. The following 3 drug classes were mostly frequent therapeutic duplication classes: 114 anti-pyretics, analgesics and anti-inflammatory drugs; 117 drugs for psycho-nervous system; 141 Antihistamines. About 3.5% of overall prescriptions analyzed showed therapeutic duplications. This result might be starting step to develop DUR therapeutic duplication standard.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.3
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• pp.1920-1927
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• 2015

This study examined health insurance costs of occupational therapy in stroke patients. The subjects were stroke patients, who underwent occupational therapy by hospitalization or out-patient centers in 2010. The cost of occupational therapy was analyzed from the insurance claims data of Health Insurance Review and Assessment Service in 2010. The kinds of occupational therapy were divided according to the insurance fee of occupational therapy in 2010. In-patients who received occupational therapy paid the highest rehabilitation treatment fee, whereas outpatients paid the highest nervous system function test fee. The cost of occupational therapy in the special rehabilitation treatment fee was highest by 25.3 billion won. The number of uses of general hospitals was the highest by 180 thousand but the total cost of long-term care hospital was highest by 10.4 billion won. The number of uses and cost by regional groups was highest in Seoul and Gyeonggi-do province. This study is meaningful in that a cost analysis of occupational therapy in stroke patients was performed for the first time using the stroke data from the whole country. The result can be used to provide basic data to improve the insurance fee in the future.

• Health Policy and Management
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• v.34 no.1
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• pp.26-37
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• 2024

Background: The purpose of this study was to compare and analyze the differences in charges and length of stay per case between spine specialty hospitals and non-specialty hospitals, and to identify the factors that influenced them. Methods: This study used claims data from the Health Insurance Review and Assessment Service, including inpatient visits from January 2021 to December 2022. The healthcare facility status data was used to identify the characteristics of study hospitals. Multilevel analysis was conducted to identify factors associated with the charges and Poisson regression analysis was conducted to analyze the length of stay between spine specialty hospitals and non-specialty hospitals. There were 32,015 cases of spine specialty hospitals and 17,555 cases of non-specialty hospitals. Results: For four of five common spinal surgeries, specialty hospitals shaped longer length of stay than those of non-specialty hospitals. Multilevel and Poisson regression analysis revealed that regardless of the type of surgery, higher age and higher Charlson comorbidity index scores were significantly associated with an increase in both the charges per case and length of stay (p<0.05). However, when hospitals were located in metropolitan areas, there was a significant decrease (p<0.05). Conclusion: This study found that specialty hospital had higher inpatient charges and loner length of stay contrary to the previous study results. Further studies will be needed to find which contribute to the differences.

• Korean Journal of Social Welfare
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• v.58 no.1
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• pp.395-423
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• 2006

The purpose of this study was to investigate the various contents of legal life's conflicts and constitutional applications by analysing on the constitutional judicial precedents regarding to social welfare law. The total cases of constitutional precedents are 62 totally, and 22 precedents among 62 are analysed through content analysis. These 22 constitutional precedents consist of nine cases of concerning Social Insurance Act, six cases in National Pension Act, two cases in National Basic Livelihood Protection Act and one cases in Social Welfare and Service Act. The major contents of these precedents are regarding to operational principles of social insurance system, rule of entitlements, benefits, social welfare organizations and the constitutional right such as property right, equal right, right of happiness. And also there are precedents to review how the rule of Act is interpreted or how the process of right protection is. Findings in this study show that Korean Constitutional Law has characteristics of welfare nationalism and social capital economics orientations, and sanctions legislation and administration discretion.