• 한국의료질향상학회지
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• 제26권2호
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• pp.95-103
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• 2020

Purpose: This study was to examine whether a health care model that provides comprehensive medical services based on population groups to members of the medical cooperative is applicable as a policy alternative in terms of medical use and cost. Methods: Data were derived from National Health Insurance claim data in 2019. We compared the medical volume and expenses of patients who visited social cooperative-type medical clinics with other patients, control group who visited other clinics in a local area. Results: The average number of visit days was 25.3 days in social cooperative-type medical clinics, more than 24.2 days in the control group (p=.004). However, the average medical cost per visit was KRW 46 thousand in social cooperative-type medical clinics, which was significantly lower than KRW 51 thousand in the control group (p<.001), and the total medical cost was also KRW 16.1 billion in social cooperative-type medical clinics and KRW 16.9 billion in the control group. Conclusion: We identified that a population-based health care model might change patients' behaviors to health care services and decrease total medical cost. Further population based experiment is needed to develop alternative healthcare model.

• 보건행정학회지
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• 제31권3호
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• pp.261-271
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• 2021

Background: In 2018, the government increased the fee for the magnetic resonance imaging (MRI) image deciphering services of the external hospital to discourage the redundant MRI scan and to induce appropriate use of the MRI services. It is important to evaluate the effect of the policy to provide the basis for establishing other MRI-related policies. Methods: The healthcare data of the patients who had brain MRI scans were organized by episode and analyzed using the panel study in order to find out the effect of the MRI-related policy on the substitution effect and the medical expenses. Results: As a result of the increase in the fee of deciphering the MRI image, there has been an uplift in deciphering the MRI scan of the external hospital. It implies that more hospitals chose to use the MRI scan taken by other clinics or hospitals, rather than the MRI scan taken at their own facilities. Conclusion: The research results imply that a policy that facilitates the exchange of the medical image data between the hospitals is needed in order to establish an efficient management system of the healthcare resources. Such improvement is expected to reduce the social cost and contribute to the stability in the finance of national health insurance.

• 한국병원경영학회지
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• 제26권1호
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• pp.55-70
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• 2021

Purpose: The purpose of this study was to examine the influencing factors of the patient leaning phenomenon in tertiary hospitals. Based on the results of this study, we intended to find implications for improving the problems of the delivery system imbalance in tertiary hospitals caused by patient leaning phenomenon. Methodology/Approach: Qualitative studies were conducted, using focus group interviews and in-depth interviews. The focus group interviews were conducted for 12 users of tertiary hospitals by 2 groups. And in-depth interviews were conducted for 6 tertiary hospital managers. This was considered to be the most effective approach to gather diverse and in-depth information about the influencing factor of patient leaning phenomenon in tertiary hospitals. Findings: In focus group interviews, the reason for choosing tertiary hospitals was the reliability of the hospital(physician, reputation, etc.). And the effect of the policy to strengthen coverage of National Health Insurance and private medical insurance was relatively small. In other words, we found that the individual's desire to receive medical services suitable for one's health status and disease condition was the biggest factor, rather than the cost and policy factors. Practical Implications: We suggested that the appropriate medical care provision should be strengthened according to the role and function of medical institutions. In addition, the education system needs to be reorganized to activate the referral program, expand community medical capabilities, and foster quality primary medical care.

• 보건행정학회지
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• 제31권2호
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• pp.173-179
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• 2021

Background: In Korea, the length of stay and medical expenses incurred by medical aid patients are increasing at a rate faster than the national health insurance. Therefore, there is a need to create a management strategy for each type of hospitalization to manage the length of stay of medical aid patients. Methods: The study used data from the 2019 National Health Insurance Claims. We analyzed the factors that affect the length of stay for 186,576 medical aid patients who were hospitalized for more than 31 days, with a focus on the type of hospitalization in long-term care hospitals. Results: The study found a significant correlation between gender, age, medical aid type, chronic disease ratio, long-term care hospital patient classification, and hospitalization type variables as factors that affect the length of hospital stay. The analysis of the differences in the length of stay for each type of hospitalization showed that the average length of stay is 291.4 days for type 1, 192.9 days for type 2, and 157.0 days for type 3, and that the difference is significant (p<0.0001). When type 3 was 0, type 1 significantly increased by 99.4 days, and type 2 by 36.6 days (p<0.0001). Conclusion: A model that can comprehensively view factors, such as provider factors and institutional factors, needs to be designed. In addition, to reduce long stays for medical aid patients, a mechanism to establish an early discharge plan should be prepared and concerns about underutilization should be simultaneously addressed.

• KDI북한경제리뷰
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• 제21권7호
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• pp.19-26
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• 2019

• 한국의료질향상학회지
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• 제27권2호
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• pp.73-82
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• 2021

Purpose: This study aims to examine the quality of tuberculosis (TB) care after the 1st to 3rd national quality assessment (QA) program for TB healthcare service in Korea was conducted. Methods: We analyzed Health Insurance Review & Assessment Service (HIRA) claims data of new TB patients during the period of January to June from 2018-2020. The new TB patients were defined as TB patients reported to Korea Centers for Disease Control and Prevention Agency (KCDA). The unit of analysis was the patient. Chi-square tests were used to analyze the differences in indicator value according to the types of medical facilities. The QA indicators of TB care were divided into 3 areas consisting of the following 7 quality indicators: 4 indicators of diagnosis test (the rate of acid-fast bacilli smear, the rate of acid-fast bacilli culture, the rate of Mycobacterium tuberculosis-polymerase chain reaction, drug susceptibility test), 1 compliance of treatment guideline, and 2 indicators of care management of TB patients (encounter rate, day of therapy). Results: The QA program for TB care was conducted among 8,246 patients from 534 facilities in 2020. The value of the 7 quality indicators was shown to increase as a result of the QA program. The indicators of the diagnostic test were all higher than 95%, with the exception of the drug susceptibility test which was 84.8%. Both indicators for care management of TB patients were 88.5%. Conclusion: The quality of TB care has been improving with the implementation of the QA program. In order to continue to improve the quality of TB care, it will be necessary to disclose the results of the QA program in medical facilities in the future.

• 보건행정학회지
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• 제34권1호
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• pp.38-47
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• 2024

연구배경: 한국의 소아청소년 인구는 최근 10년간 288만 명 감소하였으며 전례 없는 초저출산으로 더욱 감소할 것으로 예상되고 있다. 여기에 코로나19 팬데믹 영향으로 소아청소년과 의원의 수익은 크게 감소하여 폐업이 증가하고 있는 실정이다. 본 연구는 아동인구 감소로 인한 소아청소년과 의원의 수익 악화가 폐업에 실질적으로 영향을 주었는지 분석하였다. 방법: 2011-2022년 건강보험심사평가원의 요양기관현황신고, 건강보험청구자료와 통계청의 주민등록인구현황 자료를 이용하여 2012-2022년 소아청소년과와 그 외 진료과(내과, 이비인후과, 가정의학과) 의원의 연도별 자료를 구축하였다. 종속변수를 폐업 여부로 하였고, 지역의 인구 특성 및 경쟁 정도를 반영하는 변수(전년 대비 아동인구 감소 여부, 허핀달-허쉬만지수 등)와 기관 특성 변수(전년 대비 수익 감소 여부, 연간 수익 등)가 폐업에 영향을 주는지 분석하였다. 기술통계, 카이제곱분석을 실시하였으며 일반화추정방정식(generalized estimating equations, GEE)을 사용하여 변수별 오즈비를 추정하였다. 결과: 소아청소년과 의원의 폐업률은 2.66%-7.04%로 내과·이비인후과·가정의학과 1.81%-2.47%와 비교했을 때 지속적으로 높았으며 코로나19 팬데믹 시기에 7.04%로 가장 높았다. 3개 진료과와 소아청소년과의원의 기관당 진료비 격차는 2012년 126백만 원에서 2019년 245백만 원으로 더 커졌다. GEE 분석결과, 낮은 수익, 전년 대비 수익 감소는 소아청소년과의 폐업을 증가시키는 주요 요인이었으며 수익 관련 변수 보정 후 소아청소년 인구 감소 자체는 폐업을 증가시키지 않는 것으로 분석되었다. 지역 내 동일 진료과 의원 수가 많거나 독과점이 있는 경우 3개 진료과(내과·이비인후과·가정의학과) 의원의 폐업은 증가하였으나 소아청소년과 의원의 폐업에는 영향을 주지 않는 것으로 나타나 차이가 있었다. 결론: 아동인구가 감소하는 상황에서 수익 감소는 소아청소년과 의원의 폐업을 증가시키는 주요 요인이 분명하다. 추후 소아청소년 진료체계를 안정적으로 유지시키기 위한 적극적인 방안이 모색되어야 한다.

• 한국임상약학회지
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• 제31권4호
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• pp.268-277
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• 2021

Background: Most antipsychotic drugs studies have been mainly conducted on side effects, randomized clinical trials, utilization rates, and trends. But there have been few studies on the influencing factors in elderly patients. The purpose of this study was to analyze the influencing factors on the outpatient prescription of antipsychotic drugs in the elderly patients. Methods: Active ingredients of antipsychotic drugs in Korea were selected according to the Korean Pharmaceutical Information Center (KPIC)'s classification. Data source was Korean Health Insurance Review and Assessment Service (HIRA) claims data in 2020 and target patient group was the elderly patient group. We extracted patients who have been prescribed one or more antipsychotic drugs and visited only one medical institution. Data were analyzed using descriptive statistics, chi-square, t-test, negative binomial regression. Results: A number of outpatients were 245,197 and prescriptions were 1,379,092. Most characteristics of patients were 75-85 year's old, female, health insurance type, no disease (dementia, schizophrenia), atypical drugs, cci score (>2) and characteristics of medical institution were neurology in specialty, rural region, general hospitals. Results of regression showed that patient's characteristics and medical center characteristics had significant effect on the outpatient prescription of antipsychotic drugs in the elderly patients. Conclusion: This study suggests that national policy of antipsychotic drugs in the elderly patients, with the consideration of the patients' and medical institutions' characteristics, is needed.

• 대한의사협회지
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• 제61권11호
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• pp.687-698
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• 2018

Inappropriate antibiotic use significantly contributes to antibiotic resistance, resulting in reduced antibiotic efficacy and an increased burden of disease. The objective of this study was to investigate the characteristics of prescribers whose antibiotics use was high and to explore factors affecting the use of antibiotics by medical institutions. This study analyzed the National Health Insurance claims data from 2015. Antibiotic prescription data were analyzed in terms of the number of defined daily doses per 1,000 patients per day, according to the World Health Organization anatomical-therapeutic-chemical classification and methodologies for measuring the defined daily dose. We investigated the characteristics of prescribers and medical institutions with high antibiotic use. Multivariate regression analyses were performed on the basis of characteristics of the medical institution (number of patients, type of medical institution [hospital or clinic], age of the physician, etc.). The number of patients and number of beds were found to be significant factors affecting antibiotic use in hospitals, and the number of patients, region, and medical department were significant factors affecting antibiotic use at the level of medical institutions. These findings are expected to help policy-makers to better target future interventions to promote prudent antibiotic prescription.

• 보건행정학회지
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• 제28권4호
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• pp.402-410
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• 2018

Background: Monitoring appropriate medication categories can provide early warning of certain disease outbreaks. This study aimed to present a methodology for selecting and monitoring medications relevant to the surveillance of acute respiratory tract infections, such as influenza. Methods: To estimate correlations between acute febrile respiratory tract infection and some medication categories, the cross-correlation coefficient (CCC) was used and established. Two databases were used: real-time prescription trend of antivirals, anti-inflammatory drugs, antibiotics using Drug Utilization Review Program between 2012 and 2015 and physicians' number of encounters with acute febrile respiratory tract infections such as influenza outbreaks using the national level health insurance claims data. The seasonality was also evaluated using the CCC. Results: After selecting six candidate diseases that require extensive monitoring, influenza with highly specific medical treatment according to the health insurance claims data and its medications were chosen as final candidates based on a data-driven approach. Antiviral medications and influenza were significantly correlated. Conclusion: An annual correlation was observed between influenza and antiviral medications, anti-inflammatory drugs. Suitable models should be established for syndromic surveillance of influenza.