• 보건행정학회지
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• 제29권3호
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• pp.288-302
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• 2019

Background: The one-person households (OPH) are rapidly increasing and vulnerable to socioeconomic and health problems. Because it is predicted to be inequitable to health care utilization, we would like to find out about the equity of health care utilization of the OPH by comparison with the multi-person households (MPH). Methods: This study followed the theoretical framework of Wagstaff and van Doorslaer (2000), O'Donnell and his colleagues (2008), where the horizontal inequity index is the difference between the concentration indices of actual health care utilization and health care needs. This study employed the 9th Korea Health Panel survey, and a total of 10,807 cases were analyzed. Health care needs were measured by age, sex, subjective health status, chronic disease count, Charlson's Comorbidity Index, limitation of activities, and disability. Results: Compared with the MPH, there were pro-poor inequities in hospitalization, emergency utilization, hospitalization out-of-pocket payments, and pro-rich inequities in outpatient out-of-pocket payments for the OPH. The decomposition of the concentration index revealed that chronic disease count made the largest contribution to socioeconomic inequality in outpatient utilization. Age, health insurance, economic activities, and subjective health status also proved more important contributors to inequality. The variables contributing to the hospitalization and emergency utilization inequity were age, education, Charlson's Comorbidity Index, marital status, and income. Conclusion: Because the OPH was more vulnerable to health problems than the MPH and there were pro-poor inequities in medical utilization, hospitalization, and emergency costs, it is necessary to develop a policy that can correct and improve the portion of high contribution to medical utilization of the OPH.

• 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.

• 보건행정학회지
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• 제32권2호
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• pp.154-163
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• 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.

• 보건행정학회지
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• 제32권2호
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• pp.137-153
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• 2022

In the process of promoting policies to strengthen health insurance coverage, the relationship between public health insurance and private health insurance, along with the management of non-benefit, is also emphasized as a policy issue. First, the concept and scope of non-benefit were comparatively analyzed by country. Second, the interaction between the public and private health insurance was classified as 'large or small,' and the government's regulation and management policy on private health insurance was classified as 'strong or weak.' Korea has relatively smaller benefits covered by public health insurance, higher copayment expenses, and more areas and scope of non-benefits. In countries where the interaction between public and private health insurance is small, private health insurance-related policies are weak. And in countries with large interactions had public-private partnerships and the government's management policies were also strong. On the other hand, Korea has a large interaction, but the actual structure of cooperation between public and private insurance and management policies were weak. Because the non-benefit sector in Korea is relatively wide, it is difficult to manage compared to other countries where the concept of non-benefit is limited. In addition, the health authorities rarely perform the role of supervision over private health insurance, and they have so few linkages and cooperation for public-private insurance. Therefore, practical policy enforcement is necessary to achieve the easing of the burden of national medical expenses through linkage and cooperation of public-private health insurance with reference to relevant other countries' cases.

• 대한예방한의학회지
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• 제26권3호
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• pp.49-58
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• 2022

Objectives : The purpose of this study is to analyze the factors affecting the intention of traffic accident patients, who had visited Korean medicine clinics for the purpose of treating traffic accidents, on revisiting and recommending those clinics to others. Methods : This study conducted the frequency analysis, Rao-scott chi-square test, and logistic regression analysis on 389 people, who answered that they had once visited Korean medicine clinics for treatment in traffic accidents, using data from the 2020 Korean Medicine Utilization and Herbal Medicine Consumption Survey. Results : As a result of the analyses, it was revealed that the significant influencing factors entailed marital status, job status, the attitude of medical staff, and access to the Korean medicine clinics, while only access to the Korean medicine clinics was a significant influencing factor for the intention to recommend to others. Especially, the intention of to revisit and to recommend in case of satisfying access to the Korean medicine clinics were 8.476 times and 6.784 times higher than when it is not the case. Conclusions : The results of this study reflect the characteristics of automobile insurance, and indicate that both further study and policy establishment on the operation of the automobile insurance system are required to ensure sufficient treatment for traffic accident patients.

• 보건행정학회지
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• 제33권2호
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• pp.166-172
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• 2023

Background: To improve the support low-income individuals' medical expenses, it is necessary to think about ways to enhance the Catastrophic Health Expenditure Support Program. This study proposes expanding support criteria and changing the income standard. Methods: This study conducted simulations using national data from the National Health Insurance Service. Simulations performed for people who have used health services (n=172,764) in 2022 to confirm the Catastrophic Health Expenditure Support Program's size based on changes to the subject selection criteria. Results: As a result of the simulation with expanded criteria, the expected budget was estimated to increase between Korean won (KRW) 13.2 (11.5%) and 138.6 billion (37.4%), and the number of recipients increased between 41,979 (48.9%) and 150,317 (76.1%). The results of the simulation for the change in income criteria (applied to health insurance levels below the 50th percentile) estimated the expected budget to increase between KRW -8.9 (-7.8%) and 55.6 billion (15.0%) and the number of recipients to increase between -8,704 (-10.1%) and 41,693 (21.1%) compared to the current standard. Conclusion: The 2023 Catastrophic Health Expenditure Support Program's criteria were expanded as per the 20th Presidential Office's national agenda to alleviate the burden of medical expenses on the low-income class. In addition, The Catastrophic Health Expenditure Support Program needs to be integrated with other medical expense support policies in the mid- to long-term, and a foundation must be prepared to ensure the consistency of each system.

• 보건행정학회지
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• 제33권3호
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• pp.295-310
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• 2023

Background: The long-term care (LTC) group has higher rates of chronic disease and disability registration compared to the general older people population. There is a need to provide integrated medical services and care for LTC group. Consequently, this study aimed to identify medical usage patterns based on the ratings of LTC and the characteristics of benefits usage in the LTC group. Methods: This study employed the National Health Insurance Service Database to analyze the effects of demographic and LTC-related characteristics on medical usage from 2015 to 2019 using a repeated measures analysis. A longitudinal logit model was applied to binary data, while a linear mixed model was utilized for continuous data. Results: In the case of LTC ratings, a positive correlation was observed with overall medical usage. In terms of LTC benefit usage characteristics, a higher overall level of medical usage was found in the group using home care benefits. Detailed analysis by medical institution classification revealed a maintained correlation between care ratings and the volume of medical usage. However, medical usage by classification varied based on the characteristics of LTC benefit usage. Conclusion: This study identified a complex interaction between LTC characteristics and medical usage. Predicting the requisite medical services based on the LTC rating presented a challenge. Consequently, it becomes essential for the LTC group to continuously monitor medical and care needs, even after admission into the LTC system. To facilitate this, it is crucial to devise an LTC rating system that accurately reflects medical needs and to broaden the implementation of integrated medical-care policies.

• 한국학교ㆍ지역보건교육학회지
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• 제20권1호
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• pp.1-14
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• 2019

Objectives: There are few studies which reflects of each generation's own features, of the New Middle Age and the Elderly's hearing status and their quality of life even though the population of old age has been weighted as baby boom generation's entering into old age. This study is to identify the effects of the new middle age and the elderly's hearing status on their quality of life and to prepare the customized health policies for their health promotion and quality of life improvement as well as the base line data for hearing enhancement programs. Methods: This study was analyzed using the data of the 7th term of the National Health and Nutrition Survey of the Disease Management headquarters. Out of 8,150 adults over the age of 50 who participated in the hearing test, 3,306 were selected and analyzed. Results: At the result of identifying the correlation of hearing status and the quality of life between the New Middle Age and the Elderly, it was confirmed that hearing loss affects low quality of life. The average of quality of life between the New Middle Age and the Elderly was 0.95 and 0.85 each, resulting in higher quality of life in New Middle Age than in the Elderly. The factors affecting the quality of life of the New Middle Age were the level of the education, household income, the type of health insurance, subjective health status. The factors affecting the quality of life of the Elderly were gender, the type of health insurance, subjective health status. Conclusion: Hearing loss of the New Middle Age and the Elderly affects their low quality of life. Therefore the development and the provision of policy program is needed, so as to maintain and manage hearing through age-specific health education. It is expected that the second half of the New Middle Age's life will be much happier, if not taking the treatment-oriented approach of hearing loss only but strengthening the education needed for the maintenance and the management of healthy hearing at their work place, where 50 and 60 generations' workforce has been increased.

• 한국산학기술학회논문지
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• 제12권8호
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• pp.3563-3571
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• 2011

본 연구는 경남지역 20개 보건소를 대상으로 2007-2009년 까지 3년 동안의 효율성을 분석한 후, 그 결과를 토대로 비효율 보건소의 투입 및 산출변수의 목표량을 규명함으로써 운영의 효율성 제고에 실질적인 도움을 주기 위한 목적으로 수행하였다. 효율성 평가방법으로 자료포락분석(Data Envelopment Analysis: DEA)의 CCR, BCC 모형을 이용하여 보건소 전체 효율성과 사업 영역별 효율성을 평가하였다. 투입변수로는 인력(의료직, 간호 및 기술직, 사무직)을, 산출변수로는 보건소 사업(진료실적, 구강보건, 예방접종, 노인보건, 모자보건, 방문보건)을 선정하였다. 분석 결과, 기술효율성(TE)의 경우 2007년 평균은 0.912, 2008년 0.877, 2009년 0.917이었으며, 순수기술효율성(PTE)의 2007년 평균은 0.961, 2008년 0.946, 2009년 0.964, 그리고 규모의 효율성(SE)의 2007년 평균은 0.944, 2008년 0.925, 2009년 0.952로 나타났다. 본 연구를 통해 경남지역 보건소의 효율성이 전반적으로 높은 수준임을 알 수 있는데, 이는 국가 및 경상남도에서 그동안 보건소의 공공 보건사업을 활성화하기 위해 지속적으로 행정적, 재정적 지원을 추진한 결과로 보인다. 본 연구의 결과는 향후 경남지역 공공보건사업의 체계적인 기획, 수행 및 평가체계의 구축은 물론, 전국의 다른 지역 보건소에 대해서도 효율성 제고를 위한 유용한 시사점을 줄 수 있을 것으로 기대된다.

• 한국GIS학회:학술대회논문집
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• 한국GIS학회 2009년도 춘계학술대회
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• pp.224-225
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• 2009

본 연구는 기존의 U-City사례지역을 중심으로 도시특성에 따른 U-서비스를 분석하고 있다. 분석결과 U-서비스는 크게 3가지 유형으로 나타나고 있다. 첫째, 도시특성과 무관하게 선호되는 서비스 유형이다. 교통, 행정, 문화 관광 스포츠, 보건 의료 복지 등은 도시 특성과 상관없이 선호되고 있는 것으로 나타나고 있다. 둘째, 도시특성과 무관하게 선호되지 않는 서비스 유형이다. 대표적으로 물류와 근로 고용서비스는 도시특성과 상관없이 선호되지 않는 서비스로 분석되고 있다. 셋째, 도시특성에 따라 선호되는 유형과 그렇지 않는 유형이다. 교육과 환경 등은 도시특성에 따라 서비스 선호가 다르게 나타나고 있다. 이 연구에 대한 도시특성에 따른 서비스 항목의 분석결과 추후 U-City 도시건설과정에서 도시특성에 따라 적절한 U-City건설에 필요한 요소기술/서비스 개발에 활용될 수 있을 것으로 본다.