• 보건행정학회지
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• 제4권2호
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• pp.77-110
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• 1994

This study is an empiriacl analysis of effects of government intervention on the health care delivery system in Korea. The purposes of this study are to find out the effects of government intervention on the per capita national health expenditure(per capita NHE), crude mortality rate(CMR), and institutional efficiency. Here, the institutional efficiency is defined as a formula shown below: log$\frac{100-curde mortality rate }{per capita NHE}$$\times$100. The formula indicates that the instiutional efficiency increases if the CMR and/or per capita NHE goes down. In the meantime the government intervention is measured by six independent variables: I) the degree of social developments, ii) the numberr of physicians per 100, 000 population, iii) the proportion of specialists among the total physicians, iv) the proportion of public expenditure among the NHE, v) the proportion of public beds to the total number of beds, vi) the proportion of physicians working at the public sector to the total number of physicians. In the above six independent variables iv), v) and vi) are the ones that reflect the degree of government intervention. In actual calculation, the two independent variables v) and vi) are integrated into a new variable based on one to one correspondence. The materials used are the time-series data from 1970 through 1990 in Korea. A path analysis and the time-series regression analysis were adopted to estimate and examine the causal relationship between variables involved. And decomposition of the effect of causal relationship is made to find net effect, direct and indirect effect. The major findings are as follows; 1. The effect of public expenditure, number of physicians per 100, 000 population, the proportion of specialists among the total physicians and social development shows a positive relationship with per capita NHE. Only if the government intervention would be counted, the effects of the number of physicians and the proportion of specialists succeed in containing per capita NHE. 2. In additionn to the above four variables, one additional variable, per capita NHE, was also responsible for the reduction of CMR. The factor of social development found to be the most potent predictor of the CMR reduction. However, the CMR reduction due to government intervention was negligible. 3. Meanwhile, the above four variables were found to was have negative effects on the institutional efficiency. The reverse is true when the government intervention is counted. For example, the number of physicians and the proportion of specialists have played a positive role in raising institutional efficiency via goverment intervention. This comes from the factual effect that the increment of institutional efficiency via the reduction of per capita NHE is bigger than via the reduction of CMR.

• 보건행정학회지
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• 제23권1호
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• pp.19-34
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• 2013

Background: The study describes the changes resulted from imposition on tertiary hospital outpatient coinsurance rate rise policy and in tertiary or general hospital drug coverage rise policy on healthcare service utilization. Methods: Accordingly, the hypothesis about outpatient healthcare utilization after rise policy in outpatient coinsurance rate and drug coverage was established, using interrupted time-series analysis and segmented regression analysis to test the hypothesis. 5-year analysis period (2007. 3-2012. 3) from the outset year was designated, the data about most common 10 high-ranking of the main diseases targeting visiting patient from age of 6 to 64 were collected. Results: The summary on the major research is followed. First, the medical expense and duration of treatment tends to be increased in case of imposition about rise policy in outpatient coinsurance rate in the tertiary hospital under the interrupted time-series analysis. It showed temporary increase and slow down on account of influenza A even after the policy enforcement. In segmented regression analysis, duration of visit and medical expense in the tertiary hospital increased temporally right after the policy implementation and the decreased rapidly depends on period. Both rise and fall is statistically significant. The second, In case of tertiary or general hospital outpatient drug coverage rise policy, all of the tertiary hospital healthcare service utilization variables by the interrupted time-series analysis, drug coverage policy in the general hospital deeply declined according to decreasing trend before policy implementation. The third, in case of segmented regression analysis, the visit duration and medical expense statistically declined right after the policy implementation in both the tertiary and general hospital. Meanwhile, administration day was statistically meaningful only for the decrease right after the policy implementation. Otherwise, general hospital changes are not statistically meaningful. And the medicine cost was statistically, meaningfully decreased after the increase in drug coverage. Conclusion: Finally, the result demonstrated according to the analysis is only 1 hypothesis is denied, the other 2 are partially supported. Then, tertiary hospital outpatient coinsurance rate increase policy comparatively makes decrease effect on long-term healthcare utilization, and tertiary or general hospital outpatient drug coverage policy showed partially short-term effect is assured.

• 보건행정학회지
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• 제30권3호
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• pp.326-334
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• 2020

Background: Korea has gradually expanded the coverage of medical care services in its national health insurance system. On April 1, 2018, it implemented a policy that expanded the coverage for an ultrasonography in the upper abdomen. In this study, we aimed to investigate the effect of the policy on the utilization of the ultrasonography in the upper abdomen in tertiary care hospitals. Methods: Using the dataset of the Health Insurance Review and Assessment Service, we explored changes in the utilization of the ultrasonography in the upper abdomen in tertiary care hospitals from July 1, 2017 to November 30, 2018 through the difference-in-difference (DID) mixed-effects-model method. Facility factor, equipment factor and personnel factors, type of hospital, the total amount of medical care expenses, and geographic region were considered as control variables. Results: On average, the utilization of the ultrasonography in the upper abdomen increased by 228% after the coverage expansion policy. However, the results of DID mixed-effects-model method analysis showed that the utilization increased by 73%. As for the number of beds, the utilization was higher with a group of 844-930, 931-1,217, and 1,218 or greater compared with a group of 843 or fewer, while the utilization of the number of ultrasonic devices was lower with a group of 45-49 compared with a group of 44 or fewer. The utilization decreased with the number of interns and the number of nurse assistants. Besides, relative to Seoul, the utilization was lower in the other metro-cities and provinces. Conclusion: The coverage expansion policy in the national health insurance system increased service utilization among people. Future research needs to investigate the degree to which such coverage expansion policy reduces the unmet medical care needs among the deprived in Korea.

• 보건행정학회지
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• 제19권4호
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• pp.121-139
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• 2009

Objectives : The purpose of this study was to investigate regional commitment index(RGI) of hospital in Korea, and the relationship RGI and hospital characteristics, such as foundation, region, size. Therefore, we are to suggest fundamental information to make and evaluate healthcare resource policy in hospital- and government-level. Methods : The 'Patient Survey 2002(administered by Ministry of Health and Social Welfare(MOHW)' was analyzed. We selected the patient data of the hospitals above 100 beds. Then, we calculated the RGI, number of same cases divided by all cases in each hospital. By using SPSS/win ver 14.0, statistical analysis such as t-test, ANOVA, correlational and regression analysis was carried out. Results : The results are as follows. 1. Overall mean and standard deviation of RGI were revealed as 0.805${\pm}$0.225 in inpatients, and 0.871${\pm}$0.184 in outpatient. The median of inpatients' and outpatients' RGI were 0.890 and 0.933. The RGI of inpatients of private hospitals were revealed significantly higher than that of the public(public: 0.727, private: 0.822). However, outpatients' RGI was not revealed as significantly different. 2. The RGI of general specialty hospitals were significantly lower than others, therefore we could think that more inpatients and outpatients of general specialty hospitals flowed in from others province or metropolitan cities than other hospital types. 3. The RGI of hospitals holding above 400 beds were significantly lower than others in inpatients and outpatients. 5. The RGI of hospitals were significantly different among sixteen province and metropolitan cities. The RGI inpatients of Gwangju and Daejon metropolitan city were lowest sub-group(0.659, 0.664), and the RGI inpatients of Jeju was revealed as highest, 0.979. 6. Available beds, total doctors, and total employees were negatively correlated with RGI of inpatients and outpatients. 7. The significant influencing factors to RGI of inpatients and outpatients were appeared samely such as available beds, wide healthcare region, hospital size, and foundation type. Conclusions : It is considered that RGI of hospital represent competitive power in healthcare market. Also, the competitive advantage and quality of hospital clustered by characteristics could made out by RGI. Therefore, the results of this study would be useful to develop and evaluate hospital policy of individual hospital or local government.

• 보건행정학회지
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• 제17권2호
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• pp.1-17
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• 2007

Limited coverage for health care services of National Health Insurance(NHI) in Korea has been ongoing policy issue but additional NHI financing through raising contribution or taxes in order to improve coverage faces substantial obstacles. Private health insurance(PHI) is often considered as an alternative financing source to improve coverage. Recent reform that attempted to stretch the role of PHI allowed life insurance companies to provide complementary PHI, indemnity plan which will pay for uncovered services by NHI and out-of-pocket spending for covered services. Although complementary PHI may relieve financial burden of patients, it may significantly raise NHI spending as well as total health expenditure since little out-of-pocket spending may increase utilization of health care. So far, there has not been enough discussion about concerns of potential adverse effect resulting from extended role of PHI. This study investigated potential increase of NHI spending followed by extension of complementary PHI through sensitivity analysis. The amount of NHI spending for services that would be covered by complementary PHI was calculated using 2005 NHI statistics and expected complementary PHI enrollment rate by age and sex. Expected utilization increases were obtained based on price elasticities$(-0.2{\sim}-0.5)$ from previous studies and expected coverage rate$(50{\sim}80%)$ of complementary PHI and then converted to monetary figures. Because coverage rate of complementary PHI has not been determined yet, we employed the sensitivity analysis using coverage rate of $50{\sim}80%$. Findings demonstrate that additional spending for health care services is expected to be $426{\sim}1,702$ billion won, corresponding amount payed by NHI $298{\sim}1,192$ billion won. In conclusion, since complementary PHI may raise NHI spending significantly, there should be an agreement whether this additional cost would be accountable and acceptable in our society. Potential inefficiency resulting from extended role of complementary PHI should be considered since public and private financing do not operate in isolation and there should be more discussion on proper role of PHI in Korea.

• 보건행정학회지
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• 제18권4호
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• pp.148-169
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• 2008

As the Korean Government began to perceive healthcare as one of foundational industries for national dynamics, there has been mounting advocacy for the introduction of for-profit hospitals with a view to bringing efficiency in healthcare services industries and improvement of their international competitiveness. The Government is now considering the issue from all angles in favor of permitting for-profit hospitals. However, There have been few precedent studies on this subject to provide helpful data for the discussion and in the health policy making. This study used private hospitals - for-profit and nonprofit - in Florida, USA as study subjects to accumulate basic data that may be utilized for those involved in debates and health policy making relating to the introduction of for-profit hospitals in Korea. Among all the private general hospitals in Florida, those surveyed by AHA(American Hospital Association) for four consecutive years from 2001 and 2004 and others reported about to MCR(Medicare Cost Report) included in the collected data for analysis. In total 139 private general hospitals consisting of 73 for-profit hospitals and 66 nonprofit hospitals were included in the collected analysis data. Results of analysis revealed no significant difference between for-profit hospitals and nonprofit hospitals in the usage aspects of healthcare services including the average length of stay and the ratio of Medicare vs Medicaid patients. However, financial performances indicated by such factors. as the pre-tax return on assets and the pre-tax operating margin showed to be significantly higher in for-profit hospitals compared with nonprofit hospitals. And the ratio of personnel expenses and the turn period of total assets showed to be significantly lower in for-profit hospitals. Based on the hypothesis that arguments about the introduction of for-profit hospitals have considerably different viewpoints depending on the size of hospital represented by the number of bed, these two hospital types were compared again using the number of beds as a controlled factor, but the results were similar. We, therefore, could conclude that the for-profit hospitals in Florida included in this study could, in their for-profit operation, improve their financial performance by pursuing cost reduction and effectively utilizing their assets without limiting the amount and the range of their services or avoiding less medically protected groups such as Medicare and Medicaid patients.

• 보건행정학회지
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• 제24권1호
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• pp.56-70
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• 2014

Background: Korea shows rapid population aging and increase in healthcare service use and expenditure. Also, this would be accelerated because of the baby boomers who will be 65 years old and more in 2020. Chronic disease is another reason that increases the use of healthcare service and expenditure of the middle- and old-aged households. Catastrophic health expenditure (CHE) is the index which can indicate the households' burden of health spending. Despite the importance, there are few studies on CHE of middle- and old-aged households and especially no panel study yet. This is the reason that this study is carried out. Methods: This study used 3-year data from the Korea Welfare Panel Study conducted from 2009 to 2011. We defined CHE if a household's health expenditure is equal or greater than the threshold value if income remaining after subsistence needs has been met. We used 4 different threshold values which are 10%, 20%, 30%, and 40%. In order to look at the households which experienced CHE, we conducted panel logit analysis after correspondence analysis and conditional transition probability analysis. Results: This study showed three notable results. First, there has been a difference among age groups, which implies that the older people are, the more easily they can experience CHE. Second, the households with no private insurance are shown to have a higher CHE occurrence rate. Lastly, there has been a significant difference among the kinds of chronic diseases. The households which have cancer, cerebrovascular disease, and heart disease have a higher CHE occurrence rate. However, the households with diabetes have no significant effects to CHE occurrence. Also, hypertension has a negative effect to the occurrence. Conclusion: With the results, it can be implied that elderly people with chronic disease are more needed in medical coverage and healthcare. Also, private insurance can play its role in protecting households from CHE. Therefore, it needs to conduct studies on CHE especially about different age groups, private insurance, and chronic disease.

• 보건행정학회지
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• 제18권4호
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• pp.66-84
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• 2008

Objectives: This study aimed to. offer some fundamental evidences for the stroke management policy by investigating the trends of medical care utilization and regionalization in stroke inpatients. Methods: We used the National Health Insurance claims and registry data for stroke inpatients from 1998 to 2005. Among all stroke inpatient claims data, self-employed insured and their dependents were only included in this study. The classification of stroke was based on ICD-10(I60-I69) and its subtype was divided by hemorrhage(I60-I62) and infarction(I63-I64) type. To evaluate regionalization of medical care utilization, relevance index was calculated by regions. The regions were classified 8 large catchment areas and 163 self authorized areas. Results: The overall medical care utilization rate of stroke inpatient has been increased, especially infarction subtype. Among medical care institutions, the utilization of hospital has been the most rapidly increased. Although considered annual rate of interest, total medical cost of stroke inpatients has been increased, Totally, more than 84% of stroke inpatient were admitted to medical care institutions in their own large catchment area during 1998-2005. The relevance indices in their own large catchment area (self sufficiency rates) were more than 70% in most areas regardless of stroke subtype except Chungbuk catchment area. Self sufficiency rates of stroke inpatients among 163 self authorized areas in 1998 and 2005 were 84.2% and 83.1% in metropolitan, 46.7% and 45.5% in urban, and 19.5% and 22.6% in rural areas, respectively. Conclusion: Stroke management policy for improvement of distribution at the district level, especially in rural areas, may be helpful for reducing regional inequality in stroke.

• 보건행정학회지
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• 제5권1호
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• pp.80-105
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• 1995

Assuming that we introduced integration of medical insurance society for self-employed, this study was conducted to examine effects and results after the integration and to research more effective method for integration. To assess effects and results of the finacial status of 266 insurance societies after intergration, the data were obtained from "The Medical Insurance Program for Self-Employeds Statistical Yearbook in 1992". The major finding are as follows : 1. Three alternative integration proposals were made. First alternative proposal was consisted of 232 medical insurance societies, second was 187, and third was 115. 2. As the results of average number of the insured per insurance societies of medical insurance program for self-employed every alternative proposal, first was 88, 119 persons, second was 108, 576, and third was 178, 967 from 76, 576 persons of present socienties. 3. It was true that the more average size of societies increased, the more average administration expenditure per 1, 000 insured reduced. 4. The average size of societies grew bigger, the rate of general expenditure to general revenue more improved. Also, the rate of benefits to contributions was changed for better. But if not to have had correct analysis and precise preparation for integration, effects and results of integration were always not optiized. 5. According to results of simple regression formulas, it was proved that the more the average size of societies was increased, the more result was advantaged. 6. The law of majority and the economy of scale were applied in this study, and it was necessary to analyze and assess effectiveness and efficiency of integration. Therefore, when the integration of medical insurance societies for self-employeds will be performed, it must be taken into consideration. Among three alternative proposals, third was showed more effective alternative than anothe, second was presented more ineffective result than present system. To achieve more effective and efficient integration of regional medical insurance societies throughout the result of the regression formula on present cost curve, it is necessary to operate well-integrated societies and to know appropriative countermeasures of present situation of each societies. Also, for integrating regional medical insurance societies, it is necessary to continue more deep research through practical model activity and to investigate the effective size and managed method of the societies.societies.

• 보건행정학회지
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• 제6권1호
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• pp.163-190
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• 1996

본 논문은 미국 농촌병원의 경영전략과 관련하여 몇가지 가설을 검증한 연구결과이다. 구체적으로 1987년부터 1991년 사이의 미국 농촌병원들의 기본적 경영전략 지향 형태와 변화 추세, 경영전략과 환경 및 병원특성과의 관계, 그리고 경영전략과 재정적 성과의 관계 등이 연구되었다. 본 연구의 자료수집은 미국 농촌지역의 모든 종교병원과 영리병원, 그리고 무작위 표본추출로 뽑힌 50%의 공공병원 및 기타 비영리 병원의 최고경영자를 대상으로 1989년에 우편설문조사를 통해 이루어졌으며 회수된 설문지 중 사용가능한 640개 병원 (응답율 43%)의 자료가 분석 이용되었다. 조사대상병원의 환경적 특성자료는 지역자원 파일(Area Resource File)에서 수집하였고, 병원특성 및 재정적 성과자료는 미국병원협회 연감(Annual Survey of Hospitals)에서 구하였다. 응답병원과 비응답병원간에 환경 및 병원특성에 유의한 차이는 없는 것으로 나타났다. 본 연구에서는 Miles와 Snow가 개발한 방어형(defender), 분석형(analyzer), 진보형(prospector), 반응형(reactor)의 네가지 경영전략지향 형태를 사용하여 분석하였다. 본 연구의 결과를 요약하면 다음과 같다. 1) 미국 농촌 병원들은 과거에는 방어형 및 분석형의 경영전략 지향을 보이다가 점차 반응형과 진보형으로 변화해 가고 있다. 2) 가장 뚜렷한 경영전략 지향의 변화추세는 방어형이 급격히 줄고 반응형이 크게 늘어나고 있다는 점이다. 이는 많은 병원들이 급격한 환경변화에 적응하기 위해 일관된 전략 지향보다 융통성 있고 탈력적인 경영전략을 선호하고 있음을 나타낸다. 3) 농촌병원들은 경영전략의 급격한 변화를 추구하지는 않을 것이라는 가설을 뒷받침할 근거는 없는 것으로 나타났다. 이는 급격한 의료환경의 변화로 인해 병원들이 다양한 경영전략의 변화를 모새하고 있는 것으로 볼 수 있다. 4) 대부분의 외부환경 및 병원특성은 병원의 전략지향의 선택에 큰 영향을 미치지 않는 것으로 나타났으나 인구 10,000명당 의사수, 병상규모, 위탁경영 여부, 병상점유율, 소유형태 등의 변수들이 경영전략 지향 형태에 따라 유의한 차이가 있는 것으로 나타났다. 5) 경영전략 지향이 상이한 병원들은 세부 실천전략에 있어서도 치이가 있을 것이라는 가설을 일부 전략에 있어서 사실인 것으로 나타났다. 즉 방어형 병원들은 진보형이나 반응형 병원들보다 내부관리전략, 다양화 전략, 의사유치전략, 직원복지전략 등에 있어서 소극적인 것으로 나타났다. 6) 비록 방어형 병원들이 다른 형태의 병원보다 낮은 재정적 성과를 보이고 있었지만 본 연구의 자료로는 경영전략지향과 재정적 성과간의 인과관계를 구명할 수 없었다. 또한 재정적성과에 따른 전략지향의 변화여부도 통계적으로 유의한 관계가 있지는 않은 것으로 나타났다. 이는 각각의 전략지향들이 환경에 따라 나름대로 장점을 가질 수 있으며 반드시 어느 한가지의 전략지향만이 최선은 아님을 시사해주고 있다. 7) 병원의 경영전략 변화는 환경의 변화와 더블어 그러한 변화에 적응할 수 있는 내부의 능력과도 관계가 있는 것으로 보인다. 이상의 연구결과에 따르면 미국의 농촌병원들은 급격한 환경변화에 적응하기 위하여 다수의 병원들이 환경 및 벼원특성에 관계없이 생존을 위한 전략적 노력을 기울이고 있음을 알 수 있다. 끝으로 이러한 연구결과는 최근 어려운 경영환경에 처한 한국의 농촌병원들도 합리적인 경영을 위해서는 병원이 처한 외부환경분석과 함께 내부의 능력에 적합한 경영전략의 방향을 설정하고 그에 따른 실천적 세부 경영전략을 수립해야만 한다는 것을 시사해 주고 있다.