• Health Policy and Management
• /
• v.21 no.3
• /
• pp.425-456
• /
• 2011

Background: Organizations in the pharmaceutical industry are highly dependent on the institutional environment. The introduction of pharmacoeconomics to the decision-making on the price and reimbursement decisions became strong constraints to pharmaceutical companies in Korea. As little is known about the issue on organization-environment interaction in the healthcare field, this study aimed to figure out how pharmaceutical companies adapted to the environmental changes. Methods: A multicase study method was used, selecting eight cases among multi-national pharmaceutical companies in South Korea. In-depth interviews were conducted with the managers of these organizations, and secondary data were reviewed to complement the interviews. Results: Pharmaceutical companies viewed the new policies as a big threat and sought for actions against them. One of the most distinguishing organizational changes was to construct a Market Access department. Other strategies managing the environment such as co-optation, forecasting, and bargaining were also implemented. These changes were consistent with the predictions of Resource Dependency Theory and Institutional Theory. Conclusions: The interactions between pharmaceutical companies and institutional environments in healthcare were first explored. This study presents a new perspective on how organizations change and the motives for the changes. The findings of this case study will form the basis of further empirical studies.

• Health Policy and Management
• /
• v.21 no.3
• /
• pp.349-364
• /
• 2011

Objectives : The purpose of this study was to evaluate the relationship between new-building of rural public health centers and the outpatient medical utilization. Methods : The study subjects were 141 public health centers in rural area. The data were collected from 1995 to 2001, medical utilization and local population, healthcare resources, and economic characteristics were included. In order to evaluate new-building effects, we performed paired t-tests and multivariate regression analyses. Results : The following variables are significant affecting the medical utilization of rural public health centers: urban side location of public health centers(p<0.05), pre- and post-IMF economic crisis(p<0.001), number of medical aid recipients(p<0.01), number of private clinics(p<0.05), workers of public health centers(p<0.001), financial independent level of local governments(p<0.001). In contrast, the existence of new-building and number of the aged 65 and over were not significant variables. Conclusions : We could not find out the positive relationship between the existence of new-building and the volume of medical utilization in rural public health centers. In particular the medical utilization of rural public health centers is significantly affected by IMF economic recession and number of the poor strata, the economically depressed area.

• Health Policy and Management
• /
• v.25 no.1
• /
• pp.11-21
• /
• 2015

Background: The objective of this research is to investigate and provide analysis of the economic participatory change affecting the unmet needs of health care in Korean adults. Methods: We used Korea health panel 4th and 5th data of 10,261 adults. The method of investigation is threefold. First, We identified the regional factors affecting unmet needs of health care. Second, we analyzed the effect of economic participatory change as it affects the unmet needs of health care. Third, we also investigated whether there were discernable differences between the age subgroups. Results: It was determined that influencing factors included sex, education, economic level, and health status. And after the subgroup analysis of age, we found that the economic participatory change was associated with the economical unmet needs of health care especially for those over 40 years of age. Also the population are facing unemployment enduring particular economic hardship in meeting their medical needs. Conclusion: This study finds that there are some policy recommendations for the sake of medical service equality. Medical welfare policy for those 40 years of age and older has been identified as an area that needs improvement. And considering that those 40 years of age and older are facing unemployment enduring particular economic hardship in meeting their medical needs, this study finds a need for government sponsored medical stipends or subsidizing of medical premiums, co-payment, and other fees.

• Korean Journal of Health Education and Promotion
• /
• v.29 no.1
• /
• pp.27-38
• /
• 2012

Objectives: The purpose of this study is to find the influences of the perceived economical difficulty, gender equality consciousness and sexual subjectivity on the adolescents' attitude to prostitution to examine the moderating effects of gender equality consciousness and sexual subjectivity between the perceived economical difficulty and the adolescents' attitude to prostitution, and to provide some recommendations for intervention to improve more appropriate attitude of adolescents on prostitution. Methods: The data used for this study is from the survey with a sample of 1,151 students from 14 middle and high schools in Chungbuk province. Results: The main results of this study are as follows: First, there are statistical differences in the adolescents' attitude to prostitution according to gender, grade, and the type of school. Second, there is a positive effect of the perceived economical difficulty, gender equality consciousness and sexual subjectivity on the adolescents' attitude to prostitution. Third, there are positive moderating effects of sexual subjectivity between the perceived economical difficulty and the adolescents' attitude to prostitution. Conclusions: Intervening in the sex education at an early stage, advertising prostitution's harmful effect at the level of a social concern and developing diverse programs to enhance the sexual subjectivity of students are recommended to promote appropriate attitude of adolescents about prostitution.

• Health Policy and Management
• /
• v.23 no.2
• /
• pp.124-131
• /
• 2013

Background: This study aimed to measure the opportunity income by identifying the economic length of stay (ELOS) which is the intersection point of daily revenue and cost on appendectomy and pneumonia cases. Methods: The research subjects were 460 patients of appendectomy and 606 patients of pneumonia, discharged from a general hospital between July 1, 2009 and June 30, 2010. ELOS calculated with both of total revenue on diagnosis-related group (DRG) and fee-for service (FFS). The cost is calculated by activity-based costing system of the hospital. Results: Average length of stay (ALOS) of appendectomy was 4.48 days and its average revenue per case were 1,710,215 (1,989,105) won by DRG (FFS). The variable cost was 491,262 won which was 28.7% (24.7%) of DRG (FFS) total revenue. And 97.2% of the total variable cost was incurred within 2 days from admission. The ELOS was 4 (5) days in DRG (FFS). Shortening three days (two days) would increase opportunity income 52.0% (82.2%) in DRG (FFS). ALOS of pneumonia case was 4.86 days and its average revenue per case were 489,448 (761,426) won by DRG (FFS). The variable cost was 27,230 won which was 5.6% (3.6%) of DRG (FFS) total revenue. Thirty-eight point nine percent of the daily variable cost was incurred in discharge date. The ELOS was 2 (4) days in DRS (FFS). Shortening three days (one day) would increase opportunity income 27.6% (37.2%) in DRG (FFS). Conclusion: The ELOS would be used by strategic index for achieving minimum profit and developing the ways to get there. But we also should not pass over that the opportunity income obtained by the reducing ALOS may cause some problem of quality.

• The Journal of Korean Society for School & Community Health Education
• /
• v.19 no.1
• /
• pp.27-45
• /
• 2018

목적: 본 연구는 한국 청소년의 가정환경, 건강행태, 심리적 요인 및 식습관 요인에 따른 주관적 건강상태의 차이를 분석하고, 주요 관련요인을 파악하고자 수행되었다. 방법: 분석자료로서 2015~2016년도 한국 청소년 건강행태 온라인조사 자료를 이용하였으며, 분석대상자 수는 중학생 53,791명, 고등학생 50,959명, 총 104,750명이었다. 학생들의 건강수준은 주관적 건강상태를 기준으로 건강집단과 비건강집단으로 구분하였다. 건강수준에 영향을 미치는 요인으로서 성별, 가정환경, 건강행태, 심리적 요인 및 식습관이 검토되었다. 이들 요인 간 건강집단과 비건강집단의 비율차이 검증을 위해 표본설계 정보를 반영한 Rao-scott 카이제곱검정을 실시하였다. 또한 주관적 건강수준에 영향을 주는 요인을 알아보고자 로지스틱회귀분석을 실시하였다. 결과 및 결론: 주관적 건강수준은 양친부모와 살지 않은 경우, 모의 교육수준이 낮을 때, 주관적 가정경제수준이 낮을수록 낮았다. 음주군, 고강도운동이나 근력운동을 실천하지 않는 군, 과체중이나 비만인군에서 주관적 건강수준이 낮았다. 또한 스트레스나 우울감 등 부정적인 감정이나 행복감을 느끼지 못할 때도 주관적 건강수준은 낮았다. 아침을 결식하거나 탄산음료, 고카페인음료, 패스트푸드 등의 비건강식품을 자주 섭취하는 군에서도 주관적 건강수준은 낮은 것으로 관찰되었다. 한국 청소년들에게서 건강 불평등(health inequalities)은 가정환경, 건강행태, 심리적 요인, 식습관 등 여러 요인들로부터 제기되는 것을 알 수 있었다. 이러한 요인들을 충분히 반영하여 청소년들이 건강해 질 수 있는 다각적 접근 방안이 모색되어야 할 것이다.

• Health Policy and Management
• /
• v.9 no.1
• /
• pp.156-177
• /
• 1999

The current method of rate adjustment for inflation is based on the evaluation of the financial performance of hospitals. The method has the disadvantage such as too complicated, expensive process as well as low reliability. This study, therefore, develops the 'Korean Medical Insurance Economic Index(MIEI)' as a new model for the rate adjustment with the use of the macro economic indices. In addition, we calculate the 1992∼1998 rate adjustment with the MIEI, and examines the validity of the MIEI by comparing with the conventional method. Medical costs are classified into nine categories : physician salaries, nurse·pharmacist·medical technician salaries, assistants & others salaries, material cost(by imports), material cost(by domestics), depreciation & rent paid(by imports), depreciation & rent paid(by domestics), power utilities, other administrative costs. Then the category weight which is the ratio of category in the total cost is calculated. Macro economic indices are selected for each cost category in order to reflect the concept of the each cost category and inflation during the year of 1992∼1998. Finally MIEI which integrate all category according to the category weight and selected macro indices is calculated. The mean of hospital MIEI which weighting by amount paid by insurers was cacluated. The result from the application of empirical data to the MIEI model is very similar to that of the current method. Furthermore, this method is very simple and also easy to get social consensus. This MIEI model can be replaced the current method based on the analysis of the financial performance for the adjustment of medical fees.

• Health Policy and Management
• /
• v.28 no.2
• /
• pp.128-137
• /
• 2018

Background: This study aims to utilize Organization for Economic Cooperation and Development (OECD) data to identify macroscopic determinants of health at national level and to utilize it in health policy development through comparison and analysis with Korea. Methods: The potential years of life lost (PYLL) were used as dependent variables and 19 indicators were selected as health determinants to be independent variables based on the results of previous studies. Data analysis was done using SAS ver. 9.4 package (SAS Institute Inc., Cary, NC, USA) and model used in technical statistics concerning PYLL by countries, multi-linearity test between independent variables and OECD economic studies were modified and used. Results: From 1994 to 2012, the average PYLL for OECD countries was 4,262.9 years, the highest in Estonia and the lowest in Iceland. As a result of the analysis using the fixed effect model, the significant variables affecting PYLL were four variables: gross domestic product, nitric oxide, tobacco consumption, and number of doctors. The health determinants that had more influence on the PYLL of Korean people compared to other OECD countries were tobacco consumption, calorie consumption, fat intake and total health expenditure. Conclusion: In order to effectively reduce unnecessary deaths, we must continue to strengthen our smoking policy and nutrition policies such as calorie and fat intake. It is necessary to prevent the increase of total health expenditure due to the increase in the prevalence of chronic diseases and to strengthen the public health aspect.

• Journal of Environmental Health Sciences
• /
• v.21 no.1
• /
• pp.68-73
• /
• 1995

This study of culturing testicular cell types in vitro has potential to be an invaluable tool for assessing the mechanisms of testicular toxicity, especially those of intragonadal interaction and spermatogenesis. Combined with the Sertoli/germ cell cultures, Leydig cells provide comprehensive and detailed information on the action of testicular toxicants at the level of the testis. Sertoli/germ cell were isolated and incubated well in vitro from 20~30 g rats and Leydig cells from 250~300 g rats. The Sertoli cells isolated from the testis of the SD rats grew into monolayer on about the 2nd~3rd day of culture, an appreciable cell increment being observed between the 4th~5th day. The Leydig cells isolated from the testis of the SD rats grew into a monolayer on about the 3rd-4th day of culture, an appreciable cell increment being observed between the 5th-7th day. These results suggest that Sertoli and Leydig cells can be cultured as a male fertility evaluation method alternative to the in vivo/conventional fertility test method and further study for the physio-chemical determination is needed.

• Health Policy and Management
• /
• v.23 no.4
• /
• 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.