• The Korean Society of Law and Medicine
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• v.15 no.1
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• pp.335-373
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• 2014

According to one Medicare report, in the US, total federal spending on health care expends almost 18 percent of the nation's GDP, about double what most industrialized nations spend on health care. And in 2011, Medicare spending reached close to $554 billion, which amounted to 21 percent of the total spent on U.S. health care in that year. Of that $554 billion, Medicare spent 28 percent, or about $170 billion, on patients' last six months of life. So what are the reasons of this high cost in EOL care and its possible solutions? Much spendings of Medicare on End-of-Life care for the terminally ill/chronically ill in the US has led health economics experts to assess the characteristics of the care. Decades of study shows that EOL care is usually supply-sensitive and poor in cost-effectiveness. The volume of care is sensitively depending on the supply of resources, rather than the severity of illness or preferences of patients. This means at the End-of-Life care, the medical resources are being overused. On the other hand, opposed to the common assumption, "The more care the better utility", the study shows that the outcome is very poor. Actually the patient preference and concerns are quite the opposite from what intense EOL care would bring about. This study analyzes the reasons for the supply-sensitiveness of EOL care. It can be resulted from the common misconception about the intense care and the outcome, physicians' mission for patients, lack of End-of-Life Care Decision which helps the patients choose their own preferred treatment intensity. It also could be resulted from physicians' fear of legal liabilities, and the management strategy since the hospitals are also seeking for financial benefits. This study suggests the possible solutions for over-treatment at the End-of-Life resulting from supply-sensitiveness. Solutions can be sought in two aspects, legal implementation and management strategy. In order to implement advance directive properly, active ethics education for physicians to change their attitude toward EOL care and more conversations about end-of-life care between physicians and patients is crucial, and incentive system for the physicians who actively have the conversations with patients will also help. Also, the general education towards the public is also important in the long run, and easy and official advance directive registry system-such as online registry-has to be built and utilized more widely. Alternative strategies in management are also needed. For example, the new strategic cost management and management education, such as cutting unnecessary costs and resetting values as medical providers have to be considered. In order to effectively resolve the problem in EOL care for the terminally ill/chronically ill and provide better experience to the patients, first of all, the misconception and the wrong conventional wisdom among doctors, patients, and the government have to be overcome. And then there should be improvements in systems and cultures of the EOL care.

• Information Systems Review
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• v.8 no.1
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• pp.203-222
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• 2006

The chronic problems of Information System Outsourcing Development Project include frequent changes in the participants and their roles, and the evasion of project participation, which exert unfavorable influence to the outcome of the project. Such problems are due, in large part, to the low level of project participants' satisfaction in the project. However, little is known about the factors that influence project participants' satisfaction in the project development. This research identifies six potential factors such as project commitment, workload, control, communication within the organization, inter-organization communication, and system development methodology based on PMI(Project Management Institute) and empirically examines their efficacy in explaining the level of participants' satisfaction in the IS development projects based on data from 390 participants in 66 projects. The results indicate that the six factors are strong determinants of participants' satisfaction in system development projects. In other words, the level of satisfaction among project participants overall are largely influenced by project commitment and control, communication, project methodology. Especially, the results reveal that the level of satisfaction among participants from the vendor decreased largely by unrealistic project commitment, frequent changes in project planning and unreasonable control rather than by a significant amount of workload. In conclusion, there need to be a rational approach and solution based on the six factors presented in this research in order to increase participation satisfaction level of the project participants and ultimately enhance project outcome.

• Journal of Environmental Policy
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• v.13 no.1
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• pp.69-93
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• 2014

The aim of this research was to develop a climate change vulnerability index at the district level (Si, Gun, Gu) with respect to the health care sector in Korea. The climate change vulnerability index was esimated based on the four major causes of climate-related illnesses : vector, flood, heat waves, and air pollution/allergies. The vulnerability assessment framework consists of six layers, all of which are based on the IPCC vulnerability concepts (exposure, sensitivity, and adaptive capacity) and the pathway of direct and indirect impacts of climate change modulators on health. We collected proxy variables based on the conceptual framework of climate change vulnerability. Data were standardized using the min-max normalization method. We applied the analytic hierarchy process (AHP) weight and aggregated the variables using the non-compensatory multi-criteria approach. To verify the index, sensitivity analysis was conducted by using another aggregation method (geometric transformation method, which was applied to the index of multiple deprivation in the UK) and weight, calculated by the Budget Allocation method. The results showed that it would be possible to identify the vulnerable areas by applying the developed climate change vulnerability assessment index. The climate change vulnerability index could then be used as a valuable tool in setting climate change adaptation policies in the health care sector.

• Korean Journal of Environmental Agriculture
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• v.17 no.1
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• pp.76-83
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• 1998

The most remarkable aspect in the hormesis law is that dose of harmful agents can produce effect that are diametrically opposite to the effect found with high doses of the same agent. Minute quantities of a harmful agent bring about very small change in the organism and control mechanisms appear to subjugate normal processes to place the organism in a state of albert and repair. The stimulated organism in more responsive to changes in environmental factors than it did before being alerted. Routine functions, including repair and defense, have priority for available energy and matetial. The alerted organism utilizes nutrients more efficiently, grows faster, shows improved defense, and lives longer. Accelerated germination, sprouting, growth, development, blooming and ripening, and increased crop yield and resistance to disease are found in plants. Another concept supported by the data in that low doses of ionizing radiation provide increased resistance to subsequent high doses of radiation. The hormesis varies with subject plant, variety, state of seed, environmental and cultural conditions, physiologic function measured, dose rate and total exposure. The results of hormesis are less consistently found, probably due to the great number of uncontrolled variables in the experiments. The general dosage for radiation homlesis in about 100 (10 to 1,000) times ambient or 100 (10 to 1,000) times less than a definitely harmful dose, but these must be modified to the occasion. Although little is known about most mechanisms of homzesis reaction, overcompensation of repair mechanism is offered as one mechanism.

• Asia Marketing Journal
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• v.12 no.4
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• pp.55-78
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• 2011

Recently strategic alliance between business firms has become prevalent to overcome increasing competitive threats and to supplement resource limitation of individual firms. As one of allianced sales promotion activities, a new type of discount program, so called "Alliance Card Discount", is introduced with the partnership of credit cards and loyalty cards. The program mainly pursues short-term sales growth by larger discount scheme while spends less through cost share among alliance partners. Thus this program can be regarded as cost efficient discount promotion. But because there is no solid evidence that it can really deliver profitable sales growth, an empirical study for its effects on sales and profit should be conducted. This study has two basic research questions concerning the effects of allianced discount program ; 1)the possibility of sales increase 2) the profitability of the discount driven sales. In F&B industry, sales increase mainly comes from increased guest count. Especially in family restaurants, to increase the number of guests we need to enlarge the size of visitor group (number of visitors for one group) because customers visit by group in a special occasion. And because they pay the bill by group(table), the increase of sales per table is a key measure for sales improvement. The past researches for price & discount sensitivity and reference discount rate explain that price sensitive consumers have narrow reference discount zone and make rational purchase decision. Differently from all time discount scheme of regular sales promotions, the alliance card discount program only provides the right to get discount like discount coupon. And because it is usually once a month opportunity given by the past month usage level, customers tend to perceive alliance card discount as a rare chance to get. So that we can expect customers try to maximize the discount effect when they use the limited discount opportunity. Considering group visiting practice and low visit frequency of family restaurants, the way to maximize discount effect should be the increase the size of visit group. And their sensitivity to discount and rational consumption behavior defer the additional spending for ordering high price menu, even though they get considerable amount of savings from the discount. From the analysis of sales data paid by alliance discount cards for four months, we found the below. 1) The relation between discount rate and number of guest per table is positive : 25% discount results one additional guest 2) The relation between discount rate and the spending per guest is negative. 3) However, total profit amount per table is increased when discount rate is increased. 4) Reward point accumulation & redemption did not show any significant relationship with the increase of number of guests. These results suggest that the allianced discount program substantially contributes to sales increase and profit improvement by increasing the number of guests per table. Though the spending per guest is decreased by discount rate increase, the total amount of profit per table is improved. It seems the incremental profit by increased guest count offsets the profit decrease. Additional intriguing finding is the point reward system does not have any significant impact on the increase of number of guest, even if the point accumulation & redemption of loyalty program are usually regarded as another saving offers by customers. In sum, because it is proved that allianced discount program with credit cards and loyalty cards is effective to both sales drive and profit increase, the alliance card program could be recommended as strategically buyable program.

• Environmental and Resource Economics Review
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• v.27 no.2
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• pp.233-260
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• 2018

The West Coast is known as one of the world's three largest intertidal mudflats but the mudflat ecosystems have been constantly destroyed by various reclamation projects and industrial complexes. This study intends to estimate the economic values of major ecosystem services provided by the Seocheon intertidal flats using a choice modeling method. The benefits of the intertidal flats are categorized as four different attributes: number of migratory birds (related to biodiversity and cultural services), production of fish and shellfish (regulating services and habitats), tourism activities (cultural services), and number of fishing households in local communities (cultural services). Study results show that the general public enjoys the economic benefits of 1.777 trillion won (900 million won/hectare) as of 2015 in order to preserve 1,200ha of Seocheon mudflat. Assuming that future generations continue to enjoy these economic benefits of mudflat conservation, the annual value converted is about 64.7 billion won/year, corresponding to 53.9 million won/hectare per year. Individuals are willing to pay are expected to maintain their entire life in the 1,000 households living in the Seocheon tidal-flat fishing village, with an average of 11,000 won per person and an additional 50,000 tourist activities per year. It was estimated to have the amount of payment of 9,000 won. An individual's marginal willingness to pay was estimated to be about 11,000 won per year for supporting a total of 1,000 fishing households, 6,000 won to provide tourism activities of 50,000 visitors, and 9,000 won to provide the habitats of 90,000 migratory birds. For segmentation analysis, residents of Seocheon did not place significant values for the attributes besides migratory bird conservation. However, those of Gunsan showed relatively low margtinal willingness to pay for conservation of migratory birds and fishing villages but showed similar preferences for the maintenance of tourism activities compared to the general public. The results imply that the introduction of economic incentive system is needed to effectively manage and conserve ecosystem services of specific intertidal flats.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.1 no.1
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• pp.45-55
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• 1998

Purpose: To make objective standards of small intestinal mucosal changes in cow's milk-sensitive enteropathy (CMSE) we analyzed histological changes of endoscopic duodenal mucosa biopsy specimens from normal children and patients of CMSE. Methods: We review the medical records of patients who had been admitted and diagnosed as CMSE by means of gastrofiberscopic duodenal mucosal biopsy following cow's milk challenge and withdrawal. Thirteen babies with CMSE, ranging from 14 days to 56 days of age, were studied. Five non-CMSE patients were used as control, ranging from 22 days to 72 days of age. The morphometric parameters under study were villous height, crypt zone depth, ratio of villous height to crypt zone depth, total mucosal thickness and length of surface epithelium by using H & E stained specimens under the drawing apparatus attached microscope. In addition, the numbers of lymphocytes in the epithelium and eosinophil cells in the lamina propria and epithelium were measured. Results: In the duodenal mucosal biopsy specimens in CMSE we found partial and subtotal villous atrophy with an increased number of interepithelial lymphocytes. The mean villous height($135{\pm}59\;{\mu}m$), ratio of villous height to crypt zone depth ($0.46{\pm}0.28$), total mucosal thickness ($499{\pm}56\;{\mu}m$), length of surface epithelium of small intestinal mucosa ($889{\pm}231\;{\mu}m$) in CMSE was significantly decreased compared with the control (p<0.05). The mean crypt zone depth ($311{\pm}65\;{\mu}m$) was significantly greater than the control ($188{\pm}24\;{\mu}m$)(p<0.05). Infiltration of interepithelial lymphocytes ($34.1{\pm}10.5$) were significantly greater than the control ($13.6{\pm}3.6$)(p<0.05). The number of eosinophil cells in both lamina propria and epithelium was no significant differences between groups (p>0.05). The small intestinal mucosa in treated CMSE showed much improved enteropathy of villous height, crypt zone depth, interepithelial lymphocytes compared with the control as well as untreated CMSE. Conclusion: Quantitation of mucosal dimensions confirmed the presence of CMSE. It seems to be a limitation in the capacity of crypt cells to compensate for the loss of villous epithelium in CMSE. Specimens obtained by gastrofiberscopic duodenal mucosal biopsy were suitable for morphometric diagnosis of CMSE. Improvement of CMSE also can be confirmed histologically after the therapy of protein hydrolysate.