• 건강소식
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• v.27 no.12 s.301
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• pp.16-17
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• 2003

• Health Policy and Management
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• v.34 no.2
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• pp.196-210
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• 2024

Background: In January 2018, revised elderly fixed outpatient copayment for the elderly were implemented. When people ages 65 years and older receive outpatient treatment at clinic-level medical institutions (clinic, dental clinic, Korean medicine clinic), with medical expenses exceeding 15,000 won but not exceeding 25,000 won, their copayment rates have decreased differentially from 30%. This study aimed to examine the changes of health utilization of elderly after revised elderly fixed outpatient copayment. Methods: We used Korea health panel data from 2016 to 2018. The time period is divided into before and after the revised elderly fixed outpatient copayment. We conducted Poisson segmented regression to estimate the changes in outpatient utilization and inpatient utilization and conducted segmented regression to estimate the changes in medical expenses. Results: Immediately after the revised policy, the number of clinic and Korean medicine outpatient visits of medical expenses under 15,000 won decreased. But the number of clinic outpatient visits in the range of 15,000 to 20,000 won and Korean medicine clinic in the range of 20,000 to 25,000 won increased. Copayment in outpatient temporarily decreased. The inpatient admission rates and total medical expenses temporarily decreased but increased again. Conclusion: We confirmed the temporary increase in outpatient utilization in the medical expense segment with reduced copayment rates. And a temporary decrease in medical expenses followed by an increase again. To reduce the burden of medical expense among elderly in the long run, efforts to establish chronic disease management policies aimed at preventing disease occurrence and deterioration in advance need to continue.

• Journal of the Korea Convergence Society
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• v.2 no.4
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• pp.53-58
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• 2011

This Study is to propose the resonable management for cancer patients by identifying correlation among the treatment, their length of hospital stay and medical charges. Research subjbject is 144 patient that breast cancer, uterine cancer and Family Medical patients of inpatients in K University Hospital in Korea during six month, from January 1, 2010 to June 30, 2010. The analysis shows that the emergecy is superior range thag outpatient because each of them has 97.9%, 2.1% by looking at the path to admission. And the age of 40-49 is the higest group by age. When matrix components of breast cancer patients, principal component is composed of two axes. Factors associated with the first component appeared correlations between all variables without the age. Following results, this study is considered similar types of disease or treatments are need to introduce the DRG.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.11
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• pp.626-634
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• 2018

This retrospective study investigates the accuracy of triage procedures for pediatric patients in emergency departments (EDs) using the Korean Triage and Acuity Scale (KTAS). The study includes 250 randomly selected initial nursing records and clinical outcomes of pediatric patients who visited one regional ED or a local ED from October 2016 to September 2017. The collected data were analyzed by a qualified expert to determine the true triage score. The accuracy of triage was defined as the agreement between the triage score of the emergency nurses (ENs) and the true triage score as determined by the expert. Based on expert comments, the cause of the triage error was analyzed and the KTAS score was compared with the discharge, length of stay (LOS), and medical cost. The results showed that the degree of agreement in the triage score between the experts and the ENs was excellent (weighted kappa=0.77). Among the causes of triage discordance, the most frequent was the incorrect application of vital signs to the KTAS algorithm criteria (n=13). Patients with high severity KTAS levels 1 and 2 were discharged less often (${\chi}=43.25$, p<0.001). There were significant differences in the length of stay (F=12.39, p<0.001) and cost (F=11.78, p<0.001) between KTAS scores when adjusting for age. The results of this study indicate that KTAS is highly accurate in EDs. Hence, the newly developed triage tool is becoming well established in Korea.

• The Journal of the Korea Contents Association
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• v.17 no.11
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• pp.435-445
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• 2017

This study was conducted to overcome the limitations of prior research on the equity of medical care performed by identifying simple differences in the use of medical care or using limited medical needs and medical utilization indicators. Specifically, we used activity limits, chronic diseases, and subjective health status as medical needs, and used outpatient, inpatient, and emergency services as medical uses. In addition, we used concentration index, concentration curve, and Le Grand factor to analyze the equity of medical use considering medical needs. The main results are as follows. First, the amount of medical care for the low-income class is higher than that of the high-income class when considering the concentration of medical use. In particular, the number of hospitalization days for low-income households and hospitalization fees were higher than the fees of outpatient medical consultation and emergency room usage. Second, medical needs were concentrated in the low income class. In other words, low-income group is not as healthy as the high-income group. Third, the Le Grand factor was calculated in order to confirm the fairness of the medical uses considering the medical needs. Even if medical needs are taken into consideration, the high-income earners will have a large amount of medical care. In addition, when considering the limitation of activity and the number of chronic diseases, the medical use of the high income class was more frequent. However, when the subjective health condition and the chronic illness were considered, medical use of the low income class was more frequent. This may be due to the underestimation of the medical needs of the low-income earners by neglecting their own health status and perception of chronic diseases.

• The Korean Society of Law and Medicine
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• v.17 no.1
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• pp.299-346
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• 2016

There were also various decisions made in medical area in 2015. In the case that an inmate in a sanatorium was injured due to the reason which can be attributable to the sanatorium and the social welfare foundation that operates the sanatorium request treatment of the patient, the court set the standard of fixation of a party in medical contract. In the case that the family of the patient who was declared brain dead required withdrawal of meaningless life sustaining treatment but the hospital rejected and continued the treatment, the court made a decision regarding chargeable fee for such treatment. When it comes to the eye brightening operation which received measure of suspension from the Ministry of Health and Welfare for the first time in February, 2011, because of uncertainty of its safety, the court did not accept the illegality of such operation itself, however, ordered compensation of the whole damage based on the violation of liability for explanation, which is the omission of explanation about the fact that the cost-effectiveness is not sure as it is still in clinical test stage. There were numerous cases that courts actively acknowledged malpractices; in the cases of paresis syndrome after back surgery, quite a few malpractices during the surgery were acknowledged by the court and in the case of nosocomial infection, hospital's negligence to cause such nosocomial infection was acknowledged by the court. There was a decision which acknowledged malpractice by distinguishing the duty of installation of emergency equipment according to the Emergency Medical Service Act and duty of emergency measure in emergency situations, and a decision which acknowledged negligence of a hospital if the hospital did not take appropriate measures, although it was a very rare disease. In connection with the scope of compensation for damage, there were decisions which comply with substantive truth such as; a court applied different labor ability loss rate as the labor ability loss rate decreased after result of reappraisal of physical ability in appeal compared to the one in the first trial, and a court acknowledged lower labor ability loss rate than the result of appraisal of physical ability considering the condition of a patient, etc. In the event of any damage caused by malpractice, in regard to whether there is a limitation on liability in fee charge after such medical malpractice, the court rejected the hospital's claim for setoff saying that if the hospital only continued treatments to cure the patient or prevent aggravation of disease, the hospital cannot charge Medical bills to the patient. In regard to the provision of the Medical Law that prohibit medical advertisement which was not reviewed preliminarily and punish the violation of such, a decision of unconstitutionality was made as it is a precensorship by an administrative agency as the deliberative bodies such as Korean Medical Association, etc. cannot be denied to be considered as administrative bodies. When it comes to the issue whether PRP treatment, which is commonly performed clinically, should be considered as legally determined uninsured treatment, the court made it clear that legally determined uninsured treatment should not be decided by theoretical possibility or actual implementation but should be acknowledged its medical safety and effectiveness and included in medical care or legally determined uninsured treatment. Moreover, court acknowledged the illegality of investigation method or process in the administrative litigation regarding evaluation of suitability of sanatorium, however, denied the compensation liability or restitution of unjust enrichment of the Health Insurance Review & Assessment Service and the National Health Insurance Corporation as the evaluation agents did not cause such violation intentionally or negligently. We hope there will be more decisions which are closer to substantive truth through clear legal principles in respect of variously arisen issues in the future.

• Journal of Digital Convergence
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• v.12 no.7
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• pp.315-325
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• 2014

This study is investigates decisive factors impacting business profits of regional medical centers by utilizing their environmental characteristics to provide useful basic data to seek for a method to establish financial soundness and profitability. The research objects are medical treatment record and management indicators of 31 regional medical centers for the past three years from 2010 through 2012. The method of analysis are ANOVA and Multiple Regression Analysis. The results revealed the debt and management ratio in the profit rate of total medical liabilities and net worth, current balance in the medical profit on medical revenue, and hospital bed turnover rate, emergency hospitalization rate, rate of labor cost, and rate of material cost in the business profits as the decisive factors. It is recommended to identify financial feedback and establish diversified management strategies through accurate management analysis to secure financial soundness and profitability in medical centers.

• Journal of agricultural medicine and community health
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• v.26 no.1
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• pp.19-35
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• 2001

This study was conducted to investigate the internal changes and the countermeasure for performance improvement by Separation of Prescribing and Dispensing Practice (SPDP) in Health Center. Data were collected from two sources: Performance report before and after SPDP of 25 Health Centers in Kyongsangbuk-do and 6 Health Centers in Daegu-City and self-administerd questionnaire survey of 221 officials at health center. The results of this study were summarized as follows: Twenty-four health centers(77.4%) of 31 health centers took convenience measures for medical treatment of citizens and convenience measures were getting map of pharmacy, improvement of health center interior, introduction of order communication system in order. After the SPDP in health centers, 19.4% of health centers increased doctors and 25.8% decreased pharmacists. 58.1% of health centers showed that number of medical treatments were decreased. 96.4%, 80.6% 80.6% 96.7% of health centers showed that number of prescriptions, total medical treatment expenses, amounts paid by the insureds and the expenses to purchase drugs, respectively, were decreased. More than fifty percent(54.2%) of health centers responded that the relative importance of health works increased compared to medical treatments after the SPDP, and number of patients decreased compared to those in before the SPDP. And there was a drastic reduction in number of prescriptions, total medical treatment expenses, amounts paid by insureds, the expenses to purchase drugs after the SPDP. Above fifty percent(57.6%) of officers at health center responded that the function of medical treatment should be reduced after the SPDP. Fields requested improvement in health centers were 'development of heath works contents'(62.4%), 'rearrangement of health center personnel'(51.6%), 'priority setting for health works'(48.4%), 'restructuring the organization'(36.2%), 'quality impro­vement for medical services'(32.1%), 'replaning the budgets'(23.1%) in order. And to better the image of health centers, health center officers replied that 'health information management'(60.7%), 'public relations for health center'(15.8%), 'kindness of health center officers'(15.3%) were necessary in order. Health center officers suggested that 'vaccination program', 'health promotion', 'maternal and children health', 'communicable disease management', 'community health planning' were relatively important works, in order, performed by health center after SPDP. In the future, medical services in health centers should be cut down with a momentum of the SPDP so that health centers might reestablish their functions and roles as public health organizations, but quality of medical services must be improved. Also health centers should pay attention to residents for improving health through 'vaccination program', 'health promotion', 'mother-children health', 'acute and chronic communicable disease management', 'community health planning', 'oral health', 'chronic degenerative disease management', etc. And there should be a differentiation of relative importance between health promotion services and medical treatment services by character of areas(metropolitan, city, county).

• Journal of Oral Medicine and Pain
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• v.32 no.1
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• pp.9-33
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• 2007

In the field of dentistry, there existed relatively few emergency patients or patients who need intensive care and thus had low medical dispute rates. However, these days, there is a general tendency of increased medical disputes. Although many medical disputes are caused by medical accidents of the dentists, because dental assistants are also lawfully involved in practicing dentistry, there is a possibility of medical disputes or medical accidents caused by dental assistants. Therefore, the role of the dental assistants cannot be ignored. This study consists of a survey given to dental hygienists currently working in general hospitals, dental hospitals and private dental clinics. Following is the results of the analysis of 275 respondents' backgrounds, medical disputes rates including patients' complaints, their understanding of medical regulations and their general understanding of overall dental practice and medical disputes. 1. 251 of 274(91.6%) respondents doubted the risk of medical accident and dispute. 2. 81(29.5%) dental hygienist experienced complaint from patients. They have been working in the private dental clinic, the rate of this experience was high. 3. 349 case of 1805(19.3%) the complaints by patients, highest percentage among its category, were those regarding dental fees and poor service. 4. 129 case of 1805(7.1%) patients' complaints, highest percentage among it's subcategory, were those regarding the absence of explanations of precautions or request of agreements before dental treatment. 5. 252 of 267 (94.4%) dental hygienists chart after a scaling treatment. However, only 55(20.7%) dental hygienists chart the fact of explaining the precautions. 6. 6(2.2%) dental hygienists do not inspect patients' medical history, if patients don't mention it. 7. 104 of 274(38.0%) dental hygienists responded to be capable of administering first aid treatment. 8. 115(41.8%) dental hygienists have a first aid kit and equipment. 9. In case of medical dispute, 268(97.8%) dental hygienists respond that, charting plays a big role in resolving the dispute. 10. In case of medical dispute, 272(93.3%) dental hygienists respond that, explanation and agreement before treatment have an important role in settlement of dispute 11. Only 160(58.4%) dental hygienists responded correct answer that the duration of keeping medical records is 10 years. 12. 124(45.3%) respondents thought that it is legal for a dental hygienist to take a panoramic dental X-ray, 71(25.9%) respondents thought that it is legal practice cervical resin treatment by dental hygienist, and 37(13.5%) respondents thought that it is legal extract primary teeth by dental hygienist. 13. 24(18.76%) respondents thought that it doesn't matter to tell patient's state to others 14. 272(99.27%) responded that receiving education for the prevention of medical disputes was needed and of them, 61.0% thought it was urgent. 15. 186(64.2%) has never had classes regarding the prevention of medical disputes while in school and 212(77.4%) has not had the same type of classes after graduating from school. 16. 256(93.4%) responded that there will be even more of an increased number of medical disputes. Among them, 83.3% of respondents though that due to the increased opportunity of acquiring information through the internet and mass media. The study shows that 29.5 percentage of dental hygienists have experienced the medical disputes and complaints and they are lack of recognition of medical regulations and dental hygienist's official duty. So, there is a big potential of the percentage to increase. Therefore, the correct understanding of explaining precautions and requesting agreement before dental treatments and performing them are mandatory. Moreover, classes regarding the prevention and counterplans of medical disputes need to be widely offered.