• 응용통계연구
• /
• 제31권2호
• /
• pp.303-313
• /
• 2018

본 논문에서는 약품비 지출에 대한 예측을 수행하기 위하여 시계열 모형을 도입한다. 2012년 약가 일괄인하를 반영하기 위하여 구간별 모형을 토대로, 자기회귀오차모형과 전이함수모형을 고려하였다. 자기회귀오차모형에서는 예측의 편리성을 위하여 결정적 추세만을 고려하였으며, 전이함수모형에서는 주요한 외생변수와의 교차상관성을 이용하여 약품비 지출의 인과 메커니즘을 설명하였다. 각 모형에서 약가 일괄인하 이후 수준 변화가 유의하게 나타났으며, 전이함수모형에서는 의약품 사용자 수 및 노인환자 비중 시계열 변수가 유의하게 나타났다. 자기회귀오차모형은 약가 일괄인하로 의한 약품비 수준이동에 좌우되어 비교적 낮은 예측값이 도출되었으며, 전이함수모형은 약품비 지출에 영향을 미치는 외부 설명변수의 증가 추세가 적절히 반영되어 더 높은 예측값을 보였다. 설명변수를 포함하지 않을 경우, 약품비 수준이동만을 고려한 ARIMA 모형은 약품비 지출 추세를 가장 높이 예측하였다.

• 디지털융복합연구
• /
• 제11권6호
• /
• pp.221-233
• /
• 2013

본 연구는 뇌졸중 환자의 효율적인 재원일수 관리를 위해 행정자료를 이용하여 우리나라 의료기관을 이용한 뇌졸중 입원환자의 중증도 보정 적정 재원일수 예측 모형을 개발하고 이를 의료기관에서 활용할 수 있는 방안을 제시하고자 하였다. 이를 위해 2004-2009년 퇴원손상심층조사 자료 중 뇌졸중 입원환자 23,134명을 대상으로 데이터마이닝 기법을 이용하여 뇌졸중 입원환자의 적정 재원일수 예측모형을 개발하였다. 의사결정나무 모형에 따라 뇌졸중 입원환자의 평균재원일수에 가장 큰 영향을 미치는 변수는 뇌졸중 발생유형이었으며, 의사결정나무를 이용하여 개발된 뇌졸중 입원환자의 중증도 보정 재원일수 모형 결과, 적정 재원일수와 실제 재원일수의 차이는 진료비지불방법, 의료기관 소재지, 병상규모가 모두 통계적으로 유의하게 나타났다. 따라서 뇌졸중 입원환자의 재원일수 변이를 줄이고 효율적으로 관리하기 위해서는 개발된 모형을 의료기관의 의료정보시스템에 적용하고 관리하는 활동을 전개해야 할 것이다.

• 한국병원경영학회지
• /
• 제23권1호
• /
• pp.51-64
• /
• 2018

Purposes : In February 2014, the government said that the National Health Insurance Service (NHIS) will enforce plan for reducing the financial burden from two major non-covered services including physician surcharges and private room charges, the main causes to increase uninsured, by 2017. The purpose of this study is to analyze the policy effect that performed so far by comparing out-of-pocket payment rates of policy process Methodology: This study analyzed admission medical expenses that occurred from January 2013 to March 2016 at a upper grade general hospitals in Daejeon. Number of study subjects were 134,924 and the data were analyzed with SPSS 22.0 program by using frequency, percentage, mean, standard deviation, ANOVA. The effect of two major non-payment improvement plan on out-of-pocket rates was ascertained via generalized estimating equation. Findings: Out-of-pocket payment rates was statistically significantly declined 2.7 percent than enforcement ago. Also, out-of-pocket payment, physician surcharge, the proportion of out-of-pocket payment of hospital room charge to out-of-pocket payment was statistically significantly declined. However, a further analysis of the cause of the decline in total medical costs is needed. Practical Implications: Physician surcharges and private room charges improvement policy had a positive effect on the decline of out-of-pocket payment rate. The policy of physician surcharges was very effective after the first policy enforcement but it was less effective to medical aids and near poor that was a more greater coverage than national health insurance. Since the policy has not been finalized, we have to continue a research for the successful implementation of the policy.

• 보건행정학회지
• /
• 제14권3호
• /
• pp.20-44
• /
• 2004

The National Health Insurance Expenditure has been increased rapidly since the introduction of the separation of prescription and dispensing in 2000, and this trend of rapid growth in overall spendings rate has been observed predominantly among medical practitioners. This study was conducted to investigate the growth rate and distributional changes in private medical practitioners' expenses from 1999 to 2002 and its determinants using the National Health Insurance claims data. The total increasing rate of all medical practitioners' expenditure paid by the National Health Insurance between 1999 and 2002 was $41.71\%$, which exceeding that of general hospitals by $20\%$p. But the income distribution among each practitioner was improved as the changes in Gini coefficient(from 0.40 to 0.38) and decile distribution ratio(from 0.25 to 0.29) during the same period showed. However, this improvement in distributional patterns is not enough since even in 2002 it turned out that the highest $10\%$ income group earned 33times more than the lowest $10\%$ income group did. Also, higher Gini coefficient was observed in larger cities and some department like plastic surgery, obstetrics and gynecology. The major causes of this differentials in medical practitioners' expenses were factors related to medical demand like proportion of old population, residential economic status in a given area. In addition, providers' economic incentives also played an important role in determining their income distribution. The large income differentials among physicians may imply a skewed distribution of patients and thus long waiting time, inefficient utilization of resources and potential inadequate quality of care. In this sense, unreasonable distributional gaps should be reduced, so effective measures as well as ongoing monitoring would be necessary to correct current distributional problems.

• 보건행정학회지
• /
• 제26권1호
• /
• pp.63-70
• /
• 2016

Background: Selective health benefit was introduced for decreasing economic burden of patients. Medical devices with economic uncertainty have been covered as selective health benefit by National Health Insurance since December 2013. We aimed to analyze impact of selective health benefit to medical expenditure and provider behavior focused on electrosurgery (ultrasonic shears, electrothermal bipolar vessel sealers) for gastric cancer patients covered since December 2014. Methods: We used the National Health Insurance claims data of 2,698 patients underwent gastric cancer surgery between August 2014 and March 2015. Medical cost and patient sharing per inpatient day were analyzed to verify that covering electrosurgery increased medical expenditure and changed provider behavior from open surgery to endoscopic or laparoscopic surgery. Additionally, we analyzed the claim rate of medical device or goods relating gastric endoscopic and laparoscopic surgery. Results: Medical cost and patient sharing per inpatient day were increased after covering electosurgery as selective health benefit (39,724/1,421 won). However, there were no medical expenditure increases after adjusting claim of electosurgery and patient sharing was decreased 1,057 won especially. The coverage of selective health benefit did not increase the claim rate of medical device or goods related endoscopic or laparoscopic surgery, either. Conclusion: Covering electosurgery decreased patient economic burden and did not change of provider behavior. Expanding selective health benefit is needed to decrease economic burden of severe patients. Further study should evaluate the long term effect with accumulated data.

• 보건행정학회지
• /
• 제20권2호
• /
• pp.17-39
• /
• 2010

This study explored the impact on the DRG(Diagnosis-Related Groups)-based prospective payment system(PPS) operated by voluntarily participation providers. We analyzed whether the provides in the DRG-based PPS and in traditional fee-for-service(FFS) systems showed different the degree of variation in length of stay(LOS), and the providers' behaviors depending on the differences according to the varied participation periods. The study sample included all data 2,061 institutions participated in DRG-PPS in 2007 and all cases 473 FFS institutions which reported fee-for-service claims were reviewed same diagnosized diseases at least 10cases claims during three months We compared the differences of the LOS among health care institutions according to their type, region, and size. For DRGs showing significant differences in LOS, multiple regression analyses were performed to find out factors associated with LOS and interaction effect participation and hospital types or participation periods. The result provide the evidence that the DRG payment system operated by volunteering health care institutions had impact on resources use, which can reduce the institutions' the length of stay. While some DRGs had no correlation between participation periods and LOS, other DRGs, DRG participation period reversely linear relationship with LOS. That is to say, the longer participation year, the less reducing the LOS. These results support the future expansion of the DRG-based PPS plan to all health care services in Korea.

• 응용통계연구
• /
• 제21권4호
• /
• pp.639-647
• /
• 2008

본 연구는 국민건강보험공단의 건강검진데이터, 자격 및 보험료 그리고 진료비 데이터를 활용하여 고혈압 관리를 위한 맞춤형 고혈압 사후관리모형(고혈압 진료예측모형 및 고혈압 진료순응도세분화모형)을 개발하고자 하였다. 모형 개발에는 데이터마이닝의 로지스틱 회귀모형, 의사결정나무 그리고 앙상블 모형을 활용하였다. 고혈압 진료예측모형에서는 3가지 모형 중 로지스틱 회귀모형이 가장 우수한 모형으로 채택되었으며, 고혈압 진료순응도세분화모형은 의사결정나무모형을 통해 개발되었다. 본 연구는 전국 규모의 수년간 축적된 자료를 데이터마이닝을 활용함으로써 고혈압의 진료 및 진료순응도에 이르는 고혈압 사후관리 프로세스 전반에 걸친 결과를 도출함으로써 우리나라 고혈압 사후관리체계 구축에 기여할 것으로 사료된다.

• 한국사회복지학
• /
• 제37권
• /
• pp.307-326
• /
• 1999

본 연구에서는 지난 1995년 실시된 도시지역의료보험조합과 농어촌지역의료보험의 통합 이후 나타난 조합재정 및 피보험자들의 의료서비스 이용강도에 있어서의 변화를 분석함으로써 지난 1998년 10월 실시된 지역의료보험과 공무원 교직원의료보험의 통합과, 더 나아가서는 오는 2000년 시행 예정에 있는 전체 의료보험통합으로 인해 나타날 수 있는 변화를 예측하는데 필요한 기초자료를 제공하고자 시도했다. 분석결과, 1995년 실시된 통합이 조합의 총지출 증가율 및 보험급여비 증가율에 변화를 가져왔다고 볼만한 결과는 발견할 수는 없었다. 또한 입원 및 외래진료 수진률과 건당진료비로 정의되는 의료서비스 이용강도에 있어서도 통합에서 비롯된 것이라 볼 수 있을 만한 뚜렷한 변화는 나타나지 않았다. 반면, 1995년의 통합이 조합의 평균관리운영비 증가율을 감소시키는 결과를 가져왔음을 발견할 수 있었다. 이러한 연구 결과가 갖는 정책적 함의에 대한 논의와 함께 앞으로의 의료보험통합을 위한 몇 가지 제언을 시도하였다.

• 한국병원경영학회지
• /
• 제12권2호
• /
• pp.1-24
• /
• 2007

The medical fee reimbursement denied by HIRA(Health Insurance Review Agency) amounted to about 1.2% of the total medical fee claim to HIRA for reimbursement. Most of the denials stem from the inappropriate prescriptions of medical staff violating the medical fee review standards issued by HIRA. Considering the significant impacts of the standards observance behavior on the hospitals' financial viability, we attempted to analyze the predisposition factors of medical staffs' review standards observance behavior. The TPB(Theory of Planned Behavior) was adopted as the theoretical framework of the analysis. Data were collected by administrating a survey on the concepts included in TPB model to the 187 medical staff of a tertiary care hospital. Of the 187 questionaries distributed, 150 were responded resulting 80.2% of response rate. The mean differences among the groups classified by age group, years of experience, medical specialty and gender were analysis using ANOVA. The relationships among the TPB concepts were analysed by applying the Structural Equations Modeling method. The TPB model consists of three exogenous concepts (attitude toward the behavior, subjective norm, and perceived behavioral control) and two endogenous concepts (intention and the behavior). The results of ANOVA indicated significant mean differences among the groups classified by the medical staff's age, years of experience, and medical specialty. The older and the more experienced had the higher mean of observance behavior score. The results of Structural Equations analysis showed that the subjective norm and perceived behavioral control had statistically significant influences on intention, but the influence of attitude to intention was not statistically significant. The influences of perceived behavioral control and intention on behavior were significant. Based on these results the theoretical and practical implications were discussed.

• 보건교육건강증진학회지
• /
• 제27권4호
• /
• pp.83-90
• /
• 2010

objectives: This study was conducted to estimate medical expenditure attributable to overweight and obesity in adults with ischemic heart disease and stroke using Korea National Health and Nutrition Examination survey data and Korea National Health Corporation data. methods : The medical expenditure of ischemic heart disease and stroke related to overweight and obesity were composed of inpatient care costs, outpatient care costs and medication costs. The population attributable risk (PAR) of overweight and obesity was calculated from national representative data of Korea such as the National Health Insurance Corporation cohort data and 2005 Korea National Health and Nutrition Examination survey data. results: The medical expenditure attributable to overweight and obesity of ischemic heart disease were 97.4 billion won(74.1-122 billion won). and stroke were 64.6 billion won(33.1-98.1 billion won). Consequently, these costs corresponded to 11.4% of total medical expenditure due to ischemic heart disease and stroke. conclusion: We conclude that overweight and obesity have increased medical expenditure from ischemic heart disease and stroke in Korea. These findings provide important support for implementing overweight and obesity management strategies in Korea.