• Journal of the Korea Convergence Society
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• v.8 no.12
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• pp.149-157
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• 2017

Unnecessary readmissions could be the result of the inadequate and unnecessary treatments. Adequate quality indicators for readmission are important because they can identify inadequate spending by inpatients as well as quality screening. This study attempted to estimate the cost incurred by unnecessary readmissions. The Health Insurance Claims Data of 18 years or older who were admitted in the tertiary hospitals in 2014 were analyzed. Admissions and readmissions were sorted and readmissions were classified into planned and unplanned readmissions. We adopted 28 days as a criteria for the classification of the readmission. Proportion of the patients were higher in readmissions among cancer, accompanied diseases, and special rehabilitation patients. Cost of the readmissions were 50% of the total cost of the admission among the patients of same diseases, same departments, and same hospitals. Almost 1,000billion Won were used by the unnecessary readmissions. We need to reduce the readmissions in regions, departments, and diseases studying the pattern of the readmissions. National level efforts are required to improve quality of care and reduce cost by the unnecessary readmissions.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.15 no.6
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• pp.3534-3547
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• 2014

Although there are many positive sides of the current fee-for-service payment schedule, there is a strong necessity to control the rapidly increasing national healthcare expenditure. The global budget is often mentioned as one prominent alternative for solutions. In this article, both microscopic and macroscopic approaches are considered to set the hospital medical expenditure budget. In a macroscopic aspect, the SGR model, which considers the financial limit of the healthcare system, is used to set the next year target budget. In addition, the DEA model is used to measure the inefficiency and cost recognition. In this article, the national medical target expenditure is distributed to an individual hospital based on the level of efficiency. By combining the SGR and DEA, it will be possible to set a real world applicable target medical expenditure budget model.

• Journal of the Korea Convergence Society
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• v.9 no.1
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• pp.151-159
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• 2018

This study analyzes the impact of competitions clinics on the total treatment cost and anti-biotics prescription rate. The result of implementing the basic statistics, correlations, and regression analysis by facilitating the evaluation data by Health Insurance Review & Assessment Service in 2015 for acute otitis media in children is shown as follows. First, there is a significant difference for each si-gun-gu for the competition index between total treatment cost and clinics, but there is almost no significant difference for the anti-biotics prescription rate. Second, competition in clinics has statistically important impact on the total examination cost And, third, competition in clinics has no statistically important impact on the anti-biotics prescription rate. There is a need for additional studies on re-examination rate, treatment cost per visit and so forth in order to clarify other factors of competition for medical institutions impacting on the physician behavior in the future studies.

• Journal of Preventive Medicine and Public Health
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• v.30 no.3 s.58
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• pp.497-507
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• 1997

This study was conducted to evaluate the association of various lifestyle with blood pressure. The data were obtained from the individuals who got routine health examination in Department of Occupational Medicine, Yeungnam University Hospital from June to September, 1996. Among these people, we selected 130 cases of hypertensives (97 males, 33 females) and 150 normotensives(70 males, 80 females) and study was conducted. The authors collected the information of the risk factors related to hypertension such as age, family history of hypertension, fasting blood sugar, serum total cholesterol, alcohol consumption(g/week), smoking history, relative amount of salt intake (low, moderate, high), the frequency' of weekly meat consumption, BMI, daily coffee consumption(cups/day) and the frequency of regular exercise(frequency/week) through questionnaire and laboratory test. By simple analysis, BMI was significantly associated with hypertension in male(p<0.05), and the frequency of weekly meat consumption was significantly associated with hypertension in female(p<0.05). Using logistic regression model, elevated odds ratio was noted for fasting blood sugar, serum total cholesterol, family history of hypertension, alcohol consumption, salt intake and BMI, and reduced odds ratio was noted for coffee consumption and exercise in male but fasting blood sugar(odds ratio=1.022, 95% CI=1.000-1.044), family history in both of parents(odds ratio=3.301, 95% CI=1.864-4.738), salt intake(odds ratio=1.690, 95% CI=1.082-2.298) and BMI(odds ratio=1.204, 95% CI=1.065-1.343) were statistically significant(p<0.05). In female, elevated odds ratio was noted in serum total choles terol, family history of hypertension, BMI and meat consumption. Of all these variables, the family history of hypertension in either of parents(odds ratio=4.981, 95% CI=3.650-6.312), family history in both of parents(odds ratio=16.864, 95% CI=14.577-19.151), BMI(odds ratio=1.167, 95% CI=1.016-1.318) and meat consumption(odds ratio=2.045, 95% CI=1.133-2.963) showed statistically significant association with hypertension in female(p<0.05).

• The Journal of the Korea institute of electronic communication sciences
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• v.11 no.10
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• pp.1009-1016
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• 2016

In this study, an educational program was developed. The program can perform the claim for examination of medical expense, which is one of NCS Competence Unit Elements for hospital administration. Considering various coding to complex compute and process, VB.Net was employed for this development. For database, ACCESS Database was used because it is easy to learn and use. The learning effects by the developed program are expected to be as follows. First, the composition of medical expense can be understood by analyzing Medical history and then selecting insurance code according to the Standard of Medical Care Code. Second, unit cost per score can be learned according to hospital class. Third, selection of Column (medical materials) and Column II(medical practice) can classify items of additional ratio. Fourth, because patient's payment rate on hospitalization and meal expense and use of special equipment are differently applied, user can know patient's payment rate by type and can calculate it. Fifth, additional amount is the amount calculated by additional ratio of Column II(medical practice), and user can learn additional ratio according by insurance type and hospital class. Sixth, user can learn self-pay rate by hospital class and understand the process that self-pay amount and claim amount are calculated according by self-pay rate.

• The Journal of the Korea institute of electronic communication sciences
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• v.12 no.2
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• pp.401-410
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• 2017

This study aimed to identify appropriateness and efficiency in the DRG payment system by analysing the hospital length of stay and changes in fees before and after the application of DRG payment system. The subjects of the study were a total of 398 patients consisting of 204 for the fee for service system and 194 for the DRG payment system. They received surgery in the Obstetrics and Gynecology (OBGY) department of a general hospital in G metropolitan city between January and December 2013. The mean hospital length of stay was significantly decreased after application of the DRG payment system(p=0.013). Total fees, insurance charges, and deductions increased significantly(p<0.001), and non-payment charges and total deductions decreased significantly(p<0.001). Application of the DRG payment system reduced length of stay, non-payment charges and total patient's cost sharing and increased out-of-pocket, insurance charges, and total fees.

• Korea Journal of Hospital Management
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• v.22 no.4
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• pp.33-49
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• 2017

Background: Health care utilizations and costs of the patients with degenerative lumbar spine disease in Korea increased dramatically. We analyzed whether hospital market competition is associated with charges and length of stay for patients with degenerative lumbar spine disease. Methods: We used Medical claims data of 2002 and 2010 from the nationwide representative sample of National Health Insurance Service of Korea. The study subjects were inpatients with degenerative lumbar spine disease (N=24,768) in 2002 and 2010. We employed a multilevel linear mixed model that included patient- and hospital-level variables in hierarchical data. Results: Higher hospital competition was associated with lower charges (${\beta}=57.5$, p<.0001 in 2002; ${\beta}=353.7$, p<.0001 in 2010) and shorter length of stay (${\beta}=0.3$, p<.0001 in 2002; ${\beta}=0.9$, p<.0001 in 2010) in both 2002 and 2010. Compared to 2002, the magnitude of such association became greater in 2010. However, subgroup analyses show that the influence of competition on charges and length of stay differed by hospital size. Conclusions: This study showed that hospital market structure (e.g., hospital competition) affects hospital efficiency (i.e., hospital charges and length of stay). It is necessary to continue to monitor how changing market structure influences hospital outcomes, including more detailed outcomes such as patient satisfaction.

• Health Policy and Management
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• v.34 no.1
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• pp.26-37
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• 2024

Background: The purpose of this study was to compare and analyze the differences in charges and length of stay per case between spine specialty hospitals and non-specialty hospitals, and to identify the factors that influenced them. Methods: This study used claims data from the Health Insurance Review and Assessment Service, including inpatient visits from January 2021 to December 2022. The healthcare facility status data was used to identify the characteristics of study hospitals. Multilevel analysis was conducted to identify factors associated with the charges and Poisson regression analysis was conducted to analyze the length of stay between spine specialty hospitals and non-specialty hospitals. There were 32,015 cases of spine specialty hospitals and 17,555 cases of non-specialty hospitals. Results: For four of five common spinal surgeries, specialty hospitals shaped longer length of stay than those of non-specialty hospitals. Multilevel and Poisson regression analysis revealed that regardless of the type of surgery, higher age and higher Charlson comorbidity index scores were significantly associated with an increase in both the charges per case and length of stay (p<0.05). However, when hospitals were located in metropolitan areas, there was a significant decrease (p<0.05). Conclusion: This study found that specialty hospital had higher inpatient charges and loner length of stay contrary to the previous study results. Further studies will be needed to find which contribute to the differences.

• The Korean Chronic Disease News
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• no.307
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• pp.1-18
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• 2006

경기도 의왕시 보건소 임인동 소장/의료비지출 OECD국가 중 최하위/“암환자 96%가 정상활동 못해”/MRI 진료비 18.2% 환불조치/“진료비 부당 청구 심사 강화”/대형병원 환자 집중현상 심화/제왕절개 분만율 평가결과 공개/KGMP 국제적 수준 높인다/완제의약품 생산국가 표기‘명확’/“국내 제약산업 희생양”안 된다/‘산디문 뉴오랄’당뇨 발현억제/지역사회정신보건사업 선도적 추진/지역보건의료계획 어떻게 추진되고 있나/버섯, 항암 등 15가지 약리효과 입증/자궁경부암은 HPV가 주원인이다/증상 없다고 대장암 안심은‘금물’/1급발암 물질 석면 사용 금지/고지혈증/당뇨병과 비만/

• Journal of the Korean hospital association
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• v.13 no.12 s.120
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• pp.44-48
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• 1984

의료보험제도의 시행과 더불어 변화된 양태중에서 누구나 용역하게 의료에 접할 수 있는 균등한 기회를 초래한 사실은 동 제도가 끼친 공학의 하나이기도 하다. 그러나 이 제도의 도입과 더불어 기존 의료제도의 변화로 야기된 여러가지 부정적인 측면은 오늘에 있어 부인할 수 없는 것 또한 현실이기도 하겠다. 본 고는 이러한 견지에서 의료보험제도의 실시와 더불어 발생하고 있는 제반문제중에서 특히 의료보험 진료비심사 지불제도에 관한 여러가지 문제점은 검토해 봄으로써 현안제도의 개선방향을 모색하고자 한다.