• Journal of Korea Entertainment Industry Association
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• v.14 no.8
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• pp.345-352
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• 2020

This study conducted a survey targeting 414 medical institution workers to identify the impacts of their emotional labor and the recognition level of medical service fee reduction influencing the reduction rate. The results were as follows. First, a review of the difference in the reduction rate by socio-demographic characteristics revealed that in both inpatient and outpatient reduction rate, there is a significant difference in the occupational description, working history at the current hospital, and the numbers of approved beds. Second, there is a correlation between emotional labor, the recognition level of medical service fee reduction, and the reduction rate. As a result of the analysis, there is a significant positive correlation between emotional labor and outpatient reduction rate, a significant negative correlation between the recognition level of medical service fee reduction and inpatient reduction rate, and a significant negative correlation between the recognition level of medical service fee reduction and outpatient reduction rate. Third, emotional labor has a significant positive effect on the inpatient reduction rate, and the recognition level of the medical service fee reduction has a negative effect on the inpatient reduction rate. The emotional labor also has a significant positive effect on outpatient reduction rate, and the recognition level of the medical service fee reduction has a significant negative effect on outpatient reduction rate.

• Journal of Digital Convergence
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• v.10 no.11
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• pp.493-502
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• 2012

This study aimed to determine the management and environmental factors affecting medical expense reduction. For analysis, medical expenses were divided into hospitalization expenses and outpatient treatment expenses, and the rate of medical expense reduction was classified into initial and final reduction rates. Data were collected through a direct survey among 205 directors of independent health insurance review departments of hospital-level medical institutions in Korea. The results of the study are discussed below: In the analysis, differences in the initial and final reduction rates of hospitalization expenses and outpatient treatment expenses were compared. The results showed that, in hospitalization expenses, the initial and final reduction rates were both significantly affected by the following management factors: number of beds, number of departments, number of personnel reviewing health insurance cases, and total number of employees. Further, in outpatient treatment expenses, the initial and final reduction rates were both affected significantly by the following management factors: management of medical records, number of beds, number of departments, number of personnel reviewing health insurance, and total number of employees. The management factors significantly affecting both the initial and final reduction rates were higher number of beds for hospitalization expenses and electronic medical record management for outpatient treatment expenses. The environmental factors significantly affecting both the initial and final reduction rates of hospitalization expenses were a highly cooperative work environment, better implementation of indicator management systems, and overtime pay. Better implementation of indicator management system and a committee for handling medical expenses had significant effects on the initial reduction rate for outpatient treatment expenses. A highly cooperative work environment, better implementation of indicator management system, and overtime pay had significant effects on the final reduction rate for outpatient treatment expenses.

• Information Systems Review
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• v.7 no.1
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• pp.275-295
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• 2005

Changes in business environment caused by globalization of the world economy and the beginning of the knowledge society forced hospitals to equip with tools for the enhanced competitiveness. In other words, hospitals must aim three targets such as acquisition of advanced medical skills and equipments, improvement of service level for patients, and achievement of superior managerial performance simultaneously. This study has been done to suggest a way to reduce the possibility of hospital bill claim reduction as an alternative for the achievement of superior managerial performance. If the reduction rate of hospital bill claim is high, it will put negative impact on the hospital's revenue stream and hospital's reliability. Thus, if they want to stay competitive, hospitals need to device ways to cut the reduction rate as much as possible. In this study, a prototype system has been developed and implemented to check the possibility to cut the reduction rate through deep analysis of causes of reduction. The prototype first developed utilizing data mining techniques and the relation rules algorithm. Then the prototype was tested its performance using the D hospital's live data.

• Journal of Digital Convergence
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• v.13 no.7
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• pp.259-268
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• 2015

This research grasped the difference of between the daily medical expenses and the medical expenses reduction rate also the cause of change. In the centre, it was conducted in order to offer the necessary basic data to a recuperation pay management solution's establishment. This research surveyed across the country's urban region 50-general hospital's the infective enteritis disease for a year. Then it was conducted the average daily medical expenses and the average medical expenses reduction rate as a distinguishable survey that is a hospitalization and an outpatient the result is followed. The inpatient daily medical expenses correlated with the total number of medical institution personnel, and the outpatient daily medical expenses correlated with the number of beds.. Inpatient medical expense reduction rate was correlated with number of beds and the total number of medical institution personnel. The interaction between medical institution information and daily medical expenses was found to have a positive (+) effect on the total number of medical institution personnel, as well as the numbers of inpatients vs. outpatient. This research about the medical expense reduction rate and daily medical expense help medical institution's efficient, rational decision making and it will be an important basis of a priority recuperation pay's policy.

• Journal of Korea Entertainment Industry Association
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• v.14 no.7
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• pp.609-621
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• 2020

This study identified the impacts of organizational commitment on medical service reduction rates by lifestyles of medical institution workers with a medium of environmental factors in a medical institution, and it conducted a survey targeting 300 medical institution workers in Jeolla-do, South Korea. The results are as follows. First, there was a significant difference in an organizational commitment by sociodemographic characteristics based on age, academic career, gender, marital status, occupational description, monthly earnings, the years of employment, and the type of hospital. Second, there was a significant difference in environmental factors by sociodemographic characteristics based on marital status, the years of employment, and the type of hospital. Third, there was a significant difference in the inpatient reduction rate based on the occupational description, years of employment, and the type of hospital. In the outpatient reduction rate, a significant difference was shown based on age, marital status, occupational description, the years of employment, and the type of hospital. Fourth, when analyzing the relationship between organizational commitment, environmental factors, and the reduction rate, there was a significant positive correlation between inpatient reduction rate and outpatient reduction rate. Fifth, when analyzing the impacts on the inpatient reduction rate by deploying organizational commitment and environmental factors at the same time, it was shown that the environmental factors mediated partially in organizational commitment and inpatient reduction rate. In the case of outpatient reduction rate, it was shown that the environmental factors mediated completely in organizational commitment and outpatient reduction rate. The present study is aimed to contribute to providing the baseline data for an efficient operational plan and effective workforce management of medical institutions.

• Proceedings of the KAIS Fall Conference
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• 2011.12a
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• pp.248-250
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• 2011

2009년 1월 1일부터 3월 31일까지 신규 개원한 295개 의원급 의료기관을 대상으로 의료기관 행정인력이 있을 때와 없을 때에 따른 진료비 청구에 미치는 요인을 파악한 결과, 지역별로는 경인대권이 54.9% 가장 높은 분포를 보였으며, 진료과목별로는 일반의 29.8%로 높았으며, 행정인력이 많은 진료과도 일반의로 35.5%로 높게 나타났다. 행정인력이 있는 경우 단순청구오류건의 수정 및 이의신청횟수, 보완청구, 누락청구의 횟수도 높은 것으로 확인되며, 행정인력이 있는 경우 삭감된 부분에 대한 회수율일이 행정인력이 없는 경우보다 높은 것으로 확인되었다.이 상의 결과로 볼 때 행정인력은 병원행정 업무를 지속적인 교육과 의료인과의 소통을 통해 합리적인 청구방법 모색이 필요하다. 또한 병원행정인은 환자와 의료인과의 가교 역할을 담당하고 의료기관과 정부 등 관련기관과의 매개자로써 적절한 역할을 통해 의원급 의료기관의 경영의 도움이 될 것으로 사료된다.

• Health Policy and Management
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• v.12 no.3
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• pp.23-35
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• 2002

Fiscal crisis in the medical insurance system has put the pressure upon hospitals by increasing the rate of curtailment, since the implementation of the separation of prescription and dispensing of medicine. The purpose of this study is to analyse the curtailment of mdical and drug expenditure before and after the system of separation between prescribing and dispensing and to suggest the problems about current inspection system. Data were obtained from 13 general hospitals and used for analysis of trends on medical & drug expenditure, and curtailment in 1999-2000 at three months intervals. The results were as follows; The scale of curtailment for drug expenditure has been increased on outpatient and inpatient since 2000. For the curtailed drug cost with outpatient, the ratio of curtailed drug expenditure has been increased in the case of prescription within the hospital. These results suggest that review system in social insurance were over-focused to control the cost and it might to impede the validity of review function in insurance system. Therefore, it' s needed to develope the scientific and reasonable criteria for Inspection and evaluation of durg expenditure.

• Journal of Digital Convergence
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• v.10 no.1
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• pp.407-412
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• 2012

From Jan. 1 2009 to Mar. 31 2009, a study surveyed 295 national clinic medical institutions that was newly enrolled in Health Insurance Review and Assessment Service to identify the factors depending on whether the administrative personnel influences on the management of the clinic medical institutions. The survey showed that the medical institutions with administrative personnels affected more adjustments than those without administrative personnels and it appeared to be statistically significant except one time(p<0.01). The result of the survey tells whether the administrative personnel is or not in medical institutions has important effects on the reduction. So, it is considered that the placement of administrative specialists in the hospital is very important for medical institutions.

• Korea Journal of Hospital Management
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• v.13 no.4
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• pp.46-75
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• 2008

Main objective of this study is to investigate the factors that affect the reduction and recovery rate of hospital health insurance review departments of Korean tertiary hospitals, general hospitals and hospitals. A nationwide mail survey was conducted through structured questionnaire for chiefs and members of health insurance review departments of 178 hospitals, and data from 1,064 respondents were utilized in the final analysis. Major findings are as follows: 1) Monthly average reduction rate of surveyed hospitals was 1.18% for inpatients and 0.56% for outpatients. Also, average recovery rates from protests were 45.7% and 53.6%, respectively. 2) Average ages of health insurance review department employees were 41.5 for chiefs and 34.9 for members, and their average working period was 6.64 years. 69.1% of the respondents felt stress in their jobs, and they suggested 'communication problems with doctors' along with 'heavy workloads' as major reasons for the stress. 3) Reduction rates decreased and recovery rates increased when separate member in charge was assigned to each medical department, when health insurance review departments periodically provided medical parts with related education, and when the members participated in various committees.

• Journal of Oral Medicine and Pain
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• v.30 no.2
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• pp.215-230
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• 2005

The study was intended to investigate how dentists in private dental clinic thought on the present claim and review of dental insurance to reflect it in future establishing dental insurance policies. 1,465 dentists who were running own dental clinic in Pusan Metropolitan City and the south part of Kyungsang province were surveyed in February, 2004. A total of 406 copies of finished questionnaire were finally retrieved and analyzed. The findings are as follows. 1. About insurance claim affairs : Most of the subject of insurance claim was by dentist himself or dental hygienist(nurse). Agency claiming was carried under 20% of total insurance claim. 2. The degree of attendance on insurance lecture : The degree of attendance on insurance lecture was relatively low. 3. Filing a protest against insurance claim : Filing a protest against insurance claim was reavealed about half-and-half for "have been" or "have not been". 4. Private clinic dentist,s opinion about the regulations affecting review of dental insurance : Private clinic dentists opinion about current guide for insurance review of dental fee was“the guidance is difficult and unfair cutback of claim fee may be carried”. 5. The affairs about health insurance review agency : About 70% of private clinic dentists have dissatisfaction on health insurance review agency. 6. Standpoint of private clinic dentists about issuance of receipt for dental fee : About 70% of private clinic dentist have an difficulty in issuance of receipt for dental fee. 7. The affairs about change insurance noncoverage treatment to insurance coverage treatment : Most of private clinic dentists hoped that insurance coverage about full mouth scaling, pit and fissure sealant, fluoride application. But they do not hoped that insurance coverage about geriatric denture, prothodontic treatment except precious metal, photopolymerization resin treatment.