• 토지주택연구
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• 제3권3호
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• pp.241-248
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• 2012

택지개발사업비에서 간선시설 설치 비용이 차지하는 비중은 상당히 높으나, 부과의 행정적 편의상 일정규모 이상의 사업시행자가 부담하는 경향이 크다. 이로 인해 주변 기성시가지 및 소규모 택지개발사업지구에서 설치된 간선시설에 무임승차하게 되는 경우가 빈번하여 분담의 형평성 및 개발이익의 사유화 문제를 노정하고 있다. 이 연구는 대규모 택지개발사업에서 설치되는 도로시설의 무임승차를 파악하기 위한 방법론을 정립하고 실증분석하여, 합리적인 간선시설 비용분담을 위한 합리적 근거를 제시한다. 실증분석을 위한 사례지구로 부천상동택지지구를 선정하였다. 부천상동지구에 의한 교통유발을 도출하기 위해 개발시나리오를 설정하였으며, 교통네트워크 분석을 사용하여 간선시설을 이용하는 교통량, 통행시간, 통행비용을 시나리오별로 산출하였다. 그 결과, 부천상동택지지구 주요 간선시설 중 당해 지구가 부담해야 할 비율은 전체의 83% 정도로 분석되었다. 이 연구의 방법론과 결과는 향후 개발사업에서 간선시설 설치를 위한 비용의 부담주체와 부담정도를 설정하는데 기여할 수 있을 것이다.

• 자원ㆍ환경경제연구
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• 제32권2호
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• pp.107-126
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• 2023

본 연구는 노후 경유차 조기폐차 지원제도의 재정 효율성을 분석하기 위해 노후 경유차 조기폐차에 대한 행정자료를 사용하여 재정투입비용과 대기질 개선편익을 추정하여 B/C 분석을 시도하였다. 분석 결과를 살펴보면, 2020년 이전에는 지원제도의 비용 대비 편익 비율이 1보다 크지만, 2020년 이후로 그 비율이 1보다 작아지는 것으로 나타났다. 이는 최근 노후 경유차 조기폐차의 혜택을 확대하기 위한 방향으로 개편되었으나, 대기질 개선 편익의 증가율은 제도 운영 비용의 증가율만큼 빠르지 않은 것으로 판단된다. 대기질 개선편익은 조기폐차로 인해 운행기간이 어느 정도 단축하는지에 의존한다. 이 시기를 더 앞당길수록 조기폐차의 편익이 비용보다 더 클 가능성이 커진다. 본 연구결과를 살펴보면, 폐차 시기를 5년 앞당길 때 표본의 98%에 대한 B/C가 1이 되어 재정 효율성이 크게 확보되는 것으로 나타났다. 따라서 정부는 조기폐차 지원제도가 폐차시점에 대한 노후 경유차 차주의 의사결정에 영향을 줄 수 있도록 제도를 개편해나가는 것이 중요할 것이다.

• 보건행정학회지
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• 제34권1호
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• pp.48-58
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• 2024

연구배경: 이 연구는 충청남도 지역 및 환자의 특성과 관외 의료기관 이용과의 연관성을 분석한 연구이다. 충청남도 지역에 거주하는 입원 및 외래 환자들을 통해 도내 진료권을 분석하고, 수도권 및 대전권 의료기관에 대한 관외 의료이용 양상을 파악하여 도내 의료전달체계 개선 및 건강보험 재정 안정 도모를 위한 충청남도 의료정책 사업의 근거적 자료 제공을 목적으로 한다. 방법: 이 연구는 건강보험 코호트 DB 2.0 2016-2019년 자료를 활용하였다. 수집된 원시 자료 중 환자의 거주지가 충청남도 지역이면서, 이용한 요양기관이 상급종합, 종합병원, 병원, 의원인 환자로 한정하였고, 최종적으로 2,570,439건(입원=43,309, 외래=2,527,130)의 자료를 추출하였다. 먼저, 분석대상자의 일반적 특성을 파악하기 위해 각 변수별로 기술통계를 실시하였고, 충청남도 지역 및 환자의 특성과 관외 의료기관 이용과의 연관성을 파악하기 위해 다변량 로지스틱 회귀분석 및 다항 로지스틱 회귀분석을 실시하였다. 또한 관외 의료기관 이용에 따른 입원 및 외래 환자의 진료 1건당 의료비 차이를 파악하기 위해 심사결정 후 건강보험 총요양급여비용을 자연로그값으로 변환하여 분석하였다. 결과: 분석결과, 충청남도 지역 거주 환자들은 충남권, 대전권, 수도권 순으로 의료기관을 많이 이용하였고, 입원 및 외래 환자 모두 천안, 아산 거주 환자들에 비해 모든 권역에서 관외 의료기관을 더 많이 이용하였다. 특히 공주, 부여, 천안(odds ratio [OR], 72.931) 및 계룡, 논산, 금산(OR, 116.817) 거주 입원 환자는 대전권 의료기관 이용과 매우 높은 연관성을 나타냈다. 또한 충청남도 지역 거주 환자들은 충남권 의료기관에 비해 수도권(외래=17.01%, 입원=22.11%)과 대전권(외래=16.63%, 입원=15.41%) 의료기관에서 더 많은 의료비를 지불하였다. 결론: 이 연구는 충청남도 지역 거주 환자들의 관외 의료이용 양상을 분석하고 관련 시사점을 제공하였다. 향후 지역 의료기관과 서비스에 대한 신뢰도 및 만족도와 환자의 주진단과 같은 요인들을 고려한 연구가 추가적으로 진행되어야 하며, 연구결과를 바탕으로 합리적인 의료의 지역화와 의료공급 효율성 및 건강보험 재정 건정성 확보를 위한 정책사업의 기초 자료로 활용되기를 고대한다.

• 보건행정학회지
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• 제27권2호
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• pp.149-156
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• 2017

Background: This study was conducted to evaluate the performance of the Hierarchical Condition Category (HCC) model, identify potentially high-cost patients, and examine the effects of adding prior utilization to the risk model using Korean claims data. Methods: We incorporated 2 years of data from the National Health Insurance Services-National Sample Cohort. Five risk models were used to predict health expenditures: model 1 (age/sex groups), model 2 (the Center for Medicare and Medicaid Services-HCC with age/sex groups), model 3 (selected 54 HCCs with age/sex groups), model 4 (bed-days of care plus model 3), and model 5 (medication-days plus model 3). We evaluated model performance using $R^2$ at individual level, predictive positive value (PPV) of the top 5% of high-cost patients, and predictive ratio (PR) within subgroups. Results: The suitability of the model, including prior use, bed-days, and medication-days, was better than other models. $R^2$ values were 8%, 39%, 37%, 43%, and 57% with model 1, 2, 3, 4, and 5, respectively. After being removed the extreme values, the corresponding $R^2$ values were slightly improved in all models. PPVs were 16.4%, 25.2%, 25.1%, 33.8%, and 53.8%. Total expenditure was underpredicted for the highest expenditure group and overpredicted for the four other groups. PR had a tendency to decrease from younger group to older group in both female and male. Conclusion: The risk adjustment models are important in plan payment, reimbursement, profiling, and research. Combined prior use and diagnostic data are more powerful to predict health costs and to identify high-cost patients.

• 한국전자거래학회지
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• 제9권1호
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• pp.285-301
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• 2004

현재 지원되고 있는 클라이언트/서버 방식의 민원 서비스의 한계를 극복하여 인터넷으로 민원 서비스를 하기 위해서는 행정 내부망과 인터넷 망의 연계에 따른 보안문제와 공인 인증과 정부 인증 등을 통한 본인 확인 및 스마트 카드를 통한 전자지불 및 현금 등을 통한 지불 기능이 지원 되어야 한다. 특히 이를 키오스크를 통하여 지원하기 위해서는, 인터넷을 통한 민원서비스를 위한 키오스크는 관청 외부 설치를 전제로 하기 때문에, 보안이 보다 중요한 문제로 등장한다. 이러한 제반 문제점을 해결할 수 있는 민원 서비스시스템을 설계함에 있어 실질적인 민원 처리를 담당하는 민원처리 시스템인 시군구 종합행정정보시스템의 프론트 서버로서의 중계서버와 키오스크 제어를 담당하는 웹서버를 두어 중계서버와 웹서버를 연계하고 웹서버와 중계서버 사이에 인증프로세스를 거치게 함으로 민원처리 시스템과 키오스크를 직접 연계함으로 발생되는 보안 문제를 해결할 수 있다. 민원 서비스를 위한 인증 및 전자지불의 기능 지원을 위하여 본인 확인은 지문인식을, 전자지불은 지불 게이트웨이를 전제로 설계한다. 이를 설계함에 있어서 개발의 초기 단계에서 위험을 줄이고 재작업에 따른 비용을 절감할 수 있을 뿐만 아니라 높은 품질의 시스템을 효과적으로 개발할 수 있는 키오스크 기반 웹 민원서비스 시스템을 아키텍쳐 수준에서 그 모델을 제시한다.

• 보건행정학회지
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• 제9권3호
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• pp.70-94
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• 1999

This paper was performed for a cost-effectiveness analysis of pharmacologic treatment of hypercholesterolemia. Agents modeled were cholestyramine, gemfibrozil. bezafibrate, lovastatin, pravastatin, simvastatin. Pharmacologic effectiveness was estimated by regression from reported clinical trials. Pharmacologic effects were expressed as the percent change of blood cholesterol level. Cost estimates included patients' travel expenses and time loss as well as resource consumption in the health care sector. Bezafibrate was the most efficient agent for reducing total cholesterol levels, having an cost over 1 year of ￦31.400 per percent reduction in total cholesterol. Simvastatin (10mg/d) was also efficient(￦33,100 per percent reduction). Chole styramine(8g/d) was least efficient at ￦90,200. For low-density lipoprotein cholesterol. simvastatin(10mg/d) was most efficient, at ￦23,200 per percent reduction, followed by lovastatin(20mg/d) at ￦28,000. Gemfibrozil was least efficient at ￦77,800 per percent reduction. For high-density lipoprotein cholesterol. bezafibrate(400mg/d) was most efficient at ￦39,300 per percent increase of high-density lipoprotein cholesterol. Cholestyramine was least efficient at ￦514,700. Analyses combining low-density lipoprotein cholesterol and high-density cholesterol effects suggest that bezafibrate(600mg/d) and simvastatin (10mg/d) were most efficient for reducing cardiovascular risk. The cost-effectiveness analysis results show that both simvastatin and bezafibrate could be efficient treatment. Simvastatin provide more effective treatment at higher cost, whereas bezafibrate is more cost-effective, as it may be less effective, at lower cost. Therefore, clinicians should choose reasonable treatment according to the patient's needs This pharmacoeconimc analysis will provide a guideline for efficient pharmacologic treatment and also be reference data for pricing new drugs.

• 보건행정학회지
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• 제20권1호
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• pp.37-63
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• 2010

Public expenditures on long-term care are a matter of concern for Korea as in many other countries. The expenditure is expected to accelerate and to put pressure on public budgets, adding to that arising from insufficient retirement schemes and other forms of social spending. This study tried to foresee how much health care spending could increase in the future considering demographic and non-demographic factors as the drivers of expenditure. Previous projections of future long-term expenditure were mainly based on a given relation between spending and age structure. However, although demographic factors will surely put upward pressure on long-term care costs, other non-demographic factors, such as labor cost increase and availability of informal care, should be taken into account as well. Also, the possibility of dynamic link between health status and longevity gains needs to be considered. The model in this study is cell-base and consists of three main parts. The first part estimated the numbers of elderly people with different levels of health status by age group, gender, household type. The second part estimated the levels of long-term care services required, by attaching a probability of receiving long-term care services to each cell using from the sample from current year. The third part of the model estimated long-term care expenditure, along the demographic and non-demographic factors' change in various scenarios. Public spending on long-term care could rise from the current level of 0.2~0.3% of GDP to around 0.44~2.30% by 2040.

• 간호행정학회지
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• 제9권1호
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• pp.103-112
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• 2003

Purpose : This study was designed to describe the economic awareness, economic knowledge, and attitude toward cost-effectiveness in nursing of hospital nurses. Method : The sample included 272 nurses conveniently selected from 5 tertiary care hospitals. Data were collected on general characteristics of nurses, the economic awareness level, the knowledge level of economics, and the attitude toward cost-effectiveness. Data were analyzed using SPSS PC version 10.0. Result : 1) The mean of economic awareness level of hospital nurses was 44.87 (SD=3.53) with a possible range of 5${\sim}$50. The mean of the knowledge level of economics was 58.3 (SD=11.9) with a possible range of 0${\sim}$100. 2) The mean of attitude toward cost-effectiveness in nursing was 39.95 (SD=5.01) with a possible range of 5${\sim}$50, which means moderately positive. 3) Analyzing the relationships between economic awareness level and knowledge level of economics, and attitude toward cost-effectiveness, the knowledge level of economics was positively related with the economic awareness level (r=.192, p=.002) and the attitude (r=.133, p=.029). The economic awareness level was positively related with the attitude (r=.470, p=.000). 4) Backward multiple regression revealed that the linear combination of economic awareness, job position, place of employment, and the presence of CQI committee accounted for 26.1% of the variance in the attitudes toward cost-effectiveness nursing care. Conclusion : Findings reveal that RNs lack basic knowledge of economics and its link to nursing practice, yet, they want a voice in economic decision making. In an effort to fill the void of economic knowledge and respond to nurses' call for greater input, in-service programs and curricula for generic programs must be developed.

• 보건행정학회지
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• 제20권2호
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• pp.40-52
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• 2010

Health insurance fees are set by relative value scales and conversion factors. Since 2008 the conversion factor has been classified into 7 according to the provider type, and a separate contract has been made respectively. As such classification of the conversion factor reflects only the different characteristics of providers, however, further classification to reflect the different cost structures of providers is proposed. Cost varies according to the type of not only providers but also services each provider supply. In fact different cost structures of providers are the result of their different services. This study analyzed the cost structure of medical services to propose a new approach to the classification of the conversion factor. This study analyzed the cost structure of medical services using cost data constructed in the revision study of relative value scales. The cost data consist of doctor's fee, support staff's fee, cost of medical equipments, cost of medical supplies and indirect cost. The proportion of each cost component to the total cost was analyzed in terms of service department and service type. 72 service groups are defined in terms of the combination of service department and service type. Through cluster analysis, 72 service groups were reduced into 7 clusters each of which has a similar cost structure. Conversion factor is contracted annually to reflect the change in the cost of providing medical services. So the classification of conversion factor has to be based on the cost structures of medical services, not the characteristics of providers. Service clusters derived in this study can be used as a new classification for health insurance fee contract.

• 보건행정학회지
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• 제19권1호
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• pp.1-30
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• 2009

Korean medical fee contract system between the insurer and healthproviders was introduced in 2000. However, a continuous discord among contracting parties concerned and an irrational operation of an arbitration committee of Ministry for Health, Welfare and Family Affairs (MIHWAF) have made it difficult for them to reach to an agreement over last 8 years. The purpose of this study is to observe the current problems of contract system from the view of health insurance law and actual examples. Furthermore, I examined the of breakdown of negotiation by analyzing the eligibility of contracting parties, rationality of Resource Based Relative Value System (RBRVS) and contracting method and fairness of arbitration method in case of negotiation rupture. The results were as follows: First, since the introduction of medical fee contract system, there has been a problem in that both the president of National Health Insurance Corporation (NHIC) and health care provider association have not held strong negotiation power. Second, the frequent changes and notifications of Relative Value Units (RVUs) without any mutual consent between the insurer and provider association negatively have influenced the conversion factors and finally hindered the agreement of contract. Third, a current process that the conversion factors are mediated and determined at the arbitration committee of MIHWAF in the case of contract breakdown between contracting parties has some flaw in that the irrational composition of committee provoked the lack of fairness and objectivity of mediation. Fourth, we can not prospect a satisfactory outcome of arbitration committee because the mediation always has failed to proceed smoothly due to boycott of both committee members from insurer and providers over last 8 years. As a result, we have to make an every effort to resolve problems mentioned above and then dream of an advanced national health insurance system.