• Health Policy and Management
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• v.30 no.1
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• pp.72-81
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• 2020

Background: The out-of-pocket maximum is one of the distinctive healthcare systems which sets a ceiling on co-payment in order to reduce the burden of households from the unpredictable medical expenditure. However, this leads to an increase in the demand for healthcare services especially in long-term care hospitals (LTCHs) in Korea. Methods: This study analyzed the influence factor of medical service overuse of 165,592 inpatients in LTCHs which out-of-pocket maximum is applied, by utilizing data from the National Health Insurance Service (2016). Based on Anderson Model, the medical service overuse, as a dependent variable, was defined as long-stay admission more than 180 days at the LTCHs. Independent variable was comprised of predisposing factors (gender, age), enabling factors (income level, types of out-of-pocket maximum) and need factors (illness level, patient use of tertiary hospital). Results: The most powerful factor of medical service overuse in LTCHs was availability of pre-payment for the out-of-maximum (odds ratio [OR], 191.66; p<0.001). This tendency was found in high income level status (p<0.001). Furthermore, mild inpatients (OR, 1.50; p<0.001) which had no experience with the tertiary hospitals (OR, 2.06; p<0.001) were more relevant to the medical service overuse in LTCHs, compared to the severe inpatients. Conclusion: It is suggested that a separate standard of out-of pocket maximum with regards to LTCHs is required to secure the beneficial functions of long-term hospitals and prevent unnecessary financial leakage to achieve sustainable and financially sound National Health Insurance.

• Health Policy and Management
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• v.3 no.1
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• pp.53-83
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• 1993

A small number of high cost patients usually spend a larger proportion of scarce health resources. Korea is no exception. Under the national health insurance, 12% of the insured persons have consumed approximately half of the national health insurance expenditures. Therefore, it is necessary to identify the characteristics of the high cost patient group, if we would like to reduce them. This study has defined high cost patients as those who have spent one and half million won and over per 6 months. The study reveals that high cost users are those who have a longer length of stays(LOS), 40days of LOS in the 6 months, have multiple admissions, 2 to 3 admissions per 6 months and are the elderly patients. They have spent 814.126won per on the average, and commonly suffered from malignant neoplasms, circulatory diseases, fracture, diabetes mellitus, etc. Unlike the case of western developed countries, early readmissions are not the major causes of high cost spending in Korea. Undoubtedly, a lengthy admission is the main cause of large spending. Health policies should vigorously be explored to respond appropriately. There are evidences that hospital beds are often misused. As the Korean health care system is lacking in a mechanism of patient evaluation under the fee-for-service remuneration system, an idea of progressive patient care needs to be tested. The Goverment should set up health policy to diversify the role of long-term care facilities and encourage people to establish them. Further studies are needed to identify factors influencing large medical bills necessary for formulating the health policy on cost containment.

• Health Policy and Management
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• v.33 no.3
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• pp.295-310
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• 2023

Background: The long-term care (LTC) group has higher rates of chronic disease and disability registration compared to the general older people population. There is a need to provide integrated medical services and care for LTC group. Consequently, this study aimed to identify medical usage patterns based on the ratings of LTC and the characteristics of benefits usage in the LTC group. Methods: This study employed the National Health Insurance Service Database to analyze the effects of demographic and LTC-related characteristics on medical usage from 2015 to 2019 using a repeated measures analysis. A longitudinal logit model was applied to binary data, while a linear mixed model was utilized for continuous data. Results: In the case of LTC ratings, a positive correlation was observed with overall medical usage. In terms of LTC benefit usage characteristics, a higher overall level of medical usage was found in the group using home care benefits. Detailed analysis by medical institution classification revealed a maintained correlation between care ratings and the volume of medical usage. However, medical usage by classification varied based on the characteristics of LTC benefit usage. Conclusion: This study identified a complex interaction between LTC characteristics and medical usage. Predicting the requisite medical services based on the LTC rating presented a challenge. Consequently, it becomes essential for the LTC group to continuously monitor medical and care needs, even after admission into the LTC system. To facilitate this, it is crucial to devise an LTC rating system that accurately reflects medical needs and to broaden the implementation of integrated medical-care policies.

• The Journal of Sustainable Design and Educational Environment Research
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• v.5 no.2
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• pp.14-30
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• 2006

This study is to explore effective implementation strategies of elective-based curriculum in high schools, and to infer some implications for the improvement of school facilities. For the purpose, this study did three things. First, it tried to find the degree to which students are provided with the courses they want to take for the elective-based curriculum. Second, it explored effective implementation strategies of elective-based curriculum in high schools with the introduction of students' 'pre-application and lottery-allotted system' of high school admission. Third, it tried to infer the changed policy's implications for the improvement of school facilities. As a result of the study, three points are to be emphasized for the future plan and design of high school facilities. First, different school facilities are needed for each school because each school would implement different types of school curricula. Second, schools should be provided with different sized classrooms and different number of classrooms because three different types of students are assigned for each school as a result of new students' allocation policy. Third, new measures should be taken to provide students who are assigned to unwanted schools with opportunities to take courses outside their schools because students assigned by lottery system cannot have so much opportunity as students who are allocated to chosen schools.

• Journal of the Korean housing association
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• v.19 no.5
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• pp.37-46
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• 2008

The purpose of this study is to derive and adapt the Valuation Factor of urban regeneration scientifically and synthetically, which is the basis of developing a rational plan for urban revitalization. For this, we have selected 37 factors relating to urban regeneration as outlined in preceding studies and inquiry about importance of factors. we analysed he Valuation factors influencing he importance of urban revitalization through a questionnaire which was completed by inhabitants and expert groups in Gwangju Metropolitan City. From he results of he Factor analysis using SPSSWIN(VER.14.0), it was found that the factors which influence the importance of urban regeneration are Environment, Function, Resources and Policy Factors. Environment Factor comprises amenity, culture, beauty and convenience, The while the Function Factor comprises interchange, information, complexity and security. This classification has credibility because of the high factor loading through the Varimax Factor Analysis and is due to a high Cronbach's coefficient. There is a strong correlation between the classified factors through correlation analysis. Finally, through AMOS (Analysis of Moment Structure) 16.0 it was found that the upper classification is credible because main suitability index confirms recommending an admission standard.

• Journal of Gastric Cancer
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• v.24 no.4
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• pp.464-478
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• 2024

Purpose: Endoscopic submucosal dissection (ESD) is the standard treatment for early gastric cancer (EGC) with a low risk of lymph node metastasis. In Korea, ESD was included in the National Health Insurance (NHI) coverage in 2011, which was expanded in 2018. In the present study, we investigated the status and trends of ESD for EGC over the past decade since its incorporation into the NHI system. Materials and Methods: We analyzed the data from the National Health Insurance Service (NHIS) database from 2011 to 2021, focusing on patient characteristics, number of ESD procedures, in-hospital length of stay (LOS), and total medical cost (TMC) per admission. In addition, we conducted an interrupted time series analysis to assess the impact of changes in insurance coverage on these variables. Results: Overall, 95,348 cases of ESD for EGC were identified. A consistent annual increase in ESD procedures was observed, particularly in tertiary care hospitals and among patients aged >60 years. The overall median LOS and TMC were 4 days and 2,123,000 KRW, respectively. The 2018 insurance coverage expansion did not significantly affect the number of ESD procedures or LOS; however, the TMC increased significantly. Conclusions: Our study illustrates decade-long trends in the ESD for EGC in Korea. The policy needs to be revised continuously to optimize ESD use and improve resource allocation within healthcare systems.

• IE interfaces
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• v.24 no.4
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• pp.274-280
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• 2011

Delayed access to surgery may lead to deterioration in the patient condition, poor clinical outcomes, increase in the probability of emergency admission, or even death. The purpose of this work is to decide the number of patients selected from a waiting list and to schedule them in accordance with the operating room capacity in the next period. We formulate the problem as an infinite horizon Markov Decision Process (MDP), which attempts to strike a balance between the patient waiting times and overtime works. Structural properties of the proposed model are investigated to facilitate the solution procedure. The proposed procedure modifies the conventional value iteration method along with the binary search technique. An example of the optimal policy is provided, and computational results are given to show that the proposed procedure improves computational efficiency.

• Journal of information and communication convergence engineering
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• v.9 no.5
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• pp.539-544
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• 2011

In this paper, a parameter optimization method of RIO-DC (RED (Random Early Detection) with In and Out-De-Coupled Queues) scheme for Assured Service (AS) in Differentiated Services (DiffServ) is proposed. In order to optimize QoS (Quality of Service) performance of the RIO-DC policy for AS in terms of maximum tolerable latency, link utilization, fairness, etc., we should design router nodes with proper RIO-DC operating parameter values. Therefore, we propose a RIO-DC configuration method and the admission control criterion, considering the allocated bandwidth to each subclass and the corresponding buffer size, to increase throughput for In-profile traffic and link utilization. Simulation results show that RIO-DC with the proposed parameter values guarantees QoS performance comparable with the RIO scheme and it improves fairness between AS flows remarkably.

• International Journal of Internet, Broadcasting and Communication
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• v.8 no.2
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• pp.43-48
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• 2016

In the present knowledge and information society, knowledge and use of information and communication technology(ICT) is very important for every citizen. Also, for national power of a nation, IT-related industries need to be supported since those industries can be reconstructed in a short period of time unlike other industries. In this sense, identification and education of gifted children in IT become a serious national issue. Since 2013, gifted education has been conducted as a form of convergent education by government policy. However, there have been controversies on convergent education for gifted education. The purpose of this paper is to analyze the usefulness of convergent curriculum for gifted education in IT. For this purpose, gifted children in IT in a gifted education center are analyzed. By comparing the entrance ranking and graduation ranking, it is concluded that the current convergent gifted curriculum may not be efficient.

• Journal of Chest Surgery
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• v.27 no.1
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• pp.31-35
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• 1994

Dissecting aortic aneurysm is a life threatening condition which necessitates prompt diagnosis and management. Between January 1987 and September 1993,58 patients was admitted to our department. Mean age at admission was 53 years.[range 25-82]. Clinical findings included chest pain in 48 cases[83%],renal failure in 12[20%],aortic insufficiency in 11[19%] and stroke in 9[15%]. Predisposing factors were hypertension in 50 cases[86%],Marfan`s syndrome in 6[10%] and diabetes melitus in 1 [2%]. 23 patients[ type A 13,type B 10 ] underwent surgical treatment. Surgical technique for type A included graft replacement of ascending aorta in 7 cases,graft replacement and aortic valve resuspension in 3,and Bentall`s operation in 3 cases. Type B patients were operated when specific indications applied. There were three [Two in type A and 1 in type B] deaths in the operation group and nine [ 5 in type A and 4 in type B] deaths in the medical group. These results support our current policy in the treatment of dissecting aortic aneurysm.