• 보건행정학회지
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• 제10권4호
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• pp.20-56
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• 2000

The purpose of this article was to evaluate the effects of reimbursement system on the basis of diagnosis-related groups(DRGs). We searched articles which was published from 1970 to 2000 using MEDLINE ； Key words "diagnosis-related groups, DRGs, prospective payment system, PPS. Then we reviewed 97 articles on classifying them into several categories of contents. It seems that the effects of DRGs in controlling hospitals cost in the U.S. was not clear cut. The U.S. Medicare PPS using DRGs remains vulnerable to compensatory increases in ambulatory care and long-term care facilities utilization despite cost per case and cost per admission being reduced. Also some research indicated the possibilities of deterioration in health care service quality. So putting theses results together, much more consideration is needed before the application of DRGs reimbursement system in Korea. Particularly there is the crucial difference between U.S. health care system and Korean, we must be aware of the limitations of DRGs and revise the DRG system to applicable in Korea.orea.

• 한국병원경영학회지
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• 제23권1호
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• pp.51-64
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• 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.

• 한국의료질향상학회지
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• 제2권1호
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• pp.58-67
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• 1995

이 연구는 3차 진료기관 응급실의 기능을 정상화하기 위한 기초 자료를 수집하기 위하여, 한 3차 진료기관 응급실을 방문한 환자를 대상으로, 입원 결정서 발부와 환자의 입원 결정 양상 및 이에 영향을 미치는 요인을 파악하였다. 또한 적절성 평가 지침을 이용하여 응급실을 통한 입원의 적절성을 평가하였고 입원의 적절성과 응급실 입원 대기시간의 적절성에 영향을 미치는 요인을 분석하였다. 입원 결정서 발부에 영향을 미치는 요인은 환자의 내 외과계 구분, 진료과수, 환자 상태, 방문 경로, 방문 시간과 방문 요일이었다. 입원 결정서 발부 후 환자의 입원 여부는 환자의 성, 환자 상태, 방문 경로, 방문 요일에 따라 달리 나타났다. 환자의 연령, 내 외과계 구분과 방문 요일에 따라 입원의 적절성에 차이를 보였다. 입원 대기시간은 환자의 연령이 증가할수록 적절성이 낮았다. 이 연구를 통하여 응급실을 통한 입원 중 반수 이상의 입원이 부적절한 입원으로 평가되었고, 이 중 일부는 입원을 빨리 하기 위한 방법의 하나로 응급실을 편법으로 이용하고 있기 때문인 것으로 판단되었다. 또한 입원 결정서가 발부된 환자 중 상당수의 환자가 병상을 구할 수 없어 입원하지 못하고 있는 것으로 보아, 3차 진료기관의 환자 집중 현상과 응급실 과밀화 요인 해소를 위한 의료정책의 수립이 필요함을 확인할 수 있었다.

• 보건행정학회지
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• 제19권3호
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• pp.27-44
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• 2009

The length of stay in emergency departments has been used as a quality indicator to reflect the overall efficiency of emergency care. Identifying characteristics associated with length of stay is critical to monitor overcrowding and improve efficient throughput function of emergency departments. This study examined the level of waiting time for initial assessment by physician and length of stay in emergency departments. Furthermore, we investigated the characteristics of patients' attendance associated with length of stay. An observational study was performed for a sample of 1,526 patients visiting ten nation-wide emergency departments. A structured form was designed to collect information about patients' demographics, route of admission, time and mode of arrival, triage level, cause of attendance, initial assessment time by physician, departure time, and disposition. Multiple regression analysis was performed to determine factors associated with length of stay. The average length of stay was 209.4 minutes (95% confidence interval [CI]=197.1-221.7), with a mean waiting time for initial assessment of 5.9 minutes (95% CI=5.1-6.7). After controlling for emergency department characteristics, increasing age, longer waiting times, attendance due to diseases, higher acuity, multiple diagnoses($\geq$2) and requiring admission or transfer to other health care facilities were positively associated with length of stay in emergency departments. The findings suggest that both patients' characteristics and the flow between emergency departments and parent hospitals should be taken into account in predicting length of stay in emergency departments.

• 디자인학연구
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• 제15권4호
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• pp.391-398
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• 2002

본 연구는 현재 초기 단계에 있는 디자인계열의 비실기 전형 학생들의 작업과 교육과정, 학생들의 작업추이들을 구체적으로 연구ㆍ분석함으로써 실기 능력 유무에 따른 입학 전형에서 나타나는 다양한 사례들을 살펴보고 새로운 조형교육의 방향성 및 제언을 제시하고자 한다. 실기 및 비실기 전형의 학생들을 동시에 하나의 교육과정에서 운영하는 과정에서 디자인계열 대학의 입시전형에서 각 대학, 학과마다 길기 및 비실기 전형을 보다 탄력적으로 운영할 수 있는 입시제도를 마련하여야 한다. 거의 모든 대학이 같은 비율로 입시전형 하는 획일화된 실기 및 비실기 전형의 문제를 개선하여 대학 자체의 특수성을 고려한 다양한 선발기준에 의한 대학교육 적격자를 선발하는 방안이 절실히 요구된다. 본 연구는 학생들의 실기 능력 유무에 따른 학습의 효율성을 위한 것으로 일선에서 교육을 담당하는 교수들의 새로운 교육지표 및 디자인 교육기반을 형성하는데 많은 도움이 되리라 예상된다. 연구 조사 결과를 토대로 효과적인 기초 조형교육이 이루어질 수 있도록 예술교육에 적절한 적용과 연구의 가능성을 발견함과 동시에 대학의 디자인 실기교육에 적용시킬 교육과정 및 방법을 모색하여 제시하는 데 연구의 목적을 두고 있다.

• Journal of Communications and Networks
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• 제10권3호
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• pp.287-296
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• 2008

The IEEE 802.11 wireless standard uses the carrier sense multiple access with collision avoidance (CSMA/CA) as its MAC protocol (during the distributed coordination function period). This protocol is an adaptation of the CSMA/CD of the wired networks. CSMA/CA mechanism cannot guarantee quality of service (QoS) required by the application because orits random access method. In this study, we propose a new MAC protocol that considers different types of traffic (e.g., voice and data) and for each traffic type different priority levels are assigned. To improve the QoS of IEEE 802.11 MAC protocols over a multi-channel CSMA/CA, we have developed a new admission policy for both voice and data traffics. This protocol can be performed in direct sequence spread spectrum (DSSS) or frequency hopping spread spectrum (FHSS). For voice traffic we reserve a channel, while for data traffic the access is random using a CSMA/CA mechanism, and in this case a selective reject and push-out mechanism is added to meet the quality of service required by data traffic. To study the performance of the proposed protocol and to show the benefits of our design, a mathematical model is built based on Markov chains. The system could be represented by a Markov chain which is difficult to solve as the state-space is too large. This is due to the resource management and user mobility. Thus, we propose to build an aggregated Markov chain with a smaller state-space that allows performance measures to be computed easily. We have used stochastic comparisons of Markov chains to prove that the proposed access protocol (with selective reject and push-out mechanisms) gives less loss rates of high priority connections (data and voices) than the traditional one (without admission policy and selective reject and push-out mechanisms). We give numerical results to confirm mathematical proofs.

• 보건행정학회지
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• 제13권1호
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• pp.1-22
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• 2003

The principal objective of this study was to analyze and conceptualize the socio-psychological burden in utilizing a nursing home for elderly. The subjects were five elderly from a private nursing home located in Seoul and their familial caregivers. An old male and three females were currently staying at the facility, and a female had been discharged already from there. Data were collected through depth interviews, observations and review of records at the facility For analysis, the data were classified by similar contents among significant expressions and factors in common. The subjects' motives to consider admission to the nursing home might be attributed to familial caregivers' burden, a shortage of support, environmental improvement and feeling of helplessness for the case elderly. The concept of burden is including family members' being badly off in living, their weariness, complications among family members, feeling psychological uneasiness, and hospital expenses. The identified image of nursing homes for the elderly in Korea was generally negative at the point of high cost, unreasonable requisites and limitations for admission to the facilities, inferior situations, and especially in that there were few long-term care facilities within the community boundary. From their experience of nursing homes, the interviewees have felt the sentiments of sorry for their old parents, with the thought of being an undutiful, bitterness, and empathy. Additionally, they expressed a sense of anxiety of relative deprivation against the fact that there were no long-term care facilities available for the middle class. On the basis of these, multi-dimensional needs could be identified for the elderly with chronic illnesses.

• 보건행정학회지
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• 제21권4호
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• pp.617-642
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• 2011

The purpose of our study is to analyze the determinants of the benefits of the long-term care insurance in Korea using 2008 and 2009 cross-sectional data. Per capita long-term care insurance benefits can be divided into home care services utilization rate, institutional care services utilization rate, per capita home care services benefits, and per capita institutional care services benefits, which are used as the dependent variables in our regression analysis. Admission rate and the ratio of the admitted to the applicant also used as the dependent variables. The results of our analysis show that the explanatory variables such as income level, needs for care, family type, access to the services, and regional characteristics are statistically significant to explain the dependent variables, the long-term care insurance benefits. The higher is the regional income and the more of the female residents, the more are the long-term care insurance benefits. The easier is the access to the services, the more are the insurance benefits. In the rural area, the level of the insurance benefits is relatively high. We propose that copayment rates of the long-term care insurance should be examined and monitoring on the over-use of the services should be done. Also preventive services and care by the family member should be expanded.

• 한국항행학회논문지
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• 제18권4호
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• pp.347-352
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• 2014

본 논문에서는 멀티 서비스 무선 인지 망에서 2 차 사용자의 비 실시간 호의 강제 종료율을 줄이기 위한 마르코프 큐잉모델(M/M/1)을 기반으로 하는 호 수락제어를 제안한다. 멀티 서비스 무선 인지 망에서 2 차 사용자 호를 제어하는 기존의 방법에서는 가용 스펙트럼 홀을 실시간 사용자에게 우선 할당함으로써 비실시간 사용자 호의 강제 종료율이 증가하게 된다. 이를 해결하기 위해 제안된 기법은 비실시간 호의 서비스 품질 특성을 고려하여 가용채널이 생길 때까지 큐잉 시스템에서 대기한 후, 서비스를 지속하게 하여 강제 종료율을 줄인다. 1 차 사용자의 재출현은 신경망 기법으로 예측한다. 시뮬레이션을 통하여 2 차 사용자 호의 강제 종료율, 지연특성, 스펙트럼 사용효율을 분석하고, 기존의 방법과 비교하여 비실시간 호의 강제 종료율을 줄일 수 있음을 보인다.

• 디지털융복합연구
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• 제10권7호
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• pp.193-200
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• 2012

본 연구는 2008년 환자조사 자료를 이용하여 위장질환과 충수염질환을 대상으로 지역간 입원의료이용의 변이정도와 양상을 파악하고, 변이 발생에 영향을 미치는 관련 요인을 분석한 후, 이를 기초로 변이를 최소화하여 의료 이용을 적정화 시킬 수 있는 방안을 모색하기 위해 수행하였다. Extremal Quotient(EQ)와 변이계수(CV) 지표를 사용하여 변이수준을 파악하였고, 다중회귀분석을 통해 입원의료이용의 차이에 영향을 미치는 주요 요인들을 분석하였다. 주요 연구결과는 다음과 같다. 첫째, 위장질환의 소규모 지역별 성 연령 표준화에 따른 입원율의 경우 EQ 15.1, CV 0.4의 변이를 보였으며, 특히 농어촌 지역에서 변이 10대 상위군이 높은 분포를 나타냈다. 또한, 인구만명당 병상수, 의사수, 특수의료장비수에 따라 입원의료이용량이 통계적으로 유의한 양의 관계를 보였다. 둘째, 충수염질환에서는 EQ 12.41, CV 0.4를 나타냈고, 회귀분석을 통해 입원의료이용의 차이에 영향을 미치는 요인을 분석한 결과 통계적으로 유의하지 않았다. 본 연구 결과의 정책적인 함의로는 급성질환자의 입원의료이용의 형평성을 제고할 수 있도록 지역별 병상의 적정한 공급 관리와 효율적인 자원배분 및 의료서비스의 질적 차이를 감소시킬 수 있는 다각적인 정책 방안이 추진되어야 함을 시사해 준다.