• 대한예방한의학회지
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• 제19권3호
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• pp.57-66
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• 2015

Objective : Private health insurance coverage in Korean medicine has been reduced since October 2009 for preventing unnecessary utilization. The aim of this study is to identify how private health insurance coverage reduction affects on the Korean medicine utilization. Method : We analyzed the Korea Health Panel data from 2008 to 2012. Panel negative binominal regression model was used to analyze the relationship between private health insurance coverage reduction and utilization of outpatient service. Panel tobit regression analysis was used to identify the relationship between private health insurance coverage reduction and health expenditure of outpatient service. Results : Private health insurance coverage reduction significantly dropped both utilization and health expenditure of outpatient service by 9%, 9.22% respectively. In addition, therapeutic utilization significantly decreased up to 10%. Conclusion : Private health insurance coverage reduction seems to have an effect to reduce both utilization and the health expenditure of Korean medicine outpatient service. This effect was more noticeable in the therapeutic utilization. Thus, more elaborate policy will be needed to prevent unnecessary utilization of Korean medicine.

• 응용통계연구
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• 제27권5호
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• pp.667-679
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• 2014

우리나라 노인장기요양보험에서는 수급자가 월 한도액 범위 내에서 필요한 서비스를 비용-효율적으로 이용할 수 있도록 지원하고자 표준장기요양이용계획서를 작성하여 제공하고 있다. 본 연구는 표준장기요양이용계획서의 객관성 확보와 업무 효율성 제고를 위하여 의사결정나무기법을 이용해 수급자의 건강 및 기능 상태에 맞는 최적의 급여계획을 도출하는 표준급여모형을 개발하였다. 타당도 높은 모형 개발을 위하여 국민건강보험공단의 전국 220개 장기요양운영센터로부터 장기요양인정조사와 표준장기요양이용계획서 작성 경험이 풍부한 직원(본 연구에서는 '훈련된 조사자'라고 함)을 추천받아 자료수집의 내용과 방법에 대해 교육을 실시하였고, 이들이 수급자의 건강 및 기능 상태를 평가하고 작성한 수급자 개인별 맞춤형 급여계획을 자료 분석에 활용하였다. 표준급여모형은 1단계로 시설 또는 재가 급여 권고 여부를 결정하는 모형을, 2단계로 재가급여를 권고했을 경우의 재가급여 세부 종류별 권고 여부를 결정하는 모형을 개발하였다. 본 연구에서 개발된 표준급여모형은 전산프로그램화 되어 국민건강보험공단 직원이 수급자에게 제공할 표준장기요양이용계획을 수립하는 과정에 실제로 활용되고 있어 표준장기요양이용계획서의 객관성 확보와 업무 효율화가 기대된다.

• 한국임상약학회지
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• 제22권4호
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• pp.291-303
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• 2012

As respiratory tract infections (RTI) account for about 60% of all antibiotic prescriptions in outpatient care setting, there are significant concerns about emerging resistance that are largely due to the excessive or inappropriate use of antibacterial agents for viral respiratory infections. This study was aimed to develop retrospective drug utilization review (DUR) program of antibiotics for RTIs using Delphi methods. Retrospective DUR criteria of antibiotics for RTIs were identified based on clinical practice guidelines and opinion of experts. Expert panel members were clinical doctors and pharmacists and Delphi method was applied by survey on 16 members of panels. The claim data from Korean Health Insurance Review & Assessment (HIRA) were used to examine trends in outpatient antibiotic prescription between Janunary to December of 2008. As results, Quality index for RTI was assessed for the claim type, antibiotics use of quantity, duration, number and cost. Antibiotic prescription rate for RTIs, Defined Daily Dose (DDD), and duration of antibiotics use were more recognized as significant quality index by experts' opinion. Use of first line agents suggested by guidelines was low and duration of antibiotics use was shorter compared to the recommendations. Antibiotics were over prescribed for RITs. However, dose and duration of antibiotics were under-used.

• 보건의료산업학회지
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• 제8권2호
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• pp.115-125
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• 2014

This study tries to investigate inequity in supplementary private health insurance insured in terms of the analysis of insurance insured general characteristics and to analyze the influence of supplementary private health insurance on their admission and their outpatient medical utilization behavior. As a result of the analysis of the general characteristics of supplementary private health insurances insured, it has turned out that men, persons at low ages, people with a spouse and chronic diseases, and persons with a high income have applied such insurances more. We can also tell that low-income classes have difficulty in applying private health insurances as people in the fifth income quintile have applied such insurances about 9 times as much as those in the first income quintile. The analysis of supplementary private health insurance insured health care utilization behavior has revealed that both male and female insured aged less than 55 and without chronic diseases have increases the number of their use of health care, their patient charge, and their medical cost per visit.

• 응용통계연구
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• 제28권6호
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• pp.1063-1073
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• 2015

우리나라 노인장기요양보험에서는 수급자와 그 가족부양자가 수급자의 심신기능 상태와 욕구에 따라 불이익이나 불편함이 없이 비용-효과적으로 장기요양 급여를 이용할 수 있도록 지원하고자 이용지원 상담을 제공하고 있다. 본 연구는 재가급여 이용자의 이용지원 정기상담 대상자 선정시 상담 대상자의 욕구를 반영하지 않아 이용지원 상담의 만족도와 효율성이 낮은 문제를 통계학적 모형을 활용하여 해결하고자 수행되었다. 모형 개발을 위해 2013년 3월 장기요양 재가급여를 이용한 수급자와 가족부양자를 대상으로 이용지원 상담에 대한 욕구와 관련 변수를 조사하였으며, 2,000명이 조사를 완료하였다. 조사 자료를 바탕으로 이용지원 상담 대상자 선정모형을 다양한 데이터마이닝 기법(로지스틱 회귀모형, 의사결정 나무모형, Lasso 모형, 자동 신경망모형, 그래디언트 부스팅, 앙상블 모형)을 통해 개발하였고, 이중 가장 안정적이고 현장 적용이 쉽고 성능이 좋은 Lasso 모형 결과를 최종모형으로 선정하였다. 본 연구가 이용지원 상담의 만족도를 높이고 업무를 효율화 하는데 기여할 것으로 기대된다.

• 보건의료산업학회지
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• 제5권4호
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• pp.177-192
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• 2011

The arguments exist that private health insurance(PHI) policy holders tend to use the health care services more than non-policy holders due to their little out-of-pocket spending, resulting in the adverse effects on the finances of National Health Insurance. This study aims to increase the objective understanding of the issue and to draw a direction of further research, by reviewing the articles, reports and statistics which examined the effects of purchasing PHI policies on health care utilization. Significant differences in healthcare utilization, except for the very partial increase of utilization in outpatient settings, have been not found. The similar trends of the results have existed in a few previous studies which tried to control the endogeneity of medical use and health insurance with latent variables which affect the decision on medical use and health insurance. However, we can not exclude the potential change of healthcare utilization patterns because the portion of the insured of indemnity PHI is becoming rapidly larger in the market. For further research, we should try to obtain the objective information of subjects' past medical history, health status, health related behavior, and income affecting purchase of PHI and utilization of healthcare services. And the efforts of controlling the endogeneity of medical use and health insurance with latent variables which affect the decision on medical use and health insurance, are very considerable.

• 보건행정학회지
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• 제32권2호
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• pp.154-163
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• 2022

Background: The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit. Methods: We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. Results: In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated. Conclusion: High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.

• 보건행정학회지
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• 제32권1호
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• pp.53-62
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• 2022

Background: This study was designed to examine regional proportions for people who experienced unmet health care needs due to reduced mobility or unhealthiness and factors associated with experience of unmet health care needs by them. Methods: A total of 11,620 people were retrieved from the Korea Health Panel data (2014-2018). Regional proportions for people who experienced unmet health care needs due to reduced mobility or unhealthiness were estimated using cross-sectional weights and the factors associated with them were analyzed using generalized estimating equation. Results: The number of people who experienced unmet health care needs due to reduced mobility or unhealthiness was estimated as 278,083 in 2018. Women, the aged (65+), below elementary school, single as marital status, low income, bad self-rated health, people with disabilities, and long-term insurance beneficiaries were statistically significantly associated with experience of unmet health care needs due to reduced mobility or unhealthiness. Conclusion: Given high and dispersed demand for visiting health care, government need to expand the infrastructure and finance to facilitate visiting health care.

• 한국의료질향상학회지
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• 제25권1호
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• pp.11-28
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• 2019

Purpose: The purpose of this paper is to derive implication on the adoption of PROMs (Patient-Reported Outcome Measures) to improve quality of care in South Korea. With this purpose, the paper examines the status of PROMs in South Korea and other countries including OECD's PaRIS (Patient Reported Indicators Survey) initiative, and reviews policy cases that have adopted PROMs to improve performance of healthcare system. Methods: We conducted literature review on OECD reports on PaRIS, peer-reviewed journals, and information from the websites of relevant institutions such as ICHOM, NQF and OECD. Results: To identify healthcare services of best values and support patient-centered health system, OECD has initiated PaRIS which develops, collects and analyzes patient-reported indicators for cross-countries comparison. PaRIS is implemented on two work streams: 1) collect, validate and standardize PROMs in the areas where patient-reported indicators already exist such as breast cancers, hip and knee replacement, and mental conditions, 2) develop a new international survey on multiple chronic conditions. Countries like England, U.S., Sweden and Netherlands use PROMs for measuring performance of hospitals and performance evaluation at the national level, and provide the financial incentives for reporting PROMs. Conclusions: The use of PROMs can support the current policy agenda that is the patient-centered healthcare system which has been emphasized to reinforce the primary and the community-based care. For the use of PROMs, it is recommended to actively participate in PaRIS initiative by OECD, select appropriate instruments for PROMs, and continue on standardization of them. This will assure patients' involvement in improving health system performance, systemize information generated in the process of adopting PROMs, and develop a system to evaluate performance.

• Journal of Preventive Medicine and Public Health
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• 제41권5호
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• pp.331-338
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• 2008

Objectives : The purpose of this study was to measure the workload of home visit care activities and their relative values. This study examined also factors that affect the workload of home visit care activities. Methods : The participants of this study were 126 home-helpers of 50 home visit care agencies at the 2nd Long-term Care Insurance Demonstration Project. The workload of home visit care activities was divided into total work and four dimensions ; physical efforts, mental efforts, stress and time. Home visit care activities consisted of four categories with 24 items. We used magnitude estimation method to measure their relative values of the four dimensions. The participants answered the relative values of each activities based on the reference service. We used the activity for supporting their elderly's evacuation as the reference service. Results : Most of the respondents were over 40 years old female. They consumed most their time supporting elderly's going out. They consumed their highest physical, mental efforts, and stress for activities of coping with emergency situation. The Pearson correlation coefficients showed significant relationships between workload and each dimensions. This study showed that all four dimensions are statistically significant predictors of workload of home visit care activities. Also, we found that the home-helper's career affects the workload of home visit care activities. Conclusions : The workload of home visit care activities could be explained by physical efforts, mental efforts, stress and time.