• 보건행정학회지
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• 제33권3호
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• pp.355-362
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• 2023

Background: Financial efficiency in monetary units and operational efficiency in non-monetary units are separately classified and evaluated. This is done to prevent the duplication of monetary units and non-monetary units in inputs and outputs. In addition, analyses are conducted to determine the factors that affect each aspect of efficiency. To prevent duplication of monetary and non-monetary units in inputs and outputs, financial efficiency, consisting of monetary units, and operational efficiency, comprising non-monetary units, are separately classified and evaluated. Furthermore, an analysis is conducted to identify the factors that affect each aspect of efficiency. Methods: This study conducted a panel analysis of 34 regional public hospitals and influencing factors on efficiency for 5 years from 2015 to 2019. Financial efficiency and operational efficiency were calculated through data envelopment analysis. Moreover, multiple regression analysis was conducted to identify the factors that influence both financial efficiency and operational efficiency. Results: The factors that affect financial efficiency include the number of medical institutions within the treatment area and the ratio of patients receiving medical care. Additionally, operational efficiency is influenced by the type of medical institution, the number of medical institutions within the treatment area, and the number of nursing positions per 100 beds. Conclusion: In order for regional public hospitals to faithfully fulfill their functions and roles as regional base public hospitals, several measures are necessary. Firstly, continuous monitoring and reasonable support are required to ensure efficient operation and performance. Secondly, a financial support plan tailored to the characteristics of local medical centers is needed. Additionally, local medical centers should strive to enhance their own efficiency.

• 보건행정학회지
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• 제30권4호
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• pp.460-466
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• 2020

Background: The purpose of this study is to analyze whether there is a change in patterns of medical use among those likely to be converted their health insurance qualifications when the family support rule is alleviated. There is no empirical analysis that converting health insurance qualification will affect the increase in medical use. Methods: For analysis, data were extracted from the national health insurance eligibility and medical care database. To identify analysis targets similar to that of medical aids' characteristics among health insurance coverage, we compared income, property level, and medical use patterns through basic statistical analysis and used a difference-in-difference (DID) analysis to estimate the net effect of changes in medical use following the change of qualifications. Results: The main results are as follows. The results show that those who are under the 5% income group (1st income group) of health insurance coverage are the most similar to the medical aids group. DID analysis shows that changes in the medical use of people who maintain their national insurance qualification and who are not. As a results, the number of hospitalized days of converting group was reduced by 3.5 days while outpatient days were increased by 1.8 days. Conclusion: As a result, there was not much difference in the patterns of medical use for the under 5% income group who are likely to be eligible for expanded medical aids when the family support rule is alleviated. In addition, more than 30% of them are in arrears with their health insurance premiums, causing inconvenience in using medical services. These findings suggest the need of abolishing the criteria obligated to support family, and great efforts should be made to contribute to non-paid poor and remove their medical blind spot.

• 보건행정학회지
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• 제26권4호
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• pp.333-342
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• 2016

Background: The use of therapeutic materials based on new health technology has increased in recent years in the field of medicine, raising concerns for medical practitioners regarding increased spending on the new therapeutic materials amid the rapid population ageing and increase of chronic diseases in Korea. While therapeutic materials have significant importance in the health care system, they have not been given appropriate attention in the academic world of Korea. The purpose of this study is to identify factors that affect the growth of expenditure on therapeutic materials and to derive implications for an effective management considering the diversity of therapeutic materials. Methods: Using the claims data of the National Health Insurance Services, specific utilization patterns of groups of therapeutic materials in the middle classification level of Health Insurance Review and Assessment Service from 2007 to 2014 were analyzed. Four categories (J5083: drug eluting coronary stent, D0302: nonmetallic anchor, K6014: gauze, K6023: gauze) that exhibit unique patterns with respect to price and volume were selected. Then, decomposition analysis was performed to identify the largest contributor to the spending growth by dividing the products into existing, new, and abandoned products for the period between 2010 and 2013. Results: The effect of new products had larger impact on spending growth than the effect of core items in drug eluting coronary stent (J5083) and nonmetallic anchor (D0302). In addition, existing products in general included items priced relatively lower when compared with another item manufactured by the same company. In the gauze category, however, existing products had the largest impact on expenditure and the effect of volume was greater than that in other categories. Conclusion: This study provides evidence that appropriate management measures classified by the characteristics of therapeutic materials are required for therapeutic materials pricing and reassessment in Korea.

• 보건행정학회지
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• 제30권3호
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• pp.326-334
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• 2020

Background: Korea has gradually expanded the coverage of medical care services in its national health insurance system. On April 1, 2018, it implemented a policy that expanded the coverage for an ultrasonography in the upper abdomen. In this study, we aimed to investigate the effect of the policy on the utilization of the ultrasonography in the upper abdomen in tertiary care hospitals. Methods: Using the dataset of the Health Insurance Review and Assessment Service, we explored changes in the utilization of the ultrasonography in the upper abdomen in tertiary care hospitals from July 1, 2017 to November 30, 2018 through the difference-in-difference (DID) mixed-effects-model method. Facility factor, equipment factor and personnel factors, type of hospital, the total amount of medical care expenses, and geographic region were considered as control variables. Results: On average, the utilization of the ultrasonography in the upper abdomen increased by 228% after the coverage expansion policy. However, the results of DID mixed-effects-model method analysis showed that the utilization increased by 73%. As for the number of beds, the utilization was higher with a group of 844-930, 931-1,217, and 1,218 or greater compared with a group of 843 or fewer, while the utilization of the number of ultrasonic devices was lower with a group of 45-49 compared with a group of 44 or fewer. The utilization decreased with the number of interns and the number of nurse assistants. Besides, relative to Seoul, the utilization was lower in the other metro-cities and provinces. Conclusion: The coverage expansion policy in the national health insurance system increased service utilization among people. Future research needs to investigate the degree to which such coverage expansion policy reduces the unmet medical care needs among the deprived in Korea.

• 한국보건간호학회지
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• 제10권2호
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• pp.15-36
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• 1996

It is clear that the women's participation in social activity is dramatically increased in civilian field as well as military profession. Because of the characteristics of military nursing service, there are many difficulties. Frequent move, medical insurance, baby care. and the education are typical forms of difficulties for nurse officers in the military. The purpose of this research is to contribute to the perfect execution of nursing service. guarantee the active attitude for research and improve the combat strength by solving those private and economic problems. The method of research was analysis of question survey and the review of related literatures. The subject of research was 300 active nurse officers who work at the Army Hospitals. The survey was conducted 14 days from Oct 15 to Oct 28. The collected data was processed by computer using SPSS(Statistical Package of Social Science). Frequencies and percentages were used to examine the demographic characteristics of subject, and T-test was also used in the case of necessity. The result showed as follows; As the general characteristics of subject group; 28.7 years of average age, 73.6 months of service period, 63.4% of married. In regard of specialty; General 57.7%. Intensive Care 12.7% and Psychiatries 8.8%. The dissatisfactory factors about military welfare system were the difficulties in children education (36.9%). disadvantages on the civil medical insurance system (27.3%), and little chance of self education and development (21.5%). The problems in performing their duties were shown as dwelling instability due to frequent move (67.7%), and bring up children (14.2%). The reasons for resigning their job were shown as the instability of living status (64.2%), bring up children (18.8%) and dissatisfaction to the service (11.2%). The residential status was shown that military offered houses (45.2%), rental houses (29.3%) and own houses(14.64). The average numbers of moving residencies were; 3-4 time(34.6%), less than 2 times(33.1%), and 5-7 times(21.5%). Higher than 94.7% of the subject group spent more than 50.000 Won. In regard of education, they wanted to attend graduate school with their own expense(26.2%), computer science(20%) and Office Job Training(20%). The ways of taking care of children were mother-in-low(49.6%), mother(14.6%), and others(25%). The average expenditure per month for children were 20-30 hundred Won(44.2%), 10-20 hundred Won(25%) and 30-40 hundred Won(22.3%). The places of children care selected were public or occupational care center(56.2%), religious organization(20.8%), and other center managed by social organizations(10.4%). The result of survey for general welfare of nurse officers are as follows; By and large they seem to be satisfied with their job. however. there are some dissatisfactory factors. They are children care facilties, promotion. income. welfare facilities. disadvantage in medical insurance and civil hospitals. house purchase. unfair chances in specialty training. influence on promotion by educational status. and insufficient role for their children and husbands. As conclusion. the recommendations for improving nursing service are as follows; 1. Children care center managed by occupation 2. Dormitory system for children by military personnel 3. Equal opportunities in education according to ability 4. Reasonable moving price according to the distance and scope of family and extra allowance

• 보건행정학회지
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• 제33권3호
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• pp.311-324
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• 2023

Background: Long-term care insurance for the elderly has been stably established along with the quantitative expansion of long-term care facilities. Indeed, the need for a paradigm about human rights-based service approach is being raised throughout society from a service perspective. Therefore, this study aimed to analyze the association between elderly human rights awareness and quality of service by considering human rights education as a moderate variable. Methods: This study conducted surveys with 138 caregivers working in long-term care facilities located in Seoul and Gangwon. General characteristics, awareness of human rights, and the level of service quality were examined using descriptive statistics, frequency analysis, and correlation analysis. And multi-variable linear regression with a hierarchical framework was employed. These analyses were performed using IBM SPSS ver. 25.0. Results: Of the 138 caregivers, 97.1% were female, 87.7% were more than 50 years old, and most of their education level was high-school graduates. Their length of employment ranged from more than 5 years to less than 10 years. The level of awareness regarding elderly human rights of the elderly was below normal (mean=2.21), but the quality of service was high (mean=4.21), and the need for human rights education was also high (mean=4.28). Among the general characteristics, the length of employment was significantly associated with awareness of elderly human rights. Moreover, political rights awareness, included as sub-domains of human rights, was positively associated with quality of service. However, the moderating variable, human rights education, was not significantly associated with the quality of service. Conclusion: In this study, human rights education, as a moderating variable, did not have a statistically significant effect on caregivers' human rights awareness in relation to service quality. This finding is inconsistent with previous research results. These results can be explained by the fact that the frequency of education in long-term care facilities was a significant factor in the practice of protecting the human rights of the elderly. Therefore ongoing encouragement for the frequency of current human rights education and improvements in the educational approach appear to be necessary. In addition, these findings reveal the need for strength of education policies and effective in-depth research about human rights and quality of service to respect the human rights of the elderly.

• 보건행정학회지
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• 제16권1호
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• pp.17-40
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• 2006

With the prospect of rapidly growing health insurance expenditures, particularly spending for ambulatory care, the introduction of a case-based payment method is discussed as an alternative to the current fee-for-service based method. A system to measure case mixes of providers is a core component of such payment systems. The objective of this study were to develop a classification system for ambulatory care, Korean Ambulatory Patient Group (KAPG) based on the U.S. APG version 2.0 and to evaluate the classification accuracy of the system. A database of 64,258,386 records was constructed from insurance claims submitted to the Health Insurance Review Agency (HIRA) during three months from August 2002. A total of 41,347,307 records with a single visit was used for the development and 7% random sample of the database was used for the evaluation. Additional groups were defined to include both physician and hospital fees in the classification, age splits were added to classify the entire population as well as the population older than 65, and the definition of medical groups used by the HIRA was adopted. The variance reduction in charges achieved by KAPGs was computed to evaluate the accuracy of classification. A total of 474 KAPGs was defined compare to 290 groups in the U.S. APG. The variance reduction for charges of all visits ranged from 20% to 37% depending on the type of provider, and ranged from 22% to 42% for non-outliers, that were better than those achieved by the system currently used by the .HIRA for its internal review purpose. Although further study is required to improve the classification for complicated care in larger hospitals, the results indicated that KAPGs could be used for better management of costs for ambulatory care.

• Physical Therapy Rehabilitation Science
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• 제8권2호
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• pp.67-73
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• 2019

Objective: The purpose of this study was to compare the differences in the length of hospital stay between hemorrhage stroke survivors with health insurance and those with medical care after controlling all factors except for the type of medical insurance by using the propensity score matching (PSM) method. Design: Retrospective cohort study. Methods: Data from the Korean National Centers for Disease Control and Prevention's In-Depth Discharge Injury Survey between the years 2006 and 2012 were used for analysis. A total of 4,538 cases were defined as persons with hemorrhagic stroke (I60-I62) based on the block of categories in the International Classification of Diseases (10th). In order to analyze the inpatient period differences depending on the type of health care, which reflects one's socio-economic level, the chi-square and t-test was conducted. Results: Frequency and percentage were presented, and regression analysis was used to determine the factors affecting the inpatient period. Age, severity of disease, treatment outcome, and post-discharge status were no longer statistically significant after matching. The inpatient period of the persons receiving medical aid benefits was found to be significantly longer than those with national health insurance (p<0.05). Conclusions: The factors influencing the inpatient period of hemorrhagic stroke survivors were treatment outcomes, severity of disease, hospital admission process, and the type of health care. It is necessary for systematic and comprehensive governmental management for persons with hemorrhagic stroke to be transferred to long-term care facilities.

• 보건행정학회지
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• 제33권1호
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• pp.55-64
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• 2023

Background: Despite the various activities of the regional public hospitals, discussions are being made as to whether or not to continue due to the issue of financial deficit. Therefore, the main factors affecting the fiscal deficit were analyzed with 10-year data. Methods: This study is a panel analysis that analyzed the characteristics of 34 regional public hospitals and influencing factors on medical benefits for 10 years from 2010 to 2019. First, we analyze the determinants of medically vulnerable areas set by the government, analyze the trend of medical profit per 100 beds and medical profit rate from 2010 to 2019, and identify the factors that affect them. Results: Differences in medical profit per 100 beds and medical profit-to-medical profit rate were caused by market share representing regional characteristics, and both indicators improved as the number of outpatients increased. The important influencing variables are the number of doctors and nurses, and both indicators improve when there are specialists, but medical benefits decrease as the number of doctors increases when judged by the number of people per 100 beds. In addition, the number of nurses per 100 beds does not contribute to medical profit and has a negative effect on the medical profit ratio. Conclusion: As only regional characteristics were taken into account for medically vulnerable areas, operational characteristics need to be considered. The greatest impact on the finances of local medical centers is the proper staffing of doctors and nurses, and their efficient arrangement is the most important factor in financial stability.

• 근관절건강학회지
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• 제29권1호
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• pp.41-49
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• 2022

Purpose: The purpose of this study was to assess the influence of nurses staffing level on patient health outcomes in intensive care units (ICUs) in Korea. Methods: The study was retrospective in nature. Information on patients and their outcomes, as well as nurse cohort data, were obtained from Korea's National Health Insurance Service Database. The observation period was from January 1, 2008 to December 31, 2018, and data for 2,964,991 patients were analyzed. Independent variables included patient' age and sex and hospital type, intensivist, and nurses staffing level. Results: The mortality rate in ICUs was significantly higher at tertiary hospitals with a level 3~4 (HR, 1.21; 95% confidence interval, 1.19~1.22) or level 5~9 nurse staffing (HR, 1.31; 95% confidence interval, 1.27~1.34) compare to that of tertiary hospitals with a 1~2 level. 28-day mortality rate was also higher at general hospitals with a level 3~4 (HR, 1.13; 95% confidence interval, 1.12~1.14), level 5~6 (HR. 1.34; 95% confidence interval, 1.32~1.36), level 7~9 nurse staffing (HR, 1.38; 95% confidence interval, 1.38~1.42), using level 1~2 as reference. Conclusion: Nurses staffing level is a key determinant of healthcare-associated mortality in critically ICUs patients. Policies to achieve adequate nurse staffing levels are therefore required to enhance patient outcomes.