• 제목/요약/키워드: Charges per case

검색결과 19건 처리시간 0.025초

병원 특성에 따른 건당 진료비 분석 - 급성충수염과 정상분만을 대상으로 - (Analysis of charges per case by hospital characteristics - In regard to acute appendicitis and NSVD -)

  • 정상혁;유승흠;김한중
    • Journal of Preventive Medicine and Public Health
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    • 제23권2호
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    • pp.216-223
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    • 1990
  • To identify the factors influencing the charges per case of acute appendicitis and normal spontaneous vaginal delivery (NSVD), the personal data-base files and hospital-characteristics-reporting data files of Korea Medical Insurance Corporation were analyzed. One hundred and twenty-nine institutions were selected. The results of this study were as follows 1. The differences of charges per case with respect to hospital ownership, location, and equipment levels were statistically significant. 2. The results of multiple regression analysis revealed that bed capacity was the most significant variable in both diseases. 3. Ownership was significant variable in acute appendicitis. In NSVD, ownership and hospital equipment level were statistically significant. In conclusion, bed capacity was statistically the most significant variable in the analysis of charages per case. And we thought that the results of this study would influence the policy of the hospital bed supply.

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의료보호 진료비의 증가양상과 진료비 구성요소별 기여도 변화 -1992년부터 1999년까지 의료보호 진료비청구자료를 중심으로- (The Escalation of Medical Aid Expenditure and the Degree of Contribution of Its Components in Korea(1992~1999))

  • 신영전;유원섭;염용권
    • 보건행정학회지
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    • 제11권3호
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    • pp.46-70
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    • 2001
  • Medical Aid expenditure Increased rapidly at a higher rate than that of Medical Insurance during the period 1992-1999. To establish an effective cost containment strategy, knowledge of the cause and the nature of the increase of Medical Aid expenditure is required. The purpose of this study was to analyze increasing rates of Medical Aid expenditure by the components of medical expenses. Data were collected using the Medical Aid Statistical Yearbook during the period of 1992-1999. The major findings were as follows: 1. The annual mean increasing rate of Medical Aid expenditure between 1992 and 1999 was 22.8%, which exceeding that of Medical Insurance expenditure (17.5%) between 1992 and 1999. Since 1998, Medical Aid expenditure increased even more rapidly than in previous years, with the increase in number of Medical Aid beneficiaries. 2. Of Medical Aid expenditure, that of inpatient and outpatient annually increased 24.2% and 22.8% respectively and that of type 1 and type 2 increased annually 28.8% (outpatient) ∼29.9% (inpatient), 14.3% (outpatient) ∼ 15.5% (inpatient). Therefore, Medical Aid expenditure of inpatient and type 1 led the increase of Medical Aid expenditure. 3. Between 1992 and 1997, the frequencies of utilization per beneficiary and the charges per case positively contributed to the increase of Medical Aid expenditure while the number of beneficiaries contributed negatively, but since 1998, the number of beneficiaries increased and positively contributed to the increase of Medical Aid expenditure. 4. According to the analysis of the charges per case, the increase of the price index led to the increase of the charges per case but the days of medication and service intensity also contributed to the increase of the charges per case variably by year. Considering the above findings, factors associated with the Medical Aid system affected the increase of Medical Aid expenditure in addition to the general factors of the increase in medical expenditure. In conclusion, it appears that a more intensive cost containment strategy is required to control rapidly increasing Medical Aid expenditure. For this, more precise analysis and development of policy considering the effect of the number of beneficiaries and the increase of price index is needed.

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의료보험 시범지역의 전국민 의료보험실시전후의 진료비증가 기여도 분석 (Analysis of Source of Increase in Medical Expenditure for Medical Insurance Demonstration Area before(1982-1987) and after(1988-1990) National Health Insurance)

  • 차병준;박재용;감신
    • 보건행정학회지
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    • 제2권2호
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    • pp.221-237
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    • 1992
  • The reasons for cost inflation in medical insurance expenditure are classified into demand pull inflation and cost push inflation. The former includes increase in the number of beneficiaries and utilization rate, while the latter includes increase in medical insurance fee and the charges per case. This study was conducted to analyze sources of increases of expenditure in medical insurance demonstration area by the period of 1982-1987 which was earlier than national health insurance and the period of national health insurance(1988-1990). The major findings were as follows: Medical expenditure in these areas increased by 9.4%(15.1%) annually between 1982 and 1990 on the basis of costant price(current price) and for this period, the yearly average increasing rate of expenses for outpatient care[10.5%(15.8%)] was higher than that of inpatient care [7.3%(12.6%)]. Medical expenditure increased by 6.3%(8.9%) annually between 1982 and 1987, the period of medical insurance demonstration, while it increased by 10.7%(18.9%) after implementing national health insurance(1988-1990). Medical expenditure increased by 35.9%(45.9%) between 1982 and 1987. Of this increase, 115.2%(92.1%) was attributable to the increase in the frequencies of utilization per beneficiary and 61.0%(68.1%) was due to the increase in the charges per case, but the expenditure decreased by 76.2%(60.2%) due to the reduction in the number of beneficiaries. Beteen 1988 and 1990, the period of national health insurance, medical expenditure increased by 21.2%(41.4%). Of this increase, 87.5%(46.4%) was attributable to the increase in the frequencies of utilization per beneficiary and 52.4%(73.4%) was due to the increase in the charges per case, and of the increase in the charges per case, 69.6%(40.8%) was attributable to the increase in the days of visit per case. Medical expenses per person in these areas increased by 78.2%(89.0%) between 1982 and 1987. Of this increase, 76.6%(69.1%) was attributable to the increase in the frequencies of utilization per beneficiary and 23.4%(30.9%) was due to the increase in the charges per case. For this period, demand-pull factor was the major cause of the increase in medical expenses and the expenses per treatment day was the major attributable factor in cost-push inflation. Betwee 1988 and 1990, medical expenditure per person increased by 31.2%(53.1%). Of this increase, 60.8%(37.2%) was attributable to the demand-pull factor and 39.2%(62.8%) was due to the increase in the charges per case which was one of cost-push factors. In current price, the attributalbe rate of the charges per case which was one of cost-push factors was higher than that of utilization rate in the period of national health insurance as compared to the period of medical insurance demonstration. In consideration of above findings, demand-pull factor led the increase in medical expenditure between 1982 and 1987, the period of medical insurance medel trial, but after implementing national health insurance, the attributable rate of cost-push factor was increasing gradually. Thus we may conclude that for medical cost containment, it is requested to examine the new reimbursement method to control cost-push factor and service-intensity factor.

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전문병원과 비전문병원 입원환자의 의료이용 비교 분석: 인공관절치환술(슬관절)을 대상으로 (Comparison of Inpatient Medical Use between Non-specialty and Specialty Hospitals: A Study Focused on Knee Replacement Arthroplasty)

  • 김미성;정형선;유기봉;강제구;장한솔;이광수
    • 보건행정학회지
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    • 제34권1호
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    • pp.78-86
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    • 2024
  • 연구배경: 본 연구를 통해 전문병원과 비전문병원에서 인공관절치환술(슬관절)을 받은 입원환자를 대상으로, 전문병원 지정 여부에 따른 입원환자의 의료이용을 비교하여 전문병원제도의 효과성을 파악하고자 한다. 방법: 본 연구는 2021-2022년 건강보험심사평가원(Health Insurance Review and Assessment Service) 요양급여비용 청구자료를 활용하였다. 종속변수는 입원환자의 의료이용으로, 건당 진료비와 재원일수를 선정하였다. 독립변수는 전문병원 지정 여부이며, 통제변수는 환자 단위 변수(연령, 성별, 보험자 유형, 수술 유형 및 Charlson comorbidity index)와 의료기관 단위 변수(설립 구분, 종별 구분, 소재지, 정형외과 의사 수 및 간호사 수)를 선정하였다. 결과: 건당 진료비와 전문병원 지정 여부 간 다중회귀분석 결과, 건당 진료비와 전문병원 지정 여부 간 통계적으로 유의미한 음(-)의 관계가 있었다. 이는 전문병원이 비전문병원에 비해 건당 진료비가 유의하게 낮다는 것을 의미하며, 전문병원과 비전문병원의 입원환자 간 의료이용 결과에 차이가 있음을 시사한다. 결론: 본 연구의 정책적 시사점은 다음과 같다. 첫째, 전문병원 지정기준의 완화가 필요하다. 본 연구결과, 전문병원이 비전문병원에 비해 건당 진료비가 유의하게 낮은 것으로 나타났다. 이러한 전문병원의 비용 효과성에도 불구하고 전문병원 지정에 대한 높은 진입장벽으로 인해 수도권 및 대도시 지역에 전문병원이 집중되어 있다. 전문병원의 지역불균형을 해소하기 위해 "준전문병원(가칭)"을 도입하는 등 비수도권 전문병원 지정기준을 완화한다면, 지역간 건강격차 해소 및 의료비 절감의 효과를 불러올 것으로 판단된다. 둘째, 병원 의료인력 규모의 적정성을 판단할 필요가 있다. 본 연구결과, 정형외과 의사 수 및 간호사 수에 따라 건당 진료비에 영향을 미치는 것으로 나타났다. 따라서 병원 의료인력 적정 배분을 바탕으로 의료서비스의 비용 효과성을 극대화함으로써 의료비를 절감하는 효과를 불러올 수 있을 것으로 판단된다.

재원일별 진료비 발생양상과 재원일수의 결정요인 (The Determinant Factors and Medical Charges Pattern by Length of Stay in Hospital)

  • 김영훈;문재우;김기훈
    • 한국병원경영학회지
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    • 제15권2호
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    • pp.15-26
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    • 2010
  • Stroke is a high-risk disease. The future of the medical environment is that the proportion of elderly population is increasing, the average life expectancy is being increased, while the fatal rate of stroke will be low. These situation will due to the financial burden on medical insurance. The most important factor that affects on the medical costs of stroke patients is the length of stay. In this study the mean length of hospital for stroke stay was 21.81days(37.97days for intracerebral hemorrhage, 18.89 days for cerebral infarction). The payment per case of stroke was 6.86 million won(12.6 million won for intracerebral hemorrhage, 5.72 million won for cerebral infarction). The payment per case of intracerebral hemorrhage was 2.2 times more than that of cerebral infarction. The payment in the day of hospitalization was the highest and until the second day medical costs was high. After the third day medical costs tended to decline, after that seemed to show an almost constant level. The length of hospital stay was found to be the most important determinant of inpatient charges for stroke. Accordingly rational management of the length of stay will be beneficial to health care consumers, providers, states.

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척추전문병원과 비전문병원의 의료이용 비교분석 (Comparative Analysis of Medical Use of Spine Specialty Hospitals and Nonspecialty Hospitals)

  • 이영노;정윤지;이광수
    • 보건행정학회지
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    • 제34권1호
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    • pp.26-37
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    • 2024
  • 연구배경: 본 연구의 목적은 척추전문병원과 비전문병원의 건당 진료비 및 재원일수 차이를 비교 분석하고, 이에 영향을 미치는 요인을 파악하는 것이다. 방법: 본 연구는 2021년 1월부터 2022년 12월까지의 입원 환자 진료비를 포함한 건강보험심사평가원의 청구 데이터를 사용했다. 의료기관 현황 데이터는 연구대상 병원의 특성을 파악하는 데 사용되었다. 다수준분석을 통해 건당 진료비와 관련된 요인을 파악하고, 포아송 회귀분석을 통해 척추전문병원과 비전문병원 간 재원일수를 분석했다. 분석대상은 척추전문병원 32,015건, 비전문병원 17,555건이었다. 결과: 다빈도 척추 수술 5건 중 4건의 경우, 전문병원이 비전문병원보다 재원일수가 더 긴 것으로 나타났다. 다수준분석 및 포아송 회귀분석 결과, 수술유형에 관계없이 연령이 높고, Charlson comorbidity index 점수가 높을수록 건당 진료비와 재원일수 모두 유의하게 증가하는 것으로 나타났다(p<0.05). 그러나 병원이 대도시에 위치한 경우에는 유의미하게 감소하였다(p<0.05). 결론: 본 연구에서는 기존 연구결과와 달리 전문병원의 건당 진료비와 재원일수가 더 긴 것으로 나타났다. 향후 이러한 차이의 원인을 찾기 위해 추가적인 연구가 필요하다.

대단위 농업종합개발사업의 사회경제적 기대편익 추정과 결합비용의 배분 -금강지구를 중심으로- (Estimation of the Expected Socio-economic Benefits of the Largescale Comprehensive Agricultural Development Project and Jointcost Allocation -In the Case of Kumgang Project Area-)

  • 임재환
    • 농업과학연구
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    • 제23권1호
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    • pp.159-176
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    • 1996
  • This study is aimed at reviewing the methods of joint cost allocation and allocating the joint cost of estuary dam with specially repect to Kumgang Large-scale Agricultural Comprehensive Development Project. Apart from the water resource development project propelled by Water Resource Development Corporation in connection with Law of Multipurpose Dam Development, the Largescale Comprehensive Agricultural Development Projects couldn't ins-titutionally be carried out cost allocation of common facilities, even though it were concerned with irrigation, municipal and industrical water supply, flood control, sightseeing and industrial zone development components. To decrease farmer's burden of the project costs and, operation and maintenance costs, the joint costs of common facilities like estuary dam included in agricultural development projects have to be allocated by suitable method as alternative cost-remaining benefit method and the analytical activity should be supported by revising the concerned laws as Rural Development and Promotion and, Rural Rearrangement conpatible with the law for multipurpose dam development. Kumgang Agricultural Comprehensive Development Project was selected as a case study for the estimation of socio-economic benefits by project components and joint cost allocation of the estuary dam. The main results of the study are as follows; Joint cost allocation and unit charges by components 1. The project area will be 25,554ha with total project cost of 624,860 million won including the estuary dam cost of 120,843 million won. The project costs were ex-pressed by 1994 constant price. 2. Total quantity of water was estimated 365 million tons which were consisted of 245 million tons for irrigation, 73 million tons for municipal water and 47 million tons for industrial water. 3. The rates of joint cost allocation were amounted to 34.2% for agriculture, 2.5% for sightseeing, 45.7% for transportation, 11.8% for M & I water supply and 5.8% for flood control respectively. 4. The unit financial charges by project components were estimated at 7.88 won per ton for irrigation, 16.11won for M & I water, 1,686won per vehicle one pass, 977won per Pyeong according to the capital recovery method. The financial charges using straitline method for depreciation were estimated at 7.88won per ton for irrigation, 9.12won per ton for M & I water, 624won per vehicle one pass for transportation and 331won per Pyeong for sightseeing area. 5. The unit economic charges by project components were estimated at 21.1 won per ton for irrigation, 15.2won for M & I water, 977won per vehicle one pass, 977won per Pyeong according to the capital recovery method. The economic charges using straitline method for depreciation were estimated at 11.72won per ton for irrigation, 8.61won per ton for M & I water, 331won per vehicle one pass for transportation. Policy recommendation 1. The unit operation and maintenance costs for irrigation water in the paddy field couldn't be imposed as the water resource cost untreated. 2. The dam costs including investment cost and O & M cost, as a joint cost, had to be allocated by each benefited components as transportation, M & I water supply, flood control, irrigation and drainage, and sightseeing. But the agricultural comprehensive project have been dealt as an irrigation project without any appraisal socio-economic benefits and any allocating the joint cost of estuary dam. 3. All the associated project benefits and costs must be evaluated based on accounting principle and rent recovery rate of the project costs and O & M costs should be regulated by the laws concerned. 4. The rural development and promotion law and rural rearrangement law have to be revised comprising joint cost allocation considering free rider problems. 5. The government subsidy for the agricultural base development project has to be covered all the project costs. In case of common facilities representing joint cost allocation problems, all the allocated casts for other purposes like transportation and M & I water supply etc. should be recovered for formation in investment fund for agricultural base development and to procure O & M costs for irrigation facilities.

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입원서비스의 집중화 수준과 진료비 간의 관계 분석: 2009년~2011년 (A study on the relationship between the concentration status of inpatient services and medical charges per case between 2009 and 2011)

  • 곽진미;이광수;권혁준
    • 지식경영연구
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    • 제16권1호
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    • pp.209-224
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    • 2015
  • Previous studies provided that limiting the number of services provided in hospital had influences in decreasing cost in delivering medical services. Hospitals could have positive effects on their profit by concentrating small number of services which they have comparative advantages. This study purposed to analyze the relationship between the concentration status of hospitals and medical charge for inpatients. National Inpatient sample data provided by the Health Insurance Review and Assessment Service (HIRA) for three years, 2009 to 2011 was used to compute the three concentration indices (Information Theory Index (ITI), Internal Herfindahl Index (IHI), and number of distinct Diagnosis-Related Groups (DRGs) treated) and total medical charge per inpatient case in each year. It was also used to select the control variables such as bed size, number of doctors per 100 beds, and locations. The ordinary least square regression models were developed and tested for hospital and general hospitals separately. The results showed that the total medical charge per inpatient case was significantly differed depending on the concentration indices, and there were positive relationships in ITI and IHI. The number of distinct DRGs had different directions in regression coefficients depending on the locations and hospital types. Hospitals had larger absolute standardized regression coefficients compare to those of general hospitals. However, their effects could be varied by the hospital types, number of doctors, and locations. It seems that hospitals have more influences on medical charges by concentrating their services than general hospitals. Study results provide knowledges to hospital administrators that concentration strategy can positive influences on the performance of small size hospitals.

의료기관 종류별 진료내역 비교 -정상분만과 급성 충수염을 중심으로- (A Comparison of Medical Care Services by Type of Medical Care Facility -In cases of normal spontaneous vaginal delivery and acute appendicitis-)

  • 이영두
    • Journal of Preventive Medicine and Public Health
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    • 제18권1호
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    • pp.41-50
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    • 1985
  • To find out the differences in medical practice according to the environment of patient care and managerial situation of the medical care institutions, normal spontaneous vaginal delivery and acute appendicitis were selected, which is suitable for comparison because of their high comparability. A total of 473 cases of normal spontaneous vaginal delivery and 408 cases of acute appendicitis was sampled from the claims to Korea Medical Insurance Cooperations during January to June 1984. Complicated cases were excluded from population and sampling was restricted from 40 to 60 percentile for total charges by the type of medical care facility in order to rule out the influence originating from case mix. Important items representing type and quantity of medical care service were compared by type of facility. Major findings are as follows : 1. University hospital shows the highest in charges per case and decrease in order of general hospital, and clinic. 2. In case of normal spontaneous vaginal delivery, average length of stay shows statistically significant difference by type of facility. 3. Charge amount for each service item affected by practice pattern shows statistically significant difference mostly by type of facility. It is suggested that medical practice pattern is different by type of facility for medical services. 4. Difference in total medical expenditure by type of facility is affected more with charges for materials, consumables and drugs than with fee for service activity. 5. In administering drugs to patients, hospital and clinic show higher injection rate than university and general hospital. 6. Clinical Laboratory tests were common in order of uninalysis, hemoglobin, hematocrit, white blood cell count, urine microscopic examination in cases of normal spontaneous vaginal delivery; white blood cell count, urinalysis, hemoglobin, hematocrit, urine microscopic examination, white blood cell differential count, in cases of acute appendicitis. 7. The result for Laboratory test and Radiologic study shows extreme difference by type of facility. Test rate is lowest in clinic and increase hospital, general hospital, and university hospital in order, both in type and frequency.

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단양지역의 운방갱도 굴착시 갱도 지보의 필요성 판정에 관한 연구 (A Study on the Evaluation of Necessity for the Support in Case of Excavartion of the Transport Drift at Danyang Site)

  • 이종욱;조만섭;김일중;김영석
    • 터널과지하공간
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    • 제3권1호
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    • pp.54-62
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    • 1993
  • In order to evaluate the necessity for the support during the excavation of the transport drift and use the data for design applications, laboratory testings of mechanical properties of rock samples and engineering rock mass classifications on this study site were performed. The values of RMR and Q-system are 68 and 11.8, respectively. Since these results were evaluated as good, this rock mass were determined to be unsupported. Full face excavation method was determined to be suitable for excavating this drift. In case of excavation, smooth blasting techniques must be carried out at the wall rock and the crown. However, considering the blast vibration etc. that have an effect on the surrounding rock mass, approximately less than 9kg of explosive charges per blast should be maintained.

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