• 한국병원경영학회지
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• 제25권3호
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• pp.53-66
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• 2020

This study is aimed at investigated and compared the differences in the affect of hospital specialization according to hospital size using claims data of the Health Insurance and Review Assessment National Inpatient Sample in 2018 for diseases of the musculoskeletal system and connective tissue. To this end, we used multivariate hierarchical linear models(a.k.a., multi-level models) using two-tier data from 106,599 patients discharged after diseases of the musculoskeletal system and connective tissue from 734 hospitals. Multivariate results indicate that patients who were discharged with diseases of the musculoskeletal system and connective tissue from specialized hospitals with 200 beds or less stayed shorter and paid less inpatient charge than those who were discharged from less specialized hospitals. But for hospitals with 201-300 beds, no positive impact relationship was found between hospital specialization and operational performance. This finding may be limited evidence that the affect of a hospital's specialization strategy may vary depending on the size of the hospital. We discussed several managerial and health policy implications below.

• Journal of Genetic Medicine
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• 제15권2호
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• pp.110-114
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• 2018

Ataxia-telangiectasia (AT; OMIM 208900) is a rare autosomal recessive inherited progressive neurodegenerative disorder, with onset in early childhood. AT is caused by homozygous or compound heterozygous mutations in ATM (OMIM 607585) on chromosome 11q22. The average prevalence of the disease is estimated at 1 of 100,000 children worldwide. The prevalence of AT in the Republic of Korea is suggested to be extremely low, with only a few cases genetically confirmed thus far. Herein, we report a 5-year-old Korean boy with clinical features such as progressive gait and truncal ataxia, both ankle spasticity, dysarthria, and mild intellectual disability. The patient was identified as a compound heterozygote with two novel genetic variants: a paternally derived c.5288_5289insGA p.(Tyr1763*) nonsense variant and a maternally derived c.8363A>C p.(His2788Pro) missense variant, as revealed by next-generation sequencing and confirmed by Sanger sequencing. Based on claims data from the Health Insurance Review and Assessment Service Republic of Korea, we calculated the prevalence of AT in the Republic of Korea to be about 0.9 per million individuals, which is similar to the worldwide average. Therefore, we suggest that multi-gene panel sequencing including ATM should be considered early diagnosis.

• 한국임상약학회지
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• 제29권3호
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• pp.202-208
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• 2019

Objective: Suicide has recently become an important social problem. Thus, we analyzed prescription drugs that cause suicidal ideation. Methods: Of 156 drugs on the the Minister of Food and Drug Safty (MFDS) EZ-Drug site that had "suicide" listed as a side effect, 78 had "suicide" listed as a warning or contraindication; those 78 drugs were analyzed using data from the 2016 Health Insurance and Review and Assessment Services National Patient Sample (HIRA-NPS). Results: 51 "suicide risk" drugs was identified. Of all patients, 5.2% had received such drugs. The prescription rate was 0.8% of all prescriptions, accounting for 1.6% of all prescription days. From logistic regression analysis, the prescription rate for the drugs was approximately 1.1 times higher for women than for men. With regard to age, the prescription rate for patients 66 years and older was 15.5 times higher than those for patients 25-years and lower. With regard to medical departments, the prescription rates in psychiatry and dermatology departments were 8.1 times higher and 0.6 times lower than those in internal medicine departments, respectively. With regard to region, the prescription rates in Daegu and Jeju were 1.3 times higher and 0.79 times lower than those in Seoul, respectively. Conclusion: Drug-induced suicidal behavior is possible, and therefore efforts are needed to prevent it.

• 대한약침학회지
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• 제25권3호
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• pp.276-289
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• 2022

Objectives: Child and adolescent sleep is an important factor for brain and physical development. Therefore, it is necessary to investigate the prevalence of sleep disorders and nonorganic sleep disorders in children and adolescents and determine the type of utilization of medical institutions. This study analyzed the prevalence and type of medical institutions in Korean children and adolescents with sleep disorders and nonorganic sleep disorders. Methods: This study used data recorded in the Health Insurance Review and Assessment-National Patient Sample (HIRA-NPS) database from 2010 to 2017. Details of medical institution type and patient's sex, age, and treatment type were extracted for patients younger than 20 years with sleep disorders and nonorganic sleep disorders. Results: Among 2,536,478 patients under age 20, we identified 3,772 patients with sleep disorders or nonorganic sleep disorders. From 2010 to 2017, the prevalence of sleep disorders in children and adolescents was 0.07% to 0.09%. The utilization rate of Korean medical institutions was 30.47%. The prevalence of nonorganic sleep disorders and the utilization rate of Korean medical institutions were 0.06% to 0.08% and 45.99%, respectively. Conclusion: The prevalence of sleep disorders and nonorganic sleep disorders in the under-20 population was 0.14% to 0.16%. More than 70% of patients with nonorganic sleep disorder who were younger than 9 years used Korean medical institutions.

• 무역학회지
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• 제45권1호
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• pp.119-135
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• 2020

It is well-known that if a claim for damage [Note: Damage can be singular or plural] is made based on a breach of contract, calculating the existence and magnitude of certain profits to be deducted based on the damage can be problematic. In the case of a time charter party, even if the early redelivering vessel by the time charterers constitutes a breach of contract, it is still not an exception. In particular, interest in the shipping business seems to be relatively high in terms of how claims for damage by ship owners have been adjusted. In the case of the New Flamenco, there is a debate over whether or not to deduct the difference between the sale price immediately after redelivering the ship and the sale price upon expiration of the contract from the damage based on the breach of contract for the early time charter redelivery vessel. This paper focuses on this case since it appears to be of practical importance and has implications on how to calculate the amount of damage in the case of cancellation for early redelivery vessel in a time charter party.

• 한국건설관리학회논문집
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• 제16권3호
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• pp.165-176
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• 2015

국내 건설산업의 침체가 장기화됨에 따라 대형 건설업체를 중심으로 국내사업 비중이 줄고 상대적으로 해외사업의 비중이 증가되고 있으며, 중견 건설업체 및 특수기술을 가지고 있는 전문건설업체의 해외프로젝트 수행이 확대되고 있다. 이러한 해외건설공사 수행의 중요성이 부각되고 있는 최근 상황에서 해외 대형건설공사에서 일반적으로 발생되고 있는 공기지연에 대한 적극적 대응이 성공적 프로젝트관리의 중요한 이슈로 제기되고 있다. 본 연구에서는 해외 대형프로젝트의 공기지연 클레임의 공기연장기간을 입증하는데 활용되는 기존 공기연장기간 분석방법의 실무적 적용상의 문제점을 제기하였다. 제시된 문제점을 해결하기 위한 개선방법으로 1)클레임의 명확성을 확보하기 위해 지연영향력 분석이전에 주요지연(dominant delay)를 선정하는 절차를 갖는 개선개념과 2)Time Impact Analysis을 시행을 위한 분석구간의 설정방법에 대한 개선개념을 제시하였다. 본 연구에서 제시한 공기연장기간 분석방법을 실제 해외 대형건설공사의 공기지연 클레임 사례에 적용함으로써, 제안한 개선안의 실무적용에 대한 유효성을 입증하였다. 국내의 해외 대형공사 공기지연 클레임을 담당하고 있는 기술자들이 본 연구에서 제안한 방법들을 공기지연 클레임 추진 및 관련자 협상 등과 같은 실무 추진에 참고하고 활용함을 통해, 공기연장기간 입증관련 클레임의 협상실패로 인한 리스크와 후속적인 분쟁 및 회사의 경영손실 리스크를 최소화 하는데 도움이 될 것이라고 사료된다.

• Journal of Preventive Medicine and Public Health
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• 제42권2호
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• pp.135-142
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• 2009

Objectives : An appropriate sampling strategy for estimating an epidemiologic volume of diabetes has been evaluated through a simulation. Methods : We analyzed about 250 million medical insurance claims data submitted to the Health Insurance Review & Assessment Service with diabetes as principal or subsequent diagnoses, more than or equal to once per year, in 2003. The database was re-constructed to a 'patient-hospital profile' that had 3,676,164 cases, and then to a 'patient profile' that consisted of 2,412,082 observations. The patient profile data was then used to test the validity of a proposed sampling frame and methods of sampling to develop diabetic-related epidemiologic indices. Results : Simulation study showed that a use of a stratified two-stage cluster sampling design with a total sample size of 4,000 will provide an estimate of 57.04%(95% prediction range, 49.83 - 64.24%) for a treatment prescription rate of diabetes. The proposed sampling design consists, at first, stratifying the area of the nation into "metropolitan/city/county" and the types of hospital into "tertiary/secondary/primary/clinic" with a proportion of 5:10:10:75. Hospitals were then randomly selected within the strata as a primary sampling unit, followed by a random selection of patients within the hospitals as a secondly sampling unit. The difference between the estimate and the parameter value was projected to be less than 0.3%. Conclusions : The sampling scheme proposed will be applied to a subsequent nationwide field survey not only for estimating the epidemiologic volume of diabetes but also for assessing the present status of nationwide diabetes control.

• Journal of Preventive Medicine and Public Health
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• 제41권3호
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• pp.147-152
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• 2008

Objectives : Fluoridation of drinking water is known to decrease dental caries, particularly in children. However, the effects of fluoridated water on bone over several decades are still in controversy. To assess the risk of hip fracture related to water fluoridation, we evaluated the hip fracture-related hospitalizations of the elderly between a fluoridated city and non-fluoridated cities in Korea. Methods : Cheongju as a fluoridated area and Chungju, Chuncheon, Suwon, Wonju as non-fluoridated areas were chosen for the study. We established a database of hip fracture hospitalization episode based on the claims data submitted to the Health Insurance Review Agency from January 1995 to December 2002. The hip fracture hospitalization episodes that satisfied the conditions were those that occurred in patients over 65 years old, the injuries had a hip fracture code (ICD-9 820, ICD-10 S72) and the patients were hospitalized for at least 7days. A total of 80,558 cases of hip fracture hospitalization episodes were analyzed. Results : The admission rates for hip fracture increased with the age of the men and women in both a fluoridated city and the non-fluoridated cities (p<0.01). The relative risk of hip fracture increased significantly both for men and women as their age increased. However, any difference in the hip fracture admission rates was not consistently observed between the fluoridated city and the non-fluoridated cities. Conclusions : We cannot conclude that fluoridation of drinking water increases the risk of hip fracture in the elderly.

• 한국의료질향상학회지
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• 제5권1호
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• pp.152-165
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• 1998

Background : In this paper patient outcomes research is going to be reviewed and described, to be compared with relevant studies, and to consider the application in Korea. Methods : We compiled and reviewed the articles and materials related to patient outcomes research especially by PORT(Patient Outcomes Research Team) and rearranged them for seeking the main point and comparing with relevant studies. Results : Patient outcomes research emphasizes patient outcomes as well as conventional clinical outcomes. It is prospective study observing effectiveness in real situation instead of efficacy in ideal condition. Patient outcomes research comprises of 6 fields ; literature review and meta-analysis, use of claims data, decision modeling, outcomes assessment, cost of care, dissemination of research findings. SAA(small-area variations analysis), appropriateness study and clinical practice guideline are connected with patient outcomes research. Conclusion : In view of the fact that current medical policy in Korea is shifting its focus from accessibility to the improvement in quality and cost containment, and is stressing patient-based research, patient outcomes research is one direction for which the medicine is accountable and assessable. Considering that the number of patient receiving medical treatment in Korea is higher than the West, patient outcomes research has competitive power as against the West.

• 보건행정학회지
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• 제19권2호
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• pp.71-84
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• 2009

Objectives : The purpose of this study is to analyze the proportion of admission via the emergency room(the rest is ER) in an emergency medical center and to examine the factors related to admission. Methods : This study used 2005 National Health Insurance claims data for admitted patients of 112 hospitals having emergency medical centers in Korea. The study sample had 2,335,610 patients. The data was classified into emergency admission and non-emergency admission. To investigate the factors affecting the type of admission, the following were included as independent variables: type of health assurance_(national health insurance beneficiaries or medical aid beneficiaries), demographic characteristics_ (sex, age), cause of admission_ (disease or injury), whether an operation was performed or not, DRG severity level, the number of beds, and the location of the hospital. Data were analyzed using the Chi-square test for the differences in emergency admission rates for each variables, and multiple logistic regression analysis was used for identifying the factors affecting admission type. Results : The proportion of admission via the ER accounted for 40.6% of the total admission among hospitals having emergency medical centers. The risk of admission via ER was relatively high for patients who were male, the aged, the injured, the surgical patients, the patients having more severe symptoms, and the patients admitted the hospitals located in metropolitan areas, and the patients admitted the hospitals having 300-699 beds. Medical aid patients were more likely admitted through the emergency room than health insurance patients after other variables ware adjusted. Conclusions and Discussion : We analyzed the proportion of admission via the ER for the total admission rate of hospitals having an emergency medical center in Korea. And we explored the factors related to admission via the ER. This proportion may be used as an indicator of the adequacy of medical utilization or low accessibility to hospitals of patients with low socioeconomic status.