• Korea Journal of Hospital Management
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• v.26 no.3
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• pp.1-12
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• 2021

Purpose: This study aims to examine the effect of the copayment reduction policy on the health care utilization of patients under age 15 after the policy started in 2017. (이하는 아래 methodoloty로 이동) Methodology: Data on the ALOS, the average admission cost, and the out-of-pocket expenditure for patients under 15 years of age from 2015 to 2019 were obtained from the National Health Insurance database. Policy effects were measured by analyzing three dependent variables before and after policy: the average length of stay (ALOS), the average admission cost, and the out-of-pocket expenditure for patients under 15 years of age. The collected data were analyzed using the SAS package, and the analysis methods used in this study were the mean difference test and linear regression analysis. Findings: The study results reveal that, after the copayment reduction policy in the year 2017, the ALOS and the out-of-pocket expenditure were significantly decreased, but the average admission cost was significantly increased. Practical Implications: These results imply that the policy of copayment reduction for the patients under the age of 15 has contributed to mitigating the patients' financial burden with little concern about growing medical utilization.

• Quality Improvement in Health Care
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• v.8 no.1
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• pp.84-94
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• 2001

Background : in order to adapt to changes of the medical environm interests that is drawn in ambulatory surgery are increased as a method of approaching a patients' satisfaction and cost-effective management. The purpose of this study is to a assess the operation which is able to perform through ambulatory care unit, to identify the problem in ambulatory surgery, and to increased the opportunity of ambulatory surgery with safety. Methods : Between May 13th, 1998 and June 30th, 2000, we performed surgical treatment through ambulatory care unit, and evaluate the results of them. The sorts of operation, duration of stay in the hospital, total cost of treatment, satisfaction of patients and safety if anesthesia were assessed. Results : We performed ambulatory surgery without serve complications and the patients were satisfied with surgical treatment through ambulatory care unit. In comparison of ambulatory and admission surgery, there was a reduction of cost to 16.7~25.3% in ambulatory surgery. Also, the duration of admission was 2 days shorter than admission surgery. Conclusions : According to our results, the surgical treatment through ambulatory care unit is safe and useful method that increase the quality of medical service, satisfaction of patients and reduce the cost of treatments.

• Journal of Korean Academy of Nursing Administration
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• v.7 no.1
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• pp.5-14
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• 2001

To estimate total burden of hospital admission over patient of gamily, we need to know the unofficial private expenses in addition to explicit hospital admission fees. This study was conducted from June 29, 2,000 to August 10, 2,000. Subjects were 104 patient at university hospital located at chungnam province. After thorough explanation of purpose and procedures, notebooks are given to each patient or guardian. They are requested to recorded all relevant expenditures occurred during hospital stay. Incomplete records were filled-up by direct personal contact or phones. Datas were summarized and analyzed using SAS statistical package. P-value less than 0.05 was considered significant. The results of the study are as follows: 1. In 96.1% of the patient, guardians stayed at hospital to take care of patients. In 38,8% one of the family members get work-leave or temporary resting from job. Average date of leave was 7.5days. 2. Average informal cost burden per patient was 204,467 won (14,330 won${\sim}$1,594,870 won). Average hospital cost paid by the patient was 1,061,807 won. The ratio of informal cost burden to hospital cost paid by the patient was 0.327. 3. According to the regression analysis, the relevant factors affection informal cost burdens were distance from home to hospital(p=0.018), and duration of hospitalization(p=0.0001). 4. Informal cost burden was composed of expenses for personal expense of care giver (126, 720 won/patient), meal (86,924 won/patient), transportation (77,648 won/patient), necessaries of life (18,789 won/patient), tests and treatments not covered by insurance (17,289 won/patient), medical supplies not covered by insurance (15,280 won/patient), treat for visitors (14,757 won/patient), TV coin (8,247 won/patient), and others (7,582 won/patient). In addition to the hospital cost paid by the patient for hospital admission, the informal cost burdens should be recognised explicitly because it is not small. Significant proportion of informal cost burden is composed of care-giver's personal expense, transportation, meal. It is suggested that some polices are to be devised and implemented enabling that this portion of informal expenses be directed to formal professional nursing care. Thus we can improve the quality of care and decrease discomfort of patient's relatives.

• Journal of Korean Neurosurgical Society
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• v.67 no.1
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• pp.84-93
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• 2024

Objective : We aimed to examine trends in critically ill neurology-neurosurgery (NNS) patients who were admitted to the intensive care unit (ICU) in South Korea and identify risk factors for in-hospital mortality after ICU admission in NNS patients. Methods : This nationwide population-based retrospective cohort study enrolled adult NNS adult patients admitted to the ICU from 2010 to 2019 extracted from the National Health Insurance Service in South Korea. The critically ill NNS patients were defined as those whose main admission departments were neurology or neurosurgery at ICU admission. The number of ICU admission, age, and total cost for hospitalization from 2010 to 2019 in critically ill NNS patients were examined as trend information. Moreover, multivariable logistic regression modeling was used to identify risk factors for in-hospital mortality among critically ill NNS patients. Results : We included 845474 ICU admission cases for 679376 critically ill NNS patients in South Korea between January 1, 2010 to December 31, 2019. The total number of ICU admissions among NNS patients was 79522 in 2010, which increased to 91502 in 2019. The mean age rose from 62.8 years (standard deviation [SD], 15.6) in 2010 to 66.6 years (SD, 15.2) in 2019, and the average total cost for hospitalization per each patient consistently increased from 6206.1 USD (SD, 5218.5) in 2010 to 10745.4 USD (SD, 10917.4) in 2019. In-hospital mortality occurred in 75455 patients (8.9%). Risk factors strongly associated with increased in-hospital mortality were the usage of mechanical ventilator (adjusted odds ratio [aOR], 19.83; 95% confidence interval [CI], 19.42-20.26; p<0.001), extracorporeal membrane oxygenation (aOR, 3.49; 95% CI, 2.42-5.02; p<0.001), and continuous renal replacement therapy (aOR, 6.47; 95% CI, 6.02-6.96; p<0.001). In addition, direct admission to ICU from the emergency room (aOR, 1.38; 95% CI, 1.36-1.41; p<0.001) and brain cancer as the main diagnosis (aOR, 1.30; 95% CI, 1.22-1.39; p<0.001) are also potential risk factors for increased in-hospital mortality. Conclusion : In South Korea, the number of ICU admissions increased among critically ill NNS patients from 2010 to 2019. The average age and total costs for hospitalization also increased. Some potential risk factors are found to increase in-hospital mortality among critically ill NNS patients.

• Journal of Korean Medicine Rehabilitation
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• v.23 no.3
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• pp.159-175
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• 2013

Objectives Herniated Intervertebral Disc of C-spine is one of the most common diseases that causes posterior neck pain. This study was designed to analyze the general distribution and hospital cost by day and case of Korean medical treatment for Cervical Herniated Intervertebral Disc (HIVD). Methods The 132 impatients for treatment of HIVD were analyzed according to the distribution of sex, age, the duration of HIVD, the contributory factors, the Clinical grade at admission, the clinical findings at admission, the duration of hospitalization, the clinical grade at admission and the hospital cost per day and case. Results 1) The total hospital cost per case averaged 1,985,600 Won, which was consisted of room charge 584,044 Won (29.41%), performance fee 511,463 Won (25.76%), herbal medication 381,517 Won (19.21%), Korean medical physiotherapy 296,310 Won (14.92%), food expenses 199,997 Won (10.07%) in order. 2) The total hospital cost per day averaged 137,285 Won, which was consisted of room charge 39,036 Won (28.43%), performance fee 33,594 Won (24.47%), herbal medication 30,642 Won (22.32%), food expenses 12,870 Won (9.37%), and the average duration of hospitalization was 15.1 days. 3) There was statistically significant difference in the consultation fee, room charge, and herbal medication on the part of sex. 4) There was statistically significant difference not only in the performance and consultation on the part of duration of hospitalization but also the in the duration of average duration of hospitalization. 5) There was statistically significant difference in the Korean medical physiotherapy and herbal medication on the part of clinical findings. 6) There was statistically significant difference in the Korean medical physiotherapy and herbal medication on the part of duration of HIVD. 7) There was statistically significant difference in the Korean medical physiotherapy and herbal medication on the part of clinical outcome. 8) There was not only statistically significant difference in the performance, but also in the herbal medication on the part of clinical grade at admission. Conclusions This study provides plenty of information to design out the specific terms of Korean medical expenses of Cervical HIVD inpatients hospitalized at Korean medicine hospital.

• Health Policy and Management
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• v.4 no.1
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• pp.49-76
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• 1994

Small area variations in health care utilization have long been studied as an important issue related to boto cost containment and quality assurance. This study was conducted to investigate if variations in hospital services across small geographic areas in Korea existed. The claims data of the fiscal year 1992 obtained from the regional health insurance societies were used for the study. Main findings of the research can be summarized as follows : 1. Extremal Quotients(EQ) of hospital expenditure per capita and hospital days per capita varied among diagnosis types. The EQ ranged from 2.05(cataract) to 41.67(pneumonia) in hospital expenditure per capita and from 1.86(cataract) to 45.89(pneumonia) in hospital days per capita. The diagnosis groups which showed high variation were pneumonia, cephalo-pelvic disproportion, gastritis and duodenitis, fracture of rib, and acute bronchitis. Those which showed low variation were acute appendicitis and cataract. 2. The EQ level of admission rate was different in terms of diagnosis types, ranging from 2.57(catarct) to 44.45(pneumonia). The variations were high in medical disorders such as pneumonia, oephalo-pelvic disproportion, gastritis and duodenitis and acute bronchitis, while relatively low in surgical conditions such as acute appendicitis and cataract. 3. As an indicator of service intensity, the EQ of expenditure per admission ranged from 1.67(acute appendicitis) to 31.27(essential hypertension). The diagnoses which had high variation were essential hypertension, gastric ulcer, whereas those which had low variation were cephalopelvic disproportion and acute appendicitis. With regard to hospital days per admission, the EQ ranged from 1.55(acute appendicitis) to 28.13(gastric ulcer) by diagnosis types. The diagnosis groups with showed high variation were gastric ulcer, essential hypertension, and acute bronchitis, whereas those with low variation were cephalo-pelvic disproportion, intervertebral disc disorders, and acute appendicitis. Both the expenditure and hospital days per admission showed lewwer variations than the expenditure per capita, hospital days per capita and admission rate. 4. Comparing patterns of variation in utilization indices, diagnoses such as essential hypertension, gastric ulcer, fracture of rib showed higher variations in expenditure per admission than in admission rates, whereas diagnoses such as pneumonia, cephalo-pelvic disproportion and gastric ulcer showed higher variations in admission rate than expenditure per admission. These findings suggest that wide variations existed in several diagnoses groups across small areas in Korea. Further research should be performed to investigate factors related to small area variations including provider behavior.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.3
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• pp.197-208
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• 2021

Objectives: The purpose of this retrospective study was to evaluate the variables associated with length of stay (LOS), hospital costs, intensive care unit (ICU) use, and treatment outcomes in patients hospitalized for maxillofacial infections at a tertiary medical center in South Korea. Materials and Methods: A retrospective chart review was conducted for patients admitted for treatment of maxillofacial infections at Dankook University Hospital from January 1, 2011 through September 30, 2020. A total of 390 patient charts were reviewed and included in the final statistical analyses. Results: Average LOS and hospital bill per patient of this study was 11.47 days, and ₩4,710,017.25 ($4,216.67), respectively. Of the 390 subjects, 97.3% were discharged routinely following complete recovery, 1.0% expired following treatment, and 0.8% were transferred to another hospital. In multivariate linear regression analyses to determine variables associated with LOS, admission year, infection side, Flynn score, deep neck infection, cardiovascular disease, admission C-reactive protein (CRP) and glucose levels, number and length of surgical interventions, tracheostomy, time elapsed from admission to first surgery, and length of ICU stay accounted for 85.8% of the variation. With regard to the total hospital bill, significantly associated variables were age, type of insurance, Flynn score, number of comorbidities, admission CRP, white blood cell, and glucose levels, admission temperature, peak temperature, surgical intervention, the length, type, and location of surgery, tracheostomy, time elapsed from admission to first surgery, and length of ICU use, which accounted for 90.4% of the variation. Age and ICU use were the only variables significantly associated with unfavorable discharge outcomes in multivariate logistic regression analysis. Conclusion: For successful and cost-effective management of maxillofacial infections, clinicians to be vigilant about the decision to admit patients with maxillofacial infections, perform appropriate surgery at an adequate time, and admit them to the ICU.

• Korea Journal of Hospital Management
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• v.23 no.2
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• pp.42-53
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• 2018

Purpose: this study investigates the effect of private health insurance on healthcare utilization. Methodology: For the analysis, we employed the three level nested two part model. Findings: the private health insurance adoption was associated with higher health care utilization. In particular, indemnity and fixed insurances adoption was associated with higher probability of outpatient visit, the number of outpatient visit and outpatient cost. While indemnity insurance adoption was associated with higher inpatient admission probability and inpatient days, fixed insurance adoption was associated only with higher inpatient admission probability. Practical Implications: indemnity and fixed insurance adoption were related with the adverse selection as well as moral hazard.

• Journal of the Korean Dietetic Association
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• v.5 no.1
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• pp.48-53
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• 1999

This study was prospectively conducted to investigate any relationship of nutritional status at the time of admission to length of hospital stay and mortality. All patients admitted to the Asan Medical Center between October 13 and November 12, 1997 who met the study criteria were included in the study. Patients were classified as Not-at-risk, At-risk Ⅰ or At-risk Ⅱ based on the levels of serum albumin and total lymphocyte count in a computerized nutrition screening program. Sixty three percent of the patients were classified as Not-at-risk Group, 29% as At-risk Group Ⅰ and 8% as At-risk Group Ⅱ. Significant correlation was observed between nutritional status and LOS (P＜0.01) as well as mortality rate (P＜0.05). The more the patient had the nutritional risk factors, the longer the LOS and the higher the mortality rate were. Further studies have to be done in order to demonstrate cost-effectiveness of medical therapy for the malnourished hospitalized patients.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.223-228
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• 2008

Purpose: V.A.C. is a new concept which is closed dressing with negative pressure to promote wound healing. It has been widely used as the treatment of chronic and acute wounds such as pressure sores, burns, stasis ulcers, and other complicated wounds. However It has disadvantages such as high cost and the need of specific equipment. In this article, we described new method to overcome these disadvantages. Methods: We made newly innovated equipment with 50 cc syringe and spring to create negative pressure. From May 2006 to May 2007, we applied it to two patients with chronic wound. Results: The treatment period was 5 weeks for one case and 3 weeks for the other case. Both patients were healed completely without admission and wound healing was accelerated. During follow-ups, there were no complications. The mean cost for single dressing was 9,590 won. Conclusion: Modified portable negative therapy using newly innovated equipment could accelerate wound healing better than conventional dressing. It lowers the number of dressings, saves cost of treatment, and enables treatment as outpatient basis.