• The Journal of the Korea institute of electronic communication sciences
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• v.12 no.2
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• pp.401-410
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• 2017

This study aimed to identify appropriateness and efficiency in the DRG payment system by analysing the hospital length of stay and changes in fees before and after the application of DRG payment system. The subjects of the study were a total of 398 patients consisting of 204 for the fee for service system and 194 for the DRG payment system. They received surgery in the Obstetrics and Gynecology (OBGY) department of a general hospital in G metropolitan city between January and December 2013. The mean hospital length of stay was significantly decreased after application of the DRG payment system(p=0.013). Total fees, insurance charges, and deductions increased significantly(p<0.001), and non-payment charges and total deductions decreased significantly(p<0.001). Application of the DRG payment system reduced length of stay, non-payment charges and total patient's cost sharing and increased out-of-pocket, insurance charges, and total fees.

• Journal of Preventive Medicine and Public Health
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• v.18 no.1
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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.

• Journal of Korean Academy of Nursing
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• v.42 no.3
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• pp.351-360
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• 2012

Purpose: The purpose of this study was to propose optimal hospitalization fees for nurse staffing levels and to improve the current nursing fee policy. Methods: A break-even analysis was used to evaluate the impact of a nursing fee policy on hospital's financial performance. Variables considered included the number of beds, bed occupancy rate, annual total patient days, hospitalization fees for nurse staffing levels, the initial annual nurses' salary, and the ratio of overhead costs to nursing labor costs. Data were collected as secondary data from annual reports of the Hospital Nursing Association and national health insurance. Results: The hospitalization fees according to nurse staffing levels in general hospitals are required to sustain or decrease in grades 1, 2, 3, 4, and 7, and increase in grades 5 and 6. It is suggested that the range between grade 2 and 3 be sustained at the current level, the range between grade 4 and 5 be widen or merged into one, and the range between grade 6 and 7 be divided into several grades. Conclusion: Readjusting hospitalization fees for nurse staffing level will improve nurse-patient ratio and enhance the quality of nursing care in hospitals. Follow-up studies including tertiary hospitals and small hospitals are recommended.

• Journal of Korean Academy of Nursing Administration
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• v.19 no.5
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• pp.565-577
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• 2013

Purpose: This study was done to propose an improvement in the Nursing Fee Differentiation Policy to alleviate polarization of nursing staffing level among hospitals and to rectify the confusion of legally mandated standards between the Korean Medical Law and National Health Insurance Act. Methods: The policy regulation was reconstructed related to nurse staffing standards and nurse-to-patients ratios. Data on nurse staffing grades were obtained from database of the Health Insurance Review & Assessment Service (HIRA) for the third quarter of 2010 for 44 tertiary hospitals, 274 general hospitals, and 1,262 hospitals. A break-even analysis was used to estimate financial burden of the revised policy improvement proposal. An industrial engineering method was used to calculate Nurse-to-Patients ratios per shift. Results: Twelve tertiary hospitals were downgraded. 74 general hospitals and 102 hospitals were upgraded after application of the regulation. Finances for total hospitalization expenditures changed from -3.55% to +3.14%. Conclusion: The results indicate that the proposed policy would decrease polarization between tertiary hospitals and small hospitals, and would not put a major strain on the finances of the Korean National Health Insurance. Therefore, it is suggested that government stake-holders and many interest groups consider this policy proposal and build a consensus.

• Asia pacific journal of information systems
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• v.17 no.4
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• pp.97-112
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• 2007

Most traditional newspaper publishers provide online editions to counter the competition of online news providers. However, the relationship between the online and print editions of the same newspaper has not been clearly defined. Some see the online newspaper as a substitute, while others consider it a complement. A 2002 NAA online newspaper consumer survey indicated that one-third of its respondents said they were now using the print newspaper less. Others have argued that the online edition will not wipe out print consumption, and may even complement it. While the print edition offers particular advantages such as portability, less eye strain, and the tactile experience of a printed page, the online edition also offers specific advantages such as access to breaking news, continually updated information, access to old archives, etc. All these factors would tend to lower the degree of interchangeability between the products. However, recent empirical studies show that the online edition is a substitute for rather than a complement of the print edition. Still, to some print readers, the online edition provides additional value. In this paper, by capturing the two different aspects of online editions the substitute aspect and the additional value added aspect as well as other available online alternatives, we develop an analytical model to derive the optimal production and distribution strategies of both online and print editions. Confronting the "free versus fee" issue, we show that it is optimal to provide an online version of the print newspaper for free to non-print subscribers. However, the amount of free news content that the publishers need to put on the Web depends on the available alternatives on the online market. The "fee" and "free" options both have merits and demerits as well. If the publisher charges for the online version of the print newspaper, she can generate revenue from the fee charged to online readers. However, doing so will limit the size of the online audience and further reduce online advertising revenue. At the same time, by providing a high-quality online version and charging for it, the price of the print newspaper must stay low in order to lure high valued readers. On the contrary, if the publisher provides an online version of the print newspaper for free, she can obtain a larger audience for the online version. At the same time, by providing a low-quality online newspaper, the publisher can increase the print newspaper price to get more revenue from high valued offline readers, although no revenue is incoming from online version readers. Through systematic measuring of all the pros and cons, our analysis shows that the optimal option is not "fee" but "free."

• Journal of the Korea Academia-Industrial cooperation Society
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• v.11 no.4
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• pp.1504-1510
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• 2010

According to a research analysis of the factors which affect the medical utilization fee after an increase of health insurance benefits for patients with serious illnesses based on 225 patients over 6 months, both before and after the increase of benefits, from January, 1st, 2005 to June 30th, and also from January, 1st, 2006 to June 30th. In terms of genders, 67.8% of males were affected, whereas only 32.2% of females were effected, a much higher rate of men than women. Men also had higher rates before and after the increase of benefits. Out of 5 categories related to medication and treatment, radiation testing was the most expensive at about 5,300,000, operation fees were 590,000, and costs of other testing approximately 200,000 with the least expensive category being 120,000 for medication. By looking at the relationship between the fees and increase of benefits, medication was a hospital charge (p<0.01), injection fees were hospital charges (p<0.01), operation fees were hospital charges (p<0.01). Medication fees (p<0.01) and injection fees (p<0.01) were found to be related.

• Health Policy and Management
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• v.16 no.1
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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.

• Journal of the Korean Home Economics Association
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• v.42 no.3
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• pp.119-130
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• 2004

The purpose of this study is to estimate the rate of credit card payment for private education. The results of study can be used to improve credit card handling problems of private educational institutes, leading toward improvements in income transparency, increase in tax burden equity and long-term economic welfare improvement for individual households. 424 households out of 586 household that were surveyed in September of 2002 had 1,700 cases private extracurricular education. 67 of the 1,700 cases that did not have expenditure records were removed from the analysis. Only 3.67％ out of 1,633 cases were paid by a credit cards and the amount of credit card payment were only 5.65％ of the total amount spent for private education. The average fee of private educational institutes that allow credit card payment was higher than the fees of private institutes which don't allow a credit card payment or those of private institutes where consumers don't know whether a credit card payment was allowed. The average fee of private education paid by credit cards was 34,465.46 won higher than that paid by cash. Credit card payments to private educational institutions is an important social issue with respect to fair tax collection and tax burden equity since most private educational services operate in fairly small sizes and are offered by the self-employed, and the expense of private education is a fairly large proportion of the household income. It is also important for consumers if credit card acceptance expands alternatives that consumers can choose in private education. Therefore, credit card payment should be encouraged in private extracurricular education. To do this, private education providers should be forced to join a credit card payment service by the National Tax Service. A regulation that prohibits the refusal of credit card payments should be required, and credit card service charges of private education providers should be incrementally decreased. Also, consumer education and public promotions for credit card use instead of cash in paying for private education fees are recommended.

• International Area Studies Review
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• v.13 no.3
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• pp.29-49
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• 2009

We examine the effects of information transparency, lender identity, and credit rating on the commitment fees of syndicated loans originated in Japan, employing a sample of 331 facilities. A syndicated loan is a financing instrument offered to a single borrower by multiple lenders, and Japanese syndicated loan volume increased 36% to a record-high of $283 billion in 2008 compared to 2007. We find that the more informational opaque the borrower, the higher the commitment fees the lender charges to the Japanese borrowers. There is evidence that a syndicate involving a Japanese lead agent is able to extract rents through higher commitment fees. We document that there is a significant relation between the credit rating of the borrower and the commitment fee cost of syndicated loans originated in Japan. Most importantly, our results provide evidence that banks in Japan extract higher returns on syndicated loans through the commitment fees in addition to higher loan spreads. Using a micro-level of Japanese borrowers, we contribute to existing literature by providing our empirical evidence after controlling for borrowing spread.

• Health Policy and Management
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• v.2 no.2
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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.