• Journal of Preventive Medicine and Public Health
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• v.33 no.4
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• pp.393-401
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• 2000

Objectives : To evaluate the impacts of the DRG payment system on the behavior of medical insurance claimants. Specifically, we evaluated the case-mix index, the numbers of diagnosis and procedure codes utilized, and the corresponding rate of diagnosis codes before, during and after implementation of the DRG payment system. Methods : In order to evaluate the case-mix index, the number of diagnosis and procedure codes utilized, we used medical insurance claim data from all medical facilities that participated in the DRG-based Prospective Payment Demonstration Program. This medical insurance claim data consisted of both pre-demonstration program data (fee-for-service, from November, 1998 to January, 1999) and post-demonstration program data (DRG-based Prospective Payment, from February, 1999 to April, 1999). And in order to evaluate the corresponding rate of diagnosis codes utilized, we reviewed 820 medical records from 20 medical institutes that were selected by random sampling methods. Results : The case-mix index rate decreased after the DRG-based Prospective Payment Demonstration Program was introduced. The average numbers of different claim diagnosis codes used decreased (new DRGs from 2.22 to 1.24, and previous DRGs from 1.69 to 1.21), as did the average number of claim procedure codes used (new DRGs from 3.02 to 2.16, and previous DRGs from 2.97 to 2.43). With respect to the time of participation in the program, the change in number of claim procedure codes was significant, but the change in number of claim diagnosis codes was not. The corresponding rate of claim diagnosis codes increased (from 57.5% to 82.6%), as did the exclusion rate of claim diagnosis codes (from 16.5% to 25.1%). Conclusions : After the implementation of the DRG payment system, the corresponding rate of insurance claim codes and the corresponding exclusion rate of claim diagnosis codes both increased, because the inducement system for entering the codes for claim review was changed.

• Korea Journal of Hospital Management
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• v.25 no.2
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• pp.45-56
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• 2020

Purpose: The purpose of this study is to investigate medical care behaviors influencing accuracy of the payment based New diagnosis-related groups (DRG) compared to fee for service (FFS) in hospitalized patients with medical illness. Methodology: In order to estimate the difference in medical costs between New DRG and FFS depending on medical care behaviors, medical records and hospital claims data (n=4,232) were utilized, which were collected from a single public hospital during the first-half of 2018. Data were analyzed by descriptive statistics, t-test, chi-square test, and multivariate binary logistic regression. Findings: The average difference in medical costs between New DRG and FFS were KRW 506,711±13,945 with incentives and KRW -51,506±12,979 without incentives, respectively. Forty-four point two percent (44.2%, n=1,872) of total subjects were shown to have negative compensation in overall medical costs with New DRG compared to the costs with FFS. Medical care behaviors that affected on the negative compensation were the presence of severe bed sores on admission, medical consultations, death, operations, medications and laboratory or imaging tests with unit price over KRW 100,000, hospital-acquired complications or underlying comorbidities, elderly patients (≧65 years), and hospitalized for more than average inpatient days defined by New DRG (p<0.001). The difference in average medical cost between New DRG and FFS for a group with mild illness was KRW -11,900±10,544, whereas it was KRW -196,800±46,364 for a group with severe illness (p<0.0001). Practical Implications: These findings suggest that New DRG payment model without incentives may incompletely cover the variation of medical costs in real clinical practice. Therefore, policy makers need to consider that the current New DRG reimbursement should be focused and refined to improve accuracy of payment on medical care resources utilized in severe and complex medical conditions.

• Health Policy and Management
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• v.26 no.2
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• pp.135-147
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• 2016

Background: The voluntary diagnosis-related groups (DRG)-based payment system was introduced in 2002 and the government mandated participation in the DRG for all hospitals from July 2013. The main purpose of this study is to examine the independent effect of mandatory participation in DRG on various outcomes of patients. Methods: This study collected 1,809,948 inpatient DRG data from the Health Insurance Review and Assessment database which contains medical information for all patients for the period 2007 to 2014 and examined patient outcomes such as length of stay (LOS), total medical cost, spillover, and readmission rate according to hospital size. Results: LOS of patients decreased after DRGs (large hospitals: adjusted odds ratio [aOR], 0.87; 95% confidence interval [CI], 0.78-0.97; small hospitals: aOR, 0.91; 95% CI, 0.91-0.92). The total medical cost of patients increased after DRGs (large hospitals: aOR, 1.22; 95% CI, 1.14-1.30; small hospitals: aOR, 1.22; 95% CI, 1.21-1.23). The results reveals that spillover of patients increased after DRGs (large hospitals: aOR, 1.27; 95% CI, 0.70-2.33; small hospitals: aOR, 1.18; 95% CI, 1.16-1.20). Finally, we found that readmission rates of patients decreased significantly after DRGs (large hospitals: aOR, 0.28; 95% CI, 0.26-0.29; small hospitals: aOR, 0.59; 95% CI, 0.56-0.63). Conclusion: The DRG payment system compared to fee-for-service payment in South Korea may be an alternative medical price policy which can reduce the LOS. However, government need to monitor inappropriate changes such as spillover increase. Since this study also is the results based on relatively simple surgery, insurer needs to compare or review bundled payment like new DRG for expansion of various inpatient-related diseases including internal medicine.

• Land and Housing Review
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• v.5 no.3
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• pp.179-191
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• 2014

The purpose of this study is to employ a method called 'conflict impact assessment' to analyze the progress, background, cause and relevant issues of conflicts related with affordable housing for youth (Happiness Housing Project), a project that has been implemented since last May 2013, thereby identifying the relevant problems and draw out objectives for improvement. The researchers expect that this study will contribute to solving the current issues regarding Happiness Housing, and contribute to improving the quality of the government's policies. For the above purpose, literatures on Happiness Housing produced from August to November 2013 were reviewed, in-depth telephone or face-to-face interviews were conducted with personnel associated with project implementation in the Ministry of Land, Infrastructure and Transportation and LH, etc., and major interested parties including Yangcheon-gu residents. Key issues identified regarding Happiness Housing construction include: the way that the project was implemented, living quality of residents, impact on educational environment, inconsistence with existing plans, relatively high construction cost, insolvency of public corporations, land use fee issue with Korail, need of preliminary feasibility survey, securing sufficient amount for supply and issue of additional designation, likelihood of finishing construction in time and issues related with actual source of demand, etc. Through analysis of conflict development and positions of interested parties, the main causes of the conflicts were identified as follows: lack of deliberation on pledges during election, lack of viability review on pledges, lack of conflict management plans, one-way implementation without consent of interested parties, project plans established with no regard to local circumstances, frequent project revision, underwehlming level of conflict management. In order to address issues above, the following measures need to be taken: selecting election pledges based on actual effectiveness, thorough assessment on pledges by relevant departments, gradual implementation based on consideration of the actual circumstances, participation of key interested parties, consistent policy and adopting conflict management techniques that reflect the reality.

• The Journal of the Korea Contents Association
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• v.8 no.11
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• pp.74-84
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• 2008

Mobile game is a killer content among the various mobile contents provided by Telecommunication companies. Recently, Location Based Service (LBS) market is growing rapidly and LBS will be a killer content in the near future. As a consequence, mobile game combined with LBS will be a dominant trend of mobile content. However, there exist some limitations on the revitalization of the mobile service market. In this paper, analysis of the restrictions on the mobile service market is performed and then methods for the revitalization of the mobile service market are proposed various billing system is required to reduce network fee for users, a new policy to protect privacy has to be offered, and the infrastructure for high network performance should be developed. The result of this research will provide key role to find a new and more innovative approach to enhance the interaction design of the future Location Based Mobile Games.

• Korean Journal of Construction Engineering and Management
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• v.13 no.1
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• pp.148-159
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• 2012

Recently construction companies' capital condition has been aggravated due to low profit, fierce competition and market contraction. For this reason, the companies rely on public construction projects that protect construction fee by regulations. Despite these regulations, problems regarding progress payment are constantly happening. Also, insufficient analysis on interaction between contractors makes policy making difficult. Thus, in this study, interaction between contractors are quantitatively determined according to delay of application and payment based on current public construction regulations on construction stage. A system dynamics model is used, which analyzes the problems based on an interaction between contractors, and solutions for progress payment application and payment delay are suggested according to the research results.

• Journal of Korea Port Economic Association
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• v.34 no.3
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• pp.113-132
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• 2018

Mokpo port marked the $131^{st}$ anniversary of its opening in 2018. while the Mokpo has taken the new port development initiatives, it is limited by inefficient port functioning due to the lack of maritime port policy and government investment. Hence, port logistics has not been activated. Additionally, studies on Mokpo port have not been conducted, and knowledge available on the port is declarative in nature. On the other hand, research on port competitiveness focuses on how to analyze the factors that determine port competitiveness. Therefore, this study was intended to expand the existing research on Mokpo port and conduct an analysis of non-competitiveness factors and suggested improvements by considering the operational aspect of Mokpo port. In this regard the importance of non-competitiveness factors was assessed through an analytic hierarchy process(AHP) analysis and the influence of the non-competitiveness factors was analyzed through an fuzzy structural modeling(FSM) analysis. The result of the AHP analysis show ed the important non-competitiveness factors included the deactivation of industrial complexes around Mokpo port, the number of liner route, the cost of the pilot and tug. Accor ding to the FSM analysis, the top level included the non-competitive factors at Mokpo port; the intermediate level included the number of liner routes, cost of pilot and tug, enrance and clearance fee, costs of inland transportation, fee for port facilities, and loading and unloading costs; and the bottom level comprised the most non-competitive factors including the deactivation of industrial complexes around Mokpo port, hinterland connectivity, access to international port, incentives, and cost of transportation and storage. Based on the results of analysis, improvements were suggested for non-competitive factors of Mokpo.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.22 no.4
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• pp.183-194
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• 2021

In this study, the conversion factor for 2020 is estimated based on an outpatient and inpatient conversion factor separation model developed from SGR and AR by using actual medical expense data. In addition, a policy plan is proposed to calculate the values of single and multiple conversion factors for each type of medical expense, and to effectively use the conversion factor separation model as one of the means to establish a medical delivery system. The major results are as follows. First, at r=0.1, the rate of adjustment in the hospital single conversion index in 2020 was 2.0%, and the outpatient and hospitalization conversion rates for hospitals were 2.2% and 2.3%, respectively. In addition, a combination of outpatient and inpatient conversion factors can be used for the adjustment. Second, as a measure to establish a medical delivery system, instead of adjusting the addition rate, a method of interlocking the addition rate and the conversion factor is proposed. Third, it is necessary to develop a model that enables target management of volumes, in addition to the outpatient conversion factor, the inpatient conversion factor, and the adjustment coefficient.

• Journal of Digital Convergence
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• v.19 no.3
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• pp.65-79
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• 2021

The purpose of this study was to research how emotional factors affect decision-making on the maintenance and abandonment of a patent, and to present new criteria for patent policies. The types of Korean patent abandonment were analyzed according to the patent holding period, and a questionnaire survey was carried out to verify whether there are differences among patentees in terms of sunk cost bias, endowment effect, and coupling or not. Individuals and small and medium-sized enterprises showed relatively greater emotional bias toward sunk cost and endowment effect than large companies, and the sunk cost effect decreased as decision-making experience increased. In addition, the reduction in the payment cycle of the patent renewal fee has a positive effect on the increase in the willingness to use the patent right, and the individuals and small and medium-sized enterprises has a greater synergistic effect than the case of large companies, in particular. This study are expected to play a part in establishing policies to minimize wasteful factors of patent assets based on the propensity of the patentees.

• Health Policy and Management
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• v.19 no.3
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• pp.92-108
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• 2009

This study suggests a model for continuing and comprehensive management of hypertension or Type 2 diabetes mellitus (T2DM) in Korea. Moreover, this paper computed the contribution cost of hypertension or T2DM management using the healthcare medical cost, which could have occurred from stroke, myocardial infarction (MI), and end-stage renal disease (ESRD) that were successfully prevented from the effective hypertension or T2DM management. Additionally, these costs were compared with the cost of implementing the hypertension or T2DM management model suggested in this study. This study used the medical fee summary of the health insurance claims submitted to National Health Insurance Corporation by medical facilities for services provided during the period from January 1st 1999 to December 31st 2006. The prevalence rate with treatment referred to cases in which patients submitted their medical claims at least once during the period, along with an accordant diagnosis. The incidence rate with treatment referred to cases in which patients who never submitted claims for the accordant disease during the five years from 1999 to 2003 submitted claims for the accordant disease in 2004 and 2005. The relative risk of the occurrence of stroke, MI and ESRD was 11.0, 13.6, and 30.3, respectively. The attributable risk of hypertension or T2DM for stroke was 0.730, and that for MI and ESRD were 0.773 and 0.888, respectively. Based on these, the contribution cost of hypertension or T2DM is estimated to be 986.3 billion Korean Won(KRW) for stroke patients, 330.5 billion KRW for MI patients, and 561.7 billion KRW for ESRD patients as in 2005. Hence, the total contribution cost of hypertension or T2DM to stroke, MI, and ESRD is 1.878 trillion KRW. The estimate for operational costs included an annual expenditure of 50,000 KRW per each recipient and an annual subsidy of 0.22 million KRW per person for the 1.6 million low.income individuals with hypertension or T2DM to cover their out.of.pocket medical expenses. Under this assumption, it took approximately 0.6 trillion KRW to manage 5 million high.risk patients in the low. and mid.income range, coverings up to 50% of costs. In conclusion, considering the potential benefits of preventing stroke, MI, and ESRD, the costs seems to be reasonable.