• 보건행정학회지
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• 제5권2호
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• pp.35-69
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• 1995

The managerial environment of hospitals in Korea characterized by low levels of medical insurance fees is worsening by increasing government regulations as to the utilization of medical services, rising costs of labor, material, and medical equipments, growing patient expectations concerning the quality of services, and escalating competitions among large hospitals in the market. Hospitals should seek for their survival strategies in this harsh environment and they should have information about costs of their products in doing so. However, it has not been available due to the complexity of the production process of hospital services. The objectives of this study were to develop a service-based cost accounting model and to apply the developed model to a study hospital to obtain cost information of hospital services. A model commonly used for the job-order product cost accounting in the manufacturing industry was modified for the use in hospitals in Korea. Actual costs, instead of standard costs, incurred to produce a unit of services during a given period of time were estimated in the model. Data required to implement the model included financial information, statistics for the allocation of supportive cost center costs to final cost centers, statistics for the allocation of final cost center costs to services, and the volume of each services charged to patients during a study period. The model was executed using data of a university teaching hospital located in Seoul for the fiscal year 1992. Data for financial information, allocation statistics fo supportive service costs, and the volume of services, most of them in electronic form, were available to the study. Data for allocation statistics of final cost center costs were collected in the study. There were 15 types of evaluation and management service, 2, 923 types of technical service, and 2, 608 types of drug and material service charged to patients in the study hospital during the fiscal year 1992. Labor costs of each of seven types of pesonnel, material costs of 611 types of drugs and materials, and depreciation costs of 212 types of medical equipments, miscellaneous costs, and indirect costs incurred in producing a unit of each services were estimated. Medical insurance fees for basic services such as evaluation and management of inpatients and outpatients, injection, and filling prescriptions, and for operating procedures were found to be set lower than costs. Infrequent services which use expensive medical equipments showed negative revenuse as well. On the other hand, fees for services not covered by the insurance such as CT, MRI and Sonogram, and for laboratory tests were higher than costs. This study has a significance in making it possible for a hospital to obtain cost information for all types of services which produced income based on all types of expenses incurred during a given period of time. This information can assist the management of a hospital in finding an effective cost reduction strategy, an efficient service-mix strategy under a given fee structure, and an optimum strategy for within-hospital resource allocations.

• 대한의사협회지
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• 제61권11호
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• pp.638-642
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• 2018

Surgery is a very hands-on area of medical care, in that surgeons identify problems in patients' bodies and directly change them through operations. Therefore, it is not only necessary for surgeons to have a high level of expertise, but also to take considerable responsibility for the outcomes of each operation. However, surgery, which was once an object of envy, has long been a process to avoid, due to various circumstances, such as abnormal medical expenses in the medical field and social phenomena that avoids difficult work. It is unfortunate that medical professionals do not receive sympathy from others within the same medical field because of the general difficulties of the profession. The fundamental problem in this situation is the abnormal profit structure of the Korean medical system. Efforts by various related organizations will be needed to objectively evaluate the problems of the current medical insurance system and to make reasonable adjustments considering the difficulty, frequency, and resource-intensiveness of medical care.

• 간호행정학회지
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• 제19권4호
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• pp.449-461
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• 2013

Purpose: The purpose of this study was to explore the relationship between cost and revenue for inpatient nursing activities in general wards. Methods: Data were collected from 12 medical-surgical wards in one general hospital from January 1 to December 31, 2010. The nursing activities were categorized into 2 groups according to nursing service payment type in terms of the Korea health insurance system. Descriptive statistics were used to identify nursing activities and nursing activity costs. Results: Of 140 nursing activities identified as performed in general wards, payment for 69 items was included in nursing management fees. The percentage of each cost for the nursing units was 90% for labor, 4% for materials, and 6% for operating expenses. The cost for medical support nursing service accounted for 38% of costs and nursing management fees, 62%. The average profit and loss was -237,257,000 won. The cost recovery rate for nursing service was only 44%. Conclusion: The results indicate a need to measure the economic value of nursing activities performed in general wards and use it as a basis for establishing an adequate reimbursement system for nursing service.

• 보건행정학회지
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• 제3권1호
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• pp.84-101
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• 1993

The current method of rate adjustment is based on the evaluation of the financial performance of hospitals. The method has the disadvantages such as too complicated, expensive process as well as low reliability due to small sample size. This study, therefore, develops a new model for the rate adjustment with the use of the composite index. In addition to that, it examines the validity of the model by comparing the result of the new method with that of the conventional method. The idea of the new model comes from the Medicare Economic Index(MEI) on which physician fees for the Medicare patients are adjusted periodically in the United States. Medical costs are classified into three groups : labor costs, materials and other expenses. Labor costs are subdivided into physicians and other personnels. Materials are subdivided into drugs and others. Other expenses are subdivided into 5 items. Macro economic indices are selected for each cost item in order to reflect the cost inflation during the specific period. Then the composite index which integrate all items according to the ration of each item in the total costs is calculated. The result from the application of empirical data to the new model is very similar to that of the current method. Furthermore, this method is very simple and also to easy to get social concensus. This model can be replaced the current method based on the analysis of the financial performance for the adjustment of medical fees.

• 한국병원경영학회지
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• 제3권1호
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• pp.100-120
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• 1998

Tertiary been increasing rapidly. There has been shortage of beds in hospitals and effective management of beds had to b considered. For the efficient utilization of the exsisting hospital beds, bed turnover rate ha to be high and their length of stay in hospital has to be shortened. The sample of this study was in-patients admitted in 13 clinical departments of a tertiar hospital in Wonju. Daily medical fees through length of stay in hospital were observed an we analyzed the increase of hospital revenues per bed for the shortening of length of stay. The results of the analysis were as follows: 1. The average length of stay by dept. was 11.0 in dept. of internal medicine. 12.4 in dept. of general surgery, 7.1 in dept. of gynecoloty, 6.8 in dept. of pediatrics, 26.1 in dept. of nervous surgery, 21.6 in dept. of orthopedic surgery, 25.5 in dept. of plastic sersury, 7.6 in dept. of ophthalmology, 7.1 in dept. of E.N.T, 8.1 in dept. dermatoloty, 9.0 in dept. urology. 2. The trend of daily medical fees of in-patients was the highest from the first day to the third day. Because most necessary examination and various treatment or operation took place in these period. 3. The estimative model for medical fees by the length of stay at each clinical department was inferred. 4. The increased revenue per bed by shortening the length of stay was calculated by the estimative model. Shortening one day would increase 305,999 thousand won in dept. of internal medicine 232,138 thousand won in dept. of general surgery., 177,795 thousand won in dept. of gynecology medicine, 69,031 thousand won in dept. of pediatrics 360,381 thousand won in dept. of nervous surgery 211.339 thousand won in dept. of orthopedic surgery, 100,249 thousand won in dept of plastic surgery, 10,569 thousand won in dept. of ophthalmology -814,122 thousand won in dept. of E.N.T, 1,582 thousand won in dept. of dermatology, -5,821 thousand won in dept. of urology. It is expected that they can improve their profitability by shortening the length of stay of the in-patients.

• 보건행정학회지
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• 제3권2호
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• pp.27-80
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• 1993

It is widely known that patients' utilization pattern for medical care facilities and the patientflow are influenced by multi-factors, such as demographic characteristics, structural characteristics of society, socio-psychological characteristics(value, attitude, norms, culture, health behavior, etc.), economic characteristics(income, medical price, relative price, physician induced demand, etc.), geographical accessibility, systematic characteristics(health care delivery system, payment methods for physician fees, form of health care security, etc.), and characteristics of medical facilities(reliability, quality of medical care, convenience, kindness, tec.). This study was conducted to research the mechanism of patient-flow according to changes of health care system(implementation of national health insurance, health care referral system and regionalization of health care utilization, etc.) and characteristics of medical facilities(ownership of hospital, characteristics of medical services, non-medical characteristics, etc.). In this study, the fact could be ascertained that the patient-flow had been influenced by changes of health care system and characteristics of medical facilities.

• 대한한의학회지
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• 제37권1호
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• pp.135-150
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• 2016

Research Methods: This research analyzed the data on those aged 20 and older from the Report on Korean Medicine Usage Research, which was conducted in 2011. The definitions of toxicity were defined by the presence of toxicity listed in the survey. The questions used in analysis were sex, age, household income, health insurance, medical fees, satisfaction rates on treatments, as well as the types of diseases and the presence of toxicity from treatments. The analysis was done through frequency analysis using SAS 9.2 and Fisher's Exact Test. Results: Toxicity occurred in 2.1% patients out of the 3518 studied. The types of toxicity were skin problems, such as hives and pruritus (34.7%), gastrointestinal problems (20.8%), neurological diseases (4.2%), liver(1.4%), kidney toxicity(1.4%), and others (22.2%). There were no differences in toxicity by sex, age, household income and the types of health insurances. However, toxicity were positively correlated with the increase in standard of education (p=0.0124). In addition, as treatment costs increased (p<0.0001) and satisfaction rates decreased, toxicity increased (p<0.0001). Toxicity increased in patients with low back pain (p=0.0429), hwabyung (p=0.0392), lumbar sprain (p=0.0004), correction body type (p=0.0118), growth (p=0.0045), and from motor accidents (p=0.0448). In logistic regression analysis, Toxicity were positively correlated with medical fees, and cancer treatment and negatively correlated with satisfaction rate on treatments. Conclusion: The toxicity that occurred in outpatients who used Korean medical clinics mostly happened in skin, digestive organs, nerves, livers, and kidneys toxicity. The occurrences differed by the Educational lengths, expensive costs of treatments, low satisfaction rates of the treatments, and cancer.

• 한국콘텐츠학회논문지
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• 제17권11호
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• pp.435-445
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• 2017

본 연구는 단순 의료이용의 차이를 확인하거나 제한적인 의료필요와 의료이용지표를 활용하여 의료이용의 형평성을 연구한 선행연구의 한계를 극복하기 위하여 수행되었다. 구체적으로 의료필요지표로 활동제한여부, 만성질환이환여부와 수, 주관적 건강상태를 활용하였고 의료이용지표로 외래와 입원, 응급이용횟수와 진료비를 활용하였다. 아울러 의료필요를 고려한 의료이용의 형평성을 분석하기 위하여 집중지수와 집중곡선, Le Grand계수를 활용하였다. 주요 분석결과, 첫째 단순한 의료이용 집중정도로 볼 때 저소득층의 의료이용량이 고소득층에 비해서 많은 것이다. 특히, 저소득층 입원이용이 외래나 응급이용에 비해서 크게 많았다. 둘째, 저소득층에게 의료필요가 집중된 것으로 나타났다. 즉, 저소득층의 건강상태가 좋지 않은 것이다. 셋째, 의료필요를 고려한 의료이용의 형평성을 확인하기 위하여 Le Grand계수를 산출하였다. 의료필요를 고려하더라도 고소득층의 의료이용량이 많았다. 즉, 단순한 양적인 의료이용은 저소득층의 이용이 많았지만, 의료필요를 고려한 의료이용횟수는 고소득층이 많은 것이다. 또한, 전체진료비는 활동제한여부와 만성질환수를 고려했을 때는 고소득층의 의료이용이 많았으며 주관적 건강상태와 만성질환이환여부를 고려하였을 때는 저소득층의 의료이용이 많았다. 따라서 대체로 저소득층이 건강상태에 비해 의료이용을 충분히 하지 못하는 것을 알 수 있었다. 한편, 저소득층의 주관적 건강상태와 만성질환이환여부 관련 의료필요에 비해 의료비지출이 많았는데 이는 저소득층이 스스로의 건강상태와 만성질환이환에 대한 인식을 소극적으로 함으로써 의료필요가 과소평가된 것이 원인으로 사료된다.

• 한국병원경영학회지
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• 제5권1호
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• pp.129-155
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• 2000

This empirical study, activity-based costing, a newly introduced approach that has proved to be an improvement over the conventional costing system in product or service costing, is applied at department of clinical pathology in K university hospital. The study subjects were 233 test procedures done in clinical laboratory of K university hospital. Activity analysis was done by interview, questionnaires, and time study, and the amount of resources consumed by each activity and their costs are then traced and applied to the laboratory tests. The main purpose of this study were to compare the test costs of activity-bases costing with those of conventional costing, and test fees of medical insurance, and to provide accurate cost informations for the decision makers of hospital. The major findings of this study were as belows. 1. The cost drivers for application of activity-based costing at clinical laboratory were cases of sample collection, case of specimen, cases of test, and volume-related allocation bases such as direct labor hours and total revenue of each test. 2. The profits of each clinical laboratory fields analyzed by conventional costing were different from the profits analyzed by activity-based costing, especially in the field of Urinalysis(approximately over estimated 750%). 3. The standard full costs by conventional costing were quite different from the costs computed by using activity-based costing, and the difference is most significant with the tests of long labor time. 4. From the comparison between costs computed by using activity-based costing and medical insurance fees, some test fees were significantly lower than the costs, especially in the non-automated fields. As described in this study, activity-based costing provides more accurate cost information than does conventional costing system. The former approach is especially important in the health care industry including hospitals in which planning and controlling the costs services provided are the key to maintaining a healthy financial status for the organization. Despite the contribution of activity-based costing the economic as well as technical feasibilities of implementing such a cost accounting system in an organization must be evaluated. In the development of activity-based costing systems, an activity analysis has to be conducted to identify activities that consume resources. This involves a detailed study of the organization's logistics and accounting information systems, and it is an expensive project in itself. Besides, it can be quite difficult and time consuming to identify and trace resource consumption to a specific activity. Thus the activity-based costing system should be implemented only when the decrease in cost of error far exceeds the increase in cost of measurement. By combining activity-based costing with standard costing, health care administrators can better plan and control the costs of health services provided while ensuring that the organization's bottom line is healthy.

• 대한간호
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• 제32권1호
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• pp.61-76
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• 1993

This study was done in order La provide basic data to a Fee System for hospital based Home Health Care services in Korea in the future. It was done by investigating activities provided to possible Home Health Care clients who could be discharged early from genera] hospitals and then estimating the nursing care fee according to each nursing activity based upon the time used for activity. The subjects of the study were selected by convenience sampling and consisted of 35 clients who might be clients for Home Nursing Care and were presently admitted to a medical- surgical ward of Y University Medical Center located in Seoul, Korea. The data collection period was from September 1, 1991 to September 30, 1991. The research in strum nets utilized for the study were a client selection criterial for Home Health Care developed by Choo(l991) and a check-list of nursing activity developed by researcher. The results of the study were as follows : 1. There were 44 different nursing activities provided in the seven days but the time was calculated for only 25 of the nursing activities. 2. Fees for the 25 different nursing activities were calculated by multipling the median of the average wage of a staff nurse having five years experience in an A grade general hospital to the Lime of the nursing activity. The results were compared with the insurance fee which the government recognized as an appropriate fee for that activity. The nursing activities with a lower calculated fee than the insurance fee were suction, catheterization, exercise education and dressing change. The nursing activities with a higher calculated fee than the government recognized fee were 1M injection and vital sign check. 3. There was a range of 1-15 nursing activities provided daily to the client. For the average number of nursing activities per day of 6.26 events the nursing care fee was calaulated at W 6136 per day. 4. Based upon the results of the study, a recommentdation for a Home Health Care fee per visit based on the nursing activities provided could be formulated for a Home Health Care fee system. It could be formulated as following: 1) Home health Care fee per visit $=[(direct{\;} nursing{\;}fee(direct{\;}nursing{\;}care{\;}time{\;}per{\;}activity{\;}{\times}{\;}average{\;}nursing{\;}wage)+indirect fee]{\times}average$ nursing activity per visit]+management fee+ materials fee+a travel fee In this way a nursing fee could be calculated based upon the result of the study of the nursing fees per visit. 2) Nursing activity fees per visit. = $([direct nursing{\;}care{\;}fee+indirect{\;}nursing{\;}fee]{\times}average$ number of nursing activities provided per visit] (W 6, 136) + travel fee(\ 5, 542) +management fee material $fee({\alpha})\{\;}16, 436+{\alpha}$ The nursing fee per visit as calculated in this research of $\{\;}15, 0000+{\alpha}$ could be adjusted according to the patient's condition or the use of high technology nursing care or according to the amount of time spent for travel. The nursing care fee per visit presented in this study can be validated through a Home Health Care demonstration project.