• Healthcare Informatics Research
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• v.24 no.4
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• pp.327-334
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• 2018

Objectives: The objective of this study was to investigate the relationship between the level of Electronic Medical Record (EMR) system adoption and healthcare information technology (IT) infrastructure. Methods: Both survey and various healthcare administrative datasets in Korea were used. The survey was conducted during the period from June 13 to September 25, 2017. The chief information officers of hospitals were respondents. Among them, 257 general hospitals and 273 small hospitals were analyzed. A logistic regression analysis was conducted using the SAS program. Results: The odds of having full EMR systems in general hospitals statistically significantly increased as the number of IT department staff members increased (odds ratio [OR] = 1.058, confidence interval [CI], 1.003-1.115; p = 0.038). The odds of having full EMR systems was significantly higher for small hospitals that had an IT department than those of small hospitals with no IT department (OR = 1.325; CI, 1.150-1.525; p < 0.001). Full EMR system adoption had a positive relationship with IT infrastructure in both general hospitals and small hospitals, which was statistically significant in small hospitals. The odds of having full EMR systems for small hospitals increased as IT infrastructure increased after controlling the covariates (OR = 1.527; CI, 1.317-4.135; p = 0.004). Conclusions: This study verified that full EMR adoption was closely associated with IT infrastructure, such as organizational structure, human resources, and various IT subsystems. This finding suggests that political support related to these areas is indeed necessary for the fast dispersion of EMR systems into the healthcare industry.

• Journal of Society of Preventive Korean Medicine
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• v.25 no.2
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• pp.85-98
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• 2021

Objectives : This study aimed to analyze characteristics of the Korean Medicine users aged 19-39 years, the determinants of Korean Medicine use and effects of Korean Medicine use experience on behavioral intentions among youths. Methods : We studied Korean Medicine Utilization and Herbal Medicine Consumption Survey(2017) data set by complex-sample survey data analysis. In order to derive the characteristics of younger users, Rao-scott χ² test and t-test were conducted. Through multiple logistic regression model adjusted by general characteristic variables, the determinants and behavioral intentions of the Korean Medicine utilization among youths were derived. Results : Fist of all, young users and non-users have significant differences in socio-demographic characteristics and perception on Korean Medicine. Among the general characteristic variables, region, age, marital status, occupation, chronic disease, and private health insurance plans had an effect on the Korean Medicine use in young people(Model II). And adjusted by general characteristic variables as control variables, awareness of Korean Medicine and perception of safety of herbal medicine were deduced as determinants of Korean Medicine use(Model III). Secondly, Korean Medicine use experience increased intentions to use and recommend Korean Medicine services(Model IV-1, 3). Conclusions : In order to increase the use of Korean Medicine among young people, Korean Medicine institutions should strive to increase users' satisfaction, and public health insurance coverage for Korean Medicine services needs to be expanded.

• Journal of Korean Clinical Nursing Research
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• v.28 no.1
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• pp.1-12
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• 2022

Purpose: The purpose of this study is to investigate the association between the nurse staffing level and the patient mortality using Korean National Health Insurance data. Methods: The data of 1,068,059 patients from 913 hospitals between 2015 and 2016 were analyzed. The nurse staffing level was categorized based on the bed-to-nurse ratio in general wards, intensive care units (ICUs), and hospitals overall. The x² test and generalized estimating equations (GEE) multilevel multivariate logistic regression analyses were used to explore in-hospital mortality and 30-day mortality after admission. Results: The in-hospital mortality rate was 2.9% and 30-day mortality after admission rate was 3.0%. Odd Ratios (ORs) for in-hospital mortality were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.72, 95% CI=0.63~0.84) and in ICUs with a bed-to-nurse ratio of less than 0.88 compared to that with 1.25 or more (OR=0.78, 95% CI=0.66~0.92). ORs for 30-day mortality after admission were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.83, 95% CI=0.73~0.94) and in ICUs with a bed-to-nurse ratio of less than 0.63 compared to that with 1.25 or more (OR=0.85, 95% CI=0.72~1.00). Conclusion: To reduce the patient mortality, it is necessary to ensure a sufficient number of nurses by improving the nursing fee system according to the nurse staffing level.

• Safety and Health at Work
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• v.14 no.4
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• pp.398-405
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• 2023

Background: Starting from March 2020 until December 2021, different phases of Covid-19 pandemic have been identified in Italy, with several containing/lifting measures progressively enforced by the National government. In the present study, we investigate the change in occupational risk during the subsequent pandemic phases and we propose an estimate of the incidence of the cases by economic sector, based on the analysis of insurance claims for compensation for Covid-19. Methods: Covid-19 epidemiological data available for the general population and injury claims of workers covered by the Italian public insurance system in 2020-2021 were analyzed. Monthly Incidence Rate of Covid-19 compensation claims per 100,000 workers (MIRw) was calculated by the economic sector and compared with the same indicator for general population in different pandemic periods. Results: The distribution of Covid-19 MIRw by sector significantly changed during the pandemic related to both the strength of different waves and the mitigation/lifting strategies enforced. The level of occupational fraction was very high at the beginning phase of the pandemic, decreasing to 5% at the end of 2021. Healthcare and related services were continuously hit but the incidence was significantly decreasing in 2021 in all sectors, except for postal and courier activities in transportation and storage enterprises. Conclusion: The analysis of compensation claim data allowed to identify time trends for infection risk in different working sectors. The claim rates were highest for human health and social work activities but the distribution of risk among sectors was clearly influenced by the different stages of the pandemic.

• Journal of Korean Critical Care Nursing
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• v.17 no.2
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• pp.25-41
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• 2024

Purpose : This study aimed to investigate changes in critical nursing activities from 2009 to 2020 and explore the relationship between nurse staffing and such activities in intensive care units. Methods : A total of 446,445 adult patients admitted to intensive care units in tertiary and general hospitals from 2009 to 2020 were identified using the National Health Insurance claims database. The Critical Nursing Activities Index was calculated based on the following critical nursing activities: ventilator, extracorporeal membrane oxygenation (ECMO), and continuous renal replacement therapy (CRRT). Trend analysis was performed to analyze changes in critical nursing activities over 12 years and to assess linear trends across different staffing levels. Results : The annual utilization days for ventilators, ECMO, and CRRT, as well as the Critical Nursing Activities Index significantly increased over the study period (p-for-trend<.001) in tertiary and general hospitals, except for ventilator use in general hospitals. Ventilator, ECMO, and CRRT utilization exhibited a significant upward trend with higher nurse staffing levels (Bonferroni adjusted p-for-trend<.001). The Critical Nursing Activities Index was significantly higher in hospitals with higher staffing levels compared to those with lower staffing levels (Bonferroni adjusted p <.05). Conclusion : The findings underscore the need for improved nurse staffing levels in intensive care units. Government policies should ensure that staffing levels align with critical nursing activities among critically ill patients to uphold the quality of care.

• Journal of Korean Academy of Nursing Administration
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• v.7 no.1
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• pp.25-40
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• 2001

As the medical market has gradually changed from supplier-centered market to consumer-centered one, it makes hospital managers seek the consumer's satisfaction and the various marketing strategies for survival. Under the these changes, this study was accomplished to measure the consumer's satisfaction about the medial services which a general hospital provided, to identify the marketing strategies that a general hospital could establish for survival. For these purposes, a questionnaire was developed and distributed to 200 patients in general units and 100 patients in oriental units of a general hospital in Seoul. Among them, 163 reponses in general units and 71 reponses in oriental units were turned out to be useful. they were used for final analysis. The results of the survey were as follows : First, among all items of medical services which the hospital provided, patients were most satisfied by nursing services. Second, to Improve the hospital's medical service quality, it was very important for hospital staffs to be courtesy and to explain about a process of treatment or care sufficiently. Third, to decrease cost of medical service, it was very important to develop the various items and premiums of medical insurance especially in field of oriental medicine. Fourth, to make people come to the hospital easy, it was very important of fully utilize the public transportation such as subway. Fifth, to make hospital's image good, it was very important to develop well-prepared public relationship and to continuously provide the diverse medical service in the community.

• Journal of Korean Clinical Health Science
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• v.2 no.3
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• pp.158-166
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• 2014

Purpose. This study pursued the way for the effective application of the differentiated charge (Nursing grading system) by the nursing manpower which is performed for the nursing service quality improvement to the in-patients in Korea and the minimum employment problem solution of nurses. Methods. For this matter, the status of the nursing grade for 1,452 hospitals (44 high class general hospitals, 259 general hospitals, 265 hospitals, 59 oriental medicine hospitals and 825 recuperation hospitals) was identified which were registered in the Health Insurance Review and Assessment Service in March 2011 status quo. Results. In the most nursing grade by the kind of medical institutions, 70.5% of the nurses were third-graded in upper general hospitals, 38.1% were sixth graded in general hospitals, 62.7% were seventh-graded in oriental medicine hospitals and 40.4% were first-graded in recuperation hospitals. In the nursing grade by the scale of hospitals (in terms of the number of beds), there was a significant difference in general hospitals, but there was no significant difference between oriental medicine hospitals and recuperation hospitals. In the nursing grade by the location of hospitals and the foundation type of hospitals, there was a significant difference between general hospitals and recuperation hospitals. Conclusion. For the effectiveness of applying differentiated nursing fees by the number of nurses, it seems necessary to consider adjusting the present differentiated inpatient-charge system for the better so that small and medium-sized hospitals may induce more nurses.

• Journal of dental hygiene science
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• v.8 no.2
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• pp.65-71
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• 2008

The purpose of this study was to examine people's awareness of health insurance in a bid to help improve the management of dental health insurance coverage. The subjects in this study were 1,036 people who included experts in that field and medical consumers. The findings of the study were as follows: 1. In regard to the demographic characteristics of the expert group including gender and age, the female experts outnumbered the males, as the former accounted for 84.7 percent. And the experts in their 20s made up the largest age group, followed by the 30-39 age group and those in their 40s. As to the demographic characteristics of the medical consumers, the rates of the men and women stood at 49.8 percent and 50.2 percent respectively, which were similar. By age, the largest number of the medical consumers were in their 20s, followed by in their 30s and in their 40s. 2. Concerning opinions on the procurement of finance for health insurance, many respondents in both groups agreed that the health insurance coverage should be enlarged by securing more finance, and that items involved in the coverage should be prioritized again. Regarding a means of securing financial resources, the experts placed the most emphasis on extended budgetary support from the government, followed by establishing a social security system and budget compilation by local governments. The medical consumers attached the most importance to extended budgetary backing from the government, followed by budget compilation by local governments and determining contribution according to income level. 3. As for general view of the dental health insurance, the experts believed that the amounts of copayment and self-payment by the insured were appropriate(2.47), and they found the number of benefitted items to be proper(2.29) as well. The medical consumers thought that the benefit percentage of the dental health insurance in the overall health insurance budget was appropriate(2.26), and they also considered the number of benefitted items adequate(2.16). But this group didn't give a lot of marks to the appropriateness of those things. 4. As to perception about the dental health insurance, both groups took a similar view of it. Specifically, they felt the strong need for a dental health insurance system. In terms of satisfaction level, both groups were dissatisfied with it, and there was a strong tendency for them to be discontented with the health insurance coverage.

• Journal of Preventive Medicine and Public Health
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• v.14 no.1
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• pp.3-12
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• 1981

To identify the changes in professional care patterns after the introduction of medical insurance in Korea, professional care in hospitals and clinics of two succeeding years were compared. The hospitals and clinics selected for this study were those which located in Seoul city. Hospitals were classified into 3 categories: university hospital, general hospital and hospital. The diseases selected for this study were acute appendicitis and normal delivery. They were selected because their disease courses are considered to be fairly stable. The variables used for this study were length of stay, total hospital costs, costs of each components of cares. The information used for this study was obtained from the official forms requested by the medical facilities to the Korea Medical Insurance Corporation. The two periods studied were 3 months of each year from March 1st to May 31st in 1979 and 1980, The total number of normal delivery studied was 289 in 1979, 301 in 1980 respectively and the acute appendicitis was 92 and 111 respectively. In order to compare the quantity of medical care between 2 study periods the insurance price scores of 1979 were converted to prices of 1980. For statistical test of difference between 2 periods T-test and Welch's test were used. The result of the study were briefly summarized in below. 1. No significant difference was observed in the average length of stay of both disease between two study periods in all types of hospitals. 2. No significant difference was observed in the average total hospital costs of both diseases in all types of hospital, but in the private clinic the average clinic costs was rather decreased significantly in 1980. 3. More cost decrease were seen than cost increase in 1980 in all types of facilities, More cost changes by items were seen in acute appendicitis than in normal delivery between two study periods. The total hospital costs can be devided into 2 portions: charges for drug and material and for physician. In normal delivery, costs for physician's charges was significantly decreased in almost all the hospitals and costs for drug and material were not changed significantly in all the hospitals in 1980. In the university hospitals, however, the costs for drug and material were increased significantly in 1980. The cost decrease for physician's charge were mainly due to the decrease in the costs of laboratory test, treatment and physical therapy. The increase in the costs for the drug and material in the university hospitals was mainly due to the increase in the cost for drugs for oral administration and injection. 4. The proportion of components of medical care in the hospital has not been changed significantly, however, the cost for injection in normal delivery was characteristically increased in 1980 in all hospitals studied. In general the proportion of the costs for drug and material was tended to increase and the costs for physician was tended to decrease in 1980. The increase in the costs for drug and material were considered to be due to increase in the cost for drugs for oral administration and injection. The decrease in the costs for physician were due to decrease in the costs of laboratory test, treatment and physical therapy. Above mentioned changes in hospital and clinic care patterns are considered to be mostly influenced by the review criteria set by the K.I.C. for the assessment of the fee request made by clinics and hospitals.

• Health Policy and Management
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• v.13 no.1
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• pp.98-115
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• 2003

Concerns about growing health insurance expenditures became a national Issue in 2001 when the National Health Insurance went into a deficit. Increases in spending for ambulatory care shared the largest portion of the problem. Methods and systems to control the spending should be developed and a system to measure case mix of providers is one of core components of the control system. The objectives of this article is to examine the feasibility of applying Korean Diagnosis Related Groups (KDRGs) to classify health insurance claims for ambulatory care and to identify problem areas of the classification. A database of 11,586,270 claims for ambulatory care delivered during January 2002 was obtained for the study, and the final number of claims analyzed was 8,319,494 after KDRG numbers were assigned to the data and records with an error KDRG were excluded from the study. The unit of analysis was a claim and resource use was measured by the sum of charges incurred during a month at a department of a hospital of at a clinic. Within group variance was assessed by th coefficient of variation (CV), and the classification accuracy was evaluated by the variance reduction achieved by the KDRG classification. The analyses were performed on both all and non-outlier data, and on a subset of the database to examine the validity of study results. Data were assigned to 787 KDRGs among 1,244 KDRGs defined in the classification system. For non-outlier data, 77.4％ of KDRGs had a CV of charges from tertiary care hospitals less than 100％ and 95.43％ of KDRGs for data from clinics. The variance reduction achieved by the KDRG classification was 40.80％ for non-outlier claims from tertiary care hospitals, 51.98％ for general hospitals, 40.89% for hospitals, and 54.99% for clinics. Similar results were obtained from the analyses performed on a subset of the study database. The study results indicated that KDRGs developed for a classification of inpatient care could be used for ambulatory care, although there were areas where the classification should be refined. Its power to predict tile resource utilization showed a potential for its application to measure case mix of providers for monitoring and managing delivery of ambulatory care. The issue concerning the quality of diagnostic information contained in insurance claims remains to be improved, and significance of future studies for other classification systems based on visits or episodes is guaranteed.