• Health Policy and Management
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• v.11 no.2
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• pp.141-168
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• 2001

Healthcare service organizations can apply the cost of quality(COQ) model as a method to evaluate a service quality improvement project such as Total Quality Management (TQM). COQ model has been used to quantify and evaluate the efficiency and effectiveness of TQM project through estimation between cost and benefit in intervention for a quality Improvement to provide satisfied services for a customer, and to identify a non value added process. For estimating cost of quality, We used activities and activity costs based on Activity Based Costing(ABC) system. These procedures let the researchers know whether the process is value-added by each activity, and identify a process to require improvement in TQM project. Through the series of procedures, health care organizations are service organizations can identify a problem in their quality improvement programs, solve the problem, and improve their quality of care for their costumers with optimized cost. The study subject was a quality improvement program of the department of radiology department in a hospital with n bed sizes in Metropolitan Statistical Area (MSA). The principal source of data for developing the COQ model was total cases of retaking shots for diagnoses during five months period from December of the 1998 to April of the 1999 in the department. First of the procedures, for estimating activity based cost of the department of diagnostic radiology, the researchers analyzed total department health insurance claims to identify activities and activity costs using one year period health insurance claims from September of the 1998 to August of the 1999. COQ model in this study applied Simpson & Multher's COQ(SM's COQ) model, and SM's COQ model divided cost of quality into failure cost with external and internal failure cost, and evaluation/prevention cost. The researchers identified contents for cost of quality, defined activities and activity costs for each content with the SM's COQ model, and finally made the formula for estimating activity costs relating to implementing service quality improvement program. The results from the formula for estimating cost of quality were following: 1. The reasons for retaking shots were largely classified into technique, appliances, patients, quality management, non-appliances, doctors, and unclassified. These classifications by reasons were allocated into each office doing re-taking shots. Therefore, total retaking shots categorized by reasons and offices, the researchers identified internal and external failure costs based on these categories. 2. The researchers have developed cost of quality (COQ) model, identified activities by content for cost of quality, assessed activity driving factors and activity contribution rate, and calculated total cost by each content for cost for quality, except for activity cost. 3. According to estimation of cost of quality for retaking shots in department of diagnostic radiology, the failure cost was ￦35,880, evaluation/preventive cost was ￦72,521, two times as much as failure cost. The proportion between internal failure cost and external failure cost in failure cost is similar. The study cannot identify trends on input cost and quality improving in cost of qualify over the time, because the study employs cross-sectional design. Even with this limitation, results of this study are much meaningful. This study shows possibility to evaluate value on the process of TQM subjects using activities and activity costs by ABC system, and this study can objectively evaluate quality improvement program through quantitative comparing input costs with marginal benefits in quality improvement.

• Environmental and Resource Economics Review
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• v.13 no.1
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• pp.49-82
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• 2004

The study aimed to evaluate cancer damage cost due to risk from benzene inhalation. We performed health risk assessment based on US EPA guideline to estimate annual population risk in Ulsan metropolitan city. Also, we estimated a willingness-to-pay amount for reducing a cancer mortality rate to evaluate a value of statistical life. We combined the annual population risk and the value of statistical life to calculate the cancer damage cost. In the health risk assessment, we applied the benzene unit risk ($2.2{\times}10^{-6}{\sim}7.8{\times}10^{-6}$) in the US EPA'S Integrated Risk Information System to assess the annual population risk. Average concentration of benzene in ambient air is $7.88{\mu}g/m^3$(min: 1.16~max: $23.32{\mu}g/m^3$). We targeted an exposure population of 516,641 persons who aged over 30 years old. Using a Monte-Carlo simulation for uncertainty analysis, we evaluated that the population risk of benzene during ten years in Ulsan city is 2.90 persons (5 percentile: 0.32~95 percentile: 9.11persons). And the monthly average WTP for 5/1,000 cancer mortality reduction during ten years is 14,852 Won(95% C.I: 13,135~16,794 Won) and the implied VSL is 36 million Won(95% C.I: 30~40 million Won). Cancer damage cost due to risk from benzene inhalation during 10 years in Ulsan city is about 104 million Won(5 percentile: 13~95 percentile: 328 million Won). Health benefit cost to reduce a cancer mortality risk of benzene is about 50 million Won is Ulsan metropolitann city. But, it is very important that this cost is not for all health damage cost of cancer mortality in some area. We just recommended a model for evaluating a cancer risk reduction, so we must re-evaluate an integrated application of total VOCs damage cost including benzene.

• Journal of Society of Preventive Korean Medicine
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• v.7 no.1
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• pp.17-28
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• 2003

We met results like the followings through the literatures and questionnaires about the tasks and solutions about the insurance fee of packed medical herbs. 1) It's turned out that 74.8% of herb doctors agrees to the insurance fee of packed medical herbs. However, in comparison with the same survey of the herb doctor association the percentage of general approval went somewhat lower, and especially the percentage of 'positive approval' became notably lower$(43.7%{\rightarrow}26.5%)$ and the percentage of 'active objection' raised about 2 times$(6.8%{\rightarrow}12.9%)$. Inquiring into the approval reasons on the insurance fee application of packed medical herbs some heads such as 'development toward treatment medical science' and 'decrease of publics burden' were higher than the one of 'management income and expenditure.' 2) As a result of the research, 36.0% of the patients and 42.8% of the residents recognized that the pay range of Chinese herb health insurance is narrow. They recognized that less people have the experiences of Chinese medical hospital use and internal application of the packed medical herbs as they are older, men rather than women. 85.4% of the patients and 74.9% of the residents agreed on the insurance pay of packed medical herbs. It's shown that they agree on the Chinese medical hospital use more as the economic standard is lower, on the insurance pay as they have ever taken the packed medical herbs. In the aspect of increase of insurance fee, 66.7% of the patients and 44.3% of the residents agreed on the insurance pay of packed medical herbs, and 18.1% and 36.1% disagreed on the insurance pay of packed medical herbs. The main objective reason why they disagree on the insurance pay of packed medical herbs was 'because the insurance fee goes up higher,' which answered 95.2% of the patients and 78.8% of the residents. 7.22% of the patients and 1.80% of the residents answered that they can pay more insurance fee in case of the insurance pay of packed medical herbs. However, in the priority order of the insurance pay, it hold the 5th position between 2 target research groups which was less than medical examination, charges for hospital accommodation and taking MRI. 3) According to the result of analysis about the cost of packed medical herbs, current practice price is 115,000 won and the average prime cost of a packed medical herb is 73,000 to 106,000 won. It's examined that the herb doctors regard that 95,000 won will be reasonable when the packed medical herb is payed in insurance. However, it was found out that the public generally thinks that the price would be appropriate on the level of 30,000 to 40,000 won and the percentage of the answers of 20,000 won to 30,000 was fairly high. 4) the central system of a prescription should be change into the central system of demonstration and the sick and wounded. 5) To solve this problem, the government should regulate it to pass by the circulation gradation of [importer, $peasantry{\rightarrow}manufacturer{\rightarrow}wholesaler{\rightarrow}distributor$(Chinese medical hospital, pharmacy dispensary of Chinese medicine)]And it should intervene into the quality and the circulation steps of Chinese medicine through 'the office or organization which is in charge of certification of Chinese medicine' and 'the office or organization which is in charge of the circulation of Chinese medicine.' And some actions such as simple severance, lavation, drying should be included into the conception of manufacture and the boundary between food and medical supplies should be made at a manufactory. And the regulation of standardized goods at one's own house should be improved so that, the peasantry can sell the materials of Chinese medicine only to the manufacturer. 6) In company with the insurance pay of packed medical herbs, the study about the separation of dispensary from medical practice in the Chinese medicine should be accomplished.

• Journal of dental hygiene science
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• v.14 no.1
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• pp.67-73
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• 2014

This study analyzed 548 pieces of these, which were reported in the Journal of Dental Hygiene Science of having been published from 2001 to Vol. 12, No. 6 in 2012. In conclusion, as for analysis of research design, first, it was the largest in cross sectional research. Second, the research subjects of survey theses were higher in order of dental hygienist and dental hygiene student. Third, number of thesis authors was the largest in order of two persons and three persons. Fourth, statistical method was in order of descriptive statistics, t-test, and ANOVA. Research theme was in order of dental health behavioral science and clinical dental hygiene. Fifth, as for research-expense benefit, only 17.7% was supported research funds. As a result of this study, there should be a research on thesis of diverse designs in the future. There is a need of being performed actively a research on alienated classer or special subjects as well as a research on activity related to dental hygiene.

• Journal of Korean society of Dental Hygiene
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• v.7 no.4
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• pp.583-594
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• 2007

The purpose of this study was to conduct a survey on the senses that preliminary dental hygienists have on employment, who applied for the National Dental Hygienist Examination, so that it could provide a basic reference required for fostering good human resources specializing in oral health with a sense of mission and responsibility as professional. To meet these goals, a self-administered questionnaire survey was conducted for participants in a refresher education meeting for preliminary dental hygienists across three major regions(Seoul, Daejeon and Busan), which was held by the Korean Dental Hygienists Association(KDHA) on Jan. 15, 2006. Total 289 sheets of questionnaire were collected, and 262 sheets except invalid or incomplete ones were used for examination and analysis. As a result, this study came to the following conclusions: First, it was found that 40.4% respondents wanted to be employed in dental clinic or hospital. Most respondents(90.1%) answered that faithfulness is most valued as prerequisite qualification for employment in hospital, and highest percentage of respondents(39.3%) wanted to earn 16 to 17 million Korean won annually. For internship opportunities, 61.9% respondents replied that they could willingly accept the internship, provided that basic pay and switchover to regular employee are all assured. Second, as the results of survey on employment circumstances around respondents, it was found that most respondents(58.3%) were employed in dental clinic or hospital, and highest percentage of respondents(35.0%) earned 15 to 16 million Korean won. Third, it was found that interpersonal relationships among employees had most significant effects(4.81) on selection of employment, which was followed by in-house welfare benefits 1(monthly/annual vacation, resting room, etc; 4.56). For possible influential factors on the selection of employment depending on whether employed or not, it was found that there were Significant differences in pay, welfare benefit 2(seminar, orientation, refresher training opportunities, etc), post-wedding continued employment and merit system between employees and non-employees(pE0.05). Fourth, the survey on respondents' occupational senses of dental hygienist showed that major tasks of dental hygienists were represented by oral disease prevention(92.6%), case management(71.5%), oral health education(66.3%), hospital/clinic management and dental management support(10.4%) and public oral health activities(6.7%) respectively. For job satisfaction, it was found that almost half respondents(48.9%) showed satisfaction at their job and 32.6% felt satisfied at and proud of their job. That is, majority of respondents(81.5%) felt satisfied at their job as dental hygienist. For follow-up requirements to qualify for dental hygienists, it was found that 73.3% felt it necessary to give more investments to self-development, 62.2% respondents considered protection of membership's rights as one of future assignments that KDHA should be more committed to. For future social awareness about dental hygienists as occupation, 69.2% respondents expected that they would be better developed and treated as professional. And desired training courses as a part of qualification for professional dental hygienists were represented by case management(services, manners, etc; 33.3%), implant(28.9%), esthetics(correction, prosthesis, whitening; 18.9%) and so on. For an item on working years, it was noted that 75.9% respondents would keep working as dental hygienists as long as they could.

• Journal of The Korean Ophthalmological Society
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• v.59 no.11
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• pp.1039-1048
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• 2018

Purpose: To evaluate the effects of anti-vascular endothelial growth factor (VEGF) treatment on the healthcare-related finances of patients with age-related macular degeneration. Methods: Changes in health care financing due to newly introduced benefit standards were predicted over the coming 5-year period (2018-2022). We also analyzed the financial impact of scenarios in which agents similar to anti-VEGF, such as the over-licensed drug bevacizumab, were introduced. For this purpose, the future number of patients receiving anti-VEGF treatments was estimated for various scenarios based on National Health Insurance Corporation claims data followed by an estimate of the financial burden. Results: In the case of age-related macular degeneration, the current standard of care (14 times in a lifetime) was maintained in scenario 1. In 2018, the insurance budget for the coming 5-year period was estimated at approximately 440.3 billion won. The insurance cost for that period was estimated at approximately 560.1 billion won under the revised standard of December 2017 (scenario 2). For scenarios wherein, after 2020, similar treatments (scenario 3) and bevacizumab (scenario 4) were introduced, the estimated health insurance costs were 521 billion won and 419.7 billion won, respectively. Conclusions: Health insurance costs are projected to increase substantially due to the elimination of the 14 time pay standard; however, the actual budget will only moderately increase, due to new limitations of visual acuity ${\leq}0.1$ or in case of scarring/atrophic lesions. Clinically similar agents and bevacizumab could be considered as alternatives to anti-VEGF treatment for age-related macular degeneration.

• 한국노년학
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• v.30 no.4
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• pp.1359-1375
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• 2010

Expecting the expansion of the elderly population under long-term home care with the coming of the aged society, this study purposed to propose a prevention and self-reliance support model and to get practical implications for minimizing dependency on care benefits and enhancing the effectiveness of prevention and self-reliance support. Research methods employed for this study were: first, reviewing theoretical literature for clarifying the concept of prevention and self-reliance support in providing long-term care benefits for the elderly; second, identifying factors hindering prevention and self-reliance support through analyzing standard long-term care use plans and documents related to long-term care benefits at elderly welfare centers to which the research subjects belonged; and third, surveying care benefit users on factors hindering their use of prevention and self-reliance support and their needs in the use of care benefits. Based on the results of the three types of qualitative research, we proposed directions for prevention and self-reliance support modeling and suggested practical implications for enhancing the effectiveness of prevention and self-reliance support. For this study, we collected documentary materials and conducted in-depth interviews with the participants with the consents and cooperation of managers and professional social workers at day care centers and elderly welfare centers in D City. According to the results of this study, literature review suggested that long-term care prevention and self-reliance support should be provided in a way of 'strengthening user-centered support systems,' which support elderly long-term care beneficiaries' right to lead a life as the subject of their own life. Document analysis found the absence of benefits related to health and medicine and lack of social support systems for prevention and self-reliance support, and the results of in-depth interviews suggested the necessity to strengthen services related to elderly long-term care beneficiaries' prevention and self-reliance, and the keen needs of the long-term care elders for prevention and self-reliance included: ① loneliness, anxiety, fear; ② missing for and worry about children and people; ③ moving, outing; ④ health and medical services, rehabilitation programs; ⑤ desire to use day care; ⑥ inconvenience of house structure; ⑦desire for meal menus; and ⑧ the occurrence of disuse syndrome. Based on these results, we suggested the base of prevention and self-reliance support modeling with three axes: ① strengthening user-centered support systems; ② strengthening support systems connected to health and medicine; and ③ strengthening social support systems.

• Journal of Preventive Medicine and Public Health
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• v.33 no.3
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• pp.285-298
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• 2000

Objectives : To investigate the positive rate of Helicobacter pylori in patients with dyspepsia; medical compliance and related factors; the eradication rate a year after screening and related factors; the relationship between the eradication of Helicobacter pylori and the improvement of symptoms; and the estimated cost of three alternative approaches to treat Helicobacter pylori in the community. Methods : A total of 510 subjects with dyspeptic symptoms were selected and given the serological test in March 1998. The subjects were all adults over 30 years of age residing in Kyongju city. Results : Of the 510 selected subjects, 375 (73.5%) subjects proved positive for Helicobacter pylori on serological testing. Of these 304 (81.1%) who consented to an endoscopic examination, underwent a Campylobacter-like organism (CLO) test. Of these 304 subjects, 204 (67.1%), who had positive CLO test results, were given the triple therapy - tripotassium dicitrato bismuthate, amoxicillin, and metronidazole. To determine the eradication rate of Helicobacter pylori, 181 (88.1%) out of the 204 subjects who were given the triple therapy completed a follow-up urea breath test one year later. Of these, the Helicobacter pylori of 87(48.1%) subjects was eradicated. Among the 122 subjects who were medication compliant, the Helicobacter pylori eradication rate was 57.4% (70 subjects), while the eradication rates was only 28.8% (17subjects) in the non-compliant group. The Helicobacter pylori eradication was significantly related to compliance (p<0.01), but not to other characteristics and habits. The symptom improvement rate tended to be higher 62.1%), in the Helicobacter pylori eradicated group than in the non-eradicated group (59.6%). Conclusions : When the advantages and disadvantages of each alternative treatment were considered in the light of cost, antibiotic tolerance and the number of patients to be treated, alternative II was favorable in terms of cost. Alternative III was favorable in terms of the number of patients to be treated, antibiotic tolerance and early detection of gastric cancer. Further long-term research analyzing the cost-benefit and cost-effectiveness of each treatment will be needed as supporting material in creating new policies.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.4
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• pp.1909-1915
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• 2016

Background: The purpose of this study was to determine the benefit of tertiary cytoreductive surgery (TC) for secondary recurrent epithelial ovarian cancer (EOC), focusing on whether optimal cytoreduction has an impact on disease-free survival, and whether certain patient characteristics could identify ideal candidates for TC. Materials and Methods: Retrospective analysis of secondary recurrent EOC patients undergoing TC at three Turkish tertiary institutions from May 1997 to July 2014 was performed. All patients had previously received primary cytoreduction followed by intravenous platinum-based chemotherapy and secondary cytoreduction for first recurrence. Clinical and pathological data were obtained from the patients' medical records. Survival analysis was caried out using the Kaplan Meier method. Actuarial curves were compared by the two tailed Logrank test with a statistical significance level of 0.05. Results: Median age of the patients was 49.6 years (range, 30-67) and thirty-eight (72%) had stage III-IV disease at initial diagnosis. Twenty six (49%) had optimal and 27 (51%) suboptimal cytoreduction during tertiary debulking surgery. Optimal initial cytoreduction, time to first recurrence, optimal secondary cytoreduction, time interval between secondary cytoreduction and secondary recurrence, size of recurrence, disease status at last follow-up were found to be significant risk factors to predict optimal TC. Optimal cytoreduction in initial and tertiary surgery and serum CA-125 level prior to TC were independent prognostic factors on univariate analysis. Conclusions: Our results and a literature review clearly showed that maximal surgical effort should be made in TC, since patients undergoing optimal TC have a better survival. Thus, patients with secondary recurrent EOC in whom optimal cytoreduction can be achieved should be actively selected.

• Journal of Nutrition and Health
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• v.49 no.3
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• pp.179-188
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• 2016

Purpose: This cross-sectional study aimed to document the dietary behaviors, dietary changes, and health status of female marriage immigrants residing in Gwangju, Korea. Methods: The survey included 92 female immigrants attending Korean language class at a multi-cultural family support center. General characteristics, health status, anthropometric data, dietary behaviors, and dietary changes were collected. Results: Mean age of subjects was 31.3 years, and home countries of subjects were Vietnam (50.0%), China (26.0%), Philippines (12.0%), and others (12.0%). Frequently reported chronic diseases were digestive diseases (13.2%), anemia (12.1%), and neuropsychiatry disorder (8.9%). Seventeen percent of the subjects was obese ($BMI{\geq}25kg/m^2$). Dietary score by Mini Dietary Assessment was 3.45 out of 5 points. Dietary scores for dairy foods, meat/fish/egg/bean intake, meal regularity, and food variety were low, and those for fried foods and high fat meat intake were also low. Thirty-three percent of subjects answered that they have changed their diet and increased their consumption of fruits and vegetables after immigration. Length of residence in Korea was positively associated with BMI and waist circumference. Length of residence tends to be positively associated with dietary changes and obesity as well as inversely associated with disease prevalence. Conclusion: The study shows that length of residence is inversely related to disease prevalence. However, this association is thought to be due to the relatively short period of residence in Korea and thus the transitional phase to adapting to dietary practices. As the length of residence increases, disease patterns related to obesity are subject to change. Healthy dietary behaviors and adaptation to dietary practices in Korea in female marriage immigrants will not only benefit individuals but also their families and social structure. Therefore, varied, long-term, and target-specific studies on female marriage immigrants are highly needed.