• Title/Summary/Keyword: Health Care Cost

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Development of Educational Components of Managerial Cost Accounting for Nurses

  • Lim, Ji Young;Noh, Wonjung
    • Journal of Korean Academic Society of Home Health Care Nursing
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    • v.26 no.1
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    • pp.81-90
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    • 2019
  • Purpose: In accordance with changes in the healthcare environment, it is necessary to understand managerial cost accounting for nurses. This study aimed to develop educational components of managerial cost accounting for nurses. Methods: This study is comprised of a comprehensive literature review, nominal group technique using focus group interview, audit by an expert group, and priority analysis. Results: The comprehensive literature review identified 15 educational components of managerial cost accounting. In the nominal group technique, the participants finally agreed on eight educational components of managerial cost accounting for nurses. The average content validity index of these components was 0.99. "Activity-based costing" scored the highest for relative importance (15.7%). Conclusions: These results can be used to develop an education program to strengthen nurses' managerial cost accounting competencies. Furthermore, it will be helpful to use a basis for the development of cost management curricula for nursing students and on-the-job training courses of nurse managers and executives.

Determinants of Hospital Inpatient Costs in the Iranian Elderly: A Micro-costing Analysis

  • Hazrati, Ebrahim;Meshkani, Zahra;Barghazan, Saeed Husseini;Jame, Sanaz Zargar Balaye;Markazi-Moghaddam, Nader
    • Journal of Preventive Medicine and Public Health
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    • v.53 no.3
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    • pp.205-210
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    • 2020
  • Objectives: Aging is assumed to be accompanied by greater health care expenditures. The objective of this retrospective, bottom-up micro-costing study was to identify and analyze the variables related to increased health care costs for the elderly from the provider's perspective. Methods: The analysis included all elderly inpatients who were admitted in 2017 to a hospital in Tehran, Iran. In total, 1288 patients were included. The Mann-Whitney and Kruskal-Wallis tests were used. Results: Slightly more than half (51.1%) of patients were males, and 81.9% had a partial recovery. The 60-64 age group had the highest costs. Cancer and joint/orthopedic diseases accounted for the highest proportion of costs, while joint/orthopedic diseases had the highest total costs. The surgery ward had the highest overall cost among the hospital departments, while the intensive care unit had the highest mean cost. No statistically significant relationships were found between inpatient costs and sex or age group, while significant associations (p<0.05) were observed between inpatient costs and the type of ward, length of stay, type of disease, and final status. Regarding final status, costs for patients who died were 3.9 times higher than costs for patients who experienced a partial recovery. Conclusions: Sex and age group did not affect hospital costs. Instead, the most important factors associated with costs were type of disease (especially chronic diseases, such as joint and orthopedic conditions), length of stay, final status, and type of ward. Surgical services and medicine were the most important cost items.

The Association between Health Examination and Personal Medical Cost through Panel Survey (건강검진이 개인 의료비지출에 미치는 영향)

  • Lee, Hwan Hyung;Park, Jae Yong
    • Health Policy and Management
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    • v.24 no.1
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    • pp.35-46
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    • 2014
  • Background: This paper describes the relationship and effect of health examination on personal medical cost by identifying the difference of the cost for medical care in physician visit between the population without and with health examination. Methods: After classifying into three cohorts in which, independent variables were designed according to the Andersen's behavioral model, the association of personal medical cost for medical care and prescription drugs which is dependent variable was analyzed by t-test and Mann-Whitney test for description and gamma regression model for inference. Results: In personal average medical cost, the population with health examination paid significantly more than without health examination, 11.6% more in cohort 2008, 26.6% more in cohort 2009, and 48.0% more in combined cohort. The odds ratio on medical expenditure of outpatients with health examination was 1.067, 1.126, 1.398 significantly in cohort 2008, 2009, and combined cohort respectively, comparing to the group without health examination. In independent variables, that is female, the elderly, never married, non-working, non-metropolitan, the higher family income, the smaller family size, people with disability, the people with chronic disease, and people with health examination have significantly being paid more tendency showing positive association with medical cost. Conclusion: This result showed that medical expenditure in physician visit has been increased after taking a health examination. Therefore reasonable limitation of getting preventive medical service is suggested to avoid medical shopping around and reduce being repeated health examination by unifying control to find out easily the clinical results from various medical facilities.

Cost Analysis of Home Nursing Care Patients in Rural Hospital (농촌 지역 중소병원의 가정간호사업소 등록환자의 방문비용분석)

  • Kim, Jin-Soon;Kum, Ran;HwangBo, Soo-Ja
    • Journal of agricultural medicine and community health
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    • v.24 no.1
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    • pp.91-101
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    • 1999
  • The home nursing care system is an integral part of the health care delivery system in order to meet the various needs of consummer, in particular, early discharge patient from the hospital, patient with long term care needed and the elderly. To find out the cost of home nursing care services, the home nursing care records of patients registered by home nursing care units established in public hospital with 150beds during the period of 1996 - 1997 were analyzed. The subjects were 102patients, 45 of male patients and 57 of female patients, those who live in a rural area in Kymiggi - Do The results obtained are as follows : 1. The male patients accounted for 44.1% of the total, with 45cases : group aged 60 years and more was the largest group, accounting for 79.5%. 2. The most frequent disease revealed was the osteoporosis which constitute 35.3% of the total registered patients, followed, in order, by malignant tumor, cerebrovascular disease. 3. It revealed that the cost per visit for the male was 47,764won ; the female, 46,078 won per visit. Noteworthy the cost per visit was high in the older patient. It was clearly that the gender, years of age and the cost per visit were statistically significant at 0.01 level and 0.05 level. 4. The cost per visit for the non complicated disease was slightly higher than the complicated disease, but it is not statistically significant, the cost per visit by type of disease varied, the cost per visit for COPD was the highest, followed, in order, by in malignant tumor, cancer, diabetes, osteoporosis etc. 5. It revealed that home nursing care cost for a eligible disease for home nursing care was less than the cost for hospitalization of the same disease, therefore, we expect that the home nursing care is cost efficiency. In conclusion, the home nursing care costs are needed to analyze further in comparison with the hospitalization costs for a certain disease.

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A study of the Characteristics of Readmitted Patients in an University Hospital in Korea (재입원 환자의 특성연구)

  • Hong, Joon-Hyun
    • Quality Improvement in Health Care
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    • v.2 no.2
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    • pp.56-71
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    • 1996
  • Background : Review of readmissions in health care facilities is necessary from the viewpoint of both economic concerns and quality considerations. To identify the characteristics, factors, and causes of multiple admissions in comparison with single admissions is essential for both providers and payers in order to assure quality care and efficient use of medical resources. Methods: All discharges from an university hospital in 1993 were analyzed, and the characteristics of multiple admissions were identified and were compared with those of single admissions by using the data bases of the discharge abstract and billing for reimbursement. Medical records of patients readmitted within 6 days after the previous discharge were reviewed to identify the reasons for such prompt readmission. Statistical analysis between groups of patients were performed by using SPSS. Result : The mean age was higher in multiple admissions than those of single admissions, and the average length of stay was longer in multiple admissions than in single admissions. The hospital cost per day is higher in single admissions while the cost per case is higher in multiple admissions. More than half of readmissions occurred within one month after the preceding discharges. Above 15% of the readmission within 6 days after the preceding discharges seemed to have close relationship with quality of care provided during the preceding hospitalization. The death rate of the patients readmitted within 6 days was the highest in comparison with multiple admissions and single admissions. Conclusion : Potential preventable readmissions should be reduced by identifying characteristics of multiple admissions, especially unplanned readmission, and by applying some interventions such as standard predischarge assessment or careful follow-up care after discharge for high risk readmission groups. As the results of these efforts, health care facilities could achieve quality improvement in medical care, and effective use of hospital resources.

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Cost-Effectiveness Analysis of Home-Based Hospice-Palliative Care for Terminal Cancer Patients

  • Kim, Ye-seul;Han, Euna;Lee, Jae-woo;Kang, Hee-Taik
    • Journal of Hospice and Palliative Care
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    • v.25 no.2
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    • pp.76-84
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    • 2022
  • Purpose: We compared cost-effectiveness parameters between inpatient and home-based hospice-palliative care services for terminal cancer patients in Korea. Methods: A decision-analytic Markov model was used to compare the cost-effectiveness of hospice-palliative care in an inpatient unit (inpatient-start group) and at home (home-start group). The model adopted a healthcare system perspective, with a 9-week horizon and a 1-week cycle length. The transition probabilities were calculated based on the reports from the Korean National Cancer Center in 2017 and Health Insurance Review & Assessment Service in 2020. Quality of life (QOL) was converted to the quality-adjusted life week (QALW). Modeling and cost-effectiveness analysis were performed with TreeAge software. The weekly medical cost was estimated to be 2,481,479 Korean won (KRW) for inpatient hospice-palliative care and 225,688 KRW for home-based hospice-palliative care. One-way sensitivity analysis was used to assess the impact of different scenarios and assumptions on the model results. Results: Compared with the inpatient-start group, the incremental cost of the home-start group was 697,657 KRW, and the incremental effectiveness based on QOL was 0.88 QALW. The incremental cost-effectiveness ratio (ICER) of the home-start group was 796,476 KRW/QALW. Based on one-way sensitivity analyses, the ICER was predicted to increase to 1,626,988 KRW/QALW if the weekly cost of home-based hospice doubled, but it was estimated to decrease to -2,898,361 KRW/QALW if death rates at home doubled. Conclusion: Home-based hospice-palliative care may be more cost-effective than inpatient hospice-palliative care. Home-based hospice appears to be affordable even if the associated medical expenditures double.

Analysis of the Management of Home Health Care Visiting Vehicles and Nurse bags in Korea (국내 가정간호 방문차량과 방문가방 관리 현황 분석)

  • Choi, Jung Sun;Kim, Sung Nam;Eom, Jae Yeong;Yuk, In Soon;Kim, Sung Hee;Kim, Mi Ran;Park, Ae Suk
    • Journal of Korean Academic Society of Home Health Care Nursing
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    • v.29 no.3
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    • pp.263-277
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    • 2022
  • Purpose: This descriptive study examined the management status of the home health care visiting vehicles and the nurse bags, by the home health care center of hospitals (at the hospital level or higher) in Korea, and identified the relevant factors. Methods: Of 120 managers or home health care nurses from medical institutions at hospital level or higher that provide home nursing, 93 individuals participated in the study in July 2021. Results: Hospitals that followed standard guidelines were more likely to perform internal disinfection of home health care visiting vehicles, and distinguished between clean and contaminated areas inside the visiting vehicles. Further, hospitals that followed standard guidelines were more likely to use more barrier surfaces to protect the surfaces of nurse bags to prevent infection. In addition, hospitals supporting the washing cost of the interior of home health care visiting vehicles were more likely to conduct the washing, and hospitals supporting nurse bags were more likely to use barrier surfaces to protect the bags' surfaces. Conclusion: This study only investigated home health care centers at hospital level or higher. Therefore, to generalize the results of the study, it is necessary to conduct a qualitative study involving additional investigation of home health care visiting vehicles and nurse bags and interviews with nurses from all domestic home health care centers.

Factors Influencing Burnout in Primary Family Caregivers of Hospital-based Home Care Patients (의료기관 가정간호 환자 주돌봄자의 소진에 영향을 미치는 요인)

  • Yang, Ju Ok;Lee, Hye Kyung
    • Research in Community and Public Health Nursing
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    • v.29 no.1
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    • pp.54-64
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    • 2018
  • Purpose: The purpose of this study is to identify factors influencing burnout in primary family caregivers of Home Health Care Patients. Methods: Data were collected from 121 primary family caregivers of home health care patients in three different hospitals in 'D' metropolitan city and the study was conducted from August 10, 2016 to January 17, 2017. The data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's Correlation Coefficient, Stepwise Multiple Linear Regression. Results: Mean scores for the nursing needs of the participants were $3.54{\pm}0.79$, the family functions were $1.24{\pm}0.58$, the burnouts were $2.74{\pm}0.49$. The burnouts were positively correlated with the nursing needs but inversely correlated with the family function. The factor that had the greatest influence on the burnouts of primary family caregivers of Home Health Care was family function (${\beta}=-.245$, p=.001), followed by patients' daily activity (${\beta}=-.213$, p=.014), age (${\beta}=.208$, p=.032), monthly nursing services cost (${\beta}=-.196$, p=.044) and nursing needs (${\beta}=.129$, p=.014). The Explanatory Power of Models was 23%. Conclusion: Individually customized home care nursing intervention programs are required to be provided in accordance with patient's family function and daily activity, monthly home care nursing service cost, nursing needs and general characteristics of primary caregivers of Home Health Care Patients such as their age, the number of family members living together, sex and the name of disease.

The Performance and Implication of A Market-oriented Health Care System in United States (미국 시장지향 의료체계의 성과와 시사점)

  • Lee, Key-Hyo
    • Korea Journal of Hospital Management
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    • v.9 no.1
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    • pp.1-21
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    • 2004
  • The United States has a unique health care system, which is unlikely any other health care systems in the world. The major part of basic functional components of the system -financing, insurance, delivery, and payment- is in private hands. A market-oriented economy invites the participation of numerous private entities that are interested in carrying out the key functions of health systems. Due to this central feature, U.S.health care is not delivered through a network of interrelated components designed to work together coherently. For lack of standardization, the various components of the system fit together only loosely. The involvement of numerous players in the key functions leads to duplication, overlap, inadequacy, inconsistency, and waste, which add to the complexity and also make the system inefficient. Hence, cost containment remains an elusive goals. Moreover, the system falls short of delivering equitable services to all americans, though consumption of health care services is the largest in the world. On the other hand, United States leads the world in the latest and the best in medical technology, medical training, and research. It offers some of the most sophisticated institutions, products, and processes of health care delivery. This article discuss the characteristic features of the U.S. health care system. and its performance, trying to seek its implication on Korean health care system.

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An Operations Study on a Home Health Nursing Demonstration Program for the Patients Discharged with Chronic Residual Health Care Problems (추후관리가 필요한 만성질환 퇴원환자 가정간호 시범사업 운영 연구)

  • 홍여신;이은옥;이소우;김매자;홍경자;서문자;이영자;박정호;송미순
    • Journal of Korean Academy of Nursing
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    • v.20 no.2
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    • pp.227-248
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    • 1990
  • The study was conceived in relation to a concern over the growing gap between the needs of chronic patients and the availability of care from the current health care system in Korea. Patients with agonizing chronic pain, discomfort, despair and disability are left with helplessly unprepared families with little help from the acute care oriented health care system after discharge from hospital. There is a great need for the development of an alternative means of quality care that is economically feasible and culturally adaptible to our society. Thus, the study was designed to demonstrate the effectiveness of home heath care as an alternative to bridge the existing gap between the patients' needs and the current practice of health care. The study specifically purports to test the effects of home care on health expenditure, readmission, job retention, compliance to health care regime, general conditions, complications, and self-care knowledge and practices. The study was guided by the operations research method advocated by the Primary Health Care Operations Research Institute(PRICOR) which constitutes 3 stages of research : namely, problem analysis solution development, and solution validation. The first step in the operations research was field preparation to develop the necessary consensus and cooperation. This was done through the formation of a consulting body at the hospital and a steering committee among the researchers. For the stage of problem analysis, the Annual Report of Seoul National University Hospital and the patients records for last 5 years were reviewed and selective patient interviews were conducted to find out the magnitude of chronic health problems and areas of unmect health care needs to finally decide on the kinds of health problems to study. On the basis of problem analysis, the solution development stage was devoted to home care program development asa solution alternative. Assessment tools, teaching guidelines and care protocols were developed and tested for their validity. The final stage was the stage of experimentation and evaluation. Patients with liver diseases, hemiplegic and diabetic conditions were selected as study samples. Discharge evaluation, follow up home care, measurement and evaluation were carried out according to the protocols of care and measurement plan for each patient for the period of 6 months after discharge. The study was carried out for the period from Jan. 1987 to Dec. 1989. The following are the results of the study presented according to the hypotheses set forth for the study ; 1. Total expenditures for the period of study were not reduced for the experimental group, however, since the cost per hospital visit is about 4 times as great as the cost per home visit, the effect of cost saving by home care will become a reality as home care replaces part of the hospital visits. 2. The effect on the rate of readmission and job retention was found to be statistically nonsignificant though the number of readmission was less among the experimental group receiving home care. 3. The effect on compliance to the health care regime was found to be statistically significant at the 5% level for hepatopathic and diabetic patients. 4. Education on diet, rest and excise, and medication through home care had an effect on improved liver function test scores, prevention of complications and self - care knowledge in hepatopathic patients at a statistically significant level. 5. In hemiplegic patient, home care had an effect on increased grasping power at a significant level. However. there was no significant difference between the experimental and control groups in the level of compliane, prevention of complications or in self-care practices. 6. In diabetic patients, there was no difference between the experimental and control groups in scores of laboratory tests, appearance of complications, and self-care knowledge or self -care practices. The above findings indicate that a home care program instituted for such short term as 6 months period could not totally demonstrate its effectiveness at a statistically significant level by quantitative analysis however, what was shown in part in this analysis, and in the continuous consultation sought by those who had been in the experimental group, is that home health care has a great potential in retarding or preventing pathological progress, facilitating rehabilitative and productive life, and improving quality of life by adding comfort, confidence and strength to patients and their families. For the further studies of this kind with chronic patients it is recommended that a sample of newly diagnosed patients be followed up for a longer period of time with more frequent observations to demonstrate a more dear- cut picture of the effectiveness of home care.

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