• 보건의료산업학회지
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• 제3권2호
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• pp.1-15
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• 2009

The purpose of this study is to analyze the internal factors that influence the performance of local government hospitals in Korea. There are 34 hospitals in korea as of 2008. Among these hospitals 5 are profit-making and the other loss-making in terms of profitability. Data was collected by Institute of local government hospital union. The major findings of this study was as follows : Firstly, 7 hospitals are high level, over than 100% of fixed ratio. But that result was better than the other study 5 years ago. Secondly, 29 hospitals are bellow 85% of bed occupancy rate. There are a number of hospitals didn't use the facilities and the personnel cost in total costs are high. And lastly, as a result of multiple regression analysis, the factors had on significant effect on normal profit to total assets are personnel cost(-), liability to total assets(-), average length of stay(-), outpatient visits to inpatient days(-). In conclusion, to improve the profitability of hospitals, the efforts to reduce personnel cost and to increase bed occupancy rate.

• 보건행정학회지
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• 제22권1호
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• pp.109-128
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• 2012

The purpose of this study is to analyze the performance difference between multi-hospitals and free-standing hospitals. Scholars in industrial economics argue that, due to economies of scale and integration, multi-hospital system may have a better performance compared to freestanding hospitals. The study overturned the hypothesis based on a theory. By analyzing 425 acute-care hospitals in Korea, this research shows that multi-hospital systems and market factors, which have been perceived to be strengths to hospitals, are negatively related to hospitals' financial performance. Specifically, the results showed a better performance of freestanding hospitals compared to multi-hospital systems. Higher labor and administrative cost by multi-hospital system may be the reason for the difference, and it means they are not more effective at cost control. Managers in multi-hospital system, therefore, should pay attention on cost-reducing issues to regain managerial efficiency of organizations.

• Journal of Preventive Medicine and Public Health
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• 제24권4호
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• pp.531-548
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• 1991

신생아의 질적 관리를 위해 신생아실 의료인력과 의료수가의 타당성을 파악하고자 영남지역내 24개 소아과 수련병원 가운데 신설병원과 모(母)병원의 수련프로그램에 의존해 있는 병원을 제외한 20개 병원의 신생아실을 대상으로 1991년 7월 29일에서 8월 14일 사이에 각 병원을 방문하여 자료를 수집하였다. 자료는 신생아실 대장에서 1991년 6월 한달동안 입.퇴원한 정상 및 환아수를 조사하고 신생아실 수간호사와 소아과 의사를 면담하여 정상신생아 관리에 소요되는 최소한의 간호시간, 인력현황, 인력의 적정성, 그리고 인력확보의 문제점을 조사하였고 자 병원 보험심사과에서 정상 질분만시와 제왕절개분만시 산모 1인당 평균 산모 및 신생아관리분의 의료비를 조사하였다. 정상신생아 1명당 하루에 필요한 최소한의 간호시간은 평균 179.5분(${\pm}58.6$)이었고 대학병원은 202.3분(${\pm}50.7$), 종합병원은 164.2분(${\pm}60.5$)이었다. 최소한의 간호 요구시간 대 제공가능한 간호시간 비는 평균 1.42였고 환아에 대한 간호 요구량을 감안했을 때는 평균 비가 2.06으로 간호인력이 매우 부족하였다. 미국 소아과학회가 권장한 신생아실 간호인력을 기준으로 할 경우 간호사는 31%, 간호조무사는 17%가 충원된 상태였다. 신생아실 수간호사의 90%와 소아과 의사의 85%가 간호사가 부족하다고 했고 간호조무사는 각각 75%가 부족하다고 했다. 간호인력 보충이 안 되는 주된 이유는 재정사정이라고 하였다. 간호조무사의 경우는 인력구하기 힘든 것이 재정사정 다음으로 중요한 이유였다. 그러나 국립대학병원의 경우는 의사와 간호사는 T.O.의 제한이 주된 이유라고 했다. 정상 질분만으로 2박 3일만에 퇴원하는 경우 총 의료비는 평균 219,430원이었고 이 중 신생아분은 20,323원(9.3%)이었으며, 제왕절개분만으로 6박 7일만에 퇴원할 경우 평균 732,578원이었고 이 중 신생아분은 76,937원(12.0%)이었다. 원가계산방식에 의한 신생아관리에 대한 최소한의 원가는 3차진료기관의 경우 1일 16,141원, 기타 종합병원은 14,576원으로 원가가 의료보험수가의 각각 5.0배, 4.9배나 되었다. 오늘날의 의료인력의 인건비 수준과 병원시설 및 관리비를 감안할 때 현행 의료수가로 양질의 신생아관리를 기대하기 어려운 것으로 생각된다.

• 대한영양사협회학술지
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• 제12권4호
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• pp.313-328
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• 2006

This study was objectively performed to identify dietitians' job in the elderly health-care facilities, to assess facilities and dietitian's demographic characteristics, and to determine performance and importance of dietitian's job including the demand of therapeutic diet development. Survey was conducted by mail and samples were the dietitians working in 376 facilities which capacity is over 50 members from nationwide 583 the elderly health-care facilities. Returned questionnaire was 102 and used for statistic analysis. The distributions of the elderly health-care facilities showed 39 the elderly nursing facilities(38.2%), 32 skilled nursing facilities (32.4%), 13 geriatrics hospital facilities(12.7%) and 9 the elderly cost nursing facilities(8.8%). 60.0 percent of the samples showed its menu price as 1,000 to 1,500 won. A cycle-menu program was in-use at the 79.0% facilities, but only 7.1% facilities have been introduced a selected menu system. 92.9% facilities employed only one dietitian. In the demographic characteristics of dietitian only 14.7% dietitian had a clinical dietitian license and 51.5% of respondents answered at least 1 to 3 months internship program is needed. Job activities of the dietitian in the elderly health-care foodservice were identified as 45 activities with 9 dimensions. Job performance score evaluated dietitian oneself was 4.71 of 7 points. The average importance score that the dietitian evaluated their own job was 5.66 points of 7. The job activities shown higher importance but lower performance were therapeutic diet development for in-patients, menu development suitable for taste of the elderly, and leadership. Job performance score by characteristics of dietitian and their elderly health-care facilities was significantly associated with experience of dietitian in elderly health-care (F=4.480, p<0.05), education of dietitian(F=2.659, p<0.01), number of dietitian(F=2.245, p<0.05), and number of employee in foodservice(F=2.607, p<0.05). Most common diseases of the aged was proved as hypertension(81.7%), diabetes mellitus(71.4%), and dementia(65.0%). The therapeutic diets frequently provided were diabetes mellitus diet, dysphagia diet, low sodium diet, high fiber diet, and high protein diet, in order. For those reasons, dietitian in the elderly health care emphasized that the information about therapeutic diet development such as diabetes mellitus diet, dysphagia diet, low sodium diet and hypertension diet must be continuously developed and provided. The result from this study can be applicable to enlarge and enrich job activities of dietitian in elderly health-care foodservice.

• 한국병원경영학회지
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• 제9권3호
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• pp.128-142
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• 2004

To evaluate the effects of critical pathway on the length of hospital stay, the cost and quality of care provided to gastrectomy patients in a tertiary care academic medical center. The basic research design is a retrospective case-control comparative study. 470 patients of gastrectomy were included in the study; 180 before pathway development (control), 163 right after pathway implementation (path group I) and 127 one year after pathway implementation (path groupII). 476 patients of modified radical mastectomy were also analyzed to examine whether the reduction of the length of hospital stay is from the hospital-wide trend or due to the critical pathway. Death after operation, ICU stay, unplanned re-operation, readmission after discharge, the length of hospital stay and cost were analyzed. 2-test, one-way ANOVA, Bonferroni and Turkey's test were used for statistical analysis. (1) There were no significant differences in patient clinical conditions and no sign of deterioration of quality from critical pathway. (2) The length of hospital stay was 13.0 days in control group, 12.2 days in path group I and 10.0 days (p<0.01) in path groupII. (3) The total costs during the hospital stay were reduced. However the cost per day was significantly increased from reduction of hospital stay (358,488won in control, 366,017won in path group I and 413,220won (p<0.01) in path groupII). Critical pathway reduced the length of hospital stay, total hospital costs and resource utilization without harming quality of patient care.

• Journal of Hospice and Palliative Care
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• 제26권2호
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• pp.51-59
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• 2023

Purpose: We evaluated the status of patients enrolled in South Korea's pediatric palliative care pilot project based on the experience of a single center. This study examined factors related to end-of-life services and differences in medical costs. Methods: The medical records of 120 patients referred by a pediatric palliative care team were analyzed retrospectively. Data from July 1 to February 28, 2022 were collected and analyzed using the chi-square test and the Mann-Whitney U test. Results: Volunteer programs and psychological support (100%), family support and education (99.2%), and financial support through institutional linkage (62.5%) were provided to the participants. In the deceased group, there were no significant differences in general characteristics, which included age, gender, primary disease, religion, duration of hospitalization in an intensive care unit (ICU) and non-intensive care unit (non-ICU). However, the ICU group had fewer opportunities to access individual pain and physical symptom management than the non-ICU group and there were limitations in linking with external resources. Medical expenses were significantly different for the ICU group, with a 3-times higher average cost than the non-ICU group. Conclusion: Although an individualized approach is needed for each patient in pediatric palliative care, psychosocial care is essential. In addition, if early intervention for end-of-life pediatric patients is available from a palliative care team, the cost burden of medical care for patients and their families should be minimal.

• KDI Journal of Economic Policy
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• 제12권3호
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• pp.47-69
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• 1990

한국(韓國)의 의료보험제도(醫療保險制度)는 일본제도(日本制度)를 거울삼아 서둘러 적용대상자(適用對象者)를 확대하여 1989년 전국민의료보험(全國民醫療保險)을 달성하였으나 제도(制度)와 효율적(效率的) 운영(運營)을 위한 장치가 결여되어 있고 직장(職場), 공교(公敎), 지역의보간(地域醫保間)에 형평문제(衡平問題) 제기되는 등 구조적인 과제를 안고 있다. 앞으로 제도(制度)의 개혁추진(改革推進) 노력으로 이 분야의 정책수립(政策樹立)과 집행(執行) 에 있어서 경직성을 줄이고 비용효과적(費用效果的)인 의료이용(醫療利用)을 도모해 나가지 못할 경우 낭비요인(浪費要因)이 점점 더 크게 불어나 국민의료비(國民醫療費)가 계속적으로 급속히 증대될 전망이다. 이와 같은 제도(制度)의 질적개선(質的改善)의 필요성에 비추어 최근 네덜란드가 시도하고 있는 제도개혁(制度改革)은 우리에게 여러가지 귀중한 교훈을 던져주고 있다고 판단된다. 네덜란드의 개혁안은 시장경쟁원리(市場競爭原理)를 폭넓게 수용하여 제도(制度)의 능률(能率)을 높이고 의료비(醫療費)를 절감하려는 취지를 담고 있다. 특히 의보가입자(醫保加入者)가 보험자(保險者)를 선택할 수 있고 또한 보험자(保險者)가 의료기관(醫療機關)을 선택할 수 있도록 관계(關係) 집단간(集團間) 상호경쟁(相互競爭)을 유도함으로써 효율(效率)을 증진시켜 나가겠다는 정책방향이 뚜렷히 제시되고 있어 우리의 주목을 끌고 있다.

• Journal of Preventive Medicine and Public Health
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• 제30권4호
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• pp.870-883
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• 1997

The health center has to play an important role in promoting community health and satisfying a variety of community health needs and demands in the decentralized Korea. The nearly enacted Community Health Act compels every health center to make its own health plans which intend to deal with local health problems and plan its future health care. This obligation is obviously a big burden to most health centers. They do not have experiences in and abilities of making local health care plans. In order to establish a systematic community health plan, health centers have to concentrate their efforts on enhancing the ability of making health care plan through gathering and analysing the local health informations. However, it is very difficult in reality. This is simply because it will take long time to accomplish these activities. It seems natural that various professionals and researchers participate in carrying out the process of making community health plan in the initial stage. No standardized methodology and analysing framework exist even in the health professional society. Nonetheless, it is common to introduce survey research methodologies in analysing consumer's health care utilization and cost, and in identifying factors influencing health behaviors. Many researchers and professionals have applied social survey methodologies in obtaining information on providers and health policy makers as well. The authors have found that few studies have ever utilized local health data stored at the self-employed medical insurance society as the data source of planning activities. The purpose of this study is to illustrate the usefulness of the data stored at the Sung-Dong Gu Self-employed Medical Insurance Society in establishing the community health plan. The major contents of this study are as follows ; 1. frequency of utilization by age, area, sex, type of medical care institutions, and some major diseases 2. Medical treatment by type of medical care institutions, by classification of 21 diseases, by frequency of three-character categories 3. Medical treatment of major neoplasm and some chronic diseases by age, sex, and area. The conclusion of this study is that it is of great potentiality to find out the local health problems and to use them in blueprinting the community health plan through comparing the frequency of medical utilization analyzed by a variety of variables with NHI health data or the health data from survey research.

• 대한방사선기술학회지:방사선기술과학
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• 제47권2호
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• pp.107-116
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• 2024

In this study, we analyzed the use of general radiography imaging and effective dose in inpatients. Our aim is to help reduce national medical radiation exposure doses and develop rational health-care financial policies. The effective dose for each general radiography was calculated using the ALARA-GR program for 53 types (total: 260 codes) general radiography codes selected from 'National Health Insurance Care Benefit Cost'. The usage of general radiography was analyzed in the 2018 inpatient patient data of the Health Insurance Review and Assessment Service, and the effective dose for each general radiography was analyzed. 89.00% of inpatients undergo general radiography imaging at least once, with an average of 12.63 scans per person and an effective dose of 1.00 mSv. Those who received support from Medical Aid showed a higher value compared to those who were insured by National Health Insurance, with 17.39 cases and 1.43 mSv (p<.001). Chest had the highest usage rate at 23.12% for general radiography imaging, while L-spine had the highest effective dose at 24.53%. It is estimated that 420 inpatients patients undergo 121 to 820 general radiography imaging procedures per year, and 233 inpatients are estimated to have an annual effective dose of >20.00~58.25 mSv. Rational use of health-care finances and the practice of medical radiation safety management are essential for the well-being of individuals, the enhancement of quality of life, and the improvement of health-care quality.

• Safety and Health at Work
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• 제5권2호
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• pp.66-72
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• 2014

Background: The purpose of this study was to enumerate the annual morbidity and mortality incidence and estimate the direct and indirect costs associated with occupational injuries and illnesses in Bangkok in 2008. In this study, data on workmen compensation claims and costs from the Thai Workmen Compensation Fund, Social Security Office of Ministry of Labor, were aggregated and analyzed. Methods: To assess costs, this study focuses on direct costs associated with the payment of workmen compensation claims for medical care and health services. Results: A total of 52,074 nonfatal cases of occupational injury were reported, with an overall incidence rate of 16.9 per 1,000. The incidence rate for male workers was four times higher than that for female workers. Out of a total direct cost of $13.87 million, $9.88 million were for medical services and related expenses and $3.98 million for compensable reimbursement. The estimated amount of noncompensated lost earnings was an additional $2.66 million. Conclusion: Occupational injuries and illnesses contributed to the total cost; it has been estimated that workers' compensation covers less than one-half to one-tenth of this cost.