• 한국병원경영학회지
• /
• 제10권1호
• /
• pp.48-70
• /
• 2005

The purpose of this study was to make an analysis of the impact of the DRG payment system on medical care pattern and cost of cataract surgery in a general hospital. The subjects were 173 patients whose DRG severity grade was zero, selected from among the hospitalized who underwent cataract surgery before and after the joining to the demonstrational operation of the third year DRG payment system. Their medical records and the details of their medical bills were examined to find out the length of hospital stay, medical care pattern provided to them, the cost of medical care, and the quality of medical care. The length of stay and the amount of medical care supplied during being in hospital dropped significantly for both single-eye and double-eyes cataract surgery groups. The amount of antibiotic use went down during the hospitalization and upon discharge from the hospital, but decreased after discharge. The total medical bills and the rate of basic examination implementation increased in the OPD before hospitalization but after discharge dropped. For double-eyes cataract patients, the rate of double-eyes cataract surgery went down. The total medical bills of DRG payment system converted into the fee-for-service system was greater by 113.3% for the single-eye cataract surgery group and by 102.9% for the doble-eyes cataract surgery group, compared to that by the fee-for-service. The contribution shared by the insurance corporation increased for both single-eye and double-eyes cataract surgery groups, but the copayment by the insured went down. Regarding the treatment outcome, no difference was found in complication rate, resurgery rate and mortality rate before and after the joining to the DRG payment system was implemented. The use of special lens lessened significantly. The amount of medical care supplied during hospitalization decreased but the complication rate didn't increase. But the increased use of low-price artificial cataract and the avoidance of double-eyes cataract surgery was observed. The phenomenon decreased number of OPD visit and the decreased total medical bills of OPD care after discharge in this hospital required further evaluation.

• 보건행정학회지
• /
• 제33권1호
• /
• pp.19-28
• /
• 2023

Background: With the enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act in February 2018, legal guidelines for physician orders for life-sustaining treatment (POLST) were presented. This study was conducted to analyze the association of writing POLST on the use of health care before death. Methods: The study analyzed the electronic medical records and POLSTs of 1,003 adult patients who died at a tertiary hospital located in Seoul from February 4, 2018 to February 4, 2019. Results: Of the deaths, 80% (n=804) completed POLST. Among patients who completed POLST before death, 51% (n=412) were written 1-7 days before death, and only 31% (n=246) were completed by patients themselves. 99% (n=799) decided to withdraw or withhold cardiopulmonary resuscitation. As a result of analyzing the effect of POLST on medical use before death, it was found that POLST and inpatient cost had a significant negative correlation, and POLST completion significantly reduced death in the intensive care unit (ICU). However, both inpatient costs and death at ICU increased when the POLST was completed by surrogate decision-makers rather than patients themselves. Conclusion: The enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act provided a legal basis for withdrawing and withholding meaningless life-sustaining treatment. By specifying the treatment to be received at the end of one's life through the POLST, inpatient treatment costs and death at the ICU were decreased. However, the frequent decision-making by the surrogates and completion of POLST close to death may hinder the original purpose of the law.

• 한국병원경영학회지
• /
• 제29권2호
• /
• pp.37-47
• /
• 2024

Purpose: This study aimed to determine the effect of adjusted out-of-pocket maximum rules in the 'differential co-payment ceiling', which means having a higher burden of co-payment, that expanded to the entire ceiling level in long-stay admission patients in long-term care hospitals(LTCH). Methodology: We used health insurance claim data between January 1, 2022, and December 31, 2022 received from the National Health Insurance Service. The study populations were inpatients in long-term care hospitals more than 1 days during the study period. We performed the difference in characteristics of the LTCH patient of the differential and general ceiling by the chi-square test. We estimated the change of the population, cost, and co-payments per person under the assumption of restructuring. Finding: Based on adjusted out-of-pocket maximum rules in 2023, it was expected that the number of benefits decreases at the high-income level while increasing at the low-income level. The burden of health expenditure after reimbursement of co-payment ceiling, is expected to increase by 65.1% in the highest medical necessity, whereas the low medical necessity would decreases compared to 2022. Practical Implications: The results demonstrate that the current out-of-pocket maximum rules do not reflect the needs of medical necessity. This study suggested the need to reflect the medical necessity in LTCH on the out-of-pocket maximum rules in the future.

• Journal of Hospice and Palliative Care
• /
• 제5권2호
• /
• pp.101-110
• /
• 2002

Purpose : With the elongation of the average life span, the main causes of death are chronicle illness including cancers resulting in a large amount of medical resources. And there are still many patients to whom a sufficient medical care is not given. All these bring on the uneven distribution of medical resources together with the increase of medical cost. Hence, an efficient system should be set up to solve these problems. Methods : The hospice draws a great attention as a resolution of high medical cost and uneven medical resource distribution, and has been proved to be an alternative to the existing medical system. So, the characteristics of the hospice has been reviewed, particularly with respect to its scopes and related resources. And by tracking the actual cases, the necessary services and supports are investigated. Results : The intrinsic characteristics of hospice is that it executes not only the medical exercise but also all the subjects related with patients and their families. And the hospice is performed not only by the medical experts but also by all the disciplines including social and spiritual affairs. This indicates that the hospice requires the integrated system comprised of medical, social and other welfare entities. Conclusion : To establish the actual hospice, an efficient and systematic integration of all the existing medical and other welfare resources in the local society is necessary. The most practical way is the networking of resources, which practices the hospice more efficiently without additional investment.

• 가정∙방문간호학회지
• /
• 제6권
• /
• pp.5-18
• /
• 1999

This study was attempt to encourage for developing on rehabilitation delivery system and programs as a substitute service instead of hospitalization for accident patients at work, such as hospital based home health care nursing service. It needs vary substitutes service of hospitalization to curtail the length of stay for inpatients who were hospitalized with workers compensation insurance. It focused on developing an estimation of early discharge day of accident inpatients based on a detail statement of treatment for 115 inpatients who were hospitalized at General Hospital in 1997. This study has four specific purpose as follows. First, to find out the status of health service utilization. Second, to estimate the early discharge days and income increasing effect based on the early discharge for those patients. Third, to identify the factors to affect total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze of the length of stay and medical expenditure for inpatients who were hospitalized due to the accident, the authors conducted with micro-analysis and macroanalysis from medical records and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria. such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the tests consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, stable conditions. In addition to identify affected variables for medical expenditure. the length of stay and income effect due to early discharge day, the data was analyzed with multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study as follows. First, the mean length of stay was 37.1 days, whereas the mean length of stay due to early discharge was 28.2 days at the hospital. The estimation of early discharge days were shown that depends on the length of stay. The longer length of stay, the longer length of early discharge days, such as under 7 days length of stay patients was to estimated the mean length of stay was 4.9 days and early discharge days was 4.6. whereas the mean length of stay was 122.6 days and early discharge days was 92.0 respectively. The mean medical expenditure per day were found to be 133.409 Won. whereas the mean medical expenditure per day was shown negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to 11 early discharge days per bed was around 2,150,000 won. However, it means not the real benefits from early discharge, but the income increasing amount without considering medical prime cost in general hospital. Therefore, it needs further analysis on the cost containments and benefits under the considering as well turn over rates per bed as the medical prime costs. The length of stay was most significant and the sign was positive to the total medical expenditure, as expected. Surgery and patient's residential area also an important variable in explaining medical expenditure. The level of complications was most significant variable in explaining the length of stay. The level of the needs on horne health care nursing service which can be used for early discharge accident patients were shown very high. The needs distribution varied from 65.5% of patients and 88.9% of caregivers, to 96.4% of doctors, and 99.1% of nurses. In addition horne health nurse responded that they can be managed the accident inpatients from early discharge. From these research findings. the following suggestions has been drawn it needs to develop strategies on rehabilitation delivery system in order to focused on consumer's side which is planned for 21 century health policy in Korea. Vary intermediate facilities and horne health care would have been developed in the community based for comprehensive rehabilitation services as a substitutes of hospitalization for shortening the length of stay of hospitalizations. In hospital based horne health care nursing service, it's available immediately to utilize for the patients who wanted rehabilitation services as a substitutes of hospitalization under the cooperations with workers compensation insurance company.

• 한국의료질향상학회지
• /
• 제14권1호
• /
• pp.55-59
• /
• 2008

Background : The purpose of inner cannula is to protect the upper air way and permit air to pass freely, in addition, to provide endotracheal suction, artificial respiration and to maintain adequate oxygen saturation. The tube needs to be sterilized for maintenance and cleanness of air way and for prevention of bronchospasm. However, it has been reported that there is no guideline for sterilization and many hospitals conduct their own sterilization methods, for example, once a day(13's general hospital), three times a day(The Catholic University of Korea ST Mary's hospital) or even no cleansing. Consequently, the QI team of our hospital suggested the SOP(standard operating procedure) of sterilization and evaluate cost and time effect in nursing. Method : 1) Benchmarking of 13's neurosurgery department of general hospital in Seoul 2) Investigation of test records of sputum culture from patients with intubation for tracheotomy 3) Check of results of O2 Sat. monitoring to confirm of maintaining opened air way Result : 1) Improvement of process: decrease of excess sterilization of inner cannula (from 3 times a day to once a day) 2) Cost effects: saving over 10 million won per one year 3) Providing better nursing: time effects (30 min a day) permit to conduct more nursing activities Conclusion : It can get Cost and time effects in nursing with improved sterilization method of inner cannula. It needs to do research on improvement of the monthly exchange protocol of outer cannula and provide supporting data for the proper exchange schedule. The result of additional microorganism detection from patients with new process needs to be evaluated further more.

• 대한약침학회지
• /
• 제24권3호
• /
• pp.142-151
• /
• 2021

Objectives: Although Korean Medicine (KM) subsidized by the National Health Insurance (NHI) has been used for a long time, there has been no active analysis using claims data. Therefore, the purpose of this study was to examine the NHI KM utilization trend using NHI statistics and to measure the level of market concentration by year. Methods: By restructuring the contents of NHI Statistics for Pharmaceuticals for 2010-2019, the claim cases, costs, and annual growth rates of KM were demonstrated by year, sex, age group, region, therapeutic group, and KM treatment. The proportion of highly used k treatments in cost was calculated as the concentration ratio (CR) k and its trend by year was investigated. Results: In 2019, the NHI cost on KM amounted to ₩38.2 billion KRW, increasing by 11.6% per year on average in 2010-2019. Notably, KM was used more frequently among women and patients aged ≥ 65 years, and the mixed formulation accounted for 95% of the total cost of KM. The CR of the simple formulation increased rapidly, whereas that of the mixed formulation remained constant. In 2019, three simple formulation treatments- peony, licorice, and ginseng- accounted for 93.8% of the total cost for KM (CR3 = 93.8%). Conclusion: NHI KM is rapidly increasing. Investigating the CR of KM confirmed that KM prescriptions have been concentrated in small numbers over the past 10 years.

• Journal of Preventive Medicine and Public Health
• /
• 제28권1호
• /
• pp.207-223
• /
• 1995

A new medical delivery system which regulated outpatient department(OPD) use from tertiary care hospitals was adopted in 1989. Under the new system, patients using tertiary care hospital OPD without referral slip from clinics or hospitals could not get any insurance benefit for the services received from the tertiary care hospital. This study was conducted to evaluate the Patient Referral System(PRS) with respect to health care expenditures and utilization. Two data sets were used in this study. One was monthly data set(from January 1986 to December 1992) from the Annual Report of Korea Medical Insurance Corporation(KMIC). The other was monthly joint data set composed of personal data of which 10% were selected randomly with their utilization data of KMIC from January 1988 to December 1992. The data were analyzed by time-series intervention model of SAS-ETS. The results of this study were as follows: 1. There was no statistically significant changes in per capita expenditures following PRS. 2. Utilization episodes per capita was increased statistically significantly after implementation of PRS. The use of clinics and hospitals increased significantly, whereas in tertiary care hospitals the use decreased significantly immediately after implementation of PRS and increased afterwards. 3. Follow-up visits per episode were decreased statistically significantly after implementation of PRS. The decrease of follow-up visits per episode were remarkable in clinics and hospitals, whereas in tertiary care hospitals it was increased significantly after implementation of PRS. 4. There was no statistically significant changes in prescribing days per episode following PRS. Futhermore, clinics and hospitals showed a statistically significant decrease in prescribing days per episode, whereas in tertiary care hospital it showed statistically significant increase after implementation of PRS. 5. Except high income class, the use of tertiary care hospitals showed statistically significant decrease after implementation of PRS. The degree of decrease in the use of tertiary care hospitals was inversely proportional to income. These results suggest that the PRS policy was not efficient because per capita expenditures did not decrease, and was not effective because utilization episodes per capita, follow-up visits per episode. and prescribing days per episode were not predictable and failed to show proper utilization. It was somewhat positive that utilization episodes per capita were decreased temporarily in tertiary care hospitals. And PRS policy was not appropriate because utilization episodes per capita was different among income groups. In conclusion, the PRS should be revised for initial goal attainment of cost containment and proper health care utilization.

• 한국치위생학회지
• /
• 제16권2호
• /
• pp.195-204
• /
• 2016

Objectives: The purpose of the study is to investigate the knowledge, attitude, and recognition of health insurance coverage in tooth implant among Korean adults. Methods: A self-reported questionnaire was completed by 420 adults over 20 years lod in Seoul and Gyeonggido from October 1 to December 15, 2014. The questionnaire consisted of general characteristics of the subjects, knowledge, attitude, and recognition of health insurance coverage in tooth implant. Results: The mean of knowledge of regular checkup after implant was 3.05 points, and mean of advantage and disadvantage of implant was 3.03 points. The expectation for the implant treatment was 4.18 points and this was the highest score. There was no significant difference between the knowledge and attitude in age and monthly compensation(p>0.05). Only 45.6% of the adults were aware of the health insurance coverage of tooth implant since July, 2014. Health Insurance meeds to be modified in the beneficiaries age(44.6%), and cost(32.7%). The positive aspects of implant care included medical expenses(37.8%), health care beneficiary(29.1%), and oral health promotion(20.9%). Conclusions: Health insurance coverage of tooth implant is very important to enhance the quality of life in the adults because the proper management and implementation of the health insurance in implant will improve the oral health care in life.

• 보건행정학회지
• /
• 제8권1호
• /
• pp.1-14
• /
• 1998

Analysis of practice variations has been one of important issues in trying to contain costs as well as to manage quality in health care. This study was conducted to provide statistical model for analysing variations in inpatient costs by type of hospitals. Four K-DRGs including Cesarean section, appendectomy, cataract extraction, and pediatric pneumonia with CC class 0 were selected, and means and dispersions of inpatient procedure and operation costs were simultaneously compared between type of hospitals. The results indicated that joint modelling of means and dispersions by gamma distribution was a very useful analytic tool for identifying factors which might have relationship with variations in inpatient costs. This model can be expanded to test the significance of several independent variables in analysing cost variations. In surgical conditions, means and unit variations of procedure and operation costs showed consistent pattern which was tertiarty hospital, general hospital, and hospital in descending order. Different findings were identified in pediatric pneumonia, from which mean and unit variation of procedure and operation cost was the highest in general hospital. The practical implication of this difference could not be drawn from this study. It will be done by further sophisticated researches. In order to develop health policy for cost containment and quality management in Korea, it is essential to find out manageable factors affecting variations in practice patterns which include characteristics of population, providers, regions, and so on. The statistical model presented in this study will give health services researchers useful insights for future investigations in analysing cost variations.