• Journal of Preventive Medicine and Public Health
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• 제27권4호
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• pp.807-814
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• 1994

This study is to find out changes in medical practice at a university hospital before and after covering intraocular lens (IOL) from the health insurance benefit. The coverage started on March 1, 1993 and a total of 596 cases who were discharged from July 1 to December 31, 1992 and 580 cases who were discharged from July 1 to December 31, 1993 were analyzed. Since the standard reimbursement scheme was changed from March 1, 1993, the charges for 1992 were transformed into 1993 scheme. Major findings are as follows: Average length of stay was statistically significantly decreased from 8.24 days in 1992 to 6.86 days in 1993. Charges except IOL has been statistically significantly decreased from 501,000 Won in 1992 to 444,000 Won in 1993. Charges for drugs and injection have been reduced. However, charge per day for them was not much different. This is due to decrease in length of stay. Charges for laboratory tests and radiologic examination were quite the same. Charges which are not covered by the insurance remained the same. The revenue of the hospital was reduced as expected. However, the hospital reduced the length of stay and increase the turnover rate In order to compensate the potential loss of revenue due to the difference of reimbursement between the out-of-pocket expense and the insurance coverage. By introducing the IOL benefit in the insurance, the insured pays less, hospital generates more revenue through shortening the hospital stay, and the total medical care cost becomes less nationwidely.

• Journal of Preventive Medicine and Public Health
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• 제31권3호
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• pp.481-489
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• 1998

Injuries and infectious diseases have been the most important public health problems since the beginning of human life. Injuries result in death of about 30,000 people each year in South Korea. In terms of years of life lost, injuries are considerably more costly than either heart disease or cancer. In terms of cost - both the direct costs of care and the indirect costs to individuals, families, and societies of a diminished life-injuries are among the most expensive of all social problems. The main purposes of this study are (1) to describe the outcomes as well as treatment process of brain injured patients and (2) to identify the factors impacting on length of stay during hospitalization and hospital fees. The research method used in this study was to review the medical records of five hundreds brain injured cases using systemic random sampling. The multiple logistic regression was administered to identify the factors impacting on the outcomes. The results are as follow : (1) the consultation .ate was found to be 72.9% while referral rate was 11.2%; (2) nearly 30% of the respondents were hospitalized over 30 days; (3) multiple logistic regression analyses revealed that the determinants influencing LOS were number of consultations, number of lab tests, and surgery; (4) the determinants of hospital fee were severity of brain injury, gender of patients, number of consultations, number of lab tests, and surgery.

• 임상간호연구
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• 제23권2호
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• pp.236-247
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• 2017

Purpose: This study was to present improvement strategy and the problems of the nursing fee in national health insurance system. Methods: A total of 23 nursing activities performed by nurses were selected. Data were collected the relative value score and criteria of the Health Insurance Review & Assessment Agency. Sixty clinical nursing experts panels were composed and nursing time surveyed self-reported method. The actual fee was calculated through the nursing time, relative value score and actual labor costs. Nextly, the labor costs analyzed was compared with that in the national health insurance. Results: Although the practices were mainly performed by the nurse, other occupations have been recorded as main practitioners and the time of the nursing activity is partially improperly reflected. Additionally, although the nurse practiced mainly in glucose (semi-quantitative) test, it was confirmed that the principal practitioner was described as a clinical pathologist. The the labor cost gap was estimated that is 9.3 times (median) and 11.9 times (average) in this analysis. Conclusion: This study suggests that it is necessary to legislate a policy that can improve the quality of clinical nursing by reinforcing the appropriateness and improving nursing fee through reflection of the actual time spent for nursing care.

• Tuberculosis and Respiratory Diseases
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• 제80권2호
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• pp.169-178
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• 2017

Background: The purpose of this study was to assess the effect of our new video-assisted asthma education program on patients' knowledge regarding asthma and asthma control. Methods: Adult asthmatics who were diagnosed by primary care physicians and followed for at least 1 year were educated via smart devices and pamphlets. The education sessions were carried out three times at 2-week intervals. Each education period lasted at most 5 minutes. The effectiveness was then evaluated using questionnaires and an asthma control test (ACT). Results: The study enrolled 144 patients (mean age, $56.7{\pm}16.7years$). Half of the patients had not been taught how to use their inhalers. After participating in the education program, the participants' understanding of asthma improved significantly across all six items of a questionnaire assessing their general knowledge of asthma. The proportion of patients who made errors while manipulating their inhalers was reduced to less than 10%. The ACT score increased from $16.6{\pm}4.6$ to $20.0{\pm}3.9$ (p<0.001). The number of asthmatics whose ACT score was at least 20 increased from 45 (33.3%) to 93 (65.3%) (p<0.001). The magnitude of improvement in the ACT score did not differ between patients who received an education session at least three times within 1 year and those who had not. The majority of patients agreed to the need for an education program (95.8%) and showed a willingness to pay an additional cost for the education (81.9%). Conclusion: This study indicated that our newly developed education program would become an effective component of asthma management in primary care clinics.

• 보건행정학회지
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• 제18권4호
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• pp.148-169
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• 2008

As the Korean Government began to perceive healthcare as one of foundational industries for national dynamics, there has been mounting advocacy for the introduction of for-profit hospitals with a view to bringing efficiency in healthcare services industries and improvement of their international competitiveness. The Government is now considering the issue from all angles in favor of permitting for-profit hospitals. However, There have been few precedent studies on this subject to provide helpful data for the discussion and in the health policy making. This study used private hospitals - for-profit and nonprofit - in Florida, USA as study subjects to accumulate basic data that may be utilized for those involved in debates and health policy making relating to the introduction of for-profit hospitals in Korea. Among all the private general hospitals in Florida, those surveyed by AHA(American Hospital Association) for four consecutive years from 2001 and 2004 and others reported about to MCR(Medicare Cost Report) included in the collected data for analysis. In total 139 private general hospitals consisting of 73 for-profit hospitals and 66 nonprofit hospitals were included in the collected analysis data. Results of analysis revealed no significant difference between for-profit hospitals and nonprofit hospitals in the usage aspects of healthcare services including the average length of stay and the ratio of Medicare vs Medicaid patients. However, financial performances indicated by such factors. as the pre-tax return on assets and the pre-tax operating margin showed to be significantly higher in for-profit hospitals compared with nonprofit hospitals. And the ratio of personnel expenses and the turn period of total assets showed to be significantly lower in for-profit hospitals. Based on the hypothesis that arguments about the introduction of for-profit hospitals have considerably different viewpoints depending on the size of hospital represented by the number of bed, these two hospital types were compared again using the number of beds as a controlled factor, but the results were similar. We, therefore, could conclude that the for-profit hospitals in Florida included in this study could, in their for-profit operation, improve their financial performance by pursuing cost reduction and effectively utilizing their assets without limiting the amount and the range of their services or avoiding less medically protected groups such as Medicare and Medicaid patients.

• Asian Pacific Journal of Cancer Prevention
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• 제15권22호
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• pp.9679-9685
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• 2014

Background: When evaluating health-economics for cervical cancer prevention policies in Japan, it is important to use Japanese value settings. This study aimed to obtain preference-based measures (preference measures) for hypothesized health states among healthy Japanese women, and to examine differences between the EuroQol-5D (EQ-5D) and standard gamble (SG) instruments. Materials and Methods: The investigation was performed among female students at a nursing university. We used written hypothetical scenarios describing three grades of cervical intraepithelial neoplasia (CIN) and eight stages of cervical cancer, both at diagnosis and after medical intervention. Preference measures were evaluated using both EQ-5D and SG. Results: We received responses from 136 women. The mean number of respondents per stage was 24.6 (SD: 2.7). At diagnosis, average EQ-5D scores for CIN1, CIN2, CIN3, IA1, IA2, IB1, IB2, IIA, IIB, III, and IV stages were 0.84 (0.14), 0.78 (0.12), 0.73 (0.10), 0.78 (0.12), 0.72 (0.12), 0.63 (0.13), 0.64 (0.12), 0.68 (0.08), 0.62 (0.13), 0.55 (0.21), and 0.18 (0.24), respectively. Using one-way analysis of variance with the Tukey-Kramer method for multiple comparisons (each stage vs. CIN1), we found significant differences for IB1 and more advanced stages (p<0.05). After medical intervention, corresponding EQ-5D scores were 0.84 (0.12), 0.81 (0.12), 0.84 (0.12), 0.80 (0.15), 0.78 (0.11), 0.64 (0.15), 0.63 (0.15), 0.71 (0.15), 0.50 (0.17), 0.52 (0.17), 0.21 (0.28). The multiple comparisons identified significant differences for IB1 and more advanced stages, excepting IIA (p<0.05). SG evaluations were more variable and relatively higher than EQ-5D evaluations. Conclusions: We obtained preference measures for three grades of CIN1-3 and eight stages of cervical cancer. In combination with appropriate sensitivity analyses, these preference measures will provide a basis for an economic evaluation of cervical cancer prevention in Japan. We suggest that EQ-5D is appropriate for cost-utility analysis of this topic.

• 간호행정학회지
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• 제6권1호
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• pp.123-134
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• 2000

This study intended to analyze the effectiveness to obtain by developing the critical pathway presented as the method to improve the quality-betterment and cost effectiveness the through the continuous and consistent patient management for the hysterectomy patient and applying it to the real practice. This study was designed to develop and effect the critical pathway for hysterectomy patients in the way to be possible the intergrated in patient management. It was adopted the process of seven phase to develop a critical pathway. To analyze the application effect of the developed critical pathway, this author offered health care service applying the critical pathway to the hysterectomy patient from July. 20 to Oct. 19. 1999. The study method had been done by investigating the experimental group and control group through the questionnaire on 40 patients who had been inpatient hysterectomy. Dependent variables were measured by modified from satisfaction, and cost and length of hospital stay. The data anlyzed by frequency, x2-test, t-test. The results of this study was as follows; 1. It was decided that the vertical line of the critical pathway was made up of eight items such as monitoring/assessment, treatment, activity, medication, consult. Lab test, diet, patient teaching and horizontal line was 7days from admission to discharge. 2. After the verifying the validity of the expert group about the critical pathway, the horizontal line was amended from hospitalization to five postoperative days and taking their consensus, some contents of the horizontal line was amended and deleted. 3. There was no significant differences in the experimental group and control group in the satisfaction, and significant differences in the cost, the length of hospital stay.

• 디지털융복합연구
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• 제15권7호
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• pp.259-269
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• 2017

본 연구는 의료급여 사례관리의 중재방법별 접근횟수에 따른 효과를 분석함으로써 의료급여 사례관리 중재의 발전을 모색하고자 하였으며, 2010년 3개의 시 군 구에서 고위험군 564명을 대상으로 실시된 사례관리 이차자료 분석연구이다. 중재방법별 접근횟수에 따른 사례관리 전 후 점수는 방문의 경우 자가건강관리능력과 합리적 의료이용에서 유의한 차이를 보였고, 전화는 자가건강관리능력에서, 우편은 건강 삶의 질, 자가건강관리능력, 합리적 의료이용에서 유의한 차이가 있었다. 중재방법별 접근횟수에 따른 의료이용은 방문과 우편이 총급여일수에서 유의한 차이를 보였다. 중재방법별 접근횟수와 사례관리 점수 간의 상관관계에서는 방문이 자가건강관리능력과 음의 관계를, 전화는 합리적 의료이용, 우편은 사례관리 점수 전 영역, 내소는 건강 삶의 질 영역과 양의 관계로 나타났다. 중재방법별 접근횟수와 의료이용 간의 상관관계에서 방문과 자원연계는 총 급여일수와 음의 관계가 있는 것으로 나타났다. 의료급여 과다이용 수급자의 건강 삶의 질 향상과 적정의료이용을 도모하기 위해서는 사례관리 중재방법별 효율적인 접근횟수를 고려하여 사례관리를 실시하는 것이 필요하다.

• 대한의료기공학회지
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• 제8권1호
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• pp.96-114
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• 2005

This study was carried out to provide essential data for the future health promotion projects to be aimed at improving quality of life for the elderly people in the increasingly aging society of Korea by investigating factors related to the yangseng of old people in urban areas. The results of this study are to be used as basis for efficient approach toward health promotion projects for the elderly in urban communities. For the purpose, a survey by questionnaires was conducted to urbanites from May th June 2004. The collected replies were analyzed from the viewpoints of Oriental Medicine for yangseng. 1. The average points of health care were 3.24. In details by sub-areas, 3.78 was rated for morality yangseng, 3.29 for mind, 3.30 for diet, 3.79 for activity and rest, 2.32 for exercise, 3.72 for sleeping, 2.95 for season and 1.81 for sexual life, which showed that the area of activity and rest yangseng was scored highest while the area of sexual life yangseng was rated lowest. 2. As for the extent of health care depending on the characters of subjects, higher scores were rated by men than women, younger ones than aged and spoused ones than singles. Married couples living without other family members were found to yangseng most, while more yangseng was taken by the educated, job holders and those who utilize leisure and have religion in order. 3. Men exercised more yangseng than women in the diet, exercise and sleeping. By age, the group aged 65 to 69, the more yangseng in the exercise and sexual life. The group with spouse featured higher concern for yangseng in all categories except for season. Married couples who are living with no other family members recorded the highest point in all areas except for exercise. 4. The more one is educated, the more he/she is tended to take yangseng in the sub-areas of exercise and sexual life. The group with occupation is also inclined to take more yangseng in the same sub-areas as those of the highly educated. When they pay living cost together with offspring, they appeared to be the most yangseng in season and sexual life. People who enjoy leisure showed higher yangseng in all areas except for season. Religion had a significant influence in all areas except for activity and rest yangseng. 5. Those who reply that they are confident with health and have no disease proved to have higher yangseng. Depending on whether one has disease or not, higher yangseng was confirmed in such sub-categories as mind and sleeping. Those who replied they are confident with health had higher yangseng in all areas except for season. As seen above, yangseng of the old people in the urban area is found to have different extent depending on the individual and socioeconomic characters, factors which should be seriously considered in the local health promotion projects and projects for the health of the elderly. It seems therefore necessary to launch health promotion programs and to analyze their effects to promote health care particularly in the areas of sexual life, exercise and season yangseng that featured lowest grade of yangseng in each sub-area.

• 한국융합학회논문지
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• 제8권5호
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• pp.61-68
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• 2017

이 연구는 2015년 1월부터 12월까지 1년간의 자동차보험으로 진료 받은 치과와 한방을 제외한 의과 8,589,602건에 대해 자동차보험회사별로 진료특성과 진료비 차이를 분석한 것으로 그 결과는 다음과 같다. 첫째, 일반적 특성 중, 연령에서는 손해보험과 공제조합 모두 50-59세가 22.8%로 가장 높은 것으로 나타났다(p<0.001). 둘째, 진료과별 입원 건당진료비는 손해보험과 공제조합 모두 내과계가 외과계보다 높은 것으로 나타났으며, 외과계 세부과목별로는 손해보험회사와 공제조합 모두 흉부외과가 가장 높게 나타났다. 이상의 연구결과를 볼 때, 심사평가원에서는 자동차보험 청구요양기관에 대한 적정성평가를 실시하여 불필요한 진료비를 증가시키는 문제와 환자의 재활 및 일상생활의 복귀가 지연되어 발생하는 사회적 비용 문제를 해결하여야 할 것으로 사료된다.