• Health Policy and Management
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• v.16 no.4
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• pp.86-111
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• 2006

Either ways of understanding health care as a commodity or public work are at opposite ends of health care spectrum. These two rival conceptions reflected by viewpoint(ideology) would lead to different directions in policy-making for health care reform. The purpose of this study is to access the value differences of experts' policy views about health care issues by analyzing the extent of consensus among experts in the field of health care. Using primary data obtained through a mail survey of 558 experts in the field of health care, we analyzed the differences of experts' opinions about characteristics of health care market, policy issues and values Gdeology). The study represents from 50-50 split analysis, entropy index, and factor analysis that the wide spread disagreements over health policy, which is a major barriers to effective policy-making, could be caused by the ideological perception differences among experts. This implies that, if values play an important role in policy-making, we should identify the differences in value and seek ways to balance among the diverse values such as efficiency, equity, freedom, and security. For this, the policy issues debated on differences in values should be reconciled for narrowing gaps of experts' perceptions through various ways.

• Journal of The Korea Institute of Healthcare Architecture
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• v.23 no.3
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• pp.57-69
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• 2017

Purpose: This study aims to emphasize interrelation between healthcare policies, design standards and hospital architecture of the United States since 1950s; to examine spatial characteristics of inpatient care facilities through case studies; and to consider the social implication of these spatial changes. Methods: In this study, reviewing the overall healthcare system, design standards and inpatient care facilities of the United States since 1950s, a total of five inpatient care facilities, one for each period, were selected in order to analyze the spatial characteristics. The spatial maps of Space Syntax were employed for analyzing five case studies. Results: The distance between the nursing station, the support service, and inpatient room were getting closer. The spatial structure of inpatient care facilities is transformed from tree structures to annular tree structures. This result shows that the efficiency between patient, staff and support service is higher and the depth of the spaces is getting deeper, which indicates that efficiency for improving healthcare quality affect the spatial structure of inpatient care facilities. Implications: In the future, if Korea's health policy is changed to a demand-oriented health care policy, this conclusion predicts medical planning of hospital will be focused on the efficiency.

• Health Policy and Management
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• v.29 no.3
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• pp.342-356
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• 2019

Background: The objectives of the study are to find out the effect of the implementing reform in three Central Asian countries, identify its impact on health status and health care delivery systems. This study address to identify strong and weak points of the health systems and provide a recommendation for further health care organization. Methods: A comparative analysis was conducted to evaluate the effects of implemented policy on health care system efficiency and equity. Secondary data were collected on selected health indicators using information from the World Health Organization Global Health Expenditure Database, European Health Information Platform, and World Bank Open Data. Results: In terms of population status, countries achieved relatively good results. Infant mortality and under-5 mortality rate decreased in all countries; also, life expectancy increased, and it was more than 70 years. Regulations of the health systems are still highly centralized, and the Ministry of Health is the main organ responsible for national health policy developing and implementation. Among the three countries, only Kyrgyzstan was successful in introducing a national health system. Distribution of health expenditure between public expenditure and out-of-pocket payments was decreased, and out-of-pocket payments were less the 50% of total health expenditure in all countries, in 2014. Conclusion: After independent, all three countries implemented a certain number of the policy reform, mostly it was directed to move away from the old the Soviet system. Subsequent reform should be focused on evidence-based decision making and strengthening of primary health care in terms of new public health concepts.

• Quality Improvement in Health Care
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• v.19 no.2
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• pp.68-80
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• 2013

Background: This study investigates improvements in non-value-added nursing activities in clinical work, in order to improve the efficiency and quality of nursing activities. Methods: The study was performed as a quality improvement project at a tertiary general hospital. The nursing activities that needed improvements were categories into admission care, discharge care, supply management, diagnostic work-up related activities, and others. The nursing time and frequency of non-value-added activities were compared across nine nursing units before and after implementation of the quality improvement program. Post-implementation patient and nurse satisfaction were subsequently analyzed. Result: Post-implementation, the time spent on non-value-added nursing activities was reduced and patients and nurses were satisfied with the improvements. Discussion: Reducing non-value-added activities in nursing can increase the work efficiency and ensure time for patient care, thus improving the quality of nursing care. For further study, accurate surveys on nursing activities based on nursing time are required.

• Health Policy and Management
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• v.15 no.3
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• pp.79-93
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• 2005

The purpose of the study is to identify Ambulatory Care Sensitive Conditions (ACSC) and their potential health insurance applicability in Korea, using the correlation and regression analysis with the empirical data provided by Korean Health Insurance Review Agency(KHIRA). Here, ACSC would be thought of as conditions that when timely and effectively treated in the outpatient medical services can help reduce the risk of hospitalizations. As for ACSC, reducing accessibility for outpatient visit results in increasing hospitalization. In this respect, the ACSC concept is popularly adopted as one of the performance indicators of the national health system. As one of main results, fortifying the accessibility to necessary health care in a way of sharing appropriately the role with private health insurance can lead to the efficiency of national health care delivery systems in view of total health care expense, in particular in a case of ACSC children. Lastly, we would like to strongly suggest that the disease treatment data set reported to KHIRA needs to be opened to private insurance companies only for illness experience investigation.

• Health Policy and Management
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• v.19 no.1
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• pp.81-96
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• 2009

The expansion of long-term care hospitals (LTCHs) is expected to contribute to meeting the long-term care needs of the elderly with chronic diseases in a rapidly aging society. It is also expected to increase efficiency of health resource use and decrease elderly health expenditures by transferring patients from acute care hospitals (ACHs) to LTCHs. This study aimed to empirically examine how the expansion of LTCHs had influences on the length of hospitalization of the elderly in ACHs. Panel regression analysis was employed as an analytic tool using data of the National Health Insurance and the National Statistical Office from 2002 to 2006. The expansion of LTCHs was measured as location quotient (LQ) of LTCHs, denoting the share of LTCHs in a large city or province relative to the share of LTCHs at the national level. In addition, per capita GRDP (gross regional domestic product) and the proportion of population over 65 were included as control variables. The main findings are as follows. First, it was observed that LQ of LTCHs showed a statistically significant negative association with the length of hospitalization of the elderly in ACHs. Second, the negative correlation was evident among general hospitals with over 100 beds while it was not among hospitals with less than 100 beds. Third, LQ of LTCHs had more influences among the elderly over 85. In conclusion, the expansion of LTCHs seems to contribute to decrease in the inpatient cost of the elderly in ACHs and to increase efficiency in the utilization of health resources.

• Journal of Korean Academy of Nursing Administration
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• v.16 no.3
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• pp.295-305
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• 2010

Purpose: This study was conducted to evaluate the economic efficiency of a community-based nursing care center to help policy makers determine whether or not to invest in similar facilities. Methods: The subjects were 101 elderly people over 65 years who participated in a health management program from February 1 to July 31, 2007. Direct cost was estimated with center operations cost, medical cost for out-patients and pharmacy cost. Indirect cost was measured by transportation cost. Direct benefit was calculated by saved medical cost for out-patients, saved pharmacy cost, saved transportation cost, and reducing hospital charges. Indirect benefit was estimated with prevention of severe complications. Economic efficiency was evaluated by cost-benefit ratio and net benefit. Results: Operating a community-based nursing care center was found to be cost-effective. Specifically, the cost of operating the center evaluated here was estimated at 135 million won while the benefit was estimated at 187 million won. Benefit-cost ratio was 1.38. Conclusion: The Community-based nursing care center that was described here could be a useful health care delivery system for reducing medical expenditures.

• The Korean Journal of Health Service Management
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• v.5 no.2
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• pp.105-117
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• 2011

The purpose of this study is to investigate evaluation and improvement of long-term care hospitals for changing long-term care hospitals fee system. Data were collected from 104 CEOs in nationwide long-term care hospitals using structured self-administered questionnaires during August 17 to 31, 2009. Major results of the empirical analysis are as follows; first, to change fixed sum medical fee per day caused to decline the level of geriatric service in 87% of CEOs. Second, 79% of CEOs were dissatisfied with changing fixed sum medical fee per day, and 47% of them were dissatisfied with graded fee for doctor and nurse management. Finally, they suggested that to specialize and to differentiate of long-term care hospitals will drive to improve long-term care hospitals function and to measure workforce based on rate of filled vacancies will increase efficiency and productivity of doctor and nurse management.

• Journal of Korean Academy of Rural Health Nursing
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• v.19 no.1
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• pp.44-54
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• 2024

Purpose: This study identifies the factors influencing unplanned readmissions among participants of the medical aid community care pilot program. Methods: This descriptive study analyzed data from 1,013 participants in a medical aid community care pilot program. Data were analyzed using multiple logistic regression analysis. Results: The presence of mental illness, injury-related conditions, long-term care grades, and activities of daily living scores are key factors influencing the likelihood of readmission. In particular, the presence of a mental disorder or an injury-related condition increased the probability of readmission, whereas individuals with long-term care grades 1~2 showed a decreased likelihood of readmission. Conclusion: This study emphasizes the importance of enhancing the management of mental and injury-related conditions, effective utilization of long-term care services, and improvement of ADL scores to reduce readmission. These findings offer crucial insights for enhancing the efficiency of home medical care benefit programs and sustainable expansion of services.

• Health Policy and Management
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• v.33 no.3
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• pp.355-362
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• 2023

Background: Financial efficiency in monetary units and operational efficiency in non-monetary units are separately classified and evaluated. This is done to prevent the duplication of monetary units and non-monetary units in inputs and outputs. In addition, analyses are conducted to determine the factors that affect each aspect of efficiency. To prevent duplication of monetary and non-monetary units in inputs and outputs, financial efficiency, consisting of monetary units, and operational efficiency, comprising non-monetary units, are separately classified and evaluated. Furthermore, an analysis is conducted to identify the factors that affect each aspect of efficiency. Methods: This study conducted a panel analysis of 34 regional public hospitals and influencing factors on efficiency for 5 years from 2015 to 2019. Financial efficiency and operational efficiency were calculated through data envelopment analysis. Moreover, multiple regression analysis was conducted to identify the factors that influence both financial efficiency and operational efficiency. Results: The factors that affect financial efficiency include the number of medical institutions within the treatment area and the ratio of patients receiving medical care. Additionally, operational efficiency is influenced by the type of medical institution, the number of medical institutions within the treatment area, and the number of nursing positions per 100 beds. Conclusion: In order for regional public hospitals to faithfully fulfill their functions and roles as regional base public hospitals, several measures are necessary. Firstly, continuous monitoring and reasonable support are required to ensure efficient operation and performance. Secondly, a financial support plan tailored to the characteristics of local medical centers is needed. Additionally, local medical centers should strive to enhance their own efficiency.