• Journal of Environmental Health Sciences
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• v.34 no.2
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• pp.124-130
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• 2008

This study investigated the age dependencies in ambient air pollution-associated asthma hospitalization from 2003 to 2005 in Seoul. For all ages and the age groups of 0-14, 15-64, and 65+years, the Generalized Additive Model (GAM) was used to estimate the relative risks of daily asthma hospitalization associated with changes in particulate matter and ozone. The time-trends, seasonal variances, day effects, temperature, humidity, and pressure at sea level were controlled in the models. Significant associations were observed between asthma hospitalization and the levels of $PM_{10}$ and $O_3$. The relative risks (RRs) of asthma hospitalization for every 10 unit increases in $PM_{10}({\mu}g/m^3)$ and $O_3$(ppb) were 1.008 (95% CI 1.005-1.012), and 1.012 (95% CI 1.003-1.020), respectively. Evaluated over $10\;{\mu}g/m^3$ increase in $PM_{10}$, we found the relative risks of asthma hospitalization to be 1.009 (95% CI 1.004-1.014) in 0-14 age group, and 1.015 (95% CI 1.008-1.022) in 65+ age group. Considering 10 ppb increase in $O_3$, those were 1.014 (95% CI 1.003-1.024) in 0-14 age group, and 1.025 (95% CI 1.009-1.041) in 65+ age group. It was concluded that current levels of ambient air pollution in Seoul make a significant contribution to the variation in daily asthma hospitalization. Further reduction in air pollution is necessary to protect the health of the community, especially that of the higher risky groups including children and elderly population.

• Journal of Korean Public Health Nursing
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• v.3 no.2
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• pp.5-46
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• 1989

The current medical payment Insurance Rates in Korea stipulate charges for medical treatment by the doctor, pharmaceutist, medical technician and maternity nurse. But unfortunately didn't specify those charges for nursing done by the professional nurse. Only basic nursing fee is accounted insufficiently in current medical insurance fee schedule. therefore, Being face with covering entire people by medical insurance by 1991, It seems that the problems pertaining to operating the hospital and medical insurance system would be incessantly expanded in that no mention is made of medical charges rendered by major medical producer service in the current system, For that reason, this study made an attempt to clarify the importance the professional nursing puts of the current medical payment. The purpose of this study was to accounting nursing fee which diveded into the current medical fee schedule. (Method) 1. Data collection; Importance and difficulties in nursing activities was conducted in 'S' National University Hospital. Total nursing activities were selected 72 items which included direct care and indirect care. This study was conducted to evaluating the degree of importance and difficulties according to nursing activities through questionnaire to 204 RN. and so relative difficulties (acuity) were computered because the nursing cost level of each nursing service was differently established by the equivalent coefficient according to degree of relative difficulty and time required. 2. Calculation of cost according to nursing activities; After 47 nursing activities were selected in General surgery nursing units, calculation of nursing cost was as follows Cost of Nursing activity = (relative difficulty X Average hourly wage and benefits of nurse) + material cost of nursing -t- Average nursing administration cost So, Calculated cost by nursing activities was compared to current non-insured and insurance rate. 3. Calculation of nursing cost by K - DRG ; Total of 578 patients who were hospitalized in General Surgery units from January to March 1988 ware classified by K - DRG After estimation of total nursing cost based on the K-DRG, verified the appropriateness of basic nursing fee in medical insurance rate (Results) 1. Analysis of degree of importance and difficulties were 4.16 and 3.67 based on 5 point scale. This score were judged that it is worthy specifying the nursing fee 2. The nursing cost of 47 nursing service items in general surgery patients showed that the average cost of nursing activity was \1374.5 and The lowest cost was \217 of 'oral administration nursing' item, The highest cost was \11,025 of 'saline enematill clear' item 3. The result of comparison between the calculated cost by nursing activities against the current non-insured and insurance rate showed that 13 items(27.7%) involved to payment of insurance rate, 9 items(19.1%) involved to non-insured rate, remainder 25 items (53.2%) were not charged anywhere of total 47 nursing activities 4. When calculated cost by nursing activities was 100. current insurance rate was 62.3, non-insured rate was 176.6. Therefore this showed that most of non-insured rate were higher than calculated nursing cost. The insurance rate, however, were lower than it. Reim-bursement was imputed to non-insured patients. So the current rate system became estrainged from cost system. When Remainder 25 items of nursing activities compared' to \1390 of daily basic nursing fee per patient belonged to payment as a insurance fee schedule, basic nursing fee schedule was 1-2% of calculated cost of nursing activities. Therefore it showed that nursing fee was not counted adequately in it. 5. Nursing cost by K-DRG estimated in chart review based on counting number of nursing activities and length of stay The result showed that average amount of total nursing cost was \183828.1 Comparison of nursing cost calculated by K- DRG and basic nursing fee schedule showed that only 12.3% of nursing cost was charged (Conclusion) From the above research result, It is fact that nursing prime cost should be estimated more accurately and included adequately in current medical payment system. The payment system of nursing activities should be introduced not only nursing activities of drug administration and injection fee belonged to insurance fee schedule but also most nursing activities belonged not to mekical fee schedule. Even if introducing payment system of nursing activities, It should be estimated scientific method of Accounting nursing cost So nurses could offer nursing care of good quality, thereby they could make a great contribution not merely to the convalescence of the patient but to the promotion of the people's health.

• Korea Journal of Hospital Management
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• v.6 no.2
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• pp.37-69
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• 2001

A new cost management system, called Activity Based Costing (ABC) system, has arisen to solve the limitation of a Traditional Cost Accounting (TCA) system until last two decades and ABC has been applied by many companies. TCA systems have limitation in tracing cost because they arbitrarily allocate overhead cost to the cost objects without standard for direct cost distribution. ABC is an accounting system that assigns costs to products or services based on the resources they consume. The costs of all activities are traced to the products for which they are performed. Therefore ABC is a cost management system that provides a matrix to accurately quantify consumed resources triggered by activities and activities triggered by products and services. There is little implementation of ABC in the health services field, one of service industries, due to complicated and many activities, and volatile cost object. However, the necessity for applying reasonable cost accounting system is largely issuing as strategy responding hostile environment, and financial pressure, and it is imperative to implement the Activity Based Costing (ABC) system. Therefore, this study presents the framework to develop ABC system for total health service organizations. Cost objects in this study base on medical service activities per health insurance claim from one general hospital located in Metropolitan Statistical Areas (MSAs). Medical service activities include all health insurance claims in the hospital. The purpose of the study is presenting useful tools and basic frame to develop Activity Based Costing system for health service organizations which want to use ABC system. The steps to develop ABC system for health service organizations are following: 1. Identifying of activity centers; 2. Definition of cost objects and activity by activity center; 3. Analysis of activity and tracing activity contribution; 4. Allocation of direct cost for specific activity; 5. Allocation of indirect cost for specific activity; 6. Allocation of depreciation for facilities, applicants, and consumption goods; 7. Allocation of administration cost; 8. Allocation of cost among activity centers; and 9. Tracing cost of cost objects by activity center. This study identified necessary information from existing reports which hospitals generally made by each step, and defined outcome which had to be produced in each step using this information. The steps of this study had limitation to apply all different size hospitals because the steps were structured ABC system by one hospital, however, this study used similar basic framework and methods with general cases. When a health service organization want to apply Activity Based Costing (ABC) system on all activities of it in future days, this study is very useful to design system structure in the health service organization.

• International Journal of Contents
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• v.13 no.2
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• pp.14-20
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• 2017

The purpose of this study was to investigate the association of obesity with medical care use and costs according to overall diseases, cerebrovascular diseases (CVD), ischemic heart disease (IHD), hypertension (HTN) and diabetes mellitus (DM). The final sample was a group of persons who were free of diseases mentioned above and were not underweight. Their baseline screening program data and health insurance contribution data were connected with a 7-year medical claim database. The participants were classified according to their baseline BMI into normal, overweight, obese, and severely obese groups. Given the disease type, the total costs of DM showed the largest difference in each obesity group in both males and females. Also, the pharmacy costs for DM were more relevant than any other type of service to the obesity level. Considering the high prevalence of obesity and the relevantly increased medical care use and costs, there is a need for reduction in medical costs through obesity prevention efforts.

• Journal of Preventive Medicine and Public Health
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• v.35 no.4
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• pp.340-350
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• 2002

Objectives : To evaluate the annual visit days, the annual prescription days and the medical costs of hypertensive patients. Methods : The medical insurance records of 40,267 incident patients with the diagnostic code of hypertension from September 1998 through August 1999 in Daegu city were reviewed. Results : The proportion of the most proper medical care pattern group (Group VIII) who visited for 6-15 days with 240 prescription days or more a year was only 6.2%. The proper care group (Group IX) who visited for more than 16 days with 240 prescription days or more a year was 9.3%. The overall proper care group (Group VIII+IX) was therefore 15.5%. The proportion of the insufficient care group (Group I, IV) in both the number of visiting days and prescription days was 57.4%. The mean prescription day of the most proper group (Group VIII) was 29 days; the mean annual medical expenses,453,587won; the mean annual amount paid by patients, 218,013won; and mean medical expenses per prescription day, 1,483won. The proportion of the overall proper care group (Group VIII+IX) was significantly higher in adults aged 50-59, those who were enrolled in industrial workers health insurance as well as government employees and private school teachers health insurance, and those who made a higher contribution per month (p<0.01). According to the type of medical facilities, the proportion of the most proper medical care pattern group was highest in the general hospitals (9.3%) but the overall proper care group was higher in the public health centers (22.1%) and private clinics (17.1%). Conclusions : The management system of hypertension should be reinforced urgently. Therefore, it is necessary to develop guidelines including the number of visiting days per year and prescription days per visit day, and make the system provide medical facilities to more properly care for hypertensive patients.

• Korean Journal of Adult Nursing
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• v.25 no.3
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• pp.275-288
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• 2013

Purpose: The purpose of this study was to perform an economic analysis and estimate the fee for the practices that carried out by Emergency Nurse Practitioner (ENP) using relative value scale (RVS) and its conversion factor. Methods: First, we developed ENP's RVS for 25 advanced nursing services based on ENP's workload and its time spent by survey. A cost analysis was performed to evaluate the conversion factor of ENP's RVS. The share of ENP's contribution to fee-for-service in emergency setting was also analyzed. Results: Calculation of the RVS of 25 advanced nursing practices showed a range of points from 73.4 to 296.3 and an average of 145.1 points. The relevant conversion factor for advanced nursing practices among ENP was estimated at 12.2~15.9 won. The contribution rate of ENP's advanced nursing practices in the relative value scale of the national health insurance was estimated at 13.1~17.0%. Conclusion: The practices of ENP are not compensated separately and its reimbursement is usually included in physician fee. An estimation of nursing fee and an independent fee related to ENP's services shows the contribution rate to total revenue. It suggests that emergency nurse practitioners be considered as a revenue source the in emergency room.

• The Korean Journal of Health Service Management
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• v.1 no.1
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• pp.138-153
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• 2007

As the level of the national income has been improved and the whole nation health insurance project has been spread, medical demand for dental health is also increasing. To cope with the increased medical demand, the need of dental health education and preventive dental care is recognized, and the number of dental hygienists is being increased with increase in dental clinics and hospitals. While more weight is actually given to treatment than prevention in hospitals, emphasis is placed on prevention in public health centers of state-run organizations and dental hygienists are performing the duty. According to this, dental hygienists shall be treated and recognized as professionals, who instruct people in dental health and assist the dentists in hospitals. Therefore to suggest vision to the students of department of dental hygiene, give them a solid motive, and inspire them with professional sense so that they can devote themselves to their duty with pride and self-confidence in the field can lead to contribution to dental health of each individual and the whole nation, in order to train them to be dental hygienists who are active and strive for change and development as professionals and capable of adapting themselves to the field of dental medicine. In this study, the professional sense and the recognition of the way of students belonging to department of dental hygiene were examined and based on this, a new direction for department of dental hygiene of three-year college was suggested.

• Journal of the Korea Society of Computer and Information
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• v.28 no.10
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• pp.247-256
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• 2023

This study was conducted with the purpose of suggesting alternatives for the efficient operation of senior day care facilities in 22 cities and counties in the Jeonnam region by analyzing the efficiency of senior day care facilities. The analysis data for the study used the National Health Insurance Corporation's long-term care insurance for the elderly (2022), the Input variables were the number of facilities, the number of workers, the number of affordable, and the number of senior long-term care insurance recipients and the Output variables were the the number of users. As a result of the analysis, CCR was most efficient in Goheung-gun, Gokseong-gun, Gwangyang-si, Boseong-gun, Yeongam-gun, and Jindo-gun, BCC was most efficient in Goheung-gun, Gokseong-gun, Gwangyang-si, Gurye-gun, Damyang-gun, Boseong-gun, and Jindo-gun, and SE was most efficient in that order: Jindo-gun, Gokseong-gun, and Gwangyang-si. It turned out to be a super efficient area. In the contribution analysis, the number of affordable and workers variables were found to be variables that had a large impact on efficiency contribution. In the improvement potential analysis, the number of facilities variable was found to be a variable that had a significant impact on efficiency. Therefore, for the efficient operation of senior day care facilities, we suggest adjusting supply and demand, such as the number of facilities and affordable, and suggest that training programs to strengthen the expertise of workers who contribute greatly are required.

• Journal of Preventive Medicine and Public Health
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• v.50 no.5
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• pp.303-310
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• 2017

Objectives: The aim of this study was to evaluate socioeconomic inequalities in the prevalence of dental caries among an urban population. Methods: This study was conducted among 2000 people 15-40 years of age living in Kurdistan, Iran in 2015. Using a questionnaire, data were collected by 4 trained dental students. The dependent variable was the decayed, missing, and filled teeth (DMF) index. Using principal component analysis, the socioeconomic status (SES) of families was determined based on their household assets. Inequality was measured using the concentration index; in addition, the Oaxaca analytical method was used to determine the contribution of various determinants to the observed inequality. Results: The concentration index for poor scores on the DMF index was -0.32 (95% confidence interval [CI], -0.40 to -0.36); thus, poor DMF indices had a greater concentration in groups with a low SES (p<0.001). Decomposition analysis showed that the mean prevalence of a poor DMF index was 43.7% (95% CI, 40.4 to 46.9%) in the least privileged group and 14.4% (95% CI, 9.5 to 9.2%) in the most privileged group. It was found that 85.8% of the gap observed between these groups was due to differences in sex, parents' education, and the district of residence. A poor DMF index was less prevalent among people with higher SES than among those with lower SES (odds ratio, 0.31; 95% CI, 0.19 to 0.52). Conclusions: An alarming degree of SES inequality in oral health status was found in the studied community. Hence, it is suggested that inequalities in oral health status be reduced via adopting appropriate policies such as the delivery of oral health services to poorer groups and covering such services in insurance programs.

• Research in Community and Public Health Nursing
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• v.21 no.3
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• pp.362-373
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• 2010

Purpose: The purpose of this study is to evaluate the costs and benefits of individual home visiting health care using secondary data and literature review. Methods: The total number of subjects was 1,008,837. A specific program was classified into disease management, care of infant, child and women, or elderly care. The costs and effects of a program were identified from a societal perspective, and the effects were converted into monetary terms or benefits. The total cost was calculated in the way that medical expenses, travel costs and productivity losses were offset by the decrease in benefits and thus only the program budget was included in the total cost. Results: The total program cost was 47.6 billion won per year and the total annual benefit was estimated at 435.6 billion won. The benefits of arthritis management were the biggest among disease management programs. The net benefit was 388.0 billion won per year and the benefit/cost ratio was 9.16. Conclusion: Home visiting health care was validated to be economically effective. It made a positive contribution to improving the health status of vulnerable populations and reducing medical expenses. These results suggest that home visiting care should be extended more broadly to vulnerable populations.