• Korea Journal of Hospital Management
• /
• v.5 no.1
• /
• pp.129-155
• /
• 2000

This empirical study, activity-based costing, a newly introduced approach that has proved to be an improvement over the conventional costing system in product or service costing, is applied at department of clinical pathology in K university hospital. The study subjects were 233 test procedures done in clinical laboratory of K university hospital. Activity analysis was done by interview, questionnaires, and time study, and the amount of resources consumed by each activity and their costs are then traced and applied to the laboratory tests. The main purpose of this study were to compare the test costs of activity-bases costing with those of conventional costing, and test fees of medical insurance, and to provide accurate cost informations for the decision makers of hospital. The major findings of this study were as belows. 1. The cost drivers for application of activity-based costing at clinical laboratory were cases of sample collection, case of specimen, cases of test, and volume-related allocation bases such as direct labor hours and total revenue of each test. 2. The profits of each clinical laboratory fields analyzed by conventional costing were different from the profits analyzed by activity-based costing, especially in the field of Urinalysis(approximately over estimated 750%). 3. The standard full costs by conventional costing were quite different from the costs computed by using activity-based costing, and the difference is most significant with the tests of long labor time. 4. From the comparison between costs computed by using activity-based costing and medical insurance fees, some test fees were significantly lower than the costs, especially in the non-automated fields. As described in this study, activity-based costing provides more accurate cost information than does conventional costing system. The former approach is especially important in the health care industry including hospitals in which planning and controlling the costs services provided are the key to maintaining a healthy financial status for the organization. Despite the contribution of activity-based costing the economic as well as technical feasibilities of implementing such a cost accounting system in an organization must be evaluated. In the development of activity-based costing systems, an activity analysis has to be conducted to identify activities that consume resources. This involves a detailed study of the organization's logistics and accounting information systems, and it is an expensive project in itself. Besides, it can be quite difficult and time consuming to identify and trace resource consumption to a specific activity. Thus the activity-based costing system should be implemented only when the decrease in cost of error far exceeds the increase in cost of measurement. By combining activity-based costing with standard costing, health care administrators can better plan and control the costs of health services provided while ensuring that the organization's bottom line is healthy.

• Journal of Preventive Medicine and Public Health
• /
• v.22 no.2 s.26
• /
• pp.223-235
• /
• 1989

To grasp the idea about how drugs are used under Medical Insurance Scheme, the amount and share of drug cost in the total medical fee have been reviewed and analyzed for different types of patients (in-patient out-patient), medical institutions and frequently seen diseases and following findings were revealed. In 1986, drug cost took 32.78% of total medical fee for in-patients and 32.98% for out-patients averaged over 30% share as a whole. When drug cost per case in 1980 be indexed to 100, it has shown steady growth to become 200 for in-patients and about 150 for out-patients in 1986. The contribution of drug cost to the total medical fee is, regardless of patient type-in-patients and out-patients, the highest in University hospitals and followed by General hospitals, Hospitals and Clinics in decending order That for the most frequent 10 diseases came out the highest,79 a with the essential benign hypertension of out-patients in the General hospitals, 61% for the gastric ulcer of out-patients in Hospitals and 33% for the female genital diseases of out-patients in Clinics. The drug cost of oral formula was contributed the most, 7.93% by cardiovascular agents followed by hepatic detoxicants(5.47%) and out-patients(4.93%), and that of injectable formula was contributed the most by antibiotics(24.17%), followed by protein amino-acid preparations(6.19%). The order of drug usage by specialty for the in-patients was the highest with internal medicine followed by general surgery and E.N.T, and that for the out-parients was in the order of Internal medicine, neuropsychology and Ob/Gy. This study revealed that the drug dependency was characteristically different to specialty. In view of the fact that drug cost on average exceeds over 30% of total medical fee, proper drug administration appears to be vitally important for the stabilization of the financial standing of the Medical Insurance Scheme. As a consequence, drug usage guidelines including antibiotics usage shall be established first of all and the voluntary participation for the regulation of drug usage and propagation of the guidelines to medical institutions are strongly coerced.

• Journal of the Korean Society of Safety
• /
• v.37 no.6
• /
• pp.40-49
• /
• 2022

Simple statistical frequency based analysis, such as Pareto analysis, are widely used in conventional accident analysis. However, due to the dynamic and complex nature of construction works, many factors can simultaneously affect or involve the occurrence of accidents in construction projects. Therefore, the identification of the complex relationship between such factors is important to establish relevant and effective safety management policies and/or programs. In this study, characteristic factors and their relationships' contribution to non-fatal accidents in construction projects are analyzed using the association rule mining (ARM) technique. To this end, a total of 59,202 construction accident data are collected from 2015 to 2019 and the ARM is performed to retrieve specific relationships -named as association rules-among classified factors in the data. Characteristics of the retrieved relationships are analyzed and compared with the results of conventional Pareto analysis. Based on the results, it is found that both fall and trip are notable accident forms having characteristic relations with other factors for non-fatal accidents in construction projects. It is also found that small-scale construction, age of 50s, less than 1 month of working period, and architectural construction are important factors for non-fatal accidents in construction projects.

• Health Policy and Management
• /
• v.19 no.4
• /
• pp.66-77
• /
• 2009

This study aims to examine the effect of socioeconomic status (hereafter, SES) on healthcare utilization of the patients with rare and incurable diseases. Information of 2,973 patients who were self-employed insured and utilized healthcare service in 2007 was drawn from the National Health Insurance (hereafter, NHI) claim data. SES was set as four groups based on the monthly contribution. Outcome variable was the expense for outpatient and in-hospital services, which was log-transformed and square-rooted in oder to obtain normal distribution. Covariates included age, gender, residence and diagnosis. To examine the effects after controlling for covariates, we employed generalized estimating equation model, since patients with the same diagnosis are likely to have similar characteristics of demographics and healthcare utilization. Univariate statistics showed that lower SES was associated with less utilization of healthcare services. After controlling for covariates, a significantly smaller amount of money was expended for the lowest SES group compared to the highest one. Rural residence was associated with less utilization, except that residents in Seoul significantly more utilized outpatient services in tertiary hospitals. Considering that there is a subsidy program for the low income patients, such differences in healthcare utilization according to SES seems to result from the burden of out-of-pocket payments for uncovered services of the NHI.

• Korea Journal of Hospital Management
• /
• v.23 no.4
• /
• pp.15-25
• /
• 2018

Purposes: The objectives of this study present the direction of the criteria for the separately reimbursement of therapeutic medical device. Methodology: We summarized experts' opinion using Delphi survey and Analytic Hierarchy Process(AHP). 48 experts were gathered from Medical Insurance Review Nurses Association, medical device industry, academy and association, Medical Device Expert Evaluation Committee. Descriptive statistics, consistency index, content validity ratio were analyzed. Findings: Clinical utility, patient safety, infection control, cost-homogeneity, cost-effectiveness showed high feasibility and importance, but market contribution and functional utility showed low feasibility and importance in a relative sense. The results of functional utility differed between clinical and non-clinical experts. Measurability was low across the whole area. Among the criteria for the separately reimbursement of therapeutic medical device. Patient safety/infection control and clinical utility showed the highest relative importance values, analyzed using AHP. Practical Implications: Patient safety and infection control are needed to be considered as one of Value Assessment Criteria. It is important to find out how to improve the measurability of therapeutic medical device.

• Journal of agricultural medicine and community health
• /
• v.18 no.1
• /
• pp.77-91
• /
• 1993

This study was conducted to assess health medical center utilization pattern and its related factors among the rural inhabitants for the purpose of contribution to establishment of health medical center institutions. A questionnaire survey was carried out for object of 3,754 population of three primary school and three middle school student's parents (total 832 household) in Kyungbook Ulchin Gun rural area from 24 to 28 September, 1990. The summarized result are as follows, Respondents are 60.3% in male, 39.7% in female and 30-40s 81.3% in age, high school graduates 40.3% in education level and a regional medical insurance scheme in 44.1% in forms of health insurance. Recognition for health medical center was showed higher according to high educational, high income level, and short distance for location of health medical center of respondents (p < 0.01). Recognition for health medical center services was showed higher about care of medicaid in medical treatment services and higher preventive vaccination in health prevention services by respondents. Utilization rates of health medical center by out-patient care and preventive care service were 11.1 and 4.5 per 100 persons by year, but admission utilization rate was 34.6 per 10.000 persons by year. Motivations of health medical center utilization were showed a good care(45.7%), a good drugs(45.2%), and nearby health medical center(42.9%). In comparison health service levels of health medical center with general clinic was better (16.3%), similar(38.7%), 7(19.0%), and worse(19.0%) in view of health medical center utilizators. Inconvinience about health medical center utilized was the most higher longtime waiting, the next was limited utilization times. Transportation utilited were on foot(55%), by bus(35.5%), and so on. As mentioned above, there are many inhabitants who less understanding and less acknowledgement about health medical center and even mistake health center for health medical center. Therefore, there must be more information about health medical center. For higher utilization of health medical center, there must be considered expansion of health equipment, facilities, accomplishment with reinforcement of health staffs and efficiency management.

• Journal of Preventive Medicine and Public Health
• /
• v.25 no.3 s.39
• /
• pp.312-329
• /
• 1992

The purpose of this study is to estimate cesarean section rate in Korea and analyze the socioeconomic variables and health resources which affect regional variation in the rate. Samples were drawn from the record of vaginal and cesarean section deliveries based upon insurance claim bills which have been submitted to the National Federation of Medical Insurance for the first three months, January through March, 1991. The results are obtained as follows : It was found that. cesarean section rate was increasing rapidly up to 23.1% in 1991. Cesarean section per 10 thousand insured people was 4.8 and the number of cesarean section per 10 thousand insured eligible($15{\sim}49$ years old) female was 7.6. The fee for normal delivery was 109,489 won and that for cesarean section was 390,024 won. The average days of hospitalization in normal delivery was 2.3 days, and those in cesarean section was 7.6 days. On the average cesarean section has a longer of stay as much as by 4.3 days and cost 3.6 times more than normal deliveries. Cesarean section rates vary among medical facilities 19.8% at clinics 37.6% in small-scale hospitals, and 29.1% in general hospitals. The regional variation of cesarean section rates was also fairly prominent. The South Cheju Gun has the highest rate of cesarean section, 56.2%. Meanwhile no cesarean section cases has been reported in Sunchang Gun during the period of this study. The variation is noted among provinces. The rate for Cheju province has been 3.4 times higher than that for Chunnam. The number of cesarean section per 10 thousand insured people vary greatly among regions, too. This study has found that there exists significant regional variations among various geographic units in terms of average length of stay, average cost, number of obsretricians and number of beds. Multiple regression analysis was done to identify factors explaining the regional variance of various cesarean section rates : In the urban areas, no significant explaining variables were noted except the number of beds for the dependent variable of cesarean section cases per 10 thousand insured eligible females. The smaller the number of bed, the more cases of cesarean section was noted for an urban area. The is mostly because the rate of cesarean section is higher in medium-size hospitals than in large general hospitals. In the rural areas, the factor of education has been found significant for all three deplendent variables. The higher the educational level, the rate of cesarean section is most likely to rise. An income variable measured by the amount of monthly insurance contribution has been identified a powerful predictor in explaining the valiance of cesarean section rates. The same has been noted for the number of obstetricians. Similar findings are observed for the country as a whole. The income level has veen found as the most powerful explaining factor in the regional variance of cesarean section rates. In general the rate is higher in the urban areas, and lower in the area with more small hospitals. As this is the initial attempt to identify the factors relevant to the regional difference in the rates of cesarean section, more elaborated study is urgently required.

• Journal of Korean Academy of Nursing Administration
• /
• v.10 no.1
• /
• pp.63-81
• /
• 2004

Purpose: To identify job satisfaction of hospital employees and the relating factors Methods: The study sample was a total of 1,031 healthcare workers(doctors, nurses, pharmacists, medical engineers, office workers, etc) at a tertiary teaching hospital. The data were collected using a questionnaire developed by a expert group. The questionnaire consisted of 21 items including job characteristics, organizational culture, and personal characteristics on the five Likert scale. Results: The overall satisfaction on job characteristics was 3.24 on the five Likert scale. The satisfaction of each item was 4.14 in role clarity, 3.26 in communication participating rate, 3.10 in work variety, 3.06 in autonomy, and 2.64 in workload. The overall satisfaction on organizational culture was 3.00. Particularly, the satisfaction on collaboration was 3.83, co-worker's support. 3.73, identity, 3.62, education/training opportunity, 3.12, pay, 2.62, welfare, 2.35, promotion, 2.34, and organizational conflict, 2.00. The level of satisfaction on personal characteristics was 3.00. In the satisfaction of each item, the score of disposition was 3.83, contribution to the hospital, 3.75, pride as a member of hospital, 3.70, and attitude on job performance, 3.68. The correlation between satisfaction and other variables was statistically significant with the exception of work variety. The satisfaction related significantly to loyalty index(r=.486, p=.000), autonomy(r=.415, p=.000), pride as a member of hospital(r=.411, p=.000), supervisor support(r=.364, p=.000). Conclusions: The results showed developing organizational strategy to promote job satisfaction can decrease the turnover rate and increase loyalty to the organization. It will contribute to enhance productivity in hospital.

• Korean Journal of Social Welfare
• /
• v.53
• /
• pp.285-310
• /
• 2003

As National Pension Scheme for all nation complete in 1999 through expanding application in cities, the public pension including Public Occupational Pension became main axis of old-age income maintenance. After 4years since then, now, it is only half of total National Pension insured persons who have been qualified to receive pension through participate and contribution. The other half of National Pension insured is left the excluded from public pension. This paper is intended to identify scale and characteristics of the excluded from public pension and to analysis its cause, and to explore policy measures for solving the excluded's problem. for current recipients over 60 years old generation, the its excluded's scale is no less than 86% of the old over 60 years. The probability of getting in the excluded is high in case of old elderly and female for current elderly generation. For future recipients 18-59 years working generation, the its excluded's scale is no less than 61% of the 18-59 years total population. The probability of getting in the excluded is high in case of 18-29 years and female for current working generation. As logistic regression analysis determinant factor of paying or not pension contribution for future recipients, it appear that probability of getting in the excluded for current working generation is high in case of younger old, lower education attainment, irregular employee, working at agriculture forestry fishery sector, construction sector, wholesale retail trade restaurants hotels sector, financial institution and insurance real estate renting and leasing sector in comparison with manufacturing sector, occpaying at elementary occupation, professionals technicians and associate professionals, sale and service workers, plant machine operators and assemblers, legislators senior officials and managers in comparison with clerks. The Policy measures for the current recipient old generation have need to reinforce supplemental role of Senior's pension(non-contribution pension) until maturing of public pension, because of no having chance of public pension participants for them. And the Policy measures for the future recipient working generation have need to restructure social security fundamentally corresponding with social-economic change as labour market and family structure etc. The pension system has need to change from one earner one pension to one citizen one pension with citizenship rights. At this point, public pension have need to manage with combining insurance's contribution principle and citizenship principle financing by taxes. Then public pension will become substantially universal social network for old-age income maintenance and we can find real solution for the excluded from.

• 한국노년학
• /
• v.25 no.2
• /
• pp.109-126
• /
• 2005

Recently it has been encouraged in developed countries that labor force participation of the elderly is one of the means to cut down the cost of social welfare for them. However, empirical studies have rarely explored how work in later life contributes to national economy. Especially, even though 56.6 percent of elderly workers aged 65 and older engaged in agriculture and forestry in Korea, their contribution has been socio-economically overlooked. This study aims at examining the effect of farming labor in later life on social welfare expenditure. For this purpose, social welfare expenditure was defined as social benefits provided for the elderly by the social security in public sector and measured as transportation allowance, pension, livelihood aid, medical aid, and health insurance in 2003. Data were obtained from National Health Insurance Cooperation and 37 town/village offices and analyzed by 3 age groups; 65~74, 75~84, and 85 and over using SPSS/PC windows program. Results showed that both livelihood and medical support in all age groups were expended more to non-farm than to farm workers. The amount differences per person between them were 113,959~361,132 won in livelihood support and 15,644~51,418 won in medical support. Also, participation in farming influence reduction of livelihood expenditure for the group 65~74 and 75~84 and that of medical expenditure only for the group 65~74. Based on these results, it was estimated the amount of social welfare expenditure reduced by farming labor in later life. The limit of this study and the policy implications of the results are discussed.