• Korea Journal of Hospital Management
• /
• v.3 no.1
• /
• pp.121-133
• /
• 1998

We analyzed volume changes in the computerized tomography(CT) and the magnetic resonance imaging(MRI) utilizations. These two volumes are comparative because CT has been covered by the Medical Insurance from the beginning of 1996, however, MRI has not been covered up to now. We investigated 80 hospitals which afforded a facility of CT by the end of 1994. For the comparison of CT utilization, we selected two periods. The first period was from January to June of 1995, in which CT had not been covered by the Medical Insurance and the second period was from January to June of 1966, in which CT had been covered. The information we obtained were characteristics of hospitals, patients numbers per month, monthly uses of CT and MRI, and payments of CT claims, etc. After the Medical Insurance coverage, the number of CT uses per 1,000 patients were increased from January to March, however, was decreased from April to June in 1996 compared to the same periods of 1995. the number of CT uses in clinics were large than those in tertiary hospitals. The number of CT uses in small cities were larger than those in big cities. On the other hand, the number of MRI uses per 1,000 patients did not changed from January to May and was increased from June in 1996 compared to the same periods of 1995. These results showed the substitutional relationship of CT and MRI uses. After the insurance coverage for CT, the utilization of CT was increased because patients payed less than before. However, insurers restricted the payments to the CT claims. This impact might explain the substitutional relationship between CT and MRI.

• Tuberculosis and Respiratory Diseases
• /
• v.69 no.4
• /
• pp.298-302
• /
• 2010

Scedosporium apiospermum, the anamorph of Pseudallescheria boydii, is a ubiquitous saprophytic fungus. S. apiospermum can cause life-threatening infections usually in immunocompromised patients or after near-drowning incidents. Here, we report the first case of disseminated infection caused by S. apiospermum after near-drowning in Korea. A 44-year-old healthy man developed aspiration pneumonia, followed by multiple brain abscesses, and endopthalmitis, after a near-drowning incident in a septic tank. S. apiospermum infection was diagnosed on the 33rd day after the incident had occurred. The patient died from the progressive renal failure 255 days after incident, although he had been treated with voriconazole.

• Korean Journal of Clinical Pharmacy
• /
• v.27 no.3
• /
• pp.186-194
• /
• 2017

Objectives: A significant concern has been raised about the emerging resistance that is largely caused by the excessive or inappropriate use of antibacterial agents for viral respiratory infections. This study investigated the trend of respiratory tract infections (RTIs) and the use of antibiotics. Methods: Utilizing the national level health insurance claims data from 2005 to 2008, we examined encounter days, antibiotic use, and the prescription rate for respiratory tract infections including upper respiratory tract infections (URTIs), lower respiratory tract infections (LRTIs), and otitis media in outpatient settings. The antibiotic use was measured as defined daily dose per 1,000 patients per day (DDD/1,000 patients/day). Results: The visit for URTI increased from 141,693,465 in 2005 to 120,717,966 in 2008 and the visit for LRTI decreased from 61,778,718 to 66,930,122. For RTIs, prescription rates of antibiotics decreased from 65.2% to 58.5% for URTIs and 76.9% to 68.3% for LRTIs from 2005 to 2008. The antibiotic use decreased to 20.85 DDD/1,000 patients/day after a significant increase of 22.01 DDD/1,000 patients/day in 2006. Among antibiotics, J01CR had the highest use- 7.93 DDD/1,000 patients/day followed by J01DC of 3.71 DDD/1,000 patients/day and J01FA of 3.2 DDD/1,000 patients/day. One notable trend is that J01FA presented a continuous increase in antibiotic use from 2.3 in 2005 to 3.26 DDD/1,000 patients/day in 2008. Conclusion: The use of antibiotics had poor compliance to guidelines for RTIs. Despite decrease in the use of antibiotics, prescription rates for URTIs were still about 50% indicating that the delayed prescribing antibiotics (or wait-and-see) were not observed.

• Health Policy and Management
• /
• v.27 no.3
• /
• pp.191-198
• /
• 2017

Moon Jae-in Government announced the Government's 5-Year Plan on July 19, 2017, President Moon directly announced the Government's Plan for Benefit Expansion in National Health Insurance on August 7, 2017. The main contents of the announced expansion include benefit coverage for all medically necessary services with control over non-covered service occurrence, a decrease in the cost-sharing upper limit, and monetary support for catastrophic medical costs. Although past governments have been continuously striving for benefit expansion in the last 15 years, this plan has its breakthrough aspect in that all medical services will be covered by the National Health Insurance. In alignment, there are important tasks to solve: attaining a proper fee schedule, reforming the healthcare delivery system, and improving healthcare quality. This plan is a symptom oriented action in that it is limited in reducing patients' out-of-pocket money, unlike the systematic approach of the National Health Insurance. The sustainability of the National Health Insurance is being threatened due to South Korea's low birth rate, rapidly aging society, and low economic growth, in addition to the unification issue of the Korean Peninsula, medical utilization of the elderly, management of non-communicable diseases, and so on. Therefore, the Government needs to plan the National Health Insurance system reformation including actions addressed toward medical consumers.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.35 no.1
• /
• pp.31-34
• /
• 2009

Purpose: This study compared the frequency of postoperative infections in patients for a closed mandibular fracture with that without the postoperative antibiotic prophylaxis. Patients and Methods: 48 patients without any specific medical history were divided into two groups depending on whether or not antibiotics had been applied after the surgery. The 24 patients in group 1 received only a second-generation cephalosporin ($Cefotetan^{(R)}$) intravenously from admission to immediate after the surgery. Likewise, 24 patients in group 2 received 1.0g of $Cefotetan^{(R)}$ twice daily longer than the third day after surgery. The mean (SD) duration of antibiotics administration after surgery was 6.9 (${\pm}3.56$). The patients were evaluated after surgery for any postoperative infections according to the criteria: purulent drainage from a wound, spontaneous wound dehiscence accompanied by swelling, pain, and fever around the wound. Results: Postoperative infections were encountered in 2 out of 24 patients in group 1, who received antibiotic medication until shortly after surgery, and in 3 out of the 24 patients in group 2, in whom the medication was continued even after the surgery. There was no sig nificant difference in the incidence of postoperative infections between the two groups. Conclusion: From this study, postoperative use of antibiotics seems to be unnecessary with view of the little significance of the factors that could affect the wound infection.

• Korea Journal of Hospital Management
• /
• v.26 no.1
• /
• pp.71-82
• /
• 2021

Purpose: The purpose of this study is to estimate incomes and costs of the medical clinics by using secondary data. Methodology: The medical incomes and costs were estimated from 405 clinics operated by sole practitioner providing out-patient services among all clinics subject to the Medical Cost Survey on National Health Insurance Patients in 2017, excluding dental clinics and oriental medical clinics. The incomes and costs of the medical clinics were reflected with incomes and costs of health insurance benefits and were calculated by types of medical services (i.e., basic care, surgery, general treatment, functional test, specimen test and imaging test). The costs were classified as follows: labor costs, equipment costs, material costs and overhead costs. Secondary data was used to estimate the incomes and costs of the medical clinics. For allocation bases for costs for each type of the medical service, the ratio of revenue from health insurance benefits by types of medical services was applied. However, labor costs were calculated with the activity ratio by types of medical services and occupations, using clinical expert panel data. Finding: The percentage of health insurance income for all medical income was 73.1%. The health insurance cost per clinic was 401,864 thousand won. Labor cost accounted for the largest portion of the health insurance income was 191,229 thousand won (47.6%), followed by management cost was 170,018 thousand won (42.3%), materials cost was 35,434 thousand won (8.8%), and equipment costs was 5,183 thousand won (1.3%). Practical Implications: This study suggests a method of estimating incomes and costs of medical clinic services by using secondary data. It could efficiently provide incomes and costs to assess an appropriate level of the health insurance fee to the clinics.

• Journal of Preventive Medicine and Public Health
• /
• v.40 no.1
• /
• pp.51-58
• /
• 2007

Objectives : The objectives of this study were to estimate the continuity of care for all Koreans with diabetes and to identify factors affecting the continuity of care. Methods : We obtained National Health Insurance claims data for patients with diabetes who visited health-care providers during the year 2004. A total of 1,498,327 patients were included as study subjects. Most Frequent Provider Continuity (MFPC) and Modified, Modified Continuity Index (MMCI) were used as indexes of continuity of care. A multiple linear regression analysis was used to identify factors affecting continuity of care. Results : The average continuity of care in the entire population of 1,498,327 patients was $0.89{\pm}0.17$ as calculated by MFPC and $0.92{\pm}0.16$ by MMCI. In a multiple linear regression analysis, both MFPC and MMCI were lower for females than males, disabled than non-disabled, Medicaid beneficiaries than health insurance beneficiaries, patients with low monthly insurance contributions, patients in rural residential areas, and patients whose most frequently visited provider is the hospital. Conclusions : The continuity of care for patients with diabetes is high in Korea. However, women, the disabled and people of low socio-economic status have relatively low continuity of care. Therefore, our first priority is to promote a diabetes management program for these patients.

• Health Policy and Management
• /
• v.24 no.3
• /
• pp.205-218
• /
• 2014

Background: Most studies on the national health insurance benefit expansion policy have focused on policy tools or decision-making process. Hence there was not enough understanding on how policies are actually implemented within the specific policy context in Korea which has a national mandatory health insurance system with a dominant proportion of private providers. The main objectives of this study is to understand the implementation process of the benefit coverage expansion policy. Unlike other implementation studies, we tried to examine both the process of implementation and decision making and how they interact with each other. Methods: Interviews were conducted with the ex-members of the Health Insurance Policy Review Committee. Medical doctors who implement the policy at the 'street-level' were also interviewed. To figure out major variables and the degree of their influences, the data were analyzed with Winter's Policy Implementation Model which integrates the decision making and implementation phases. Results: As predicted by the Winter model, problems in the decision making phase, such as conflicts among the members of committee, lack of applicable causal theories application of highly symbolic activities, and limited attention of citizen to the issue are key variables that cause the 'implementation failure.' In the implementation phase, hospitals' own financial interests and practitioners' dependence on the hospitals' guidance were barriers to meeting the policy goals of providing a better coverage for patients. Patients, the target group, tend to prefer physicians who prescribe more treatment and medicine. To note, 'fixers' who can link and fill the gap between the decision-makers and implementers were not present. Conclusion: For achieving the policy goal of providing a better and more coverage to patients, the critical roles of medical providers as street-level implementers should be noted. Also decision making process of benefit package expansion policy should incorporate its influence on the implementation phase.

• Korea Journal of Hospital Management
• /
• v.21 no.4
• /
• pp.45-54
• /
• 2016

The purpose of this study is to identify patient and hospital characteristics with pulmonary tuberculosis and to analyze factors which were influencing length of stay and treatment. The Korean National Hospital Discharge In-depth Injury Survey database from 2006 to 2012 was used for analysis. Study subjects were 4,704 patients and analyzed by using frequency, chi-square and logistic regression through using STATA 12.0. To avoid selection bias, we used propensity score matching. Analysis results show that the length of stay and treatment of pulmonary tuberculosis was different between insurance types. Patients characteristic(female, comorbidity, admission by outpatient department, medical insurance type) and hospital characteristic(500-999 beds, over 1000 beds) significantly influence length of stay. Admission by outpatient department and over 1000 beds are significantly influence treatment. Based on these findings, it is necessary to clarify between length of stay and treatment outcome by medical aids beneficiaries and audit hospitals follow discharge guidelines in pulmonary tuberculosis patients.

• Quality Improvement in Health Care
• /
• v.27 no.2
• /
• pp.73-82
• /
• 2021

Purpose: This study aims to examine the quality of tuberculosis (TB) care after the 1st to 3rd national quality assessment (QA) program for TB healthcare service in Korea was conducted. Methods: We analyzed Health Insurance Review & Assessment Service (HIRA) claims data of new TB patients during the period of January to June from 2018-2020. The new TB patients were defined as TB patients reported to Korea Centers for Disease Control and Prevention Agency (KCDA). The unit of analysis was the patient. Chi-square tests were used to analyze the differences in indicator value according to the types of medical facilities. The QA indicators of TB care were divided into 3 areas consisting of the following 7 quality indicators: 4 indicators of diagnosis test (the rate of acid-fast bacilli smear, the rate of acid-fast bacilli culture, the rate of Mycobacterium tuberculosis-polymerase chain reaction, drug susceptibility test), 1 compliance of treatment guideline, and 2 indicators of care management of TB patients (encounter rate, day of therapy). Results: The QA program for TB care was conducted among 8,246 patients from 534 facilities in 2020. The value of the 7 quality indicators was shown to increase as a result of the QA program. The indicators of the diagnostic test were all higher than 95%, with the exception of the drug susceptibility test which was 84.8%. Both indicators for care management of TB patients were 88.5%. Conclusion: The quality of TB care has been improving with the implementation of the QA program. In order to continue to improve the quality of TB care, it will be necessary to disclose the results of the QA program in medical facilities in the future.