• Korean Circulation Journal
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• v.52 no.8
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• pp.576-592
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• 2022

Acute heart failure is associated with high mortality and frequent rehospitalization, resulting in enormous healthcare costs and declining physical function, activities of daily living, and quality of life. Cardiac rehabilitation has been recommended as one of the non-pharmacologic treatments for patients with heart failure. However, much of the evidence for cardiac rehabilitation interventions reported to date has been limited to chronic heart failure. In recent years, the effectiveness of rehabilitation intervention in patients with acute heart failure has been reported, led by the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial. This review overviews the recent evidence of rehabilitation in patients with acute heart failure.

• Korean Journal of Radiology
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• v.24 no.12
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• pp.1249-1259
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• 2023

Objective: This study aimed to evaluate the clinical outcomes and cost-effectiveness of dual-energy X-ray absorptiometry (DXA) for osteoporosis screening. Materials and Methods: Eligible patients who had and had not undergone DXA screening were identified from among those aged 50 years or older at Kaohsiung Veterans General Hospital, Taiwan. Age, sex, screening year (index year), and Charlson comorbidity index of the DXA and non-DXA groups were matched using inverse probability of treatment weighting (IPTW) for propensity score analysis. For cost-effectiveness analysis, a societal perspective, 1-year cycle length, 20-year time horizon, and discount rate of 2% per year for both effectiveness and costs were adopted in the incremental cost-effectiveness (ICER) model. Results: The outcome analysis included 10337 patients (female:male, 63.8%:36.2%) who were screened for osteoporosis in southern Taiwan between January 1, 2012, and December 31, 2021. The DXA group had significantly better outcomes than the non-DXA group in terms of fragility fractures (7.6% vs. 12.5%, P < 0.001) and mortality (0.6% vs. 4.3%, P < 0.001). The DXA screening strategy gained an ICER of US$ -2794 per quality-adjusted life year (QALY) relative to the non-DXA at the willingness-to-pay threshold of US$ 33004 (Taiwan's per capita gross domestic product). The ICER after stratifying by ages of 50-59, 60-69, 70-79, and ≥ 80 years were US$ -17815, US$ -26862, US$ -28981, and US$ -34816 per QALY, respectively. Conclusion: Using DXA to screen adults aged 50 years or older for osteoporosis resulted in a reduced incidence of fragility fractures, lower mortality rate, and reduced total costs. Screening for osteoporosis is a cost-saving strategy and its effectiveness increases with age. However, caution is needed when generalizing these cost-effectiveness results to all older populations because the study population consisted mainly of women.

• Health Policy and Management
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• v.19 no.3
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• pp.92-108
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• 2009

This study suggests a model for continuing and comprehensive management of hypertension or Type 2 diabetes mellitus (T2DM) in Korea. Moreover, this paper computed the contribution cost of hypertension or T2DM management using the healthcare medical cost, which could have occurred from stroke, myocardial infarction (MI), and end-stage renal disease (ESRD) that were successfully prevented from the effective hypertension or T2DM management. Additionally, these costs were compared with the cost of implementing the hypertension or T2DM management model suggested in this study. This study used the medical fee summary of the health insurance claims submitted to National Health Insurance Corporation by medical facilities for services provided during the period from January 1st 1999 to December 31st 2006. The prevalence rate with treatment referred to cases in which patients submitted their medical claims at least once during the period, along with an accordant diagnosis. The incidence rate with treatment referred to cases in which patients who never submitted claims for the accordant disease during the five years from 1999 to 2003 submitted claims for the accordant disease in 2004 and 2005. The relative risk of the occurrence of stroke, MI and ESRD was 11.0, 13.6, and 30.3, respectively. The attributable risk of hypertension or T2DM for stroke was 0.730, and that for MI and ESRD were 0.773 and 0.888, respectively. Based on these, the contribution cost of hypertension or T2DM is estimated to be 986.3 billion Korean Won(KRW) for stroke patients, 330.5 billion KRW for MI patients, and 561.7 billion KRW for ESRD patients as in 2005. Hence, the total contribution cost of hypertension or T2DM to stroke, MI, and ESRD is 1.878 trillion KRW. The estimate for operational costs included an annual expenditure of 50,000 KRW per each recipient and an annual subsidy of 0.22 million KRW per person for the 1.6 million low.income individuals with hypertension or T2DM to cover their out.of.pocket medical expenses. Under this assumption, it took approximately 0.6 trillion KRW to manage 5 million high.risk patients in the low. and mid.income range, coverings up to 50% of costs. In conclusion, considering the potential benefits of preventing stroke, MI, and ESRD, the costs seems to be reasonable.

• Information Systems Review
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• v.15 no.2
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• pp.59-73
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• 2013

Healthcare costs are continuously increasing due to longer life expectancy and providing global healthcare services through medical tourism is new service growth engine for Korea. Several countries have well established programs and infrastructure dedicated to medical tourism. South Korea is attempting to become a major player in this domain by undertaking broad initiatives. The success of medical tourism is greatly impacted by easy access to two types of information, namely, medical and travel information. The National Health Insurance System in Korea collects huge amount of clinical and financial information from all hospitals. However, this information does not get used effectively in health and travel information systems to support medical tourism. This paper provide clear process map of medical tourism to understand how the patient and information process both medical and tourism fields also describe the need of customer and service provider. In this paper, we develop a medical tourism service system that will promote information exchange and service delivery.

• Korean Journal of Health Education and Promotion
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• v.31 no.4
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• pp.63-72
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• 2014

Objectives: The current study reviews the implementation and evaluation of the Chronic Disease Self-Management Program (CDSMP) in the United States (U.S.) to illustrate the program's potential contribution to improving health among Korean adults with chronic conditions while saving healthcare costs. Methods: This study examines existing literature on the history, theoretical background, essential elements, and delivery outcomes of CDSMP with special focus on the successes and challenges to be faced in the implementation of CDSMP to Koreans with chronic conditions. Results: CDSMP is designed to empower people with chronic conditions to develop skills necessary for medical, social role, and emotional management of chronic conditions. Recent studies show the utility of CDSMP in achieving the Triple Aim health reform goals (i.e., better care, better health, better value). Lessons learned from the U.S. experience emphasize the importance of establishing evidence-based studies, collaborating with community partners, and diversifying funding sources to make CDSMP more sustainable. Conclusion: The current study demonstrates the replicability of CDSMP and potential for expansion in Korea. More concerted efforts among academia, government, and communities are needed to deliver CDSMP to Korean adults and identify its effectiveness within the Korean context in terms of meeting the Triple Aim goals of better care, better health, and better value.

• Health Policy and Management
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• v.27 no.3
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• pp.247-255
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• 2017

Background: South Korea has experienced problems with excessive pharmaceutical expenditures. In 2010, the South Korean government introduced an outpatient prescription incentive program to effectively manage pharmaceutical expenditures. Therefore, we examined the relationship between the outpatient prescription incentive program and pharmaceutical expenditures. Methods: We used data from the Korean National Health Insurance claims database, which included medical claims filed for 22,732 clinics from 2011-2014 to evaluate associated pharmaceutical expenditures. We performed multiple regression analysis and Poisson regression analysis using generalized estimating equation models to examine the associations between outpatient prescription incentives and the outcome variables. Results: The data used in this study consisted of 123,392 cases from 22,372 clinics (average 5.4 periods follow-up). Clinics that had received outpatient prescription incentives in the last period had better cost saving and Outpatient Prescribing Costliness Index (OPCI) (received: proportion of cost saving, ${\beta}=6.8179$; p-value < 0.0001; OPCI, ${\beta}=-0.0227$; p-value < 0.0001; reference = non-received). Moreover, these clinics had higher risk in the provision of outpatient prescription incentive (relative risk, 2.772; 95% confidence interval, 2.720 to 2.824). The associations were higher in clinics that had separate prescribing and dispensing programs, or had professional staff. Conclusion: The introduction of an outpatient prescription incentive program for clinics effectively managed problems with rapid increases of pharmaceutical expenditures in South Korea. However, the pharmaceutical expenditures still increased in spite of the positive impact of the outpatient prescription incentive program. Therefore, healthcare professionals and health policy makers should develop more effective alternatives (i.e., for clinics without separate prescribing and dispensing programs) based on our results.

• Health Policy and Management
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• v.23 no.3
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• pp.289-300
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• 2013

Background: Patients' trust in their physicians or hospitals is important to guarantee the effectiveness of care and to encourage revisits. This study aimed to identify the relationship between the experience of requesting verification of healthcare benefit coverage via the Health Insurance Review Agency (HIRA) and patients' trust in their physicians or hospitals. Methods: For this population-based study, 800 adult respondents aged 20 to 65 years were recruited using random sampling and telephone surveys. Respondents were divided into two groups: 1) 400 people had experience in requesting the HIRA verification service for the purpose of confirmation of whether the costs they paid were appropriate among metropolitan habitants, and 2) 400 people comprised members of the public who had no experience requesting the verification service. Results: Experience with requesting verification services was likely to lower the patients' trust in medical institutions, but not in their physicians (p<0.05). In addition, patients who were satisfied with their physicians and hospitals were more likely to trust the physicians and hospitals than dissatisfied patients. Conclusion: Patients' trust might be an important factor influencing hospital success. Patients' trust in medical suppliers, such as physicians and hospitals, encourages a positive relationship between medical suppliers and patients. Therefore, medical suppliers must provide appropriate care to patients to improve patients' trust in them.

• Safety and Health at Work
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• v.8 no.4
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• pp.337-342
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• 2017

Background: Workplace violence (WPV) against healthcare workers (HCWs) employed in psychiatric inpatient wards is a serious occupational issue that involves both staff and patients; the consequences of WPV may include increased service costs and lower standards of care. The purpose of this review was to evaluate which topics have been focused on in the literature and which are new in approaching the concern of patient violence against HCWs employed in psychiatric inpatient wards, in the past 20 years. Methods: We searched for publications in PubMed and Web of Science using selected keywords. Each article was reviewed and categorized into one or more of the following four categories based on its subject matter: risk assessment, risk management, occurrence rates, and physical/nonphysical consequences. Results: Our search resulted in a total of 64 publications that matched our inclusion criteria. The topics discussed, in order of frequency (from highest to lowest), were as follows: "risk assessment," "risk management," "occurrence rates," and "physical/nonphysical consequences." Schizophrenia, young age, alcohol use, drug misuse, a history of violence, and hostile-dominant interpersonal styles were found to be the predictors of patients' violence. Conclusion: Risk assessment of violence by patients appeared the way to effectively minimize the occurrence of WPV and, consequently, to better protect mental HCWs. We found paucity of data regarding psychologic sequelae of WPV. According to these findings, we suggest the need to better investigate the psychologic consequences of WPV, with the aim of checking the effective interventions to assist HCW victims of violence and to prevent psychologic illness.

• Korea Journal of Hospital Management
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• v.24 no.2
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• pp.67-83
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• 2019

The aim of this study is to analyze the differences in the publicness indices depending on the environmental factors of regional public hospitals to derive the policy implications for improving management for regional public hospitals. The data of the 34 regional public hospitals from 2016 was used for the analysis. Major results of this study are as follows. First, the analysis of the differences in the scores of the medical safety net function showed significantly higher scores for regional public hospitals with a larger location, a larger number of hospitals in a unit area, a larger number of nurses per 100 beds, and the lower management fee ratio. Second, the analysis of the differences in the scores of the unmet healthcare needs showed significantly higher scores for regional public hospitals with a larger number of hospitals in a unit area, and a larger number of beds. Third, the analysis of the differences in the scores of the hospital-specialized services showed significantly higher scores for regional public hospitals with a larger location, a higher financial independence of the local government, a larger number of hospitals in a unit area, a larger number of beds, and a larger number of nurses per 100 beds. Major conclusions of this study are as follows. Consideration should be given to the appropriate number of nurses for each regional public hospital to maximize publicness by providing the appropriate amount of medical services, but not to incur unnecessary labor costs. In addition, efforts should be made to enhance profitability, which can be a means of strengthening publicness, by identifying the minimum administrative expenses required for efficient operation and reducing unnecessary administrative expenses. Finally, it is necessary to identify the appropriate number of beds to meet the needs of the customers and to create maximum profits.

• Journal of Korean Neurosurgical Society
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• v.65 no.1
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• pp.57-63
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• 2022

Objective : To study the factors relating to operative treatment for spinal metastasis in Thailand during 2005-2014 and to determine the hospital costs, mortality rate, and incidence of perioperative complication. Methods : Inpatient reimbursement data from 2005 to 2014 was reviewed from three national healthcare organizations, including the National Health Security Office, the Social Security Office, and the Comptroller General's Department. The search criteria were secondary malignant neoplasm of bone and bone marrow patients (International Classification of Diseases 10th revision, Thai modification codes [ICD 10-TM], C79.5 and C79.8) who underwent spinal surgical treatment (ICD 9th revision, clinical modification procedure with extension codes [ICD 9-CM], 03.0, 03.4, 03.09, and 81.0) during 2005-2014. Epidemiology, comorbidity, and perioperative complication were analyzed. Results : During the study period, the number of spinal metastasis patients who underwent operative treatment was significantly increased from 0.30 to 0.59 per 100000 (p<0.001). More males (56.14%) underwent surgical treatment for spinal metastasis than females. The most common age group was 45-64 (55.1%). The most common primary tumor sites were the unknown origin, lung, breast, prostate, and hepatocellular/bile duct. Interestingly, the proportion of hepatocellular/bile duct, breast, and lung cancer was significantly increased (p<0.001). The number of patients who had comorbidity or in-hospital complication significantly increased over time (p<0.01); however, the in-hospital mortality rate decreased. Conclusion : During the last decade, operative treatment for spinal metastasis increased in Thailand. The overall in-hospital complication rate increased; however, the in-hospital mortality rate decreased.