• Title/Summary/Keyword: Healthcare insurance

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Estimation of cost by unnecessary readmission of the tertiary hospitals (불필요한 재입원 비용 추정에 관한 연구)

  • Shin, Min Sun;Lee, Won Jae
    • Journal of the Korea Convergence Society
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    • v.8 no.12
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    • pp.149-157
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    • 2017
  • Unnecessary readmissions could be the result of the inadequate and unnecessary treatments. Adequate quality indicators for readmission are important because they can identify inadequate spending by inpatients as well as quality screening. This study attempted to estimate the cost incurred by unnecessary readmissions. The Health Insurance Claims Data of 18 years or older who were admitted in the tertiary hospitals in 2014 were analyzed. Admissions and readmissions were sorted and readmissions were classified into planned and unplanned readmissions. We adopted 28 days as a criteria for the classification of the readmission. Proportion of the patients were higher in readmissions among cancer, accompanied diseases, and special rehabilitation patients. Cost of the readmissions were 50% of the total cost of the admission among the patients of same diseases, same departments, and same hospitals. Almost 1,000billion Won were used by the unnecessary readmissions. We need to reduce the readmissions in regions, departments, and diseases studying the pattern of the readmissions. National level efforts are required to improve quality of care and reduce cost by the unnecessary readmissions.

A Study on the Association between Healthcare Utilization and the Burden of Families Caring for the Elderly in the Last 6 Months of Life (노인의 사망 전 6개월간 의료이용수준과 간병가족의 가족부담과의 관련성)

  • Yi, Jee-Jeon;Lee, Hee-Na;Ohrr, Hee-Choul;Jung, Hye-Young;Yi, Sang-Wook
    • Journal of Preventive Medicine and Public Health
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    • v.36 no.4
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    • pp.332-338
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    • 2003
  • Objective : To investigate the relationship between medical expenses and the burden of families caring for the elderly in the last 6 months of life, and to evaluate the factors relating to the burden of family caregivers. Methods : The families of 301 persons older than 65 years, who died between 1 July and 31 December 2001, and were registered in Resident-based- Health Insurance Programs in Seoul, were interviewed. The medical expenses and length of stay among the elderly were collected from Korean Health Insurance Corporations. Results : 31 percents of the elderly had no medical expenses in the last 6 months of life. On average, the objective burden (4.92) was higher than the subjective burden (3.35). Families caring for male elderly had a higher burden. With increasing age af death, the objective burden was significantly increased. The burden on a family seemed to be influenced more by the family income than the property of the elderly. With increasing total health care costs, the objective burden on the family caregivers was significantly increased, but with increasing medical expenses, the subjective burden was significantly decreased. Conclusion : An association between healthcare utilization and burden on families was observed. The reason for the decreasing subjective burden when medical expenses were decreased was unclear. Further research will be needed.

Study on HIPAA PHI application method to protect personal medical information in OMOP CDM construction (OMOP CDM 구축 시 개인의료정보 보호를 위한 HIPAA PHI 적용 방법 연구)

  • Kim, Hak-Ki;Jung, Eun-Young;Park, Dong-Kyun
    • The Journal of Korean Institute of Next Generation Computing
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    • v.13 no.6
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    • pp.66-76
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    • 2017
  • In this study, we investigated how to protect personal healthcare information when constructing OMOP (Observational Medical Outcomes Partnership) CDM (Common Data Model). There are two proposed methods; to restrict data corresponding to HIPAA (Health Insurance Portability and Accountability Act) PHI (Protected Health Information) to be extracted to CDM or to disable identification of it. While processing sensitive information is restricted by Korean Personal Information Protection Act and medical law, there is no clear regulation about what is regarded as sensitive information. Therefore, it was difficult to select the sensitive information for protecting personal healthcare information. In order to solve this problem, we defined HIPAA PHI as restriction criterion of Article 23 of the Personal Information Protection Act and maps data corresponding to CDM data. Through this study, we expected that it will contribute to the spread of CDM construction in Korea as providing solutions to the problem of protection of personal healthcare information generated during CDM construction.

Prevalence and Determinants of Catastrophic Healthcare Expenditures in Iran From 2013 to 2019

  • Abdoreza Mousavi;Farhad Lotfi;Samira Alipour;Aliakbar Fazaeli;Mohsen Bayati
    • Journal of Preventive Medicine and Public Health
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    • v.57 no.1
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    • pp.65-72
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    • 2024
  • Objectives: Protecting people against financial hardship caused by illness stands as a fundamental obligation within healthcare systems and constitutes a pivotal component in achieving universal health coverage. The objective of this study was to analyze the prevalence and determinants of catastrophic health expenditures (CHE) in Iran, over the period of 2013 to 2019. Methods: Data were obtained from 7 annual national surveys conducted between 2013 and 2019 on the income and expenditures of Iranian households. The prevalence of CHE was determined using a threshold of 40% of household capacity to pay for healthcare. A binary logistic regression model was used to identify the determinants influencing CHE. Results: The prevalence of CHE increased from 3.60% in 2013 to 3.95% in 2019. In all the years analyzed, the extent of CHE occurrence among rural populations exceeded that of urban populations. Living in an urban area, having a higher wealth index, possessing health insurance coverage, and having employed family members, an employed household head, and a literate household head are all associated with a reduced likelihood of CHE (p<0.05). Conversely, the use of dental, outpatient, and inpatient care, and the presence of elderly members in the household, are associated with an increased probability of facing CHE (p<0.05). Conclusions: Throughout the study period, CHE consistently exceeded the 1% threshold designated in the national development plan. Continuous monitoring of CHE and its determinants at both household and health system levels is essential for the implementation of effective strategies aimed at enhancing financial protection.

Educational Demands among Teachers at Infant Daycare Centers (영아전담보육시설 보육교사의 교육요구)

  • Ha, Younghea;Bang, Kyung-Sook
    • Korean Parent-Child Health Journal
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    • v.18 no.1
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    • pp.19-27
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    • 2015
  • Purpose: This study was performed to investigate educational demands of teachers in the daycare centers for infant healthcare. Methods: Sixty-nine teachers who in charge of children under 1 year old at infant daycare centers participated from January 2 to March 31, 2012. The data were analyzed using frequency, percentage, average, and standard deviation using SPSS 21.0. Results: Education demands among teachers of infant daycare centers were high in health and safety domain. Teachers prefer 6 month as the term of education, at the beginning of the semester. Also, three hours or less of session under the auspices of health and safety organizations were preferred. Mostly demanded education contents were first-aid skills depending on diverse types of accidents. In addition, teachers required repeat of practically available first-aid education programs with improved educational conditions. Conclusion: This study offered crucial examination of current status and key problems of infant healthcare at infant daycare centers in Seoul and Gyeonggi areas, and identified educational demands for infant healthcare among infant teachers.

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The Relationship between Role Conflict, Job Satisfaction, and Organizational Commitment among Community Healthcare Workers of the Seoul Preventive Project for Metabolic Syndrome (보건소 대사증후군관리사업 참여인력의 역할갈등, 조직몰입, 직무만족 간의 관계)

  • Ryu, Hosihn;Cho, Jeonghyun
    • Journal of Korean Public Health Nursing
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    • v.27 no.1
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    • pp.16-26
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    • 2013
  • Purpose: The aim of this study was to identify a conceptual link between role conflict, job satisfaction, and organizational commitment, with a specific examination on how job satisfaction mediated the relationship between role conflict and organizational commitment, among community healthcare workers. Methods: Participants were 119 community healthcare workers of the Seoul Preventive Project for Metabolic Syndrome at 15 community health centers. Descriptive analysis, correlations analysis, and multiple regression analysis were used for statistical analysis of our data. Additionally, Sobel's test was used to verify the significance of the mediating effect. Results: An inverse association between role conflict and organizational commitment was found (beta=-0.53, p<.001). This relationship was fully mediated by job satisfaction (z=-6.43, p<.001). Conclusion: Job satisfaction mediates the effects of role conflict on the organizational commitment of healthcare workers in community health centers. Strategies for improving the components of job satisfaction are needed to achieve better outcomes in organizational commitment in the Seoul Preventive Project for Metabolic Syndrome and possibly other work settings.

Design for Automation System for Pharmaceutical Prescription Using Arduino and Optical Character Recognition

  • Lim, Myung-Jae;Jung, Dong-Kun;Kim, Kyu-Dong;Kwon, Young-Man
    • International journal of advanced smart convergence
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    • v.10 no.3
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    • pp.66-71
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    • 2021
  • Recent healthcare environments have characteristics of expanding the scope of healthcare-impacting healthcare, complexity resulting from diversification of components, and accelerating the pace of change. Drugs are used for the prevention, mitigation, and treatment of diseases, so they can inevitably cause harm, while they have efficacy and effectiveness, which are key elements of health recovery. Therefore, many countries regulate permits for safe and effective medicines, and also designate essential drugs directly related to life as pay targets and guarantee health insurance. Especially Pharmacist relying on manpower for composition medicine is liable for mal-manufacture due to combination of toxic medical substances or other chemical usage. In this paper, we focus on using Kiosk and Optical Character Recognition (OCR) for automated pharmacy to level up medical service and create labor friendly environment for pharmacist themselves through maintenance of prescription data and automated manufacturing solution. Presentation of drug substances and precautions will lead to efficient drug prescription and prevent misuse of information while auto manufacturing system efficiently maintain labor force and raise patient satisfaction level by reduction of waiting time.

Factors Associated with Unmet Healthcare Needs According to Households (가구 구성원에 따른 미충족 의료 관련요인)

  • Kim, Yun-Jeong;Choi, Seong-Ji;Hwang, Byung-Deog
    • The Korean Journal of Health Service Management
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    • v.12 no.2
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    • pp.39-49
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    • 2018
  • Objectives : In this study, we used the data of the 2015 National Health and Nutrition Survey in its 6th Phase, and the total number of subjects included was 4,884. Methods : Frequency analysis, crosstab and logistic regression analysis were conducted to investigate unmet medical factors related to family members. Results : The subjects of the study were 10.3% single-person households and 89.7% non-single-person households. There were statistically significant differences in age, education level, marital status, income level, private health insurance, and subjective health status. Factors associated with unmet healthcare needs according to single-person households was subjective health status. Age, gender, marital status and subjective health status were the factors associated with unmet healthcare needs according to non-single-person households. Conclusions : It is necessary to establish health care policies that can expand the health education necessary for providing appropriate information on medical care and improving awareness of social illnesses and improving affordability and convenience.

Effect of Socioeconomic Status on Healthcare Utilization in Patients with Rare and Incurable Diseases (희귀난치성질환자에서 사회경제적 수준이 의료이용에 미치는 영향)

  • Im, Jun;Kim, Myeong-Hee;Im, Jeong-Soo;Oh, Dae-Gyu
    • Health Policy and Management
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    • v.19 no.4
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    • pp.66-77
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    • 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.

Economic Evaluation of Prostate Cancer Screening Test as a National Cancer Screening Program in South Korea

  • Shin, Sangjin;Kim, Youn Hee;Hwang, Jin Sub;Lee, Yoon Jae;Lee, Sang Moo;Ahn, Jeonghoon
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.8
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    • pp.3383-3389
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    • 2014
  • Background: Prostate cancer is rapidly increasing in Korea and professional societies have requested adding prostate specific antigen (PSA) testing to the National Cancer Screening Program (NCSP), but this started a controversy in Korea and neutral evidence on this issue is required more than ever. The purpose of this study was to provide economic evidence to the decision makers of the NCSP. Materials and Methods: A cost-utility analysis was performed on the adoption of PSA screening program among men aged 50-74-years in Korea from the healthcare system perspective. Several data sources were used for the cost-utility analysis, including general health screening data, the Korea Central Cancer Registry, national insurance claims data, and cause of mortality from the National Statistical Office. To solicit the utility index of prostate cancer, a face-to-face interview for typical men aged 40 to 69 was conducted using a Time-Trade Off method. Results: As a result, the increase of effectiveness was estimated to be very low, when adopting PSA screening, and the incremental cost effectiveness ratio (ICER) was analyzed as about 94 million KRW. Sensitivity analyses were performed on the incidence rate, screening rate, cancer stage distribution, utility index, and treatment costs but the results were consistent with the base analysis. Conclusions: Under Korean circumstances with a relatively low incidence rate of prostate cancer, PSA screening is not cost-effective. Therefore, we conclude that adopting national prostate cancer screening would not be beneficial until further evidence is provided in the future.