• 보험의학회지
• /
• 제30권2호
• /
• pp.16-19
• /
• 2011

In patents with diabetes, the higher the serum glucose level was, the more cardiovascular events and death were observed. But with a certain kind of group, to control glucose level tightly does not decrease the incidence of these events. Several studies show that intensive glucose control does not gain benefit in patient with long standing, uncontrolled diabetes, especially having previous cardiovascular events, while definitely preventing progression of newly onset of diabetic nephropathy. Whether intensive glucose control increases mortality in high risk group is obscure and needs more studies with longer observation time.

• 한국시스템다이내믹스연구
• /
• 제17권1호
• /
• pp.5-24
• /
• 2016

This study structurally analyzes major inefficiency of Korea's healthcare delivery system by utilizing the systems thinking. In particular, the phenomenon of patient's concentrated visits to large hospitals, waste of resource due to competitions between clinics and large hopitals, and the structure of oversupply were visualized using the causal loop diagram. The inefficient structure of healthcare delivery system can be understood more clearly by utilizing the major system archetypes of 'success to the successful', 'tragedy of commons', 'escalation' and 'limits to growth'. This study also finds solution from archetypal structure suggested by Wolstenholme. The inefficient status of healthcare delivery system might be explained by the 'out of control' archetype. In conclusion, the public resources such as the national health insurance need to be acknowledged as the entire achievement. All the participants should cooperate with each other in order to improve the inefficiency of the healthcare delivery system. In addition, the arrangement of incentive system for cooperation, acceleration of health information technology, and development of innovative business models make the sustainable healthcare delivery system.

• 한국병원경영학회지
• /
• 제24권2호
• /
• pp.1-11
• /
• 2019

Purpose: The purpose of this study is to identify relationship between work unstability and personal medical expenditure ratio focusing on wage workers' contract period. Method: This study analyzed 2015 yearly data beta version of Korea Health Panel, co-managed by Korea Institute for Health and Social Affairs and National Insurance Corporation for data analysis. When executing linear regression, Household income was applied with equivalized income, and the proportion of personal medical expenditure was naturally logged to perform linear regression and the demographic and socioeconomic factors were taken into account. The demographic and socio-economic factors were also considered. Findings: As a result of reviewing the used factors, it was found that the more unstable work status, the higher personal medical expenditure ratio. This result corresponds to 'The Theory of Fundamental Causes' by Link & Phelan. Conclusion : It indicates that policy efforts should be made to improve the working environment and health level of socially unstable workers.

• 한국병원경영학회지
• /
• 제24권1호
• /
• pp.21-35
• /
• 2019

Purposes: This study examines academic research trends and the change of patterns by analyzing researches related to healthcare service marketing from 1988 to 2016. Methodology: As research subjects, a total of 486 published articles were selected. It's to analyze them by dividing into research topics, methods and data by classifying the period into 1988-1999, 2000-2009, 2010-2016. Findings: From 1988 to 2016, 486 research articles on healthcare service marketing were published in academic journals. Research on healthcare service marketing has steadily increased. Most of the articles were about service quality, satisfaction, revisitation, and reuse. 452 research articles were quantitative research. Generally questionnaire surveys were used. Practical Implications: We suggest future research directions on the basis of the status of research on healthcare service marketing for the last 30 years.

• 보건행정학회지
• /
• 제28권2호
• /
• pp.105-106
• /
• 2018

Korea, which entered the aged society in 2018, is accelerating the progress of the aged society due to the rapid decrease in birth. Although the low birth rate is the important issue, comprehensive measures to cope with the aged society should be established. In particular, the reform of the healthcare system in response to the aged society is very urgent. The reorganization of the healthcare system in response to the aged society should focus on improving the functional abilities of the elderly and should be transformed into integrated older person-centered health service. The benefit package of National Health Insurance should be diversified and appropriate payment of each benefit package should be applied. The ageism should be overcame, and it is important to recognize that the measures for the older person are investments in future society. The reform of healthcare system for older person are very urgent in Korea, which is advancing into a rapidly aged society.

• 대한안과학회지
• /
• 제59권11호
• /
• pp.1039-1048
• /
• 2018

목적: 연령관련황반변성 환자에 대해 항혈관내피성장인자의 가능한 치료 방법에 따라 건강보험 재정에 미치는 영향을 분석하였다. 대상과 방법: 여러 치료 방법에 따른 건강보험 재정의 변화를 향후 5년(2018-2022년) 동안 추정하였다. 새로운 급여기준 이외 바이오시밀러 등장, 허가초과 비급여약제 사용 등을 고려한 시나리오에 대해서도 재정 영향을 분석하였다. 국민건강보험공단 청구자료 및 의료기관 자료를 기준으로 각 시나리오별로 향후 5년 동안 예상 진료환자 수, 치료 횟수를 추정하였으며, 재정부담을 추계하였다. 결과: 연령관련황반변성에서 현행의 사용형태로 기존 급여기준(평생 14회)이 유지되는 경우(시나리오 1) 2018년 기준 향후 5년간 보험소요재정은 약 4,403억 원으로 추정되었다. 2017년 12월에 변경된 급여기준하에서 5년간 보험소요재정은 약 5,601억 원으로 추정되었다. 2020년 이후 바이오시밀러 급여(시나리오 3), 현재 허가초과 비급여약제인 베바시주맙(시나리오 4)을 급여전환하는 경우에 각각 5,210억 원, 4,197억 원으로 예상되었다. 결론: 본 평생 14회라는 급여기준 삭제로 인해 건강보험 재정이 크게 증가할 것이 예상되었으나 실제 0.1 이하 그리고 반흔화/위축성 병변일 경우 급여 중단 등의 새로운 기준으로 중간폭으로 증가하는 것으로 나타났다. 또한 고령화로 인한 연령관련황반변성 유병환자의 증가를 고려할 때 바이오시밀러 및 베바시주맙 도입 등의 정책적 대안도 고려할 수 있다.

• Journal of Preventive Medicine and Public Health
• /
• 제38권2호
• /
• pp.132-140
• /
• 2005

Objectives: To propose a risk-adjustment model from insurance claims data, and analyze the changes in cesarean section rates of healthcare organizations after adjusting for risk distribution. Methods: The study sample included delivery claims data from January to September, 2003. A risk-adjustment model was built using the 1st quarter data, and the 2nd and 3rd quarter data were used for a validation test. Patients' risk factors were adjusted using a logistic regression analysis. The c-statistic and Hosmer-Lemeshow test were used to evaluate the performance of the risk-adjustment model. Crude, predicted and risk-adjusted rates were calculated, and compared to analyze the effects of the adjustment. Results: Nine risk factors (malpresentation, eclampsia, malignancy, multiple pregnancies, problems in the placenta, previous Cesarean section, older mothers, bleeding and diabetes) were included in the final risk-adjustment model, and were found to have statistically significant effects on the mode of delivery. The c-statistic (0.78) and Hosmer-Lemeshow test ($x^2$=0.60, p=0.439) indicated a good model performance. After applying the 2nd and 3rd quarter data to the model, there were no differences in the c-statistic and Hosmer-Lemeshow $x^2$. Also, risk factor adjustment led to changes in the ranking of hospital Cesarean section rates, especially in tertiary and general hospitals. Conclusion: This study showed a model performance, using medical record abstracted data, was comparable to the results of previous studies. Insurance claims data can be used for identifying areas where risk factors should be adjusted. The changes in the ranking of hospital Cesarean section rates implied that crude rates can mislead people and therefore, the risk should be adjusted before the rates are released to the public. The proposed risk-adjustment model can be applied for the fair comparisons of the rates between hospitals.

• 응용통계연구
• /
• 제28권4호
• /
• pp.663-683
• /
• 2015

저출산과 고령화 등의 인구구조의 변화는 미래 건강보험 재정의 안전성을 위협하고 있다. 이에 본 논문에서는 2002년부터 2013년까지 국민건강보험 표본코호트 DB를 이용하여 유병율 및 진료비에 대한 통계적 모형을 추정하고 인구구조와 경제상황의 변화에 대한 다양한 미래 가정들을 반영하여 건강보험 재정의 연도별 수입과 지출을 2060년까지 추계하였다. 지출 추계에는 건강보험공단 표본 코호트 DB를 이용하여 유병율 및 진료비를 추계하였다. 유병율 모형은 VECM-LC모형을 그리고 1인당 공단 부담 진료비에 대한 추계는 이중지수평활법에 근거 하였다. 두 모형 모두를 의료기관별, 질병별, 성별, 연령별로 적합하고 경제상황의 변화에 대한 국회와 정부의 여러 가정들을 반영하여 최종 추계치를 산출하였다. 수입 추계는 고령화 속도에 대한 두 개의 다른 가정에 근거한 두 개의 미래 인구구조를 반영한 두 개의 피부양률 가정에 근거하고, 지출 추계에서와 마찬가지로 경제 상황의 변화에 대한 여러 가지 가정을 반영하여 최종 추계치를 산출하였다. 그 결과 건강보험 재정적자는 2015년 불변가격으로 2030년에는 2030조 원, 2060년에는 4070조 원이 될 것으로 추계되었다.

• 보건행정학회지
• /
• 제23권2호
• /
• pp.152-161
• /
• 2013

Korea has a single National Health Insurance program and all citizens are covered under this program, accounting 97% of the population, approximately 50 million people. Claims submitted by Health care providers are reviewed by Health Insurance Review and Assessment (HIRA) for the reimbursement. HIRA database contains not only individual beneficiary's information, but also healthcare service information such as diagnosis, procedures, prescriptions and tests for them. HRA database has gained attention as importance source for research due to its rich healthcare information and the demand of HIRA database has increased. Due to its tremendous size, however, researchers have had problems in accessing the database to conduct research. To meet this demand, we conducted a study to develop the inpatient sample data from HIRA database for research. This study has two purposes: 1) to determine a needed sample size; 2) to test reliability and validity of the sample data. We determined an adequate sample size to ensure representativeness and generality with additional consideration for convenience of calculation. The minimum sample size was 729,904 for the generality, and 488,861 for representativeness. After considering the convenience of calculation, our final sample size was 13% of the population, which was about 7.7 million beneficiaries. Age (5 years interval) and gender were used as stratification variables for sampling. In order to examine whether this sample data appropriately reflect population, we tested the reliability and validity of the sample data. From the sample data, we computed average expenditure of total claims per inpatient for 2011, frequency of top 30 disease, estimation of the number of stroke patients from the sample data, and then compared them to those from the population. Results confirmed reliability and validity of the sample data.

• 대한치과의료관리학회지
• /
• 제11권1호
• /
• pp.47-53
• /
• 2023

This study aims to analyze the research trends of the Journal of Korean Academy of Dental Administration and identify the characteristics of the journal. The research was based on 10 academic journals from 2013 to 2022 and related documents. The type of paper, research method, statistical analysis, topic classification, and research subject of 65 papers were extracted and categorized. As a result, the distribution of paper types was as follows: research articles accounted for 83.2%, review articles for 12.3%. In terms of research methods, questionnaire surveys were used in 46.2% of the papers, literature reviews in 23.1%, and national data analysis in 7.7%. Research topics included dental manpower at 20.0%, infection control at 7.7%, dental information at 6.2%, patient safety at 6.2%, and oral health care quality at 6.2%. 72.3% of the papers were quantitative studies, and the majority of research subjects were dental hygienists or dental hygiene students, accounting for 26.2% of the total. The Journal of Korean Academy of Dental Administration covers topics such as dental healthcare marketing, dental healthcare organization and management, dental healthcare information, dental healthcare policy, dental healthcare insurance, dental healthcare quality management, patient safety, medical disputes, and infection control. The authors are also contributed by a variety of dental personnel, including dentists, dental hygienists, and dental technicians.