• 경영정보학연구
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• 제9권1호
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• pp.45-65
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• 2007

다른 산업과 달리 병원/의료 산업에서는 건강 보험료 심사 평가라는 독특한 검증 과정이 필수적으로 있게 된다. 건강 보험료 심사 평가는 병원의 수익 문제 뿐 아니라 적정한 진료행위를 하는 병원이라는 이미지와도 맞물려 매우 중요한 분야이며, 특히 대형 종합병원일수록 이 부분에 많은 심사관련 인력들을 투입하여, 병원의 수익과 명예를 위해서 업무를 수행하고 있다. 본 논문은 이러한 건강보험료 청구 심사 과정에서, 사전에 수많은 진료 청구 건 중 심사 평가에서 삭감이 될 수 있는 진료 청구 건을 데이터 마이닝을 통해서 발견하여, 사전의 대비를 철저히 하고자 하는 한 국내 대형 종합병원의 사례를 소개하고자 한다. 데이터 마이닝을 적용함에 있어, 주요한 문제점 중 하나는 바로 지도학습 기법을 적용하기에 곤란한 데이터 불균형 문제가 발생하는 것이다. 이런 불균형 문제를 해소하고, 비교 조건 중에 가장 효율적인 삭감 예상 진료 건 탐지 모델을 만들어 내기 위하여, 데이터 불균형 문제의 기본 해법인 Sampling과 오분류 비용의 다양한 혼합적인 적용을 통하여, 적합한 조건을 가지는 의사결정 나무 모델을 도출하였다.

• 경영정보학연구
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• 제7권1호
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• pp.275-295
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• 2005

경제의 세계화와 지식정보화 사회로의 진입과 함께 초래된 경영환경의 급속한 변화는 의료기관들에게도 경쟁력강화를 위한 변신을 강요하게 되었다. 다시 말하면, 의료기관들은 선진 의료기술의 확보, 환자들에 대한 서비스제고와 함께 경영의 효율성 증대라는 세가지 목표를 동시에 달성해야만 하는 상황에 놓이게 된 것이다. 본 연구는 의료기관들이 당면하고 있는 이러한 세가지 과제 중 병원의 경영효율성 증대를 위한 한가지 대안으로 진료비 청구삭감의 빈도 및 발생 가능성을 낮추기 위한 해법의 마련이 시도되었다. 진료비청구삭감이란 의료기관들이 환자들에 대한 의료서비스에 대한 진료비 중 의료보험으로 인해 환자들이 감면 받은 진료비를 건강보험심사원에 청구하면, 심사원이 의료기관의 청구내역의 적정여부를 심사하여 적정하지 않은 내용에 대한 청구금액을 삭감하는 제도를 이른다. 청구금액에 삭감이 발생하면 해당 의료기관의 수입이 감소하는 것은 물론 원인분석이나 재청구 작업등에 비용과 인력이 이중으로 투입되게 되어 의료기관의 경영에 부담을 주게 되고, 이러한 상황이 빈발하게 되면 해당 의료기관에 대한 환자와 건강보험심사평가원의 신뢰에 문제가 발생하게 된다. 그러므로, 효과적인 진료비 청구삭감분석시스템에 의한 사전대비의 필요성이 높아지게 되는 것이다. 이를 위하여 본 연구에서는 진료비 청구삭감분석을 위한 프로토타입의 개발이 시도되었다. 프로토타입은 데이터마이닝 기법 중 연관분석 알고리즘을 적용하여 개발되었으며, 이렇게 개발된 프로토타입을 D의료원에서 10개월간 발생한 실제 진료데이타를 사용하여 성능을 시험하였다.

• 한국산업보건학회지
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• 제8권1호
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• pp.36-49
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• 1998

The purpose of this study is to investigate the relationship between the work postures and upper extremity cumulative trauma disorders(CTDs) in female medical insurance bill reviewers(n=448). This study included diagnosis for CTDs, anthropometry and job analysis (workstations and posture). The characteristics of subject were 33.6 years of average age and 8.7 years of average work duration. The results were as fallows. Ergonomic conditions of workstation were unsuitable compared with anthropometry result. The height of work surface(79.5 cm) and chair(43.0 cm)were high. work space was small, and legs space under the table was limited. Work postures were awkward compared with recommended neutral postures. Neck flexion($21.0-36.0^{\circ}$), elbow elevation, shoulder abduction ($46.0-47.0^{\circ}$). wrist radial and ulnar deviation, forearm supination and pronation, and wrist repeated motion(12.7-21.5 freq./min) were analyzed as hazardous risk factors by job analysis. The prevalence of CTDs was 32.8 % by medical diagnosis. The prevalence rate of CTDs in hazardous work posture group was significantly greater than safe work posture group both neck-shoulder (relative prevalence = 5.2, p<0.001) and wrist-hand (relative prevalence = 2.5, p<0.05).

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제47권3호
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• pp.197-208
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• 2021

Objectives: The purpose of this retrospective study was to evaluate the variables associated with length of stay (LOS), hospital costs, intensive care unit (ICU) use, and treatment outcomes in patients hospitalized for maxillofacial infections at a tertiary medical center in South Korea. Materials and Methods: A retrospective chart review was conducted for patients admitted for treatment of maxillofacial infections at Dankook University Hospital from January 1, 2011 through September 30, 2020. A total of 390 patient charts were reviewed and included in the final statistical analyses. Results: Average LOS and hospital bill per patient of this study was 11.47 days, and ₩4,710,017.25 ($4,216.67), respectively. Of the 390 subjects, 97.3% were discharged routinely following complete recovery, 1.0% expired following treatment, and 0.8% were transferred to another hospital. In multivariate linear regression analyses to determine variables associated with LOS, admission year, infection side, Flynn score, deep neck infection, cardiovascular disease, admission C-reactive protein (CRP) and glucose levels, number and length of surgical interventions, tracheostomy, time elapsed from admission to first surgery, and length of ICU stay accounted for 85.8% of the variation. With regard to the total hospital bill, significantly associated variables were age, type of insurance, Flynn score, number of comorbidities, admission CRP, white blood cell, and glucose levels, admission temperature, peak temperature, surgical intervention, the length, type, and location of surgery, tracheostomy, time elapsed from admission to first surgery, and length of ICU use, which accounted for 90.4% of the variation. Age and ICU use were the only variables significantly associated with unfavorable discharge outcomes in multivariate logistic regression analysis. Conclusion: For successful and cost-effective management of maxillofacial infections, clinicians to be vigilant about the decision to admit patients with maxillofacial infections, perform appropriate surgery at an adequate time, and admit them to the ICU.

• 의료법학
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• 제10권2호
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• pp.203-249
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• 2009

It is the so-called Shinchon Severance Hospital Case brought to an end by the decision of the Supreme Court that opened the real discourse of withholding or withdrawing of LST (Life-Sustaining Treatment) in the legal profession as well as medical profession in Korea. Everyone has sympathy with the validity and necessity of legal regulation on withdrawing-including withholding-of LST save the requirements & procedure of withdrawing of LST. In this situation, the legislative bill of amendment to the Korean Civil Law introducing of adult guardianship was pre-announced by the Ministry of Justice on September 18th 2009. The adult guardianship is a guardianship system that supports an mentally handicapped adult to deal with his affairs by support of a guardian. The object of adult guardianship includes affairs of body or well-being as well as property of adult wards. In particular, affairs of medical matters are of importance in the duty and authority of adult guardians. So, the introduction of adult guardianship is of much importance de lege lata as well as de lege ferena in the discussion of withdrawing of LST as a medical treatment. Since the legislation on withdrawing of LST intents to protect the right of death with dignity on the basis of patients' autonomy, the ratio legis of withdrawing of LST is variant from that of adult guardianship. In this context, it seems reasonable to legislate the withdrawing of LST separately from the adultguardianship. In the meantime, the adult guardianship of the legislative bill of amendment to the Korean Civil Law is related to the withdrawing of LST, since the main purpose of adult guardianship is to protect patients' quality of lives and to regulate guardianship contracts based on patients' autonomy. In that context, it seems reasonable to incorporate the legislation of withdrawing of LST into the adult guardianship system. In the latter case, it is not easy to adopt the withdrawing of LST into the legislative bill of the Korean Civil Law for the bill is pre-announced already as previously stated. However, the legislation of withdrawing of LST is not inferior to the legislation of adult guardianship as a matter of urgency. Moreover, it is likely that the legislative bill of Amendment to the Korean Civil Law generates discrepancies in interpretation of the requirements & procedure of withdrawing of LST as the amended German Civil Law did. In short, it is desirable for the legislator to revise the legislative bill despite delay.

• The Journal of Korean Physical Therapy
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• 제32권4호
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• pp.258-265
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• 2020

Purpose: This study examined the legal basis related to a physical therapist's home-based rehabilitation. Methods: The policy data were referenced to the comprehensive plan for national health promotion and the guidebook Community Health Promotion Project issued by the Korea Health Promotion Institute and other institutes. The legal data were referenced to the Bill information system on the National Assembly website. Results: The physical therapist's home-based rehabilitation did not have a legal basis in the community-based rehabilitation project (CBR) of the HP 2020 project. On the other hand, according to the Home health care part of the community health promotion project that began in 2013, physical therapists were allowed to play a role from 2020 under Article 16-2 (Public Officials in Exclusive Charge of Visiting Health Management) of the REGIONAL PUBLIC HEALTH ACT. Conclusion: Policies and laws are being developed in the field of healthcare, but the necessary policies and laws in the field of rehabilitation are still insufficient. A bill to rehabilitate in a variety of fields and spaces by modifying the scope of work of physical therapists will be needed.

• 디지털융복합연구
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• 제12권1호
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• pp.431-443
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• 2014

본 연구에서는 의료기관인증을 받은 병원과 받지 않은 병원의 내부 구성원을 비교 분석하여 의료기관인증제도가 구성원 만족도와 병원운영효과에 어떤 영향을 미치는지 파악하고자 하였다. 인증제도에 따른 직원만족도 차이는 인증을 받은 병원에서 인센티브 지급, 본인업무 자부심 등에서와 병원운영효과는 업무표준화로 업무수행의 정확성 등의 문항에서 통계적으로 유의미한 차이로 정(+)적 영향을 미치는 것으로 나타났다. 인증을 획득한 병원에서 구성원 만족이 높으며, 만족도가 높을수록 병원운영효과에 영향을 미치는 것으로 나타났다. 인증을 획득한 의료기관에 국가가 의료수가의 차별화나 의료장비를 지원하면, 인증을 받지 않은 병원들의 자발적인 인증 평가를 적극적으로 참여시킬 수 있는 활성화 방안이라고 사료된다.

• 한국병원경영학회지
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• 제6권1호
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• pp.1-17
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• 2001

According to the increase of the proportion of aged people, the medical demand for a senile chronic disease has been increased; therefore, aged people call for a geriatric hospital for special geriatric medical service. The main purpose of this study was to analyze the general characteristics and financial status of geriatric hospitals. For the study, a questionnaire was designed and sent to the geriatric hospitals to fill out the patient statistics, number of headcount by department, etc. to find out the stability, profitability, activity and so on financial statements of the hospitals were analyzed. The major findings of this study were as belows. 1. The ratio of the medical expenses to the revenue of the geriatric hospitals is much lower than acute care hospitals. But the probability of bankruptcy is higher due to the high ratio of the liabilities therefore it is required to stabilize the financial position by donating more money. 2. Government budget for the elderly people is not enough. To support the geriatric hospitals by going subsides, government should increase the budget. 3. Portion's of the patient of the geriatric hospitals are government support patient. Since the government doesn't pay the medical charges quickly, geriatric hospitals have a serious cash flow problem. Therefore, it is required that government is to prepay the bill. 4. Since geriatric hospitals treat elderly patient and most patients are government support patients, geriatric hospitals can be said to operate under the strict. 5. When we introduce the daily medical charge, the self-liability will be reduced on approximately 50% of current. This affection will bring a huge progressing financial structure to the medical profit of the geriatric hospital, and also patient family will feel less economical burden.

• 약학회지
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• 제49권6호
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• pp.449-458
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• 2005

There have been rapid changes in the pharmaceutical environment after the separation of Dispensing and Prescribing practice. In the early stage of this system, outpatients had few options to choose their pharmacies due to various obstacles. Under these circumstances, this study on the defection tendency of long-term care patients was performed through the analysis of outpatients who quit visiting a pharmacy nearby general hospital. PowerBuilder ver 9.0 program was used to extract significant data, and SPSS package was employed for statistic analysis. 3,308 outpatients who visited a pharmacy nearby hospital for a month (in January, 2004) were studied. Patients' sex, age and location of residence, the class of medical insurance, the characteristic type of medication (powder, split form, medication for external use/injection), waiting time, disease (department) were considered as variable factors. It turned out that the patient revisit ratio was 80.8$\%$ and the patient defection ratio was 32.4$\%$. As was expected, those factors mentioned above influenced on the revisit and defection ratio considerably. In terms of patient factors, it proved that there was no relationship among sex, location of residence, the class of medical insurance and revisit (defection) ratio. Only age factor influenced the ratio; the older, the higher revisit ratio and the less defection ratio. In respect of dispensing factors, there were obvious relationships among the factors and the ratio: bill (money they had to pay individually), waiting time, number of medications, splitting of tablets, unit price of drug and revisit (defection) ratio showed significant relationship. The result of this study revealed an aspect of outpatients' behavior and it could be used as a reference for better patient service and customer relationship management.

• 한국경영과학회:학술대회논문집
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• 대한산업공학회/한국경영과학회 2006년도 춘계공동학술대회 논문집
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• pp.1667-1676
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• 2006

다른 산업과 달리 병원/의료 산업에서는 건강 보험료 심사 평가라는 독특한 검증 과정이 필수적으로 있게 된다. 건강 보험료 심사 평가는 병원의 수익 문제 뿐 아니라 적정한 진료행위를 하는 병원이라는 이미지와도 맞물려 매우 중요한 분야이며, 특히 대형 종합병원일수록 이 부분에 많은 심사관련 인력들을 투입하여, 병원의 수익과 명예를 위해서 업무를 수행하고 있다. 본 논문은 이러한 건강보험료 청구 심사 과정에서, 사전에 수많은 진료 청구 건 중 심사 평가에서 삭감이 될 수 있는 진료 청구 건을 데이터 마이닝을 통해서 발견하여, 사전의 대비를 철저히 하고자 하는 한 국내의 대형 종합병원의 사례를 소개하고자 한다. 데이터 마이닝을 적용함에 있어, 주요한 문제점 중의 하나는 바로 지도학습 기법을 적용하기에 곤란한 데이터 불균형 문제가 발생하는 것이다. 이런 불균형 문제를 해소하고, 비교 조건 중에 가장 효율적인 삭감 예상 진료 건 탐지 모형을 만들어 내기 위하여 데이터 불균형 문제의 기본 해법인 과, Sampling 오분류 비용의 다양하고 혼합적인 적용을 통하여, 적합한 조건을 가지는 의사결정 나무 모형을 도출하였다.