• Korea Journal of Hospital Management
• /
• v.17 no.4
• /
• pp.87-115
• /
• 2012

This research classified hospital specialization strategy types through cluster analysis, analyzed fitness of hospital specialization strategy types for external environment or organizational structure, and examined relation between hospital specialization strategy types and organizational performance. This research surveyed 1,437 hospitals which have more than 30 patient's bed and practice national health service in Korea. Specifically, this research divided into two part : external fit - analysis of relation between external environment and specialization strategy, internal fit-analysis of relation between organizational structure factors and specialization strategy. also, as the organizational performance for achieving specialization strategic purpose, not only the productivity, efficiency, profit but also the medical quality was considered. In case of external fit, many hospitals chose integration type if there are a lot of competitive hospitals and regional population. Particularly, if there are many competitive hospitals, concentration type is chosen. In contrast, if there are many doctors in the region, differentiation type is chosen. In case of internal fit, according to organization type and patient's bed number, hospitals chose different types. If it is a general hospital and has a few bed number, generalization or concentration type is chosen. Tertiary hospital or the hospital with many patient's bed chose differentiation type. According to the number of specialists, if there are a few specialists, generalization or concentration type is chosen. If there are many specialists, differentiation type has high fitness for the hospital. In relation to strategy types and organizational performance, differentiation type has best result. Differentiation type has a good result in 7 items out of 11.

• Health Policy and Management
• /
• v.26 no.2
• /
• pp.107-114
• /
• 2016

Background: Over the last few decades, because hospitals in South Korea also have undergone dramatic changes, Korean hospitals traditionally have provided specialized health care services in the health care market. Inner Herfindahl-Hirschman Index (IHI) measures hospital caseloads based on patient proportions, independent of patient volumes. However, IHI that rely solely on patient proportions might be problematic for larger hospitals that provide a high number of diagnosis categories, as the patient proportions in each category are naturally relatively smaller in such hospitals. Therefore, recently developed novel measure, category medical specialization (CMS) is based on patient volumes as well as patient proportions. Methods: We examine the distribution of hospital specialization score by hospital size and investigate association between each hospital specialization and length of stay per case and hospital cost per case using Korean National Health Insurance Service-cohort sample data from 2002 to 2013. Results: Our results show that IHI show a decreasing trend according to the number of beds and hospital type but CMS show an increasing trend according to the number of beds and hospital type. Further, inpatients admitted at hospitals with higher IHI and CMS had a shorter length of stay per case (IHI: B=-0.104, p<0.0001; CMS: B=-0.044, p=0.001) and inpatients admitted at hospitals with higher IHI and CMS had a shorter hospital cost per case (IHI: B=-0.110, p=0.002; CMS: B=-0.118, p=<0.0001). Conclusion: This study may help hospital policymakers and hospital administrators to understand the effects of hospital specialization strategy on hospital performance under recent changes in the Korean health care environment.

• Health Policy and Management
• /
• v.20 no.3
• /
• pp.21-35
• /
• 2010

This study examined the changes in the service mix of Korean hospitals in 6 metropolitan cities between 2003 and 2005, and assessed whether the sample hospitals exhibit consistent trend or chance variation in multiple years. Three measures of hospital service mix, focusing on the specialization of services, were applied: information theory index, internal Herfindahl index, and number of distinct diagnosis-related groups (DRGs) treated. National Health Insurance claims were used to calculate the indexes. Specialization indexes were calculated in each year, and then examined to identify the pattern over time. Kappa analysis was applied to assess the agreements of specialization score between two years after hospitals were categorized into 4 groups with quartiles. Kappa score showed that the service mix of hospitals were changed during the study years. Specialization scores were increased given the market structure for three years. Hospitals which showed higher or lower specialization scores than the average of the scores consistently classified into the same group. Specialization indexes showed relatively consistent pattern over 3 years, and such consistencies were evident for hospitals regardless of the specialization status. Policy makers can identify the degree of specialization with the indexes, and it could provide a picture of how hospital services were mixed and changed over time.

• Korea Journal of Hospital Management
• /
• v.25 no.3
• /
• pp.53-66
• /
• 2020

This study is aimed at investigated and compared the differences in the affect of hospital specialization according to hospital size using claims data of the Health Insurance and Review Assessment National Inpatient Sample in 2018 for diseases of the musculoskeletal system and connective tissue. To this end, we used multivariate hierarchical linear models(a.k.a., multi-level models) using two-tier data from 106,599 patients discharged after diseases of the musculoskeletal system and connective tissue from 734 hospitals. Multivariate results indicate that patients who were discharged with diseases of the musculoskeletal system and connective tissue from specialized hospitals with 200 beds or less stayed shorter and paid less inpatient charge than those who were discharged from less specialized hospitals. But for hospitals with 201-300 beds, no positive impact relationship was found between hospital specialization and operational performance. This finding may be limited evidence that the affect of a hospital's specialization strategy may vary depending on the size of the hospital. We discussed several managerial and health policy implications below.

• The Korean Journal of Health Service Management
• /
• v.10 no.1
• /
• pp.1-11
• /
• 2016

Objectives : Medical service specialization could have positive effects on their profits and medical service quality. This study was to examine the relationship between medical service specializations and operational performance in hospitals. Methods : We used the National Inpatient Sample data provided by the Health Insurance Review and Assessment Service from 2010 to 2013. The hospital operational performance was determined by measuring the specialization level of the hospital based on DRGs. Results : The information theory index was 2.38 in 2010, 2.38 in 2011, 2.37 in 2012, and 2.37 in 2013. A multiple regression model was constructed which showed that if the specialization level becomes higher, it decreases the length of stay per case with an increase in medical expense. Conclusions : Differentiation and concentrated medical service specialization strategy have had a positive effect on the operational performance of hospitals.

• Health Policy and Management
• /
• v.18 no.2
• /
• pp.67-85
• /
• 2008

This study evaluated the specialization status of Korean hospitals by applying index measures that were developed to determine how hospitals are specialized. In addition, multivariate regression analysis was applied to assess how the measures responded to the internal and external factors of hospitals. National Health Insurance claims for 2004 were used to calculate the information theory index, internal Herfindahl index, number of distinct diagnosis-related groups (DRGs) treated, and percent of the five most common DRGs. Data from the Ministry of Health and Welfare and Korean Hospital Association were used to determine the size, ownership, teaching status, organization type, and location of the hospitals. The four indexes analyzed showed that there were significant differences in the specialization status of providers, depending on the provider size, organization type, and location. Hospitals that were smaller and located in metropolitan areas tended to provide specialized services; this is considered to constitute a competitive strategy for hospitals. It is expected that specialized hospitals will increase given the current market structure. Therefore, policy makers will need an index for measuring how hospital services are specialized. Information from such an index could provide a picture of how hospital services are mixed and change over time.

• Health Policy and Management
• /
• v.28 no.1
• /
• pp.53-69
• /
• 2018

Background: This study investigates association modified category medical specialization (CMS) and hospital charge, length of stay (LOS), and mortality among lumbar spine disease inpatients. Methods: This study used National Health Insurance Service-cohort sample database from 2002 to 2013, using stratified representative sampling released by the National Health Insurance Service. A total of 56,622 samples were analyzed. The primary analysis was based on generalized estimating equation model accounting for correlation among individuals within each hospital. Results: Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had a shorter LOS (estimate, -1.700; 95% confidence interval [CI], -1.886 to -1.514; p<0.0001). Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had a lower mortality rate (odds ratio, 0.635; 95% CI, 0.521 to 0.775; p<0.0001). Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had higher hospital cost per case (estimate, 192,658 Korean won; 95% CI, 125,701 to 259,614; p<0.0001). However, inpatients admitted with lumbar spine surgery patients at hospitals with higher modified CMS had lower hospital cost per case (estimate, -152,060 Korean won; 95% CI, -287,236 to -16,884; p=0.028). Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had higher hospital cost per diem (estimate, 55,694 Korean won; 95% CI, 46,205 to 65,183; p<0.0001). Conclusion: Our results showed that increase in hospital specialization had a substantial effect on decrease in hospital cost per case, LOS, and mortality, and on increase in hospital cost per diem among lumbar spine disease surgery patients.

• Korean Journal of Occupational Health Nursing
• /
• v.19 no.1
• /
• pp.97-104
• /
• 2010

Purpose: The purpose of this study was to determine factors that affect satisfaction of the hospital services among injured workers. Methods: The subjects of this study were 532 injured workers. The questionnaires were selected as literature suggested for explaining satisfaction of the hospital services, general characteristics of injured workers, characteristics of the hospital services. The data were analyzed with descriptive statistics, t-test, ANOVA, multiple regression analysis by SPSS 19.0. Results: There were significant differences in satisfaction scores, depending on the types of disease, health status and possibility to return to work among the injured workers. Also, there were significant differences in satisfaction scores, in terms of medical facilities, food service, specialization of doctors and nurses, cleanliness of hospital, convenience of hospital teaching and counselling of doctors and nurses, supporting workers' compensation process, counselling of workers' compensation and unfair treatment. In the results of the standard multiple regression analysis, food service, medical facilities, specialization of doctors and nurses, health status and hospital cleanliness were significant factors for satisfaction scores of the hospital services. Conclusion: It is necessary to promote food service, medical facilities, specialization of doctors and nurses, hospital cleanliness, health status of injured workers for developing hospital services.

• The Journal of Korean Physical Therapy
• /
• v.10 no.1
• /
• pp.223-227
• /
• 1998

The purpose of this study was to determine of the present conditions and course of Korea physical therapy. As reviewing the curriculums for physical therapy education, the system for physical therapist licence issue. and working condition of physical therapist have been suggested a strategy far specialization of physical therapist and course of Korea physical therapy. Based on the research results, the following considerations and guidelines are presented. 1. Need to specialization of curriculum for physical therapy education. 2. For increase quality of treatment, decrease the number of patient per daily treatment by a physical therapist. 3. Specialization of physical therapist role at department of physical therapy, university hospital and general hospital. 4. Establishing physical therapy residency program at university hospital and general hospital. 5. Preparing the law for independent clime open of physical therapist.

• Korea Journal of Hospital Management
• /
• v.4 no.2
• /
• pp.85-105
• /
• 1999

The main purpose of this article is to analyze the managerial performance of small and medium-size hospitals that are specialized in certain areas of medical services. Data of 189 hospitals were obtained from the data file of Korea Institute of Health Services Management The items include general characteristics of the hospitals, fianancial reports, and utilization records. Degree of specialization is measured by concentration(Herfindahl) index, and the sample hospitals are accordingly classified into specialized and unspecialized groups, by means of cluster analysis. These groups are compared in terms of various measures of managerial performance, which include several profitability indices such as operating margin, return on assets(ROA), and return on equity(ROE). To examine the relationship between specialization and managerial performance, we estimate the regression model, where the profitability indices are used as the dependent variables and the concentration index as the independent variable, controlling for the hospital characteristics such as size, type and location. Also, we perform 'Du Pont' analysis, to investigate the basic elements that can explain the differences in profitability between specialized and unspecialized hospitals. Major findings are as follows: 1. Managerial performance is better for the specilized hospitals than the unspecilized, in all aspects of profitability(operating margin, ROA, ROE). 2. Regression analysis suggests that there is a positive, statistically significant relationship beween the degree of specialization(i.e. concentration) and hospital profitability. 3. Main reason for the higher profitability of specialized hospitals lies in lower expenses rather than higher revenue. 4. In particular, personnel and material expenses are significantly smaller for the specialized hospitals, and this result seems to stem from the efficiency of operating fewer lines of business.(some kind of 'economies of scale') 5. Specialized hospitals also have fewer employees compared with the unspecialized, especially in administrative departments, which implies their efficient personnel management.