• Korea Journal of Hospital Management
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• v.9 no.1
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• pp.1-21
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• 2004

The United States has a unique health care system, which is unlikely any other health care systems in the world. The major part of basic functional components of the system -financing, insurance, delivery, and payment- is in private hands. A market-oriented economy invites the participation of numerous private entities that are interested in carrying out the key functions of health systems. Due to this central feature, U.S.health care is not delivered through a network of interrelated components designed to work together coherently. For lack of standardization, the various components of the system fit together only loosely. The involvement of numerous players in the key functions leads to duplication, overlap, inadequacy, inconsistency, and waste, which add to the complexity and also make the system inefficient. Hence, cost containment remains an elusive goals. Moreover, the system falls short of delivering equitable services to all americans, though consumption of health care services is the largest in the world. On the other hand, United States leads the world in the latest and the best in medical technology, medical training, and research. It offers some of the most sophisticated institutions, products, and processes of health care delivery. This article discuss the characteristic features of the U.S. health care system. and its performance, trying to seek its implication on Korean health care system.

• Korea Journal of Hospital Management
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• v.14 no.1
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• pp.123-144
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• 2009

Recently, a long strike by hospital labor union emerged as a serious social issue. During the Worldcup Games in June, 2002, labor strikes broke up at 'C', 'K' and other hospitals, and in 2007, 'Y' hospital suffered much from a strike. Such series of extreme labor disputes have awakened people of importance of a more stable labor-management relationship for the medical institutions responsible for people's health than any other business organization. The purpose of this study was to examine the labor-management disputes at 'Y' hospital in 2007 and 'C' and 'K' hospitals in 2002. The results of this study can be summarized as follows; First, requests of the labor union such as pay raise, reemployment of the irregular workers as regular employees and participation of the labor union in personnel affairs are the long-held or core issues suffered by the medical institutions. Such issues are not independent from each other but complicated with each other surrounding the pay raise. Accordingly, it is not easy to determine the genuine bone of issue for labor-management disputes. Second, the model type of disputes between labor and management at medical institutions may be strike. However, it is conceived that the type of disputes would be subject to change as the essential medical service area system began to be operated since 2008. Third, the common characteristic of the labor strike among the 3 sample hospitals was occupation of the hospital lobby for a sit-in strike to maximize the negative effects of strike. Article 42 (Prohibition of Violence) of Labor Union and Labor Relation Coordination Act prohibits occupation of production or other important business facilities. In addition, since Ministry of Labor interprets that the hospital lobby belongs to the important business facilities enumerated by Article 42 of the above act, occupation of the hospital lobby for a sit-in strike may be too controversial to be admitted as a fair act of labor dispute when its legitimacy should be judged. Fourth, the counter-measures taken by the hospitals against the strike were observance of the principle 'no labor no pay,' closure, legal action, accusation, claim for recovery of damage, provisional seizure, disciplinary punishment, etc., but the principle of 'no labor, no pay' was not applied in a fair manner by 'C' and 'K' hospitals. However, 'Y' hospital applied this principle thoroughly to the strike; the hospital conduced to correction of the wrong labor-management relationship by refusing inclusion in the labor collective agreement of a provision about payment of wage during the period of strike or labor union's request to that effect during a strike. In addition, 'Y' hospital took an effective measure to end the strike earlier by notifying the labor union of cancellation of the collective agreement and banning the unionists from entering the hospital.

• Journal of the Korean Dietetic Association
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• v.11 no.4
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• pp.381-392
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• 2005

This study compared he importance of food service, views to the performance, management objectives, and recognition gap about the contract contents towards the dietetic departments of hospitals that manage the patients' food service and managers of contract managed companies, and dieticians. It conducted questionnaires and survey towards the vice director and dieticians of 17 hospitals, over 500 beds, and the persons responsible for contract managed companies and dietitians who were in charge of food service. The hospitals showed significantly(p<0.05) higher the importance scores in menu planning, the distribution of meal, sanitation management, and leadership than those of the contract managed companies. In the difference of hospitals and contract managed companies about performance, it appeared high in the contract managed companies. In the importance of the foodservice management objective, the hospital had significantly(p<0.05) higher scores in the management of client's satisfaction and quality improvement element through management innovation than those of the contract managed companies. In the importance of contract term, the contract method, expense, and payment condition of commission fee were significantly(p<0.05) high scores in the contract managed companies, compared to the hospital.

• Korea Journal of Hospital Management
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• v.6 no.2
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• pp.138-155
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• 2001

This study was designed to find out the factors which influence on the financial performance of the hospital. Out of 32 provincial hospitals which were established by the government, 10 hospitals were selected as sample hospitals. Ten hospitals were divided into two groups(5 hospitals each), one of which was profit-making and the other loss-making. The criteria in selecting profit or loss-making hospitals was net profit to total revenue. The major finding of the study was as follows; 1. Whether or not a hospital had specialized in certain departments was proved to be the major factor influencing on the financial performance. Three out of five profit-making hospitals could harvest following results by operating specific departments. (1) Man powers needed for the operation of specific departments were 14.6 persons per 100 bed, which was only 1/7 of the general hospital. (2) The number of doctors has not increased in proportion to the increase of the number of beds. (3) Ratio of total revenue to MD.'s payroll expenses of the profit-making hospitals was 75.0% higher than the loss-making hospitals. (4) The average length of stay of specific department was very long(388.1 days). However, the specific departments were found to have contributed much to the financial performance because the occupancy rate of such departments was very high(94.5%). 2. The headcount per 100 bed of the profit-making hospitals was 23.9 persons(24.0%) less than the loss-making hospitals and the ratio of payroll expenses to total revenue 15.1% less. 3. Averagel revenue per specialist of the profit-making hospitals was 100 million(25.1%) more than loss-making hospitals and the ratio of total revenue to MD's payroll expenses of profit-making hospital was 75.0% higher. 4. Profit-making hospitals have introduced new systems or renovation in 36 fields, such as incentive payment system, utilization of contracted man powers, change of the payroll structure of the nurses, specialization in certain departments, etc; however, loss-making hospitals introduced only 25 new systems or renovations. These kind of renovation could not be achieved without the cooperation of the labor union and the strong will of the top management. Therefore, it could be said that the labor union of the profit-making hospitals seems to have been very cooperative compared with that of loss-making hospitals.

• Korea Journal of Hospital Management
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• v.6 no.2
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• pp.173-201
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• 2001

This study purports to examine the current management and information technology related strategy of Korean hospitals and suggest the effective management strategy in the 21st century when is digital era. Specifically the study tries to analyze the changing trends of strategic orientation and investigate the general management and information technology strategy of Korean hospitals. Self-administered Questionnaires were distributed to 721 hospitals nationwide and finally 98 Questionnaires were analyzed for the study. The results of the study are as follows : 1) Half of the respondent hospitals reported that they have an analyzer orientation in 2000, whereas 19.4% were prospectors, reactors 16.4%, and defenders 14.3%. However, the respondent hospitals intended to have a prospector orientation in the future (2002), while 29.6% planned on being analyzers, 17.3% reactors, and 3.1% defenders. 2) Hospital services for improving patient satisfaction were the most common. strategy for the respondent hospitals, followed by cost containment, organizational restructuring, employee education, purchasing system change, specialization of clinical services, quality improvement of medical care, strengthening the networking with the stakeholders, public relations and marketing strategy, diversification, and installing the information system. However, the strategies of annual salary system, retrenchment of unprofitable services, merit payment based on performance were still not popular for the respondent hospitals. 3) As for the strategies related with information technology, most hospitals have not implemented actively, except for the establishment of home-pages, order communication systems, and insurance claims through electronic data interchange system. 4) There were significant differences in the level of strategy implementation in terms of the ownership, bed size, financial performance, and the top managers I knowledge of information technology. The larger bed size, the higher financial performance, the better knowledge of information technology the top managers have, the more strategies the respondent hospitals implemented. The managerial and political implications for Korean hospitals in digital era were also discussed.

• Journal of Korean Society for Quality Management
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• v.27 no.4
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• pp.1-19
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• 1999

This study examines the service quality management and the use of women employees for the productivity improvement in Korean service industry. Five service industries, bank, hotel, PCS(Personal Communication Service), department store, and hospital industry were chosen for this study. The results indicate that the five industries show different characteristics. It was found that department stores made the most effort to improve service quality among the five industries and that hospitals did the least effort. In the use of women employees, the proportion of women in service industry is much higher than that in the manufacturing industry, but the proportion of women in management level is still very low. Women employees do not feel high degree of sexual discrimination. But they feel unfairness in promotion and payment, and low degree of job satisfaction.

• Asia-Pacific Journal of Business
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• v.2 no.2
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• pp.36-60
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• 2011

Radio frequency identification(RFID) is a system of technology that transmits digitally coded identity information in the form of a unique serial number of an object or person wirelessly, using radio waves. The primary use of RFID has been in asset tracking. This makes it highly useful across various industries for effective and efficient conduct of different business processes like supply chain management (SCM). As the use of RFID expands, the use of this technology is observed in such industries as transportation, traffic payment, hospital and medical care, education, and retail. Although this technology offers immense potential, it faces multifarious roadblocks, particularly in developing countries like India. Under this backdrop, this paper attempts to present an overview of the use and application RFID technology in India with a highlight on business-ecosystem for RFID in India. We also present various technical and non-technical challenges in the implementation of RFID in India.

• Health Policy and Management
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• v.26 no.2
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• pp.135-147
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• 2016

Background: The voluntary diagnosis-related groups (DRG)-based payment system was introduced in 2002 and the government mandated participation in the DRG for all hospitals from July 2013. The main purpose of this study is to examine the independent effect of mandatory participation in DRG on various outcomes of patients. Methods: This study collected 1,809,948 inpatient DRG data from the Health Insurance Review and Assessment database which contains medical information for all patients for the period 2007 to 2014 and examined patient outcomes such as length of stay (LOS), total medical cost, spillover, and readmission rate according to hospital size. Results: LOS of patients decreased after DRGs (large hospitals: adjusted odds ratio [aOR], 0.87; 95% confidence interval [CI], 0.78-0.97; small hospitals: aOR, 0.91; 95% CI, 0.91-0.92). The total medical cost of patients increased after DRGs (large hospitals: aOR, 1.22; 95% CI, 1.14-1.30; small hospitals: aOR, 1.22; 95% CI, 1.21-1.23). The results reveals that spillover of patients increased after DRGs (large hospitals: aOR, 1.27; 95% CI, 0.70-2.33; small hospitals: aOR, 1.18; 95% CI, 1.16-1.20). Finally, we found that readmission rates of patients decreased significantly after DRGs (large hospitals: aOR, 0.28; 95% CI, 0.26-0.29; small hospitals: aOR, 0.59; 95% CI, 0.56-0.63). Conclusion: The DRG payment system compared to fee-for-service payment in South Korea may be an alternative medical price policy which can reduce the LOS. However, government need to monitor inappropriate changes such as spillover increase. Since this study also is the results based on relatively simple surgery, insurer needs to compare or review bundled payment like new DRG for expansion of various inpatient-related diseases including internal medicine.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.15 no.6
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• pp.3534-3547
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• 2014

Although there are many positive sides of the current fee-for-service payment schedule, there is a strong necessity to control the rapidly increasing national healthcare expenditure. The global budget is often mentioned as one prominent alternative for solutions. In this article, both microscopic and macroscopic approaches are considered to set the hospital medical expenditure budget. In a macroscopic aspect, the SGR model, which considers the financial limit of the healthcare system, is used to set the next year target budget. In addition, the DEA model is used to measure the inefficiency and cost recognition. In this article, the national medical target expenditure is distributed to an individual hospital based on the level of efficiency. By combining the SGR and DEA, it will be possible to set a real world applicable target medical expenditure budget model.

• Health Policy and Management
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• v.16 no.1
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• pp.17-40
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• 2006

With the prospect of rapidly growing health insurance expenditures, particularly spending for ambulatory care, the introduction of a case-based payment method is discussed as an alternative to the current fee-for-service based method. A system to measure case mixes of providers is a core component of such payment systems. The objective of this study were to develop a classification system for ambulatory care, Korean Ambulatory Patient Group (KAPG) based on the U.S. APG version 2.0 and to evaluate the classification accuracy of the system. A database of 64,258,386 records was constructed from insurance claims submitted to the Health Insurance Review Agency (HIRA) during three months from August 2002. A total of 41,347,307 records with a single visit was used for the development and 7% random sample of the database was used for the evaluation. Additional groups were defined to include both physician and hospital fees in the classification, age splits were added to classify the entire population as well as the population older than 65, and the definition of medical groups used by the HIRA was adopted. The variance reduction in charges achieved by KAPGs was computed to evaluate the accuracy of classification. A total of 474 KAPGs was defined compare to 290 groups in the U.S. APG. The variance reduction for charges of all visits ranged from 20% to 37% depending on the type of provider, and ranged from 22% to 42% for non-outliers, that were better than those achieved by the system currently used by the .HIRA for its internal review purpose. Although further study is required to improve the classification for complicated care in larger hospitals, the results indicated that KAPGs could be used for better management of costs for ambulatory care.