• 보건행정학회지
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• 제19권4호
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• pp.121-139
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• 2009

Objectives : The purpose of this study was to investigate regional commitment index(RGI) of hospital in Korea, and the relationship RGI and hospital characteristics, such as foundation, region, size. Therefore, we are to suggest fundamental information to make and evaluate healthcare resource policy in hospital- and government-level. Methods : The 'Patient Survey 2002(administered by Ministry of Health and Social Welfare(MOHW)' was analyzed. We selected the patient data of the hospitals above 100 beds. Then, we calculated the RGI, number of same cases divided by all cases in each hospital. By using SPSS/win ver 14.0, statistical analysis such as t-test, ANOVA, correlational and regression analysis was carried out. Results : The results are as follows. 1. Overall mean and standard deviation of RGI were revealed as 0.805${\pm}$0.225 in inpatients, and 0.871${\pm}$0.184 in outpatient. The median of inpatients' and outpatients' RGI were 0.890 and 0.933. The RGI of inpatients of private hospitals were revealed significantly higher than that of the public(public: 0.727, private: 0.822). However, outpatients' RGI was not revealed as significantly different. 2. The RGI of general specialty hospitals were significantly lower than others, therefore we could think that more inpatients and outpatients of general specialty hospitals flowed in from others province or metropolitan cities than other hospital types. 3. The RGI of hospitals holding above 400 beds were significantly lower than others in inpatients and outpatients. 5. The RGI of hospitals were significantly different among sixteen province and metropolitan cities. The RGI inpatients of Gwangju and Daejon metropolitan city were lowest sub-group(0.659, 0.664), and the RGI inpatients of Jeju was revealed as highest, 0.979. 6. Available beds, total doctors, and total employees were negatively correlated with RGI of inpatients and outpatients. 7. The significant influencing factors to RGI of inpatients and outpatients were appeared samely such as available beds, wide healthcare region, hospital size, and foundation type. Conclusions : It is considered that RGI of hospital represent competitive power in healthcare market. Also, the competitive advantage and quality of hospital clustered by characteristics could made out by RGI. Therefore, the results of this study would be useful to develop and evaluate hospital policy of individual hospital or local government.

• 한국병원경영학회지
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• 제21권1호
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• pp.62-64
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• 2016

• 보건행정학회지
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• 제17권2호
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• pp.68-90
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• 2007

Nurse staffing level is an important factor that influences the quality of health service and patient outcomes. This study was carried out to examine the current state of acute hospital nurse staffing and find out factors that affect the nurse staffing level. Nurse staffing of individual hospitals was measured using the number of registered nurses per 100 beds. Descriptive and multiple regression analyses were conducted using 592 acute care hospitals' data. Regression model included structure factors such as referral level, ownership, medical and general staffing, and financial outcome factors such as occupancy rate, inpatient and outpatient revenues. Market characteristics included strength of competition, supply of nurses, and income and health status level of consumers. The average number of nurses per 100 beds was 28 and showed a great variation according to the referral level. Regression model explained this variation as much as 76.87%. Hospital structure variables which affecting the hospital nurse staffing level positively were ICU bed ratio, the staffing level of specialist, training doctor and employees except doctor and nursing personnel, while the negative factor was nurse aid staffing level. General hospitals employed more nurses than hospitals. Among outcome characteristics, occupancy rate and the amount of health insurance inpatient revenue affected positively on the hospital nurse staffing level. The more supply of the new nurse and the higher consumer income and health status in the medical service markets, the more nurses were employed by the medical institutes. According to the study result, hospitals employed more nurses when they had more financial incentive by increasing nurses. This means appropriate hospital incentive policy and regulation policy, which hospital violate nurse staffing level have to pay penality, should be needed. Clarifying job description between nurses and nurse aids and the reentry program for unemployed experienced nurses will be helpful to increase nurse staffing level.

• 보건행정학회지
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• 제2권1호
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• pp.147-166
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• 1992

The purpose of this study is to analyze the effects of the health center hospital on the health service utilization pattern of the rural population in a county. Two field studies had been conducted in Yonchon County, Kyunggi Province, on February 1989 and on August 1991 before and after the establishment of the Yonchon health center hospital. This study revealed that Yonchon health center hospital occupied 7.3% of total outpatient visits and 16.8% of hospitalization of the county population and the self-sufficient rate of the outpatient visit and hospitalization of Yonchon County between two field studies increased by 1.7% and 20.9% each. Yonchon health center hospital contributed to the growth of the public health sector but it weakened the role of health sub-centers. For the efficient health service utilization of the population in that County, more investment to health center hospital would be needed and the primary health activities of the health subcenter should be enforced.

• 한국의료질향상학회지
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• 제2권1호
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• pp.126-135
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• 1995

Background: Korean Hospital Standardization Program(KHSP), as a hospital accreditation program initiated and promoted by Korean Hospital Association since 1981, has played a key role in the hospital quality improvement in structural aspect particularly. Recently, however, KHSP has been critisized by hospitals and health personnels in that it is unpractical to be utilized as an initiative to improve hospital quality. In particular, the section of quality assurance in KHSP, strongly influenced by old version of Hospital Accreditation of Joint Commission in U.S.A., has been required to be fundamentally revised. For design of new criteria in quality assurance section, a survey for evaluation of existing program and collection of opinions for ideal one was conducted. Methods: For a month in 1994, structured questionnaires were administered by mailing to 470 hospital staffs from 200 hospitals, participated in the survey for the 1994 KHSP in each hospital. The total number of respondents was 116. Results: Less than half of the respondents(34.5%) value positively on the impact of current KHSP in general on the quality improvement of their hospitals. Moreover, most responses indicated that KHSP should be reorganized towards more practical and applicable one. Current KHSP criteria for quality activities in hospitals were regarded as a unpractical one which should be basically renewed. For new criteria and standards, most respondents emphasized the importance of applicability of those in real situations. Conclusion: For the KHSP to be effective, new evaluation criteria for quality activities should be more practical and fully accommodated to hospital situations in reality.

• 보건행정학회지
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• 제25권3호
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• pp.221-228
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• 2015

Background: This study explored the relationship between hospital resources and services uses in outpatient/inpatient-based hospital service area (HSA) in Korea. Methods: Study hospitals included all acute care hospitals except tertiary hospitals. Inpatient and outpatient hospital claims from the Korean National Health Insurance (NHI) program in 2010 were used to identify the service uses. Hospital resources and the degree of insurance premium in study areas were identified with the NHI corporation data. Study variables were computed by summing the service uses or hospital resources of study hospitals in each HSA. Service uses were represented by the total medical charges and number of visits/inpatient days. Hospital resources were measured by number of beds, number of doctors, and number of computed tomography (CT). The economic status of NHI enrollees in each HSA was controlled by the average monthly premium of NHI program per household in each HSA. The degree of using local hospitals was controlled with the localization index. Results: Analysis results showed that hospital resources such as beds, CT were statistically related to the service uses. And also localization index was found to have positive significant relationships with service uses. Conclusion: Hospital resources such as beds, CT had not only positive impacts on inpatient service uses, but also influences on the outpatient setting. Health policy makers will require monitoring and assessing the hospital resources in Korea.

• 보건행정학회지
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• 제21권2호
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• pp.263-278
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• 2011

As the competition among hospitals become intensified, hospital management is required to carry out more effective marketing and positioning of the hospital. Successful positioning of a hospital requires the knowledge about how the concrete attributes inherent in the medical service associated with the customer values that customers seek eventually in the medical service. Thus, it is required for hospital management to understand which hospital attributes should be emphasized in order to improve the customer values. The hierarchical structure of service attributes can provide valuable information about effective positioning and advertising. To obtain such knowledge, we employed the order analysis technique as an objective means-end chain method. Order analysis is useful for identifying the causal structure among attributes. Thus, we can examine the underlying causal relationship and eventually the vertical structure of hospital selection attributes. For this study, we conducted a survey to obtain 370 responses for the analysis. The result suggests that hospital management had better increase the scale of hospital, improve the services of health care providers, and modernize the hospital facilities and equipments so as to enhance customer values and eventually to lead them to recommend the hospital to others. Our findings would provide the valuable information for hospital management to develop the more effective hospital positioning and marketing strategies.

• 보건행정학회지
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• 제23권3호
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• pp.281-288
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• 2013

Background: The purpose of this study is to grasp the factors forming hospital image and to measure evaluation of internal and external customers towards hospital choice factors. Methods: This study is based 4 types of choice factor such as physical, human, accessibility, and connection. Data were assessed using 98 patients and 96 internal employees who work at A general hospital in Seoul and 116 patients and 97 internal employees at B general hospital in Chunkcheongbuk-do. Data were collected with self-administered questionnaires from February 17 to April 29 in 2012 and analyzed SPSS ver. 18.0 by using frequency, t-test, analysis of variance, correlation, and multiple regression. Results: The results of this study show that factors affecting hospital image is significant different between internal and external customers of hospital A and B. Expecially the finding of this study will be applied to improve connection factors in administrative department of hospital for hospital image. Conclusion: This study presents primary data for correct decision making to authorities of local hospitals that have concern about marketing strategy for hospital image.

• Journal of Preventive Medicine and Public Health
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• 제30권1호
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• pp.195-207
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• 1997

High price equipment is one of the major factors that increases national health expenditure in developed countries. Computerized Tomography(CT), one of the important high price equipment, has been concerns of health service researchers and policy makers in many countries. In Korea, CT, first introduced in 1984, have spreaded nationwide with rapid speed. Though the Committee for Approving Import of High Price Medical Equipment, founded in 1981, tried to regulate the introduction of high price medical equipment including CT, the effort resulted in failure. The exact situation of diffusion of the high price equipment, however, was not yet investigated. We aimed at the description of the diffusion of CT in Korea and analysis of influencing factors on hospitals for the adoption of CT. We mainly used the database of CT, made in 1996 by the National Federation of Medical Insurance for the purpose of insurance payment for CT. Also characteristics of hospitals were gathered from yearbooks published by the central and local governments and by the Korean Hospital Association. We calculated the cumulative number of the CT per one million population year by year. In turn, multiple linear logistic regression was done to find out the contributing factors for the adoption of CT by each hospital. In the logistic regression model, it is regarded as dependent factor whether a hospital retained CT or not in 1988 and 1993. The major categories of the independent factors were hospital characteristics, environmental factors and competitive conditions of hospitals at the period of the adoption. The results are as follows: Number of CT scanners per one million persons in Korea marked more higher level compared with those of most OECD countries. Major influencing factors on the adoption of CT scanners were hospital characteristics, such as hospital referral level, and competitive condition of hospitals, such as number of CT scanners per 10,000 persons in each district where the hospital was located. In Korea, CT diffused with rather rapid speed, comparable with those of the United States and Japan. The major factors contributing on the adoption of CT for hospitals were competitive condition and hospital characteristics rather than regional health care need for CT. In conclusion, a kind of regulating mechanism would be necessary for the prevention of the indiscreet adoption and inefficient use of high price equipment including CT.

• Journal of Preventive Medicine and Public Health
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• 제26권3호
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• pp.400-411
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• 1993

The aim of this study is to analyze the variations among hospitals and hospital groups in resource use and procedures of diagnostic and therapeutic process, such as laboratory tests, radiologic examinations, tissue diagnosis, timing of surgery after admission, the time required for operation. The study was performed for five procedures including cesarean section (C/S), appendectomy, cholecystectomy, cataract extraction, and pediatric pneumonia. The 2,316 subjects were selected from medical insurance claims list, and from this list 413 cases were sampled for medical record review. The patterns of resource utilization and process of treatment were described according to hospitals and characteristics of hospital groups. The major results were as follows : 1. The numbers of laboratory and radiologic tests showed significant difference among hospitals and hospital groups. In case of hospital groups, we could find tendencies of more tests with increasing hospital bed size. 2. In general, the proportion of operative cases evaluated by tissue diagnosis postoperatively among all operations ranged from 28.3% to 100%. The proportion varied among hospital groups, of which general hospital A group(more than 15 specialty) showed the highest proportion. 3. Post-admission delay until operation and the time required for operative procedure were not invariable among hospitals and hospital groups. The duration of operation in tertiary hospitals was slightly shorter than general hospitals, with varying statistical significance. We could find that probably there were differences of quality among hospitals in some components of procedures, which suggested that the implementation of quality assurance activities would be mandatory. In this study, we simply described the patterns of resource utilization and some features of clinical process, with institution of the need for advanced studies with in-depth analyses for each component of diagnosis and treatment procedures.