• Journal of Preventive Medicine and Public Health
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• 제23권4호
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• pp.451-464
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• 1990

The variation in resource utilization for hospitalized patients who had a group of similar diseases -- a Korean Diagnosis Related Group (KDRG) -- among the same type of hospitals was studied to assess the utillization variation due to the practice pattern of hospitals. Information about inpatients who were beneficiaries of the medical insurance for teachers and government officials discharged from 20 large university teaching hospitals in Seoul during 1986 and information about the hospitals were analyzed to achieve the study objective. A total of 20,223 non-outlier patients in 100 most frequent KDRGs were included in the analysis. Case charges after the review and length of stay (LOS) were used as measures of resource utilization during a hospitalization. A substantial variation among hospitals was found in most KDRGs : o the ratio of the maximum and the minimum among the mean case charges of hospitals was greater than 2 in 83 KDRGs ; o the difference between the maximum and the minimum among the mean case charges of hospitals was greater than 100,000 Won in 94 KDRGs : o the ratio of the maximum and the minimum among the mom LOS of hospitals was greater than 2 in 82 KDRGs ; o the difference between the maximum and the minimum among the mean LOS of hospitals was greater than 3 days in 94 KDRGs. The practice pattern of hospitals explained more than 20% of charge variation in 49 KDRGs and more than 20% of LOS variation in 43 KDRGs. The study results indicated need for a new health policy initiative for cost containment and quality assurance.

• Journal of Preventive Medicine and Public Health
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• 제20권1호
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• pp.67-83
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• 1987

This study relates to the problems of organizational performance in the Christian hospitals. In this study, quality of working life (QOWL), which harmonizes individual as well as organizational goals, was used as an indicator of organizational performance from the open systems view. In order to identify the behavioral factors influencing QOWL in hospitals, self-administered questionnaires were distributed to 1,926 employees who were randomly selected from fifteen Christian hospitals from August 1 to August 30, 1986. The following results were obtained: 1) All correlation coefficients between QOWL and behavioral variables were statistically significant even though their magnitude varied according to hospital size. 2) Using factor analysis, 32 variables were parsimoniously grouped into four factors: individual conflicts, group behavior, organizational characteristics and situation, and job characteristics. The proportion of variance explained by these factors ranged from 33.5% to 38.6% according to hospital size. 3) The overall effects of the four factors in the multiple logistic models ranged from 0.85 to 3.12 according to hospital size. Among three hospital models, the model for small hospitals showed the best statistical fit. 4) The most influential factor was organizational characteristics and situation with an odds ratio ranging from 1.99 to 3.02. Again, the odds ratio was the highest for small hospitals. 5) For large hospitals, the two main factor effects were statistically significant: organizational characteristics and situation, and job characteristics. For medium hospitals, all main factor effects except job characteristics were statistically significant. For small hospitals, all main factor effects except group behavior were statistically significant. However, a factor interaction effect was shown only for large hospitals where it was statistically significant. 6) To examine whether the four factors influence financial performance, the four factor scores from the two financial performance groups were compared using Mann-Whitney test. The test results showed that the organizational characteristics and situation factor score was significantly different only for small hospitals.

• 한국병원경영학회지
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• 제12권4호
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• pp.119-142
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• 2007

Although Korea joined OECD in 1996, there has still seen much unbalance in medical care and welfare standard between urban and rural area. The unbalance of medical demand between urban and rural area deepened low utilization of rural hospitals. So it caused many hospital's failure and conversion in rural area. Many rural hospitals are in difficulty managing business because of low medical demand along with the shortage of medical manpower, medical equipment and facilities. The objectives of this study were to reveal the cause of low utilization of hospitals in rural area, and to increase utilization of those hospitals. In this study the improvement methods of rural hospital's utilization were presented by examining were placed in difficult management condition, in respect of hospital's management conditions, manpower input, patient medical treatment record, financial record, and actual output. The causes of rural hospital's low utilization were as follows; 1) changes in number and structure of population 2) rural people's preference for large hospitals and hospitals which located in urban area 3) rural hospitals lacking in hospital management skill. Consequently rural hospital's operation condition got more and more deteriorated. To raise rural hospital's utilization, method for social policy, method for health policy, and intrinsic method of hospitals were presented in turn. For rural residents to utilize medical service conveniently, it is necessary for rural hospitals operated normally. So government must insist that rural hospitals solve the problems which come out from their internal management problems. And also these rural hospitals should be supported and nurtured by the government until their management is operated normally.

• 한국경영과학회지
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• 제37권4호
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• pp.211-223
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• 2012

This study purposed to evaluate the influences of rival hospitals on the number of patients who visited the a study territory hospital. Spatial analysis technique was used to measure the impact of rival hospitals in study region. Selected hospitals were all medical school affiliated hospitals which were located in Daejeon metropolitan city and Chungchungnamdo. Patient data was collected from the claims data of the study hospital, and the number of inpatient and outpatients who visited the study hospital between January and June in 2008 were calculated on the smallest administrative district, Eup, Myeon, and Dong, in study region. To control the differences of regional characteristics among Eup, Myeon, Dong, socio-economic variables (total population, number of people aged over 65, number of basic livelihood security recipients, distance from the study hospital to the centroid point of each Eup, Myeon, Dong, number of business, and number of employees) were included in analysis model. These variables were collected from the annual year book of city as well as county located in study region. Cluster analysis classified the study region into three groups by using the difference of between th actual number of inpatient/outpatient and the predicted number of inpatient/outpatient in Eup, Myeon, and Dong. Most areas around the rivalry hospitals were categorized into same group. Multiple regression analysis indicated that areas around rivalry hospitals had statistically significantly negative relationship with the number of inpatients and outpatients who visited the study hospital. As the buffer size was increased from 5Km to 10Km, the standardized regression coefficients were decreased. These study results confirmed that rivalry hospitals in region had negative impacts on the performance of hospitals. It suggests that hospitals will require not only to select their location to minimize the effects of rivalry hospitals, but also to establish their strategy to cope with the rivalry's threats in their region.

• 대한지역사회영양학회지
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• 제6권4호
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• pp.678-685
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• 2001

Although breastfeeding is recognized to be vital to the health and well-being of children and women, the rate of breastsfeeding among Korean women has continuously decreased. One barrier to breastfeeding has been identified to be associated with health care providers. Health care professionals do not give sufficient advice and encouragement, next do hospitals provide supportive environments for breastfeeding by separating infants from mothers or providing formula. The purpose of this study was to investigate prenatal breastfeeding education and infant feeding practices in public health centers and baby-friendly hospitals. A telephone survey was carried out on 57 public health centers located in the Seoul and Chungcheong areas and 13 baby-freindly hospitals from February to April in 2000. Among the public health centers, 43.8% offered periodic prenatal education for pregnant women who visited the centers. Most of them used leaflets or pamphlets developed by the Ministry of Health and Welfare or UNICEF. Twenty six percent of the public health centers developed their own educational materials. All of the 13 baby-friendly hospitals gave additional fluids to infants, did not allow mothers and infants to stay together 24 hours a day, and did not foster the establishment of breatfeeding support groups among the mothers. Most of the baby-friendly hospitals gave artificial teats, did not help mothers initiate breastfeeding within a half-hour of birth. Findings indicate that current practices even in the baby-friendly hospitals are not consistent with the '10 steps to success breastfeeding'. Therefore, deliberate efforts should be made to incorporate adequate breastfeeding education into prenatal program in both public health centers and hospitals, and create environments to support breastfeeding in hospitals, even in baby-friendly hospitals.

• 한국병원경영학회지
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• 제5권2호
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• pp.78-99
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• 2000

Objectives: The purpose of this study was to evaluate the opinions of hospital managers on DRG pilot study. Methods: Managers of 800 hospitals which had participated in DRG pilot study during the period 1997-1999, were requested to respond to structured self-administerd questionnaire. The questionnaire was composed with six categories: the motivation and satisfaction for the DRG pilot study, the opinions on the level of unit price, the appropriateness of DRG classification, the change of medical service quality during the pilot study, the patient's complains resulted from DRG system. and the opinions on the nation-wide application of DRG system. Results : Of the 800 subjects, 327(clinic, 210: 25 hospitals, 82 general hospitals, and 16 tertiary hospitals) completed the questionnaire, and the overall response rate was 41%, 121 hospitals(27%) answered that they participated in DRG pilot study because of convenience of claims and 118 hospitals(35%) dissatisfied with DRG system. 251 hospitals(85%) thought that the level of unit price under the DRG system was same as or lower than that of fee-for service. 297 hospitals(92%) responded that DRG classification should be modified and 137 hospitals(47%) experienced deterioration of medical service quality during the DRG pilot study. The 116 hospitals(35%) experienced the patient's complains resulted from DRG system. The 85 hospitals(88%) didn't want nation-wide application of DRG system. Conclusion: Most of the responded managers seemed to have negative opinions on DRG pilot study, even though they had been participated voluntarily. Further studies and extensive evaluations of DRG reimbursement system are needed before nation-wide application.

• 한국의료질향상학회지
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• 제22권1호
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• pp.59-69
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• 2016

Objectives: Healthcare Accreditation Program in Korea started in 2011. The aim of this study is to contribute to the development of the Healthcare Accreditation Program in Korea by comparing the perception of the Healthcare Accreditation Program for the accredited hospitals and the surveyors. Methods: This study was performed targeting 77 accredited acute care hospitals and 245 surveyors who have surveyed acute care hospitals from 2010 to February 2014. They responded to our questionnaire via a survey website, and we analyzed the results. Results: We found that the hospitals rated the professionalism of surveyors more positively than surveyors. While average score of the hospitals was higher for 'The understanding of the accreditation standards and survey methods was correct' than that of the surveyors (p<0.01), average score of the surveyors was higher for 'Mediation and collaboration between surveyors were smooth' than that of the hospitals (p<0.05). And we found that the surveyors rated the Accreditation Program more positively than hospitals. While average score of the hospitals was higher for 'Surveyors have the professionalism' than that of the surveyors (p<0.05), average score of the surveyors was higher for 'It is easy to understand the accreditation standards and evaluation items' than that of the hospitals (p<0.01). Conclusion: In order to development of the accreditation program, it is necessary to strengthen the professionalism of surveyors and improve the acceptability of the accreditation program.

• 대한영양사협회학술지
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• 제19권4호
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• pp.317-342
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• 2013

The purpose of this study was to evaluate the current state of foodservice and clinical nutrition management in a hospital-based nutrition department. Nutritional guidelines and survey reports of hospital evaluation programs from 2004 to 2009 were analyzed. In total, 275 hospitals in the first period and 288 hospitals in the second period were evaluated. The division of knife and chopping board use decreased from 97.2% in 2005 to 89.7% in 2008, the maintenance of a proper freezer temperature (below $-18^{\circ}C$) increased from 82.1% in 2004 to 97.7% in 2007 (88.9% to 97.4% from large hospitals and 69.8% to 86.5% from small/medium hospitals in 2005 and 2008, respectively). In tube-feeding management, the performance rate of material cold storage and the offer rate of tube-feeding were 65.9% and 94.2% in 2007, respectively. The cold storage of material, proper use within 24 hours after opening or production, and the use of an appropriate label were 47.3%, 71.2% and 67.2% in 2009, respectively. The rate of a management system for undernourished patients was 86.0% in 2007 (56.4% for large hospitals, 18.9% for small/medium hospitals) and 14.3% in 2009. In standards of nutrition support management, the performance rates of constructing a nutrition support team, the nutrition support team activity, and organizing multidisciplinary team were 66.7%, 43.6%, and 64.1% respectively, in 2004. For large hospitals, those rates were 61.1%, 36.1%, and 58.3%, in 2005, 93.0%, 62.8%, and 91.9% in 2007, and 69.2%, 43.6%, and 69.2% in 2008, respectively. The results of this study suggest standards on sanitary foodservice preparation, production, and tube-feeding production need to correspond with HACCP regulations for small/meidium hospitals in standards of a healthcare accreditation system. It will be necessary to understand the operating conditions of nutrition departments in convalescent hospitals, psychiatric hospitals, and geriatrics hospitals. As the application of accreditation is required from 2013, standards will need to be improved and continuously updated for healthcare accreditation.

• 한국병원경영학회지
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• 제4권2호
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• pp.85-105
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• 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.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제23권3호
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• pp.9-17
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• 2017

Purpose : The easiest and most cost-effective way to prevent medical-related infections is known as proper hand washing of health care workers. The experience of MERS in domestic medical institutions has increased the importance of hand hygiene for medical workers to prevent infections in hospitals. It is necessary to investigate the level of hand hygiene practice by type of medical institutions and the factors influencing the infection prevention. Methods : Domestic and overseas hand hygiene related business cases and literature data were collected and analyzed in order to investigate the hand hygiene status of medical institutions in Korea. Result : As a result of hand hygiene monitoring of all hospital-level medical institutions in 2016, the total number of observations was 24,328 and the hand hygiene performance rate was 75.9%. The hand hygiene performance rate of hospitals was 71.5% for general hospitals, 75% for general hospitals, and 81.3% for hospitals. Implications : In general hospitals and hospitals, the HR(Hand Rubbing) method is preferred as a way of performing hand hygiene, whereas the HW(Hand Washing) method is relatively high in the small hospitals. It is estimated that the HW system is preferred because of the cost burden at the hospital medical institution. Therefore, it is necessary to compensate the related expenses to improve the hand hygiene performance of the physicians who are engaged in the hospitals.