• Journal of Preventive Medicine and Public Health
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• 제22권3호
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• pp.380-388
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• 1989

To evaluate the costs of the hypertension screening program of the Korea Medical Insurance Corporation, the records of the screening examinations were used. The sample size was 49,983 of the 906,554 people insured by the Corporation and was obtained by two-stage stratification random sampling. The alternatives for efficiency of the screening program, which were divided into three categories : modification of the screening test package, application of other hypertension diagnostic criteria, and selective approach of tested groups by age, were evaluated according to the cost per patient detected. The results of this study were as follows In the hypertension screening system, the cost per patient detected was Won 30,883. The most nonsensitive test for hypertension detection was ophthalmoscopy, which was examined during the second stage of screening. If the ophthalmoscope examination was excluded, olny one person was not detected, which was 0.2% of detected persons, and the cost per patient detected decreased to Won 28,098. The most efficient modification of the screening test package was measurement of blood pressure through the first and second stages of screening. The cost per patient detected by this modification was Won 24,408. The application of other diagnostic critera, which were more restricted criteria, increased the cost per patient detected by 3.7%-6.7%. The cost per patient detected were Won 170,582 for persons less than 39 years old, Won 20,032 for persons 40 to 59 years old, and Won 8,675 for persons 60 years old and over. In conclusion, the best alternative suggested with respect to efficiency and practical application excluded the ophthalmoscope examination of second stage screening and restricted the target population to persons greater than 40 years old. The application of this alternative decreased 54.9% of the screening costs and the cost per patient detected was Won 15,222. This study was limited in that measurement of effectivenes was not of the ultimate goal of screening, which is decreasing morbidity and mortality, but was of disease detection as the short-term objective.

• 한국보건간호학회지
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• 제31권2호
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• pp.284-295
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• 2017

Purpose: This study was conducted to compare the hypertension management between a non-elderly group and elderly group of hypertension patients in Community residents. The study also sought to generate strategies for increasing the hypertension management of residents using Community health center. Methods: Data on the general characteristics and hypertension management from 381 hypertension patients between non-elderly and elderly, living in P city, Gyeonggi Province and C city, Chungnam Province. South Korea, were collected based on a structured questionnaire, The data were analyzed using the SPSS 20.0 statistics program. Results: The use of a Community health center in the non-elderly and elderly groups showed a statistically significant difference in facility excellence and cheaper cost. Hypertension management was measured every day, The daily blood pressure and physician counseling was performed according to the changes in blood pressure. The management of hypertension medication in a community health center provided for hypertensive patients can be evaluated as an efficient service. Conclusion: The self-management ability of hypertension needs to be improved. In particular, especially, the elderly managed by the Community health center have good accessibility and a good alternative for the treatment cost. Therefore, it is necessary to provide support and measures to make hypertension management safer.

• 보건행정학회지
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• 제19권3호
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• pp.92-108
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• 2009

This study suggests a model for continuing and comprehensive management of hypertension or Type 2 diabetes mellitus (T2DM) in Korea. Moreover, this paper computed the contribution cost of hypertension or T2DM management using the healthcare medical cost, which could have occurred from stroke, myocardial infarction (MI), and end-stage renal disease (ESRD) that were successfully prevented from the effective hypertension or T2DM management. Additionally, these costs were compared with the cost of implementing the hypertension or T2DM management model suggested in this study. This study used the medical fee summary of the health insurance claims submitted to National Health Insurance Corporation by medical facilities for services provided during the period from January 1st 1999 to December 31st 2006. The prevalence rate with treatment referred to cases in which patients submitted their medical claims at least once during the period, along with an accordant diagnosis. The incidence rate with treatment referred to cases in which patients who never submitted claims for the accordant disease during the five years from 1999 to 2003 submitted claims for the accordant disease in 2004 and 2005. The relative risk of the occurrence of stroke, MI and ESRD was 11.0, 13.6, and 30.3, respectively. The attributable risk of hypertension or T2DM for stroke was 0.730, and that for MI and ESRD were 0.773 and 0.888, respectively. Based on these, the contribution cost of hypertension or T2DM is estimated to be 986.3 billion Korean Won(KRW) for stroke patients, 330.5 billion KRW for MI patients, and 561.7 billion KRW for ESRD patients as in 2005. Hence, the total contribution cost of hypertension or T2DM to stroke, MI, and ESRD is 1.878 trillion KRW. The estimate for operational costs included an annual expenditure of 50,000 KRW per each recipient and an annual subsidy of 0.22 million KRW per person for the 1.6 million low.income individuals with hypertension or T2DM to cover their out.of.pocket medical expenses. Under this assumption, it took approximately 0.6 trillion KRW to manage 5 million high.risk patients in the low. and mid.income range, coverings up to 50% of costs. In conclusion, considering the potential benefits of preventing stroke, MI, and ESRD, the costs seems to be reasonable.

• 약학회지
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• 제54권2호
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• pp.126-133
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• 2010

This study was conducted to analyze cost-utility of bosentan versus iloprost indicated for pulmonary arterial hypertension (PAH) in a Korean healthcare setting from a payer's perspective. We constructed a Markov model to estimate total costs and outcomes for 1-year time horizon in a hypothetical cohort of 50-year-old patients with PAH. Base analysis showed that bosentan resulted in KW 5.5 billions saving and 18 quality-adjusted life year (QALY) gains per 100 patients compared to iloprost. Bosentan as a dominant strategy was found to be robust through various sensitivity analyses.

• 지역사회간호학회지
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• 제22권4호
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• pp.438-450
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• 2011

Purpose: This study was to investigate the effect of home visiting care service and to evaluate the effect from the cost-benefit perspective. Methods: Target participants were enrolled in 2007~2008 for home visiting care and provided with a home visiting nursing service for more than 18 months in J Ward of S City. Of 391 participants, 244 who satisfied the inclusion criteria were used in the final analysis. Cost-benefit analysis was done using the net benefit and benefit/cost ratio. Results: After providing the home care nursing service, the blood pressure control rate increased from 50.8% to 75.4%. Of the subjects, 39.8% maintained their blood pressure level within the target range. As a whole, the net benefit of home visiting care per person ranged from 434,964.86 to 447,112.43 won and the benefit/cost ratio ranged from 2.82 to 2.84. Conclusion: Home visiting care for vulnerable populations with hypertension was effective in both maintaining blood pressure and reducing blood pressure to the target range. Therefore these results are especially useful for establishing the value of home visiting services for policy makers as well as for prioritizing vulnerable populations.

• 한국콘텐츠학회논문지
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• 제22권2호
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• pp.782-793
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• 2022

만성질환의 증가는 국민의 삶에 부정적인 영향을 미칠 뿐 아니라, 보건의료 기술의 향상, 평균 수명 증가, 급속한 인구고령화 등에 따른 의료이용으로 의료비 재정에 대한 부담을 가중시킨다. 이에 본 연구는 만성질환 중 대표질환인 고혈압을 중심으로 인구통계학적 정보에 따른 질환손실비의 차이 및 초기 진단 나이와 치료기간이 질환손실비에 주는 영향을 살펴보았다. 이를 위해 2010년부터 2017년까지의 한국의료패널조사를 이용하였으며, 30세에서 80세 미만의 건강보험적용대상자를 기준으로 대상자를 선정하였다. 선정된 데이터로 질병비용접근법에 따라 질환손실비의 직접비용과 간접비용을 계산했으며, 고혈압에 대한 진단 나이와 치료 시점을 고려해 질환손실비 코호트를 구축하였다. 연구 결과에 따르면 고혈압 환자의 연간 질환손실비는 성별에 따라 110,107원의 차이가 있었고, 치료 시점이 증가할수록 1.8배가량 비용이 증가하는 것으로 나타났다. 또한 같은 나이대 간 질환손실비 비교에서 60대와 70대의 질환손실비는 치료 시점 변수에 영향을 받는 것으로 나타났다. 본 연구를 통해 고혈압이 질병 비용에 큰 영향을 미치고 조기 진단 관리가 필요할 뿐만 아니라, 고혈압 질환의 발병률을 낮추기 위한 예방적 노력을 강화해야 한다는 점이 확인되었다.

• 간호행정학회지
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• 제16권3호
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• pp.295-305
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• 2010

Purpose: This study was conducted to evaluate the economic efficiency of a community-based nursing care center to help policy makers determine whether or not to invest in similar facilities. Methods: The subjects were 101 elderly people over 65 years who participated in a health management program from February 1 to July 31, 2007. Direct cost was estimated with center operations cost, medical cost for out-patients and pharmacy cost. Indirect cost was measured by transportation cost. Direct benefit was calculated by saved medical cost for out-patients, saved pharmacy cost, saved transportation cost, and reducing hospital charges. Indirect benefit was estimated with prevention of severe complications. Economic efficiency was evaluated by cost-benefit ratio and net benefit. Results: Operating a community-based nursing care center was found to be cost-effective. Specifically, the cost of operating the center evaluated here was estimated at 135 million won while the benefit was estimated at 187 million won. Benefit-cost ratio was 1.38. Conclusion: The Community-based nursing care center that was described here could be a useful health care delivery system for reducing medical expenditures.

• 한국보건간호학회지
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• 제10권1호
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• pp.95-105
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• 1996

This study was uncertaken to find an effective management modality for patients with hypertension. Patients 60years or older were selected for this purpose from a general hospital and a welfare center in Pusan and from a public health clinic in Cheju Island. During the month of October in 1984. the management modality for hypertension. the incurred medical expenses. and knowledge about the hypertension were analyzed and compared. The following results were obtained: 1. The a erage total medical expense per year was highest at the general hospital followed by the public health clinic and the welfare center. 2. It was found that the patients chose the public health clinic for its low medical cost. the welfare center for its proximity as well as for its low medical cost. and the general hospital for its quality medical services Also. the study has shown that the prescription of drugs was the major service provided by the public health clinic whereas the blood pressure measurement. the prescription of drugs. and family planning were the primary service offered by the welfare center. Drug prescription and blood pressure measurement were two of the most important services by the general hospital. 3. It was shown that the knowledge of hypertension was highnest at the welfare center whereas the management of hypertension was highest at the public health clinic. Based on above results and considering the chronic nature. it is believed that family awareness of the illness was one of the most important aspects for effective management of the hypertension for the elderly patients. In addition. the health care clinics at every level should come forward to execition of the educational programs and home nursing schomes for the effective management of the hypertension patients.

• 대한간호학회지
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• 제41권6호
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• pp.750-757
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• 2011

Purpose: Cost-benefit analysis is one of the most commonly used economic evaluation methods, which helps to inform the economic value of a program to decision makers. However, the selection of a correct benefit estimation method remains critical for accurate cost-benefit analysis. This paper compared benefit estimations among three different benefit estimation models. Methods: Data from community-based chronic hypertension management programs in a city in South Korea were used. Three different benefit estimation methods were compared. The first was a standard deterministic estimation model; second, a repeated-measures deterministic estimation model; and third, a transitional probability estimation model. Results: The estimated net benefit of the three different methods were $1,273.01, $-3,749.42, and $-5,122.55 respectively. Conclusion: The transitional probability estimation model showed the most correct and realistic benefit estimation, as it traced possible paths of changing status between time points and it accounted for both positive and negative benefits.

• 보건행정학회지
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• 제31권1호
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• pp.65-73
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• 2021

Background: With the recent aging of the population, the transition to a disease structure centered on chronic diseases is accelerating. Moreover, the socio-economic gap and the polarization of the health gap between regions further increase the burden of disease on the country. Accordingly, this study calculated the disease cost of hypertension, diabetes, and hyperlipidemia, which are the three major chronic diseases, to establish an effective health promotion policy strategy for each region, and analyzed the gap in disease cost within the region to determine health determinants at the individual as well as the regional level. Methods: This study utilized data from the 2015 sample cohort of the National Health Insurance Service and calculated the disease cost of patients (diabetes: I10-I15, hypertension: E10-E14, hyperlipidemia: E78) based on the main diagnosis. Results: Based on our analysis, the case of medical use in cities and provinces was higher than in metropolitan cities, with relatively small medical use in Seoul and Gangwon-do. In terms of the disease cost, the cost of chronic diseases in Seoul and Jeju was the highest, but the difference in disease cost between patients in each region was the largest in Seoul and Gangwon-do. Conclusion: The results of this study provide meaningful data for implementing efficient health promotion policies by analyzing the differences in disease cost and identifying health determinants in different regions. Furthermore, in Korea, where socioeconomic differences are clearly revealed, it can be used as a basis for preparing a strategic plan, from a long-term perspective, to improve the health of patients with chronic diseases in the future.