• 보건의료산업학회지
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• 제10권4호
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• pp.97-107
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• 2016

Objectives : This study aims to : (i) characterize and differentiate between two different periods of baby boomers, (ii) study the utilization of their health care services, and (iii) establish effective ways of providing better health service utilization and preventive policy strategies for upcoming and older generations. Methods : A multiple regression analysis using descriptive statistics, frequency analysis, and dummy variables was utilized to access the presence of correlations between socio-demographic factors and health care service utilization. Results : Medical insurance type, marital status, and chronic disease were factors that influenced health care service utilization. Furthermore, the factors that influenced individual medical expenses were cohabitation, inpatient days, and chronic disease. Conclusions : Primary findings and exploratory statistics revealed that there were strong correlations and interaction among some of the predictor variables. Because of the chronologically limited nature of the sample data set gathered in 2012, it would be helpful to continue to develop or research related constructs that may capture relationships more effectively among extended populations.

• 보건교육건강증진학회지
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• 제27권4호
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• pp.83-90
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• 2010

objectives: This study was conducted to estimate medical expenditure attributable to overweight and obesity in adults with ischemic heart disease and stroke using Korea National Health and Nutrition Examination survey data and Korea National Health Corporation data. methods : The medical expenditure of ischemic heart disease and stroke related to overweight and obesity were composed of inpatient care costs, outpatient care costs and medication costs. The population attributable risk (PAR) of overweight and obesity was calculated from national representative data of Korea such as the National Health Insurance Corporation cohort data and 2005 Korea National Health and Nutrition Examination survey data. results: The medical expenditure attributable to overweight and obesity of ischemic heart disease were 97.4 billion won(74.1-122 billion won). and stroke were 64.6 billion won(33.1-98.1 billion won). Consequently, these costs corresponded to 11.4% of total medical expenditure due to ischemic heart disease and stroke. conclusion: We conclude that overweight and obesity have increased medical expenditure from ischemic heart disease and stroke in Korea. These findings provide important support for implementing overweight and obesity management strategies in Korea.

• Clinical and Experimental Pediatrics
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• 제58권11호
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• pp.434-439
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• 2015

Purpose: Kawasaki disease involves acute febrile systemic vasculitis that can cause a variety of symptoms by affecting various organs. Here, we aimed to evaluate the prevalence, causes, and prognosis of sensorineural hearing loss (SNHL) occurring in children with Kawasaki disease. Methods: Patients who were diagnosed with Kawasaki disease and received inpatient treatment in the Pediatrics Department at one of three university hospitals in Daegu city from February 2012 to September 2012 were enrolled in the study. The clinical features, hematological results, echocardiography results, audiometry results, and aspirin and salicylic acid serum levels of the patients were evaluated. Results: Of the 59 children enrolled in the study, three showed mild bilateral SNHL on audiometry tests conducted after 48 hours of defervescence; these patients demonstrated normal patterns of recovery on follow-up tests 8 weeks later. Aspirin serum levels were significantly higher in the SNHL group after 48 hours of afebrile condition with high dose aspirin intake (P=0.034). However, no significant differences were found in other laboratory tests or for fever duration (P>0.05). Upon echocardiography, coronary artery abnormality was observed in 9 cases, but none of these patients showed hearing loss. Conclusion: The results indicate that SNHL in children with Kawasaki disease might occur during treatment of the acute phase; this SNHL usually involves mild bilateral hearing loss and recovers naturally. However, this study suggests that determination of the causes and clinical implications of hearing loss in Kawasaki disease requires long-term follow-up studies with more cases.

• 한국의료질향상학회지
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• 제10권2호
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• pp.204-215
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• 2003

Background : ICD-10 Classification, which is used domestically as well as internationally, has limited use in the clinical practice since it is developed for at disease statistics and epidemiology. Therefore, the purposes of this study were to improve the quality of diagnosis by constructing a new disease classification based on the diagnoses doctors currently make in the clinical setting and connecting this classification with OCS and EMR, and to meet the demands of doctors for high quality medical study data in medical research. Methods : The specialists in each ophthalmic subfield collected clinical diagnoses and abbreviations based on the ophthalmology textbooks and confirmed the classifications. Total number of clinical diagnoses collected was totaled 672, for which ideal diagnoses had been selected and a new model of disease classification model in connection with ICD-10 was constructed. The constructed classification of clinical diagnoses consisted of six steps: the first step was the classification by ophthalmic subspecialty field; the second to fifth steps were the detailed classification by each specialty field; the sixth step was the classification by site. Results : After introducing the new disease classification, research on the use and a pre-post comparison was conducted. The result from the research on the use of the clinical diagnoses in inpatient and outpatient care has shown a gradually increasing tendency. From the pre-post comparison of EMR discharge summary diagnoses, the result demonstrated that the diagnosis was stated correctly and in detail. Since the diagnosis was stated correctly, code classification became correct as well, which makes it possible to construct high quality medical DB. Conclusion : This construction of clinical diagnoses provides the medical team with high quality medical information. It is also expected to increase the accuracy and efficiency of service in the department of medical record and department of insurance investigation. In the future, if hospitals wish to construct a classification of clinical diagnosis and a standard proposal of clinical diagnosis is presented by a medical society, the standardization of diagnosis seems to be possible.

• Psychiatry investigation
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• 제15권11호
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• pp.1064-1070
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• 2018

Objective Several cell line studies have demonstrated thioridazine's anticancer, multidrug resistance-reversing and apoptosis-inducing properties in various tumors. We conducted this nationwide population-based study to investigate the association between thioridazine use and cancer risk among adult patients with schizophrenia. Methods Based on the Psychiatric Inpatient Medical Claim of the National Health Insurance Research Database of Taiwan, a total of 185,689 insured psychiatric patients during 2000 to 2005 were identified. After excluding patients with prior history of schizophrenia, only 42,273 newly diagnosed patients were included. Among them, 1,631 patients ever receiving thioridazine for more than 30 days within 6 months were selected and paired with 6,256 randomly selected non-thioridazine controls. These patients were traced till 2012/12/31 to see if they have any malignancy. Results The incidence rates of hypertension and cerebrovascular disease were higher among cases than among matched controls. The incidence of hyperlipidemia, coronary artery disease and chronic pulmonary disease did not differ between the two groups. By using Cox proportional hazard model for cancer incidence, the crude hazard ratio was significantly higher in age, hypertension, hyperlipidemia, cerebrovascular disease, coronary artery disease and chronic pulmornary disease. However, after adjusting for other covariates, only age and hypertension remained significant. Thioridazine use in adult patients with schizophrenia had no significant association with cancer. Conclusion Despite our finding that thioridazine use had no prevention in cancer in adult patients with schizophrenia. Based on the biological activity, thioridazine is a potential anticancer drug and further investigation in human with cancer is warranted.

• 보건행정학회지
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• 제24권4호
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• pp.322-329
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• 2014

Background: As most of people in Korea are covered by National Health Insurance (NHI), the disease information collected in NHI provides high availability for health policy. Nevertheless, the validity of disease codes in NHI data has been controversial till now. So we tried to evaluate the validity of them by comparing the NHI claims data with Korean National Hospital Discharge In-depth Injury Survey (KNHDIIS) data. Methods: We compared the NHI patients sample data (2009) with the KNHDIIS data (2009). We selected the inpatient data of KNHDIIS and NHI patients sample. The weighted number of patients from NHI patients sample was 5,551,210 and the number of patients from KNHDIIS was 5,559,874. We classified the disease codes into principal diagnoses and other diagnoses, and we compared as one, two, three unit level. Also we calculated the agreement rate of each of them. Results: In the comparison of principal diagnoses, NHI claims data had more C code than KNHDIIS data did, whereas KNHDIIS data had more Z code than NHI claims data did. In the comparison of other diagnoses, NHI claims data had 2, 3 more codes than KNHDIIS data did. The overall agreement rate at three unit level was 76.5% in principal diagnoses and 46.8% in other diagnoses. Conclusion: Considering the large difference between the two data, the validity of disease codes in NHI Claims data seems to be low. To increase the validity of them, the definite detail coding indicator, the reinforcement of coding education, and the reform of system are needed.

• Journal of Preventive Medicine and Public Health
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• 제30권2호
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• pp.437-461
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• 1997

이 연구는 의료보험관리공단의 공 교 의료보험자료를 이용하여 1989년부터 1993년까지의 5년간의 60세이상의 노인의 의료이용과 진료비의 변화를 연령별, 성별, 의료 보험료 수준별 코호트를 구성하여 상병당으로 분석함으로써 좀 더 정확한 변화의 양상을 파악하고 예측을 하는데 연구의 목적이 있다. 연령별 연도별 입원 수진율은 연도별 입원수진율은 70-74세 군이 89년과 93년에 각각 1,000명당 117.3과 141.1로 가장 높았으며, 매년 증가하는 추세이다. 연령 코호트의 연도별 상병건수는 전체적으로는 5년 동안에 40.5%증가하였다. 성별 코호트의 연도별 상병건수는 남자 상병건수보다 여자가 많이 증가하였으며, 남자와 여자의 연평균 증가율은 각각 9.1%와 10.2%였다. 연령 코호트의 상병당 연도별 입원진료비의 변화는 전체적으로 보았을 때 5년간 총 진료비는 15.4%증가 하였다. 이 중 진료행위료의 증가가 21.5%로 가장 큰 폭으로 증가하였다. 의료 보험료 수준별 코호트의 상병당 입원진료비 변화는 보험료 수준이 낮은 군보다 높은 군에서 진료비가 높았으며, 보험료 수준별 코호트의 연도의 경과에 따라서 각종 진료비가 증가하였다. 재원기간은 0.08% 증가하여 거의 변화가 없었으며, 1991년을 기점으로 감소하는 경향이었다. 10대 다빈도 상병 중에서 가장 흔한 질병은 백내장이었다. 1993년의 10대 다빈도상병 중 1989년에 비하여 비율이 증가한 상병은 백내장, 뇌동맥 폐색이었으며, 감소한 질병은 폐결핵과 본태성 고혈압이었다. 전체 상병에서 10대 상병이 차지하는 비율은 30-35%였으며, 연령군별로는 차이가 없었다. 연령 코호트의 이용의료기관별 평균진료비 및 재원 기간은 전체적으로는 병원급 의료기관에서의 진료비 증가율이 가장 높았으며, 재원기간은 의료기관 종별에 관계없이 감소하였으며, 병원이 4.9% 감소하여 감소폭이 가장 켰다. 총 상병건수에서 고액진료건수가 차지하는 비율은 67.6% 증가하였고, 암환자건수는 8.9% 증가하였으며, 장기입원환자가 차지하는 비율은 오히려 1.2% 감소하였다. 총 진료비 규모는 62.2% 증가하였으며, 고액상병진료비가 차지하는 비율은 5년간 129.9% 증가하였고, 암환자 진료비는 68.5%, 장기입원환자의 진료비는 59.4% 증가하였다. 상병당 입원진료비 및 재원기간을 1989년 수가로 환산하여 변화 추이를 보면, 상병당 총 진료비는 매우 완만한 증가를 보이고, 약제비는 오히려 약간 감소하는 경향이었고, 진료행위료는 지속적으로 상승하는 추세였다. 재원기간은 완만하게 감소하는 양상을 보였다. 연령구간별로 구분하여 분석한 결과 진료비와 재원기간과는 연령에 관계없이 비슷한 상관계수를 보였으나, 의료보험료 수준과 연령구간별 진료비는 상관계수는 매우 작았으며, 연령군별로 큰 차이는 없었다. 시계열 분석 결과 향후 약제비는 매우 완만한 감소 추세를 보일 것이고, 진료행위료와 총 진료비는 지속적으로 증가할 것으로 예측되었으며, 재원기간은 13.0일로 변화가 없을 것으로 예측되었다. 이 연구에서는 진료행위료의 증가가 총 진료비의 상승을 주도하고 있는 것으로 생각된다. 이는 첨단 의료기기나 신기술의 도입에 의한 것으로 의료기관들의 서비스 다각화 전략과도 관련 있는 것으로 생각된다. 또한 의료이용량 즉 입원상병건수의 증가가 진료비 상승에 영향을 많이 미치는 것으로 판단되며 전체 인구 집단의 의료비 상승요인과는 다른 양상을 보일 수 있으므로 노인 인구에 대한 의료비 절감 대책은 다른 연령층과 구별하여 적용할 필요성이 있다고 볼 수 있다. 향후 노인 연령 군별 질병양상의 변화와 서비스량 및 변화에 대한 연구를 개인특성 자료나 의료기관의 특성 등과 연계하여 포괄적인 연구를 수행함으로써 노인입원 특성과 향후 노인의료 이용량과 진료비의 추이를 판단하고 이를 토대로 노인의료문제의 해결을 위한 방안을 마련할 수 있으리라 생각된다.

• 한국식품위생안전성학회지
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• 제36권1호
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• pp.68-76
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• 2021

식중독에 의한 사회경제적 손실을 최소화하기 위해서는 식중독과 관련된 경제적 비용 손실을 추정하는 것이 중요하다. 하지만 자료의 부족과 다양한 비용 항목의 존재로 식중독과 관련된 사회경제적 손실비용을 정확하게 추정하기에 어려운 점 있다. 본 연구에서는 국내 식중독 발생에 의한 손실비용을 추정하기에 앞서 국외에서 사용되는 사회경제적 비용항목의 기반 자료 확보를 목적으로 수행되었다. 2009-2019년 국외 식중독과 관련된 사회경제적 손실비용 측정 연구의 사례 조사를 위해 문헌 조사를 실시하였다. 이 연구에서는 사회경제적 손실비용을 크게 의료기간에 방문한 외래/입원환자 및 의료기관에 미방문한 경험환자로 구분하였다. 또한 이들의 직접비용 및 간접비용을 고려하였고, 더 나아가 기업비용 및 행정비용 항목으로 구분하여 조사하였다. 조사 결과 문헌별, 나라별 상이한 비용항목을 사용하여 손실비용을 추정하는 것으로 관찰되었다. 직접의료비의 경우 모든 연구에서 외래 또는 입원진료비를 선정하여 비용을 산출한 것으로 관찰되었기 때문에 나라별 의료서비스의 체제 및 비용에 따라 항목을 선정해야 한다. 직접비의료비의 경우 몇 몇의 연구에서 외래 방문에 소요된 교통비만을 고려하였기 때문에 간병비 고려 여부에 대해서는 더 논의가 필요할 것으로 사료된다. 간접비용 중 조기사망비용, 작업손실비용, 여가손실비용 및 삶의 질 저하/고통비용은 고려하였으나, 병문안 기회비용은 모든 연구에서 고려하지 않았다. 직접의료비와 마찬가지로 행정비용의 경우에도 국가별 정부 예산이 상이하기 때문에 각 나라에 맞는 항목을 고려해야할 것이다. 따라서 이러한 조사 결과를 바탕으로 국내 식중독 발생에 의한 사회경제적 손실비용 분석을 위해 어떠한 비용 항목을 고려해야 할 것인지에 대한 검증절차가 필요할 것이다. 본 연구는 국내 식중독 발생에 의한 사회경제적 손실비용 분석을 위한 기초적인 정보를 제공할 것이다.

• 보건행정학회지
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• 제11권3호
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• pp.31-45
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• 2001

With an economic development and epidemiologic transition, the burden of disease due to chronic diseases and accidents is increasing. However, in most of developing countries, long-term care facilities are not available, therefore acute care facilities should provide both acute and long-term care services. It is also true in Korea. The demand for long-term care services needs to be estimated to establish the adequate supply system of health resources. This article introduces the reclassification methodology of inpatients' healthcare utilization to acute and long-term care services. All discharged patients from hospitals for one month were analyzed. The distribution of inpatients' hospital days were fitted to Chi-squared distribution by ICD disease categories, and they were grouped in five clusters. For each cluster, the lower and upper limit of classification criteria to acute and long-term care services were chosen. Summarizing all hospital days corresponding to acute and long-term care respectively, 24 to 28 percent of inpatient services fumed out to be long-term care services. The study results are consistent with those of the existing studies. They can be used practically in the allocation of long-term care resources.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제12권2호
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• pp.31-39
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• 2006

Much has changed in the healthcare field since the beginning of the industrial age. In the healthcare field changes are occurring so rapidly and dramatically that yesterday's paradigm will not be tomorrow's paradigm, creating the need above all else to stay fluid and flexible as strategies(included healthcare architecture planning) for the future are developed. The purpose of this study is to analyze the latest architectural trends of general hospital outpatient department based on the healthcare environment changes in Korea. The major healthcare environment change is to change the object of hospital's healthcare services from inpatient to outpatient. In conclusion, the first, medical faculties of outpatient department are subdivided specialized small faculty. The second, clinic systems for medical examination and treatment of specific disease are activated in the most outpatient department. The third, specialized medical centers for chronical disease(Cancer, Cardiac etc.) control are arranged in existed outpatient department or freestanding facility. Specialized medical center for preventive medicine is regionally decentralized for corresponding with the healthcare paradigm shifts.