• 대한간호학회지
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• 제38권3호
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• pp.363-371
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• 2008

Purpose: This analysis was conducted to evaluate the cost-effectiveness of gemcitabine-cisplatin chemotherapy for non small-cell lung cancer patients in an outpatient setting compared with the traditional inpatient setting. Methods: A cost-effective analysis was conducted from a societal perspective. The effects of treatment, which was measured as an adverse event rate, were abstracted from a published literature search and empirical data from one university hospital. The costs included both direct and indirect costs. Direct costs included hospitalizations, outpatient visits, and lab tests. Pharmaceutical costs were excluded in analysis because they were same for both options. Indirect costs included productivity loss of patients as well as care-givers. In order to determine the robustness of the results, sensitivity analysis on treatment protocol was conducted. Results: Literature search showed no difference in adverse effect rates between inpatient treatment protocol and outpatient treatment protocol. Therefore, this analysis is a cost-minimization analysis. Cost-savings in the outpatient setting was 555,936 won for one treatment cycle. Our sensitivity analysis indicated that the outpatient chemotherapy still showed cost-savings, regardless of changes in treatment protocol. Conclusion: The outpatient gemcitabine-cisplatin chemotherapy for non small-cell lung cancer resulted in cost savings compared to inpatient chemotherapy. More importantly, outpatient chemotherapy could improve the utilization of health service resources in terms of available beds.

• Journal of Preventive Medicine and Public Health
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• 제23권3호
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• pp.285-295
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• 1990

The utilization of medical care services has been partly regionalized with the implementation of referral requirement by the government since July 1, 1989 when the health insurance coverage was extended to all the people. For the purpose of regionalization, the whole country has been primarily divided into tertiary care regions, and each of them again into secondary care regions. This study investigates the self-sufficiency for in-patient care services of secondary care regions focusing on why it varies among the regions. In doing so, analysis is performed to examine a model which embodies three sets of hypotheses as follows : 1) The regional self-sufficiency for medical care services would be subject to direct influences of regional characteristics, amount of available services and structural properties of regional medical care system ; 2) The regional characteristics would have indirect effects on the self-sufficiency which are mediated by medical care services ; and 3) The amount of available services would indirectly affect the self-sufficiency by influencing the structure of regional medical care system. The results of analysis were generally consistent with the model. The findings have some practical implications. The regional self-sufficiency for medical care services partly depends upon basic properties of each region which cannot be changed in a short period of time. Thus the self-sufficiency for medical care services can be improved mainly by health policy measures. In some of the regions the self-sufficiency for in-patient care services was much higher or lower than can be predicted from the bed-population ratio. Indication is that the allocation of health resources should be made considering a variety of factors bearing upon the supply of and demand for health care ; not on the basis of just a single criterion like the availability. The self-sufficiency of a certain region is related to not only its own characterstics but also the characteristics of neighboring regions. Therefore, attention should be also directed to the inter-regional relationships in health care when the needs for investment of health resources in a region are assessed. However, it should be noted that this study used the data collected before the referral requirement was imposed. A replication of this analysis using recent data would provide an evaluation of the impact on the self-sufficiency of the referral requirement as well as a confirmation of the findings of this study.

• 보건행정학회지
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• 제19권1호
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• pp.81-96
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• 2009

The expansion of long-term care hospitals (LTCHs) is expected to contribute to meeting the long-term care needs of the elderly with chronic diseases in a rapidly aging society. It is also expected to increase efficiency of health resource use and decrease elderly health expenditures by transferring patients from acute care hospitals (ACHs) to LTCHs. This study aimed to empirically examine how the expansion of LTCHs had influences on the length of hospitalization of the elderly in ACHs. Panel regression analysis was employed as an analytic tool using data of the National Health Insurance and the National Statistical Office from 2002 to 2006. The expansion of LTCHs was measured as location quotient (LQ) of LTCHs, denoting the share of LTCHs in a large city or province relative to the share of LTCHs at the national level. In addition, per capita GRDP (gross regional domestic product) and the proportion of population over 65 were included as control variables. The main findings are as follows. First, it was observed that LQ of LTCHs showed a statistically significant negative association with the length of hospitalization of the elderly in ACHs. Second, the negative correlation was evident among general hospitals with over 100 beds while it was not among hospitals with less than 100 beds. Third, LQ of LTCHs had more influences among the elderly over 85. In conclusion, the expansion of LTCHs seems to contribute to decrease in the inpatient cost of the elderly in ACHs and to increase efficiency in the utilization of health resources.

• 보건행정학회지
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• 제13권1호
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• pp.98-115
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• 2003

Concerns about growing health insurance expenditures became a national Issue in 2001 when the National Health Insurance went into a deficit. Increases in spending for ambulatory care shared the largest portion of the problem. Methods and systems to control the spending should be developed and a system to measure case mix of providers is one of core components of the control system. The objectives of this article is to examine the feasibility of applying Korean Diagnosis Related Groups (KDRGs) to classify health insurance claims for ambulatory care and to identify problem areas of the classification. A database of 11,586,270 claims for ambulatory care delivered during January 2002 was obtained for the study, and the final number of claims analyzed was 8,319,494 after KDRG numbers were assigned to the data and records with an error KDRG were excluded from the study. The unit of analysis was a claim and resource use was measured by the sum of charges incurred during a month at a department of a hospital of at a clinic. Within group variance was assessed by th coefficient of variation (CV), and the classification accuracy was evaluated by the variance reduction achieved by the KDRG classification. The analyses were performed on both all and non-outlier data, and on a subset of the database to examine the validity of study results. Data were assigned to 787 KDRGs among 1,244 KDRGs defined in the classification system. For non-outlier data, 77.4％ of KDRGs had a CV of charges from tertiary care hospitals less than 100％ and 95.43％ of KDRGs for data from clinics. The variance reduction achieved by the KDRG classification was 40.80％ for non-outlier claims from tertiary care hospitals, 51.98％ for general hospitals, 40.89% for hospitals, and 54.99% for clinics. Similar results were obtained from the analyses performed on a subset of the study database. The study results indicated that KDRGs developed for a classification of inpatient care could be used for ambulatory care, although there were areas where the classification should be refined. Its power to predict tile resource utilization showed a potential for its application to measure case mix of providers for monitoring and managing delivery of ambulatory care. The issue concerning the quality of diagnostic information contained in insurance claims remains to be improved, and significance of future studies for other classification systems based on visits or episodes is guaranteed.

• Journal of Hospice and Palliative Care
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• 제21권1호
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• pp.23-32
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• 2018

목적: 미국 병원에서 만성폐색성폐질환으로 사망하는 환자의 연명치료 및 완화의료에 대한 연구는 부족한 현실이다. 이 연구에서는 병원의 의료비 추세 및 완화의료 이용 및 연명치료 이용과의 관련성을 파악하고자 하였다. 방법: 이 연구는 2005~2014년 미국 입원환자 샘플(National Inpatient Sample, NIS)을 후향적 코호트 디자인으로 전환하였으며, ICD-9-CM (International Classification of Diseases, 9th revision) 코드를 활용하여 완화의료 및 집중치료(전신지지치료, 호흡기치료, 호흡기 수술)를 받은 환자를 구분하였다. 결과: 연평균성장률(Compound Annual Growth Rates, CAGR)을 활용하여 병원 의료비의 시계열변화를 확인하였으며, 다수준 다변량 회귀분석을 통해 병원의 의료비에 영향을 미치는 요소를 파악하였다. 전체 77,394,755 입원 건 중 79,314명의 환자가 최종 분석에 사용되었다. 병원 의료비는 연평균성장률이 5.83% (P<0.001)였으며, 전신지지치료와 완화의료의 연평균성장률은 각각 5.98%와 19.89% 였다(모두, P<0.001). 전신지지치료, 호흡기 치료, 호흡기 수술은 각각 59.04%, 72.00%, 55.26%의 병원 의료비 상승에 영향을(모두, P<0.001) 주었던 반면 완화의료는 28.71%의 병원 의료비 감소에 영향을 주었다(P<0.001). 결론: 미국에서 만성폐색성폐질환으로 사망하는 환자 중 전신지지 치료는 병원 의료비 상승의 주된 원인인 반면 완화의료 이용은 비용절감에 영향이 있는 것으로 파악되었다.

• 한국콘텐츠학회논문지
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• 제11권7호
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• pp.259-274
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• 2011

이 연구는 2004년 KTX의 도입 이후 증가하고 있는 서울 지역 의료기관으로의 원거리 의료 이용 현상의 특성 및 그 영향 요인을 분석하였다. 설문조사를 통해 KTX로 서울지역 의료기관을 이용한 경험이 있는 203명에 대한 자료를 확보하여 이들을 대상으로 분석하였다. 분석 결과 최신 설비 및 의료장비의 보유 여부, 의료진의 수준 등이 원거리 의료 이용의 가장 중요한 이유로 나타났고, 질병 치료의 방문 목적, 40세 이상 연령, 전문대졸 이하 등의 요인이 서울지역 의료기관에서의 입원서비스 이용 가능성을 유의하게 높였다. 이는 지방 소재 상급종합병원의 중증질환 진료능력 제고와 이를 위한 정부 지원의 필요성, 그리고 의료 기관 인증 및 가감지급평가사업 결과 공시의 강화를 통한 합리적인 의료기관 선택 유도의 필요성을 시사한다.

• 한방안이비인후피부과학회지
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• 제34권2호
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• pp.21-37
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• 2021

Objectives : Allergic rhinitis(AR) is a common chronic disease that accounts for 10-40% of the world's population. This study aims to analyze the status of claims, prevalence, and medical utilization of allergic rhinitis patients using representative patients sample data. Methods : This study used the National Patients Sample(HIRA-NPS) of the Health Insurance Review and Assessment Service for 7 years(2010-2016). And we defined AR patients as all statements including J30 or a subcategory of J30 as the main disease, using the Korean Standard Classification of Diseases(KCD-7). The trend of AR patients by year was divided into Western medicine(WM) and Korean medicine(KM), and analyzed by subgroup analysis such as inpatient/outpatient, gender, age, insurance type, and care institution. Results : Patients with AR were mainly claimed for first sub diagnosis in WM and major diagnosis in KM, and the number of claims increased about 1.3 times and 1.4 times compared to 2010 in WM and KM, respectively. In addition, the total annual medical expenses in 2016 increased 1.3 times and 1.7 times compared to 2010, respectively. Conclusions : Both WM and KM are showing a steadily increasing trend in medical use due to allergic rhinitis. Further research is needed by considering genetic and environmental factors and individual characteristics, and linking with additional data.

• 한국콘텐츠학회논문지
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• 제17권4호
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• pp.585-595
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• 2017

본 연구는 의료급여와 건강보험환자의 의료이용량의 차이를 분석하여 의료급여환자의 도덕적 해이로 인한 진료비 증가문제를 평가하고 합리적 의료급여 정책결정의 근거를 제시하기 위한 것이다. 이를 위하여 서울시민대상 건강보험과 의료급여 급여자료를 성별 연령별 의료기관 종별로 비교 분석하였다. 분석결과는 다음과 같다. 첫째, 상급종합병원의 입원 외래이용 모두 의료급여환자가 건강보험환자에 비해서 적어서 도덕적 해이가 존재하지 않았다. 오히려 의료급여환자들이 고비용 의료서비스를 이용하고 못하고 있었다. 둘째, 종합병원의 입원이용은 건강보험환자가 많은 반면 외래이용은 의료급여환자가 많아서 의료급여환자들이 본인부담이 적은 외래서비스 이용을 많이 이용하고 있었다. 셋째, 병원 의원은 의료급여환자의 이용이 입원과 외래이용 모두 건강보험환자에 비해서 많았다. 따라서 의료급여환자들은 병원 의원의 입원과 외래이용, 종합병원의 외래이용시 적은 본인부담으로 인해 불필요한 의료이용을 할 가능성이 있는 반면에 상급 종합병원 입원과 외래이용, 종합병원의 입원이용시 비급여 의료비 등 과도한 의료비 부담으로 인해 필요한 의료서비스 이용을 하지 못할 가능성도 있었다. 따라서 중증질환을 가진 의료급여환자들의 의료비 부담을 경감시키기 위한 정책은 지속하고, 의원 병원을 이용하는 의료급여환자들이 불필요한 의료서비스를 이용하지 않도록 관리해야 할 것이다.

• 지역사회간호학회지
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• 제10권1호
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• pp.80-92
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• 1999

The purpose of this study was to survey appropriateness of admission and days of care for the cerebral ischemia patients as a basis to provide an effectiveness of hospitalization. The authors retrospectively reviewed the medical records of cerebral ischemia patients in two hospitals from November 1997 to February 1998. Of 194 medical records reviewed, there were 2108 medical days. I t is used a 'Appropriateness Evaluation Protocol' previously developed by Gertman and Restuccia (1981) and translated by Department of Health Management, Seoul National University and Korea Institute for Health Services Management (1993), It was found that the 'Appropriateness Evaluation Protocol' had a high inter-rater reliability(k=.92), Statistical significant was tested by using the percentage, mean, and logistic regression by SAS 6.12. The results were as follows; 1. The appropriate admissions were 87.6%, days of care 63.4%, and the average length of stay $10.9{\pm}6.7$ days. 2. The reasons of inappropriate admissions were for work-up(75.0%) and conservative care (25.0%). Major reasons of inappropriate days of care were 'cases in which the medical purpose of hospitalization has been accomplish or can be addressed in a less setting(45.0%)', and 'cases in which there is a delay in performing the work-up or treatment which required patients is hospitalized (44.4%)'. 3. Appropriate days of care were higher as ageing. Appropriate days of care were higher in patients with lower accademic back ground than those of upper college graduates, and in the patients who enter a hospital via emergency room than out-patients department. Appropriate days of care were higher in the patient with MCA infarction, and lower in the patient with cerebellar infarction than the patient with lacunar infarction. Appropriate days of care were higher in attack first than attack above second, in nomortension patients than hypertensive, and lower in groups who engaged in semi-private room and public room than private room in hospital. Appropriate days of care were higher in shorter length of stay than longer length of stay. 4. Diagnosis, admission path, and appropriate days of care explained appropriate admissions. Diagnosis, appropriate admissions, hypertension explained appropriate days of care. According to the above results, author confirms the substantial amount of inappropriate hospital bed utilization. To reduce inappropriateness, it is necessary to develop some alternative services such as home care services or nursing home with which can be replaced inpatient services and to introduce policy such as case management which includes Critical Pathway for consistent management. And, it should be followed the further study for the effectiveness.

• 한국콘텐츠학회논문지
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• 제11권5호
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• pp.270-279
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• 2011

본 연구는 건강보험심사청구자료에 대한 공변량분석과 다중회귀분석을 통해 노인 암환자의 건강보험과 의료급여 이용차이를 분석하고, 의료보장유형이 노인 암환자의 의료이용량에 미치는 영향을 분석함으로써 의료급여 환자의 도덕적 해이가 존재하는지 파악하는 데 목적이 있다. 연구결과, 첫째, 노인 의료급여 암환자가 건강보험 환자에 비해서 장기간 입원으로 총진료비를 많이 사용하고 있었다. 그러나 진료건당 외래진료비와 진료일당 입원진료비는 건강보험 암환자가 많아서 비용이 많이 소요되는 의료서비스를 더 많이 이용하고 있었다. 둘째, 노인 의료급여 암환자일수록 의료기관을 자주 외래방문하고 장기간 입원하여서 총진료비를 많이 사용하고 있었다. 그러나 진료건당 외래진료비와 진료일당 입원진료비는 건강보험 암환자일수록 증가하였다. 노인 의료급여 암환자들의 의료이용량 증가원인이 높은 비급여본인부담을 피해서 본인 부담이 없는 보험급여 의료서비스를 많이 이용 것에 있음을 알 수 있다.