• 제목/요약/키워드: Medical Costs

검색결과 736건 처리시간 0.032초

관상동맥질환 치료를 위한 시롤리무스 방출 스텐트 ($CYPHER^{TM}$)의 경제성 분석 (Economic Value of the Sirolimus Eluting Stent($CYPHER^{TM}$) in Treating Acute Coronary Heart Disease)

  • 이후연;박은철;박기동;박지은;김영;이상수;강혜영
    • Journal of Preventive Medicine and Public Health
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    • 제36권4호
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    • pp.339-348
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    • 2003
  • Objective : To quantify the economic value of the Sirolimus fluting Stent ($CYPHER^{TM}$) in treating acute coronary heart disease (CMD), and to assist in determining an adequate level of reimbursement for $CYPHER^{TM}$ in Korea. Methods : A decision-analytical model, developed by the Belgium Health Economics Disease Management group, was used to investigate the incremental cost-effectiveness of $CYPHER^{TM}$ versus conventional stenting. The time horizon was five years. The probabilities for clinical events at each node of the decision model were obtained from the results of large, randomized, controlled clinical trials. The initial care and follow-up direct medical costs were analyzed. The initial costs consisted of those for the initial procedure and hospitalization, The follow-vp costs included those for routine follow-up treatments, adverse reactions, revascularization and death. Defending on the perspective of the analysis, the costs were defined as insurance covered or total medical costs (=sum of insurance covered and uncovered medical costs). The cost data were obtained from the administrative data of 449 patients that received conventional stenting from five participating Korean hospitals during June 2002. Sensitivity analyses were peformed for discount rates of 3, 5 and 7%. Since the major clinical advantage of $CYPHER^{TM}$ over conventional stenting was the reduction in the revascularization rates, the economic value of $CYPHER^{TM}$, in relation to the direct medical costs of revascularization, were evaluated. If the incremental cost of $CYPHER^{TM}$ per revascularization avoided, compared to conventional stenting, was no higher than that of a revascularization itself, $CYPHER^{TM}$ would be considered as being cost-effective. Therefore, the maximum acceptable level for the reimbursement price of $CYPHER^{TM}$ making the incremental cost-effectiveness ratio equal to the cost of a revascularization was identified. Results : The average weighted initial insurance covered and total medical costs of conventional stenting were about 6,275,000 and 8,058,000 Won, respectively. The average weighted sum of the initial and 5-year follow-up insurance covered and total medical costs of conventional stenting were about 13,659,000 and 17,353,000 Won, respectively. The estimated maximum level of reimbursement price of $CYPHER^{TM}$ from the perspectives of the insurer and society were $4,126,897{\sim}4,325,161$ and $4,939,939{\sim}5,078,181$ Won, respectively. Conclusion : By evaluating the economic value of $CYPHER^{TM}$, as an alternative to conventional stenting, the results of this study are expected to provide a scientific basis for determining the acceptable level of reimbursement for $CYPHER^{TM}$.

비외상성 급성 복부 통증 환자에게 시행한 복부 전산화단층촬 영과 복부 단순 촬영의 적정성 비교 (The Comparison of Appropriateness of Abdominal Computed Tomography (CT) and Abdominal Radiography Imaging Modality for Patients with Acute Nontraumatic Abdominal Pain)

  • 송정흡;염헌규
    • 한국의료질향상학회지
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    • 제24권2호
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    • pp.15-25
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    • 2018
  • Purpose: To compare the Appropriateness of abdominal CT to abdominal radiography as an imaging modality in terms of the diagnostic value, medical costs and decision making times for patients presented to the emergency department with nontraumatic abdominal pain. Methods: This study used the records of 530 cases presented to the emergency department(ED) with nontraumatic abdominal pain from February to March 2012. Imaging modalities were categorized into abdominal radiography and CT (radiography first or CT first) or radiography alone or CT alone. The diagnostic value, total medical costs and effect on decision making time of the each imaging modalities were compared. Especially, in retrospective review, to evaluate the predictability of the abdominal radiography, alit was assumed that all the 530 cases performed that exam as initial imaging. Results: Among 530 cases, 255 cases underwent abdominal radiography only, 28 cases underwent abdominal CT only and the remnant 247 cases underwent abdominal CT with plain abdominal radiography. The diagnostic value was higher in the cases with abdominal CT (268/275, 97.5%) than in the cases with plain abdominal radiography (19/255, 7.5%).The number of cases predicted by abdominal radiography only as initial imaging were 39/530 (7.4%). In cases where the patients performed the abdominal CT as the first imaging modality thereby omitting the abdominal radiography, the total diagnostic imaging fee was lower than in cases with plain abdominal radiography first followed by the abdominal CT (277,140 vs. 284,226(mean, Korean Won)). Although diagnostic value of the plain abdominal radiography as first imaging modality was lower than the abdominal CT, Decision making time, average duration of hospital stay was longer and the total medical costs was higher than abdominal CT. Conclusion: As an imaging modality in the ED for patients with acute nontraumatic abdominal pain, plain abdominal radiography is an avoidable procedure when viewed in terms of the diagnostic value and total medical costs and decision making times comparing with abdominal CT.

Dynamic Economic Dispatch for Microgrid Based on the Chance-Constrained Programming

  • Huang, Daizheng;Xie, Lingling;Wu, Zhihui
    • Journal of Electrical Engineering and Technology
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    • 제12권3호
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    • pp.1064-1072
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    • 2017
  • The power of controlled generators in microgrids randomly fluctuate because of the stochastic volatility of the outputs of photovoltaic systems and wind turbines as well as the load demands. To address and dispatch these stochastic factors for daily operations, a dynamic economic dispatch model with the goal of minimizing the generation cost is established via chance-constrained programming. A Monte Carlo simulation combined with particle swarm optimization algorithm is employed to optimize the model. The simulation results show that both the objective function and constraint condition have been tightened and that the operation costs have increased. A higher stability of the system corresponds to the higher operation costs of controlled generators. These operation costs also increase along with the confidence levels for the objective function and constraints.

분만관련 불가항력적 의료사고 보상제도에 있어 분담금부과에 관한 연구 -헌법재판소 2018. 4. 26. 선고 2015헌가13 사건을 중심으로- (A Study on Imposing Contribution in the Compensation for Uncontrollable Medical Malpractice during Delivery)

  • 범경철
    • 의료법학
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    • 제19권2호
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    • pp.139-171
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    • 2018
  • 「의료사고 피해구제 및 의료분쟁 조정 등에 관한 법률」(이하 '의료분쟁조정법'이라 한다)에서는 보건의료인이 충분한 주의의무를 다하였음에도 불구하고 분만 중 불가항력적으로 발생한 의료사고에 대하여 국가가 예산의 범위 안에서 그 피해자에게 보상하도록 하고 있다(의료분쟁조정법 제46조). 지금까지 의료사고 피해자가 소송을 통해서만 피해회복을 기대할 수 있었던 것에 비한다면 획기적인 법률이라 할 수 있다. 그런데, 이러한 의료사고보상사업에 드는 비용의 100분의 30은 보건의료기관개설자 중 분만 실적이 있는 자가 부담하고 있는 바(의료분쟁조정법 시행령 제21조), 이 분담금 부과 조항이 분만 과정에서의 산모·신생아 사망 등의 사고가 의사의 과실이 없이 불가항력적으로 발생했음에도, 의사들에게 책임을 묻는 것은 아닌지 문제가 되어 왔다. 그러나 최근 헌법재판소에서 분담금 부과와 관련한 의료분쟁조정법법 제46조 제3항 중 '보건의료기관개설자의 범위' 및 '보상재원의 분담비율' 부분에 대하여 합헌 결정을 내린 바 있다(헌법재판소 2018. 4. 26. 선고 2015헌가13 결정, 이하 '이 사건 결정'이라 한다). 이 사건 결정에서는 법률유보원칙 및 포괄위임입법금지원칙에 의하여만 판단하였으나, 본고에서는 실질적인 판단도 가미하였다. 이 사건 분담금운 과잉금지원칙에 비추어 보더라도 보건의료기관개설자들의 재산권을 침해하지 않는 점을 논증하였다. 불가항력 의료보상제도의 분담금 부과가 민사책임의 중요 원칙인 과실책임원칙에 거스르는 측면이 존재한다. 그러나 의료사고보상사업은 의료사고 피해자를 위한 국가정책으로 합리성이 있으며, 동시에 의료분쟁의 조기종결 효과로 의료계 역시 이익을 얻는 측면이 분명 존재한다. 분담금의 납부를 통한 보상재원의 확충은 이러한 의료사고보상제도를 빠르게 정착시킴으로서 분만과정에서 발생한 의료사고 피해자의 고통과 오해를 경감시키고 의료인의 안정적 진료환경 구축에 큰 도움이 될 것이다.

성인의 고혈압, 당뇨병, 이상지질혈증으로 인한 총 진료비 중 과체중 및 비만의 기여분 : 국민건강영양조사자료와 국민건강보험공단 자료를 중심으로 (Medical Expenditure Attributable to Overweight and Obesity in Adults with Hypertension, Diabetes and Dyslipidemia : Evidence from Korea National Health and Nutrition Examination Survey Data and Korea National Health Corporation Data)

  • 강재헌;정백근;조영규;송혜령;김경아
    • 농촌의학ㆍ지역보건
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    • 제35권1호
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    • pp.77-88
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    • 2010
  • 이 연구는 고혈압, 당뇨병, 이상지질혈증으로 지출된 진료비 중 과체중 및 비만의 기여분을 추계하기 위한 질병비용연구로서 국민건강보험공단의 건강검진 및 건강보험급여 자료를 활용한 연구이다. 연구결과 2005년 현재 고혈압, 당뇨병, 이상지질혈증 때문에 지출된 총 진료비 중 과체중 및 비만의 기여분은 각각 4,561억원(4,328억원-4,805억원), 2,823억원(2,487억원-3,176억원), 165억원(147억원-183억원)이었고, 이를 모두 합하면 7,549억원(6,961억원-8,164억원)이었다. 이는 해당 연도의 고혈압 총 진료비의 34.6%(32.9%-36.5%), 당뇨병 총 진료비의 32.5%(28.6%-36.6%), 이상지질혈증 총 진료비의 19.4%(17.3%-21.6%)를 차지한다. 또한 이 세 가지 질병의 총 진료비를 기준으로 했을 때 과체중 및 비만이 기여한 금액은 33.3%(30.7%-36.0%)에 해당하였다. 이는 과체중과 비만을 예방한다면 고혈압, 당뇨병, 이상지질혈증으로 지출되는 총 진료비의 33.3%를 감소시킬 수 있다는 의미이며, 향후 만성질환 예방과 관련하여 과체중 및 비만의 예방관리사업이 얼마나 중요한가를 시사해 주는 것이다.

중증도 분류에 따른 진료비 차이: 간질환을 중심으로 (Differences of Medical Costs by Classifications of Severity in Patients of Liver Diseases)

  • 신동교;이천균;이상규;강중구;선영규;박은철
    • 보건행정학회지
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    • 제23권1호
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    • pp.35-43
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    • 2013
  • Background: Diagnosis procedure combination (DPC) has recently been introduced in Korea as a demonstration project and it has aimed the improvement of accuracy in bundled payment instead of Diagnosis related group (DRG). The purpose of this study is to investigate that the model of end-stage liver disease (MELD) score as the severity classification of liver diseases is adequate for improving reimbursement of DPC. Methods: The subjects of this study were 329 patients of liver disease (Korean DRG ver. 3.2 H603) who had discharged from National Health Insurance Corporation Ilsan Hospital which is target hospital of DPC demonstration project, between January 1, 2007 and July 31, 2010. We tested the cost differences by severity classifications which were DRG severity classification and clinical severity classification-MELD score. We used a multiple regression model to find the impacts of severity on total medical cost controlling for demographic factor and characteristics of medical services. The within group homogeneity of cost were measured by calculating the coefficient of variation and extremal quotient. Results: This study investigates the relationship between medical costs and other variables especially severity classifications of liver disease. Length of stay has strong effect on medical costs and other characteristics of patients or episode also effect on medical costs. MELD score for severity classification explained the variation of costs more than DRG severity classification. Conclusion: The accuracy of DRG based payment might be improved by using various clinical data collected by clinical situations but it should have objectivity with considering availability. Adequate compensation for severity should be considered mainly in DRG based payment. Disease specific severity classification would be an alternative like MELD score for liver diseases.

건강보험 청구자료를 이용한 우리나라 뇌졸증 환자의 사회경제적 비용 추계 (Socioeconomic Costs of Stroke in Korea: Estimated from the Korea National Health Insurance Claims Database)

  • 임승지;김한중;남정모;장후선;장영화;김세라;강혜영
    • Journal of Preventive Medicine and Public Health
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    • 제42권4호
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    • pp.251-260
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    • 2009
  • Objectives : To estimate the annual socioeconomic costs of stroke in Korea in 2005 from a societal perspective. Methods : We identified those 20 years or older who had at least one national health insurance (NHI) claims record with a primary or a secondary diagnosis of stroke (ICD-10 codes: I60-I69, G45) in 2005. Direct medical costs of the stroke were measured from the NHI claims records. Direct non-medical costs were estimated as transportation costs incurred when visiting the hospitals. Indirect costs were defined as patients and caregivers productivity loss associated with office visits or hospitalization. Also, the costs of productivity loss due to premature death from stroke were calculated. Results : A total of 882,143 stroke patients were identified with prevalence for treatment of stroke at 2.44%. The total cost for the treatment of stroke in the nation was estimated to be 3,737 billion Korean won (KRW) which included direct costs at 1,130 billion KRW and indirect costs at 2,606 billion KRW. The per-capita cost of stroke was 3 million KRW for men and 2 million KRW for women. The total national spending for hemorrhagic and ischemic stroke was 1,323 billion KRW and 1,553 billion KRW, respectively, which together consisted of 77.0% of the total cost for stroke. Costs per patient for hemorrhagic and ischemic stroke were estimated at 6 million KRW and 2 million KRW, respectively. Conclusions : Stroke is a leading public health problem in Korea in terms of the economic burden. The indirect costs were identified as the largest component of the overall cost.

아동실종으로 인한 사회경제적 비용 분석 (Analysis of Socioeconomic Costs of Child Missing)

  • 정익중;김성천;송재석
    • 한국사회복지학
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    • 제61권2호
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    • pp.371-389
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    • 2009
  • 실종아동문제는 한 가정의 문제로 끝나는 것이 아니라 사회문제로 발전할 수 있다는 데에 그 심각성이 있다. 하지만 실종아동문제에 대한 사회적 관심은 초보적인 수준에 머무르고 있다. 본 연구의 목적은 실종아동문제에 대한 사회적 관심을 불러일으키기 위해 아동실종의 사회경제적 비용을 추계하는 것이다. 전체적으로 1명의 장기실종아동이 발생하였을 경우, 약 5억 7천만원 정도의 비용이 발생하였다. 직접비용은 약 6,532만원으로 전체의 11.5%였으며 간접비용은 약 5억원으로 전체의 88.5%였다. 이는 실종을 예방하는 것이 가장 중요하지만, 실종 이후에는 단기간 내 찾기가 매우 중요함을 보여주고 있다. 본 연구결과를 통해 실종으로 인한 사회경제적 비용이 계산되어 실종에 대한 국민의 관심을 유발할 수 있고 예방에 대한 적정 투자비용에 관하여 자료를 추산할 수 있으며, 결과적으로 실종 예방에 대한 적극적인 국가적 투자를 유인할 수 있을 것이다.

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의료보험수가 조정을 위한 복합지표 개발에 관한 연구 (The Development of the Composite Index as a method of rate adjustment)

  • 김한중;조우현;이해종
    • 보건행정학회지
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    • 제3권1호
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    • pp.84-101
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    • 1993
  • The current method of rate adjustment is based on the evaluation of the financial performance of hospitals. The method has the disadvantages such as too complicated, expensive process as well as low reliability due to small sample size. This study, therefore, develops a new model for the rate adjustment with the use of the composite index. In addition to that, it examines the validity of the model by comparing the result of the new method with that of the conventional method. The idea of the new model comes from the Medicare Economic Index(MEI) on which physician fees for the Medicare patients are adjusted periodically in the United States. Medical costs are classified into three groups : labor costs, materials and other expenses. Labor costs are subdivided into physicians and other personnels. Materials are subdivided into drugs and others. Other expenses are subdivided into 5 items. Macro economic indices are selected for each cost item in order to reflect the cost inflation during the specific period. Then the composite index which integrate all items according to the ration of each item in the total costs is calculated. The result from the application of empirical data to the new model is very similar to that of the current method. Furthermore, this method is very simple and also to easy to get social concensus. This model can be replaced the current method based on the analysis of the financial performance for the adjustment of medical fees.

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모유수유의 경제적 효과 (The Economic Benefits of Breastfeeding)

  • 현태선;김기남;강남미;임은영
    • 대한지역사회영양학회지
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    • 제7권6호
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    • pp.863-871
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    • 2002
  • To compare the costs incurred by infant feeding between mothers who breastfed their infants and those who fed them infant formula, a questionnaire survey was carried out to 136 mothers living in Seoul, Cheongju and Chungju who breastfed and 199 mothers who formula-fed their infants. The cost of formula-feeding was estimated based on the expenditures for formula and feeding apparatus, and the time needed to wash bottles and prepare formula. The cost of breastfeeding was estimated based on the expenditures for food for the additional nutritional intake of these mothers. The mean cost of formula-feeding was ₩ 1,870,125 during the first year of the baby's life. The food cost for the additional nutritional intake of the breastfeeding mothers was ₩ 203.004 per year. The extra medical cost for respiratory illnesses in the formula-fed group compared to the breastfed group was W 62,920 because the formula-fed infants required medical attention for respiratory illnesses more often than the breast-fed infants. Therefore, breastfeeding could save ₩ 1,730,041 during the first year of an infant's life. We may have underestimated the cost savings from breastfeeding because we did not take into account the potentially decreased costs of fertility control and the health benefits for mothers. as well as the decreased usage of water and gas. Analyses showed that breastfeeding is not only nutritionally advantageous, but also economically advantageous for families and society.