• Korean Journal of Clinical Pharmacy
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• v.13 no.2
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• pp.82-90
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• 2003

Dopamine is an effective pressor for the treatment of shock and hypotension when patients do not respond to plasma volume expansion. Two dopamine intravenous delivery systems are currently available in Korea. The objective of this study was to compare dopamine premixed with prefilled system in terms of supply costs (preparation costs + personnel time), contamination rates and convenience. Time-and-motion studies were conducted to determine the time and costs associated with preparation and administration of the two systems. They were analyzed and compared by Mann-Whitney test. To evaluate the contaminaton rates of the two systems, both systems were prepared in an open environment similar to that of practical situations. Premixed and compounded solutions were then filtered by $0.22{\mu}m$ membrane filters, which were cultured at $37^{\circ}C$ for 10 days and their contents were visually checked for bacterial contamination. The convenience of the two systems was compared by itemized user assessments on preparation, dose calculation, admixture, administration and disposal of waste matters. They were analyzed by Wilcoxon's signed rank test and 100 part percentage. It was found that the preparation costs $(mean{\pm}SD)$ for premixed and prefilled systems were $271.70\pm293.55\;Won$ (Korean currency) and $1521.04\pm510.63\;Won$, respectively. The preparation time $(mean{\pm}SD)$ for premixed system was $68.10\pm35.69\;sec.$ while at for prefilled system was $154.03\pm50.06\;sec.$ (n=59 each, p<0.001). No bacterium was observed in the samples of both systems (n=20, each). User assessments indicated that the premixed system was more convenient than the prefilled system except for the item of dose calculation (n=24, p<0.001). Subjective evaluations have proven that the use of the dopamine premixed system resulted in increased efficiency of intravenous preparation by allowing personnel to devote more time to other labor-intensive duties and lower total medical costs.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.10
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• pp.4729-4733
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• 2016

Objectives: Lung cancer is a major public health problem and one of the most costly illnesses. The study aimed to estimate the economic burden of lung cancer in Iran in 2014. Methods: A cross-sectional study was conducted to estimate the direct and indirect costs for patients with lung cancer using a prevalence-based approach. A human capital approach was employed to estimate the indirect costs. Data were obtained from several sources such as through patient interview using structured questionnaire, medical records, the GLOBOCAN databases, the Iranian Statistical Center, the Iranian Ministry of Cooperation, Labor and Social Welfare, and the Institute for Health Metrics and Evaluation (IHME). Results: The economic burden of lung cancer in Iran in the year 2014 was 3,225,998,555,090 IR. The main components of the cost were associated with mortality (81.9 %) and hospitalization (7.6 %). The costs of direct medical care, non-medical aspects, patient time, and mortality accounted for 10.8%, 2.7%, 4.5%, and 81.5% of the total cost, respectively. Conclusion: Findings from this study indicated that the economic burden of lung cancer is substantial both to Iran's health system and to society as a whole. Early diagnosis, strengthening cancer prevention, implementing new cancer therapy and medical technology, and effective smoking-cessation interventions could offset some of the costs associated with lung cancer in Iran.

• Health Policy and Management
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• v.32 no.2
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• pp.154-163
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• 2022

Background: The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit. Methods: We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. Results: In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated. Conclusion: High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.

• Korea Journal of Hospital Management
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• v.8 no.4
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• pp.149-181
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• 2003

It has been asserted that per diem payment system should be introduced, in place of the current fee-for-service system, for payment of the inpatient services of the geriatric hospitals, Based on the assentation, this study aims at calculating costs and profits per inpatient-day of the geriatric hospitals, and thereby at contributing to the managerial improvement from the both sides of the Government and the hospitals. Relevant data of the three months, May to August, 2002 were collected from the five geriatric hospitals, and per inpatient-day costs and profits were calculated for the three disease groups. Major results and conclusions are as follow : Firstly, total costs per insured inpatient-day of the geriatric hospitals are 65, 389 won for dementia (including optimal profit of 3,858 won), 69,730 won for stroke (including optimal profit of 4,117 won), and 70,085 won for other diseases (including optimal profit of 4,134 won). Secondly, the amount of the non-insured costs per inpatient-day occupies 34.5% of the total costs for dementia, 30.3% for stroke, and 30.1% for other diseases. Thirdly, the total amount of the per inpatient-day costs calculated including the optimal profits is, on the average, higher by 12% than the present price level calculated for the current fee-far-service system. This implies that the present price level should rise by 12% when the current fee-far-service payment system be maintained, and Finally, introduction of a sliding-scale payment system should be considered for the inpatient medical management fees for the length of stay over six months or more that are being cut in the claim examination process by the insurance corporation.

• Clinical and Experimental Pediatrics
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• v.51 no.9
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• pp.977-986
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• 2008

Purpose : This study aims to estimate the financial cost of rotavirus infection in Korea in the year of 2005. Methods : The incidence rates used were from the epidemiological profile at Jeoungeub District (5.8 cases/1,000 children <5 years old for inpatients, and 22.65 cases/1,000 children <5 years old for outpatients, per year). The health care cost per capita of rotavirus infection (ICD code: A08.0) was extracted from the Health Insurance Review and Assessment Service database in Korea. The patient survey was conducted to capture information about non-medical costs and associated productivity loss incurred by adult caregivers. Results : The number of annual national cases among children <5 years old with rotavirus infection was estimated to be 69,122 (i.e., 55,030 outpatients and 14,092 inpatients). The total cost of rotavirus infection was estimated at 13.3 billion Korean won, comprising 11 billion Korean won (82.7%) of direct medical costs, 1.6 billion Korean won (12.0%) of direct non-medical costs (e.g., transportation and supplies), and 0.68 billion Korean won (5.1%) of productivity lost by adult caregivers. Conclusion : Rotavirus infection carries not only medical costs but also non-medical and indirect costs; together, these costs incur a significant burden on South Korean society. The impact of rotavirus on quality of life and health among patient caregivers was not considered in this study, but it does merit further research.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.3
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• pp.1295-1301
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• 2015

Background: Cancer imposes a significant economic burden on individuals, families and society. The purpose of this study was to estimate the economic burden of cancer using the healthcare claims and cancer registry data in Korea in 2009. Materials and Methods: The economic burden of cancer was estimated using the prevalence data where patients were identified in the Korean Central Cancer Registry. We estimated the medical, non-medical, morbidity and mortality cost due to lost productivity. Medical costs were calculated using the healthcare claims data obtained from the Korean National Health Insurance (KNHI) Corporation. Non-medical costs included the cost of transportation to visit health providers, costs associated with caregiving for cancer patients, and costs for complementary and alternative medicine (CAM). Data acquired from the Korean National Statistics Office and Ministry of Labor were used to calculate the life expectancy at the time of death, age- and gender-specific wages on average, adjusted for unemployment and labor force participation rate. Sensitivity analysis was performed to derive the current value of foregone future earnings due to premature death, discounted at 3% and 5%. Results: In 2009, estimated total economic cost of cancer amounted to $17.3 billion at a 3% discount rate. Medical care accounted for 28.3% of total costs, followed by non-medical (17.2%), morbidity (24.2%) and mortality (30.3%) costs. Conclusions: Given that the direct medical cost sharply increased over the last decade, we must strive to construct a sustainable health care system that provides better care while lowering the cost. In addition, a comprehensive cancer survivorship policy aimed at lower caregiving cost and higher rate of return to work has become more important than previously considered.

• Health Policy and Management
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• v.17 no.3
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• pp.1-25
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• 2007

Relative value scales introduced in 2001 remarkably improved health insurance fee schedule, but current relative value scales have many problems. In the beginning the government intended to introduce 'resource based relative value scales(RBRVSs)' like USA, but political adjustment of RBRVS studied in 19.17 weakened the relationship between relative value scale and resource consumption. So unbalance of health insurance fees are existing till now. Also relative value was not divided to physician work and practice expense, and malpractice fee was not divided separately. To correct the unbalance of current relative value scales, the refinement project of health insurance relative value scales started in 2003. The project team divided relative value scales into three components, which are physician work, practice expense, malpractice fee. Physician work was studied by professional organizations like Korean medical association. To develop the practice expense relative value, project team organized clinical practice expert panels(CPEPs) composed of physicians, nurses, and medical technicians. CPEPs constructed direct expense data like labor costs, material costs, equipment costs about each medical procedures. The practice expense relative values of medical procedures were developed by the allocation of the institution level direct & indirect costs according to CPEPs direct costs. Institution level direct & indirect costs were collected in 21 hospitals, 98 medical clinics, 53 dental clinics, 78 oriental clinics, and 46 pharmacies. The malpractice fee relative values were developed through the survey of malpractice related costs of hospitals, clinics, pharmacies. Putting together three components of relative values in one scale, the final relative values were made. The final relative values were calculated under budget neutrality by medical departments, that is, total relative value score of a department was same before and after the revision. but malpractice fee relative value scores were added to total scores of relative values. So total score of a department was increased by the malpractice fee relative value score of that department This project failed in making 'resource based' relative value scales in the true sense of the word, because the total relative value scores of medical departments were fixed. However the project team constructed the objective basis of relative value scale like physician's work, direct practice expense, malpractice fee. So step by step making process of the basis, the fixation of total scores by the departments will be resolved and the resource based relative value scale will be introduced in true sense.

• Journal of Society of Preventive Korean Medicine
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• v.18 no.1
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• pp.43-52
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• 2014

This study was conducted to analyze if there is a difference between the head hospital and branch hospital by comparing the profitability and operating expenses to patient revenue of oriental medicine hospitals affiliated with universities in order to find whether opening branch hospitals is an appropriate method to increase profitability. Profit indices used for the comparison of head hospital and branch hospital include ratio of operating profit on medical revenue, net-income on medical revenue, net profit to total assets, and operating profit to total assets; and cost indices included ratio of labor costs, material costs and administrative costs. In comparison of profit indices of head hospitals and branch hospitals, head hospitals displayed negative(-) in all four profit index averages while branch hospitals displayed positive(+), showing that branch hospitals have higher profitability. In particular, in the case of head hospitals, ratio of net profit to total assets was -13.6%, while that of branch hospitals was 12.9%, which was higher than 3.1%, the average of Korean oriental medicine hospitals in 2011. As a result of difference analysis between groups of head hospitals and branch hospitals, profit indices of ratio of operating profit on medical revenue, net-income on medical revenue, and ratio of net profit to total assets were found to vary by hospitals, but there was no statistically significant difference between head hospitals and branch hospitals(p<0.1). Only the ratio of operating profit to total assets of head hospitals and branch hospitals indicated significant difference between the two groups, showing that ratio of operating profit to total assets of branch hospitals is larger than that of head hospitals. Meanwhile, the cost indices of ratio of labor costs, material costs and administrative costs in the difference test results did not show significant difference between the head hospital and branch hospital(p<0.1). Thus, it cannot be said that a certain oriental medicine hospital's profitability is high or low depending on whether it is head hospital or a branch as profitability varies depending on the management environment of the hospital. Therefore, oriental medicine hospitals affiliated with universities would need to make efforts to increase their profitability as an individual hospital rather than focusing on whether they are head hospital or a branch.

• 대한예방의학회:학술대회논문집
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• 1994.02b
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• pp.84-86
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• 1994

AS A SOCIETY, we are in conflict with ourselves about the cost of health care. 1 On one hand, we want the best care possible, regardless of cost. On the other hand, we are not willing to pay the cost of the care we want. Our conflict parallels a flaw in the medical marketplace. An essential condition for achieving an equilibrium between cost and value is that the two must be connected through decisions. When people decide what products and services (goods) they want, they must not only see the value they will receive, but they mast also be responsible for the costs. Because of a variety of features of the medical marketplace-most notably third-party coverage, third-party advice, and uncertainty about outcomes-the required connection between value and cost is severed. The result is what we see. One side of our collective mind demands more services while the other side cries that costs are too high. Resolving our conflict will require connecting value to cost. An essential step in accomplishing this will be to incorporate costs in practice policies. 1 As controversial as that thought might seem (the great majority of practice policies currently do not take costs into account except in the most rudimentary way), arriving at the conclusion is the easy part. A more difficult issue is how to implement the goal of connecting value to cost. Suppose we agree that, in principle, costs should be considered when practice policies are designed, and that an activity should be recommended and covered only if its health outcomes (benefits minus hanns) are deemed to be worth its costs. The next questions are, Who should do the deeming? What should the deemers be asked?

• Korea Journal of Hospital Management
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• v.15 no.2
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• pp.15-26
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• 2010

Stroke is a high-risk disease. The future of the medical environment is that the proportion of elderly population is increasing, the average life expectancy is being increased, while the fatal rate of stroke will be low. These situation will due to the financial burden on medical insurance. The most important factor that affects on the medical costs of stroke patients is the length of stay. In this study the mean length of hospital for stroke stay was 21.81days(37.97days for intracerebral hemorrhage, 18.89 days for cerebral infarction). The payment per case of stroke was 6.86 million won(12.6 million won for intracerebral hemorrhage, 5.72 million won for cerebral infarction). The payment per case of intracerebral hemorrhage was 2.2 times more than that of cerebral infarction. The payment in the day of hospitalization was the highest and until the second day medical costs was high. After the third day medical costs tended to decline, after that seemed to show an almost constant level. The length of hospital stay was found to be the most important determinant of inpatient charges for stroke. Accordingly rational management of the length of stay will be beneficial to health care consumers, providers, states.