• 약학회지
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• 제57권5호
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• pp.369-375
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• 2013

Objective: Using the Korean Health Panel data (KHP) of 2008 and 2009, this paper analyzed the effect of antihypertension medication adherence on the changes in medical service utilization and medical expenditure in the next year. Method: Through a face-to-face interview survey, KHP has provided an extensive data on demographic characteristics, medical utilizations behavior, medical expenditure and health behaviors of the targeted households and their members since 2008. KHP is recognized as highly accurate regarding medical expenditure in that it makes the target households to record 'Health diary' whenever they use healthcare service, which could minimize their cognitive bias or memory distortion. The 2010 KHP data was based on the interview from 6,432 households and 19,697 household members. Two part model was used to explore the effects of medication adherence on medical use (logistic regression analysis) and medical expenditures (OLS). Result: Our study result demonstrated that the 74.7% of the patients who strictly adhere to their medication in both years, in 2008 and in 2009, were likely to use inpatient service in 2010. This shows the noncompliant patients were in fact use emergency service less than the compliant patients. Conclusion: Based on our analysis, this paper concludes that the high medication adherence of hypertensive patients could contribute to reduce the emergency service use. Therefore it is highly recommendable for the Korean government and the insurer, NHIS, to actively invest in developing education and promotion program to improve medication adherence among hypertensive patients.

• 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.

• Tuberculosis and Respiratory Diseases
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• 제81권3호
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• pp.241-246
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• 2018

Background: The "Tuberculosis Relief Belt Supporting Project (Tuberculosis Patient Management Project for Poverty Groups)" is a national program for socioeconomically vulnerable tuberculosis (TB) patients. We sought to evaluate the clinical and socioeconomic characteristics of poverty-stricken TB patients, and determined the need for relief. Methods: We examined in-patients with TB, who were supported by this project at the National Medical Center from 2014 to 2015. We retrospectively investigated the patients' socioeconomic status, clinical characteristics, and project expenditures. Results: Fifty-eight patients were enrolled. Among 55 patients with known income status, 24 (43.6%) had no income. Most patients (80%) lived alone. A total of 48 patients (82.8%) had more than one underlying disease. More than half of the enrolled patients (30 patients, 51.7%) had smear-positive TB. Cavitary disease was found in 38 patients (65.5%). Among the 38 patients with known resistance status, 19 (50%) had drug-resistant TB. In terms of disease severity, 96.6% of the cases had moderate-to-severe disease. A total of 14 patients (26.4%) died during treatment. Nursing expenses were supported for 12 patients (20.7%), with patient transportation costs reimbursed for 35 patients (60%). In terms of treatment expenses for 31 people (53.4%), 93.5% of them were supported by uninsured benefits. Conclusion: Underlying disease, infectivity, drug resistance, severity, and death occurred frequently in socioeconomically vulnerable patients with TB. Many uninsured treatment costs were not supported by the current government TB programs, and the "Tuberculosis Relief Belt Supporting Project" compensated for these limitations.

• 한국임상약학회지
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• 제10권1호
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• pp.30-37
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• 2000

Adverse drug reactions (ADR) may result in increased hospital admissions, morbidity and mortality, adding extra cost to healthcare expenditures. Thus, it is critical to activate ADR monitoring and reporting program in tertiary hospitals in developing countries such as Korea. This study was performed to identify the types of ADR being reported in a tertiary hospital, Samsung Medical Center, and to find out the ways to improve current ADR monitoring system. Of 464 ADR reports submitted to the pharmacy department during the 6-month survey period, $97.8\%$ of the reports were from out patient and $48.5\%$ were from patients aged between 50 and 60. The medical department with the highest frequency in ADR reporting was Internal Medicines $(35.6\%)$. The most common ADR manifestations were gastrointestinal complaints $(43.4\%)\;and\;75\%$ of the reported cases were mild in their severity. The most common drugs suspected of causing ADR were CNS drugs which accounted for $32.8\%$. In terms of causality assessment, $85.1\%$ of the reports were probable cases by WHO causality assessment criteria. In regards to sources of report, $75.6\%$ of ADR were reported by physicians and $24.4\%$ by nurses. There were no ADR reported by pharmacists. In conclusion, there is an urgent need to improve ADR monitoring system for inpatient and to motivate pharmacist involvement in ADR monitoring and reporting in Korea.

• 보건행정학회지
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• 제29권2호
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• pp.160-171
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• 2019

Background: This study purposed to compare the difference on medical utilization and health expenditure of baby boomer generation by depression between gender. Methods: Korea Welfare Panel Survey 2016, provided by the Korea Institute for Health and Social Affairs, was used for the analysis. For the research, we used the two-part model, yes or no of use (part 1), and frequency of use (part 2) for medical utilization. The dependent variables are the whether or not to use of hospitalization services, outpatient services, length of stay, outpatient service visits, and health expenditure. And the independent variables are used as the predisposing (education, spouse presence), enabling (insurance type, private insurance, economic activity, income), and need (chronic disease, self-rated health, disability) factors in the Andersen behavior model. Depression was used as intervening variables. Structural equation model and multiple group analysis by gender were used. Results: There were differences in the medical care usage and cost between men and women in baby boomer. For men, mediating effects of depression were present at the hospitalization (yes/no), length of stay, and health expenditure. On the other hand, for women, the mediating effect of depression was found only at the outpatient visits. Specially, depression was working at the medical services by the different way between gender. The size of effect (multiple group analysis) was affected by significant differences between men and women. Conclusion: This study found that the mediating effect of depression is increased medical usage and health expenditure and the effect factors are different by gender. Therefore, it is necessary to establish a medical care policy considering the socio-economic characteristics of baby boomers.

• 보건행정학회지
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• 제30권4호
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• pp.451-459
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• 2020

Background: Although Korean government have been adopting several policies to expand coverage of National Health Insurance (NHI) program, the coverage rate is still below average across Organization for Economic Cooperation and Development countries. This study was to identify public perception on appropriateness of coinsurance rate and factors associated with coinsurance rate in National Health Insurance. Methods: For this cross-sectional study, 507 participants over aged 20 years were recruited from telephone surveys. Respondents experienced at least one and more visiting medical facilities due to medical problems in last 12 months. Demographic factors, socioeconomic positions, and experiences on medical utilization were measured in order to identify factors associated with perception appropriateness of coinsurance rate. Results: The 49.9% (n=209) of the public responded that the coinsurance rate of NHI program was appropriate. There were no differences in positive perception according to socio-demographic factors and experiences on medical utilization except for gender, residential area, and felt expensive when using medical services. People who felt burden of medical expenditure were more likely to perceive coinsurance rate inappropriate (odds ratio, 2.33; 95% confidence interval, 1.52-3.58) Conclusion: In spite of the relatively low coverage rate of NHI, this study identified that 49.9% of the public perceived the current coinsurance rate was adequate. However, people who felt the burden of medical expenditure were still had a negative perception of the coinsurance rate needed to decrease the coinsurance rate.

• 농촌의학ㆍ지역보건
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• 제33권2호
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• pp.181-192
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• 2008

Objective: The use of complementary and alternative medicine (CAM) is common especially among patients with osteoarthritis The aim of this study was to investigate the utilization rate and expenditures of patients who use CAM. Method: Two hundred seventy four patients with osteoarthritis were interviewed by a telephone survey. A structured questionnaire about sociodemographic features and type, cost, satisfaction and reason of CAM utilization was used Results: Among 274 patients with osteoarthritis, 251 patients(91.6%) had used at least one type of CAM during six months. There was a significant difference in sex (female), age (70 years), medical security (insurance), educational level between the user and non-user of CAM. Hyperthermia was the most use. The average cost for CAM utilization was 120 thousands won/person during six months and there was no difference in sociodemographic features among the out-of-pocket cost of users. The scores of satisfaction for CAM use were ranged between 60-70. Conclusions: CAM became a popular source of health care because of elderly and lay referral system. And Korean spent a substantial amount of out-of-pocket money on CAM without benefit. Health care system and professionals should pay more attention to CAM, make a evidence for CAM.

• 응용통계연구
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• 제31권2호
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• pp.303-313
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• 2018

본 논문에서는 약품비 지출에 대한 예측을 수행하기 위하여 시계열 모형을 도입한다. 2012년 약가 일괄인하를 반영하기 위하여 구간별 모형을 토대로, 자기회귀오차모형과 전이함수모형을 고려하였다. 자기회귀오차모형에서는 예측의 편리성을 위하여 결정적 추세만을 고려하였으며, 전이함수모형에서는 주요한 외생변수와의 교차상관성을 이용하여 약품비 지출의 인과 메커니즘을 설명하였다. 각 모형에서 약가 일괄인하 이후 수준 변화가 유의하게 나타났으며, 전이함수모형에서는 의약품 사용자 수 및 노인환자 비중 시계열 변수가 유의하게 나타났다. 자기회귀오차모형은 약가 일괄인하로 의한 약품비 수준이동에 좌우되어 비교적 낮은 예측값이 도출되었으며, 전이함수모형은 약품비 지출에 영향을 미치는 외부 설명변수의 증가 추세가 적절히 반영되어 더 높은 예측값을 보였다. 설명변수를 포함하지 않을 경우, 약품비 수준이동만을 고려한 ARIMA 모형은 약품비 지출 추세를 가장 높이 예측하였다.

• Journal of Preventive Medicine and Public Health
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• 제40권4호
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• pp.329-335
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• 2007

Objectives : To identify the effects of supplemental private health insurance on health care utilization and expenditure under the mandatory National Health Insurance(NHI) system in Korea. Methods : The data were collected by the National Cancer Center in Korea. Cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer were included as study subjects. Data were gathered using a structured questionnaire from face-to-face interviews, the hospital Order Communication System (OCS) and medical records. Clinical, socio-demographic and private health insurance related factors were also gathered. The differences of health care utilization and expenditure were compared between those who have private health insurance and those who do not using t-test and multivariable regression analysis. Results : Individuals with private health insurance spent larger inpatient costs than those without, but no differences were found in utilization in other service such as hospital admissions, hospital days and physician visits. Conclusions : We found that private health insurance exerts a significant effect on the health care expenditure in inpatient service. These study results can provide a rational basis to plan a national health policy regarding private health insurance. Further studies are needed to investigate the impacts of private health insurance on cancer patients' outcomes and survival rates.

• 대한예방의학회:학술대회논문집
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• 대한예방의학회 1999년도 제51차 추계 학술대회 연제집
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• pp.167-168
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• 1999