• 보건행정학회지
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• 제6권2호
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• pp.115-130
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• 1996

This study was performed to investigate the practical oriental medical expenses by the use of internal data of an oriental hospital due to the bias of medical insurance program data. The purpose of this study was to describe prevalent diseases of clinical department in the studied hospital, to analyze medical expenses structure and to verify the each cost share ration of expenses on insurer to insuree. Under this purpose, we analyzed actual medical expenses data of 1,611 hospitalized patients of the oriental medical university hospital with 150 beds that can be approached to internal data from Jan. 1, 1994 to Dec. 31, 1994. The major findings are as follows : 1. Upper five of most frequent diseases of admitted patients were Joul-Jung-Pung(55.5%), Yoo-Kak-Tong(7.3%), Yoo-/Tong(7.1%), Gu-An-Wa-Sa(2.7%) and sequale of Joul- Jung-Pung(2.4%) 2. In medical expenses structure, hospital ward fee was 47.1%, medication fee 41.3%, fee for procedure(acupuncture, moxibustion, negative therapy, physical therapy, etc) 11.1% and consultation fee 0.5%. In addition to the cost share ration of insuree & that of insurer was 75:25 respectly.

• 의료법학
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• 제8권1호
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• pp.137-177
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• 2007

The medical expenses review system in Korea has developed under fee-for-service system with its own unique structure. The importance of reviewing medical expenses has been emphasized, as the size of medical expenditures moving through the health insurance legal context and its weight in the national economy have increased very rapidly. It is, however, analyzed that the feuds and arguments continue among the stakeholders for the lack of laws supporting the medical expenses review system. The medical expenses review is a series of administrative procedures, deciding whether claims from medical care institutions to the insurer are legal and valid or not. It mainly controls the increase of unnecessarily excessive health insurance claim and prevents fraudulent claim and abuse and checks the less use or unsuitable use of medical resources. It also works a function guarantees medical benefits for the appropriate treatment according to the object of health insurance system as a social insurance scheme. The dispute on legal base of the medical expenses review is about the source of law in the medical expenses review. There are the Health Insurance Act and administrative laws as jus scriptum and the guidelines of review as administrative orders. The medical expenses review should reflect various factors, such as the development of medical healthcare technologies, the health expenditures distribution, the financial situation of the health insurance, and the evaluation on the level of appropriate benefits. It is also likely to adapt to the traits of characters of medicine, and trends and transition, Besides it should judge the legality and the validity of medical benefits expenditures by synthesizing these all factors. And the evaluation system of appropriateness of medical benefits was administrative procedure which was consecutive with reviewing the medical expenses system and it was intended to make up for the result of reviewing the medical expenses in more comprehensive levels.

• 농촌의학ㆍ지역보건
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• 제44권4호
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• pp.195-208
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• 2019

의료급여수급권자는 낮은 본인부담으로 인해 공급자에 의한 유발의료수요가 발생하거나 수급권자의 도덕적 해이가 발생하여, 의료서비스 남용으로 인한 의료급여 재정의 건전성을 저해한다는 지적을 받고 있다. 이 연구는 관상동맥중재술과 같은 질병부담이 높은 의료서비스 이용에 있어서 우리나라의 대표적인 의료보장형태인 건강보험환자와 의료급여환자의 진료비 발생 구조를 분석하여 진료비 관리의 정책적 방향을 제시하고자 수행되었다. 관상동맥중재술 시행을 받은 환자에서 의료보장형태에 따라 의료서비스 이용 양상 및 진료비 구조에 차이가 있었다. 의료급여군이 건강보험군에 비해 재원일수가 길고, 응급실을 경유하여 입원한 환자의 비율이 높았으며, 비급여진료비, 선택진료비, 일당 비급여진료비가 적게 발생하였고, 재원일수와 관련 있는 진찰료 및 입원료, 식대, 투약 및 주사료 항목에서는 총 진료비가 많이 발생하였다. 따라서, 국가차원의 효율적인 진료비 관리를 위해서 취약계층에 대한 예방과 교육서비스를 제공하여 사전적 진료비관리가 이루어져야 하며, 의료급여 환자의 재원일수 증가에 따른 급여진료비 발생을 관리하는 전략이 필요할 것으로 보인다. 또한, 비급여 진료비에 있어서 의료급여환자의 미충족 의료서비스가 발생하지 않도록 의료비 지원방안도 마련되어야 한다.

• International Journal of Advanced Culture Technology
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• 제9권1호
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• pp.16-21
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• 2021

As the average age of national veterans has increased from 69 years old(2011) to 71 years old(since 2015) over the past five years, the overall medical service cost of veterans has increased by about 20%. The main cause of this phenomenon is 'ultra-aging', which accounts for 67% of veterans, while the proportion of health insurance patients aged 70 or older is 9%. Therefore, it is judged that the analysis of the trend of use of medical services at veterans hospitals in each region that is in charge of severe medical services of national veterans can serve as an opportunity to seek countermeasures for the severe medical system of national veterans. First of all, based on the details of major medical expenses (hospitalization, outpatient, pharmaceutical expenses) by region for the last 10 years(2010-2019), data significance was performed through a chi-square test, and the Central Veterans Hospital and Non-Central Veterans Hospital using EXCEL. 'Expected frequency' was calculated by year. By applying the CHITEST(observation frequency, expected frequency) function again, the p-value(p<0.05) was calculated, and the profit bias of each region's veterans hospital could be determined. The specific research method is for the last 10 years(2010-2019) for state-sponsored patients_outpatient treatment income, state-sponsored patients_hospitalization income, exempt patients_outpatients at the Central Veterans Hospital, Busan Veterans Hospital, Gwangju Veterans Hospital, Daegu Veterans Hospital, and Daejeon Veterans Hospital. A one-way analysis of variance was conducted to verify the significance of the difference between group averages on the status of 5 medical revenues of veterans hospitals in each of the 5 regions, including medical treatment income, reduced patients_hospitalization income, and reduced patients_medicine expenses. It was found to be significant(p<0.05) at all levels, including region and type. Finally, the bias in the profit structure of regional veterans hospitals was the highest in 2017(p=0.0004) and the lowest in 2013(p=0.0349). In addition, in the profit structure of the Veterans Hospital, the year in which the'regional' variable worked the most was 2019, and the year with the least affected was 2010. The order of the former is Jungang(=31,674,713), Busan(=12,314,614), Gwangju(=11,957,038), Daegu(=10,168,015), and Daejeon(=6,991,034), and the order of the latter is Jungang(=57,868,791), and Busan(=19,183,194). Gwangju(=17,904,712), Daegu(=15,656,034), and Daejeon(=14,377,395). In conclusion, the profit bias of veterans hospitals repeatedly raced the lowest(p=0.01986) and highest(p=0.03499) for the past five years(2010-2014) year by year, with the 'regional' variable being the most in the veterans hospital's profit structure It was identified as a major influence factor. On the other hand, for the last 5 years (2015-2019), the influence factors of the'regional' variable every year were in 2015(p=0.02015), 2016(p=0.01741), 2017(p=0.00045), and 2018(p=0.00394). in 2019(p=0.00227), a significant difference was confirmed at a very low level.

• 한국병원경영학회지
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• 제4권2호
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• pp.305-329
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• 1999

Financial ratio indicators of the 46 sample hospitals provided by the Korea Health Industry Development Institute, together with the survey data responded by the 57 sample hospitals, were analysed to identify the characteristics of the red-figured hospitals' financial structure, financial operational efficiency and management decision-making behavior, The financial characteristics identified through the analysis include high dependency to liabilities, high salary expenses and overhead costs, low profitability of the unduly large amount of fixed assets, and low managerial efficieny of inventory. The hospitals, in face of the IMF economic impasse, took the necessary decision-making and counter measures to cut down salary expenses, to increase the number of patient and medical revenue, and to reduce investment to fixed assets. Based on these findings this study suggested that the hospitals should take more active cost containment measures, financial structural reorganization, and developoment of the strategies that can contribute to increase of the number of patient and medical revenue and that do not. require much capital funds.

• 한국정보통신학회논문지
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• 제18권6호
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• pp.1388-1394
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• 2014

최근 고령화의 가속화로 인하여 의료비 부담이 증가하고 있으며 의료서비스의 질을 높이고 의료비용을 감소시키기 위한 연구가 계속되고 있다. 특히, U-헬스는 스마트기기의 확산, 무선통신, 센싱 기술과 함께 의료서비스와의 융합으로 더욱 지능화된 의료서비스가 이루어지고 있으며 아울러, 의료분야에서의 활용범위가 점점 확대되고 있다. 따라서 본 논문에서는 기존의 HL7 표준 메시지 전송 구조를 분석하고 신속한 처리를 위한 HL7 메시지의 처리개선 방안을 제시하고자 한다.

• 대한예방한의학회지
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• 제10권2호
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• pp.95-120
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• 2006

The purpose of this paper is to investigate the structure of cost-sharing for oriental medical services in the national health insurance. Out-of-pocket payment in ambulatory oriental medical care is a co-payment of KRW3,000 up to total expenses of KRW15,000, and co-insurance rate of 30% thereafetr. The empirical analysis based on medial claims data shows that the frequency of medical claims for outpatient care are mostly concentrated just below a total expenses of KRW15,000, and it decreases beyond a total expense of KRW15,000, while it rebounds between KRW17,000${\sim}$20,000. This means the current co-payment(KRW3,000) in oriental medical services should be applied up to a total payment of KRW17,000${\sim}$20,000, or the level of co-payment should be adjusted upward to KRW45,000 in order to be consistent in cost-sharing, between co-payment and co-insurance.

• 대한의사협회지
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• 제61권11호
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• pp.638-642
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• 2018

Surgery is a very hands-on area of medical care, in that surgeons identify problems in patients' bodies and directly change them through operations. Therefore, it is not only necessary for surgeons to have a high level of expertise, but also to take considerable responsibility for the outcomes of each operation. However, surgery, which was once an object of envy, has long been a process to avoid, due to various circumstances, such as abnormal medical expenses in the medical field and social phenomena that avoids difficult work. It is unfortunate that medical professionals do not receive sympathy from others within the same medical field because of the general difficulties of the profession. The fundamental problem in this situation is the abnormal profit structure of the Korean medical system. Efforts by various related organizations will be needed to objectively evaluate the problems of the current medical insurance system and to make reasonable adjustments considering the difficulty, frequency, and resource-intensiveness of medical care.

• 대한한의학회지
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• 제41권1호
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• pp.1-10
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• 2020

Objectives: This study investigated the financial performance of Korean Medicine hospitals in Korea in order to understand the current status of hospital management and improve its efficiency. Methods: Financial statements of 24 medical corporations, 19 juridical foundations and 18 school hospitals from 2016 to 2018 were obtained from the secondary data published by the Health Insurance Review and Assessment Service, the National Tax Service and the Korea Advancing Schools Foundation. Financial performance was measured on 6 dimensions: liquidity, profitability, activity, growth, cost and productivity (investment efficiency) by analyzing 8 financial indicators: Liability to Total Assets, Net Profit to Patient Service Revenues, Total Assets Turnover, Growth Rate of Patient Service Revenues, Operating Expenses to Patient Service Revenues, Value Added to Patient Service Revenues, Value Added to Total Assets, and Value Added to Personnel Expenses. Results: Korean Medicine hospitals showed lower Liability to Total Assets, Liquidity and Value Added to Total Assets than Western Medicine hospitals did. They also showed higher Value Added to Patient Service Revenues and Value Added to Personnel Expenses than Western Medicine hospitals did. They also showed higher Value Added to Patient Service Revenues and Value Added to Personnel Expenses than those of Western Medicine hospitals do. The net profit decreased significantly (-50.8%) in 2018 whereas Patient Service Revenues increased (6.9%) for the same period due to Operating Expenses increase and Non-Operating loss. Conclusions: These findings suggest that the Korean Medicine hospital sector in Korea needs to improve liquidity and financial structure and to enhance profitability by reducing Personnel Expenses and generating Non-operating revenues in order to improve its investment efficiency and competitiveness.

• KDI Journal of Economic Policy
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• 제33권3호
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• pp.57-85
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• 2011

본 연구는 저출산 고령화의 진전과 여성 경제활동참여 증대 등에 따른 가구구조 변화가 가계생산에 영향을 주어 서비스 수요를 변화시키는 효과를 분석한다. 특히 기존에 가계생산에 의존하던 가사노동 및 돌봄서비스 등을 시장서비스로 대체하는 과정에서 추가적인 서비스 수요가 발생할 수 있음을 이론적 실증적으로 분석하고 있다. 우선 3부문 시간배분모형을 통해 가계생산의 시장화가 서비스산업의 확장을 가져오는 메커니즘을 이론적으로 탐색하였다. 다음으로, 우리나라 가구구조 변화가 각 소비항목별 수요에 미치는 효과를 분석하기 위해 QUAIDS 수요분석모형에 따른 엥겔곡선을 추정하였다. 분석자료로는 "가계동향조사"를 이용하였다. 분석 결과에 따르면, 단신가구의 증가, 유배우가구의 감소, 6세 미만 자녀 가구의 감소와 같은 가구 구성의 변화, 그리고 맞벌이가구의 증가 등은 의료비, 교육훈련비, 가사서비스 등 전형적으로 가계생산서비스를 대체하는 시장서비스에 대한 수요를 증가시키고 있는 것으로 분석되었다.