• 보건행정학회지
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• 제9권1호
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• pp.156-177
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• 1999

The current method of rate adjustment for inflation is based on the evaluation of the financial performance of hospitals. The method has the disadvantage such as too complicated, expensive process as well as low reliability. This study, therefore, develops the 'Korean Medical Insurance Economic Index(MIEI)' as a new model for the rate adjustment with the use of the macro economic indices. In addition, we calculate the 1992∼1998 rate adjustment with the MIEI, and examines the validity of the MIEI by comparing with the conventional method. Medical costs are classified into nine categories : physician salaries, nurse·pharmacist·medical technician salaries, assistants & others salaries, material cost(by imports), material cost(by domestics), depreciation & rent paid(by imports), depreciation & rent paid(by domestics), power utilities, other administrative costs. Then the category weight which is the ratio of category in the total cost is calculated. Macro economic indices are selected for each cost category in order to reflect the concept of the each cost category and inflation during the year of 1992∼1998. Finally MIEI which integrate all category according to the category weight and selected macro indices is calculated. The mean of hospital MIEI which weighting by amount paid by insurers was cacluated. The result from the application of empirical data to the MIEI model is very similar to that of the current method. Furthermore, this method is very simple and also easy to get social consensus. This MIEI model can be replaced the current method based on the analysis of the financial performance for the adjustment of medical fees.

• 대한예방한의학회지
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• 제12권3호
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• pp.21-34
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• 2008

Objectives : This paper analysed the alternative methods of calculating conversion factor for oriental medicine in the National Health Insurance and estimated the conversion factor(reimbursing price level) of the oriental medical services, based on health insurance claims data and macro economic data. Methods : Comparing cost accounting method, SGR model, and index model to estimate conversion factor in the national health insurance, six empirical models were derived depending on the scope of revenue considered in financial indicators. Classifications of data and sources used in the analysis were identified as officially released by the government. Results and Conclusion : Cost accounting analysis and SGR model showed a two digit decrease in the physician fee schedule of oriental medical services in the national health insurance, while index model indicated a positive increase in the fee reimbursed. As expected, SGR model measured an overall trend of health expenditures rather than an individual financial status of medical institutions, and index model properly estimated the level of payments to oriental medical doctors. Upon a declining share of health expenditures on oriental medicine, a global budget system fixed to a flat rate of total budget could be an opportunity as well as a challenge.

• 간호행정학회지
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• 제10권1호
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• pp.1-9
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• 2004

Korean health insurance has adopted preliminary DRG payment system through 8 DRGs from 1997. But present DRG payment system gives economic incentives for hospitals to hire less nurse. This study was attempted to develope DRG adjust index to differentiate DRG price by nurse staffing level for nursing care quality. Method: We analyzed inpatient care cost by medical institute and developed DRG adjust index to differentiate DRG price by nurse staffing level. Results: Among same medical institute, inpatient care cost are very different according to hospital's nurse staffing level. In the case of casarean section, inpatient care cost of the 1st grade general hospital are more expensive 85,732won than the 6th grade hospital. The cost difference are 8.24% of total casarean section DRG price and 16.48% of DTG variable price. We developed DRG adjust index-a to apply DRG variable price and index-b to apply DRG total price for compensation cost difference of hospitals. Conclusions: DRG price adjust index will give economic incentive for hospitals to hire more nurse and improve nursing care quality.

• 여성건강간호학회지
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• 제17권4호
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• pp.328-336
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• 2011

Purpose: The purpose of this study is to develop the optimal nursing fee for nurse-midwifery center (MC) in the national health insurance system. Methods: The three methodologies used to calculate the conversion factors for the MCs in the national health insurance include cost accounting method, sustainable growth rate (SGR) model, and index model. In this study, the macro-economic indicators and the national statistics were used to estimate the conversion factors for the MCs. Results: The optimal nursing fee for the MCs in 2011 was estimated to be an increase of 57.7% by cost accounting analysis, a decrease of 17.1% by SGR model, and a decrease of 16.1% by index model. The results from SGR model and index model could had been biased due to the upswing of medical spendings in the short-term period (2008~2009). A sensitivity analysis of pre-delivery subsidy program for OB & GYN hospitals and clinics showed that the program has substantially diminished the demand for the MC services. Conclusion: More reliable methodologies to estimate nursing fees precisely are required to prove the value of nurses' services and a government subsidy program for the MC services should be followed from a social perspective.

• 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.

• 보건행정학회지
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• 제29권3호
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• pp.288-302
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• 2019

Background: The one-person households (OPH) are rapidly increasing and vulnerable to socioeconomic and health problems. Because it is predicted to be inequitable to health care utilization, we would like to find out about the equity of health care utilization of the OPH by comparison with the multi-person households (MPH). Methods: This study followed the theoretical framework of Wagstaff and van Doorslaer (2000), O'Donnell and his colleagues (2008), where the horizontal inequity index is the difference between the concentration indices of actual health care utilization and health care needs. This study employed the 9th Korea Health Panel survey, and a total of 10,807 cases were analyzed. Health care needs were measured by age, sex, subjective health status, chronic disease count, Charlson's Comorbidity Index, limitation of activities, and disability. Results: Compared with the MPH, there were pro-poor inequities in hospitalization, emergency utilization, hospitalization out-of-pocket payments, and pro-rich inequities in outpatient out-of-pocket payments for the OPH. The decomposition of the concentration index revealed that chronic disease count made the largest contribution to socioeconomic inequality in outpatient utilization. Age, health insurance, economic activities, and subjective health status also proved more important contributors to inequality. The variables contributing to the hospitalization and emergency utilization inequity were age, education, Charlson's Comorbidity Index, marital status, and income. Conclusion: Because the OPH was more vulnerable to health problems than the MPH and there were pro-poor inequities in medical utilization, hospitalization, and emergency costs, it is necessary to develop a policy that can correct and improve the portion of high contribution to medical utilization of the OPH.

• Journal of Preventive Medicine and Public Health
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• 제46권6호
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• pp.300-308
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• 2013

Objectives: The purpose of this study was to classify determinants of cost increases into two categories, negotiable factors and non-negotiable factors, in order to identify the determinants of health care expenditure increases and to clarify the contribution of associated factors selected based on a literature review. Methods: The data in this analysis was from the statistical yearbooks of National Health Insurance Service, the Economic Index from Statistics Korea and regional statistical yearbooks. The unit of analysis was the annual growth rate of variables of 16 cities and provinces from 2003 to 2010. First, multiple regression was used to identify the determinants of health care expenditures. We then used hierarchical multiple regression to calculate the contribution of associated factors. The changes of coefficients ($R^2$) of predictors, which were entered into this analysis step by step based on the empirical evidence of the investigator could explain the contribution of predictors to increased medical cost. Results: Health spending was mainly associated with the proportion of the elderly population, but the Medicare Economic Index (MEI) showed an inverse association. The contribution of predictors was as follows: the proportion of elderly in the population (22.4%), gross domestic product (GDP) per capita (4.5%), MEI (-12%), and other predictors (less than 1%). Conclusions: As Baby Boomers enter retirement, an increasing proportion of the population aged 65 and over and the GDP will continue to increase, thus accelerating the inflation of health care expenditures and precipitating a crisis in the health insurance system. Policy makers should consider providing comprehensive health services by an accountable care organization to achieve cost savings while ensuring high-quality care.

• 보건행정학회지
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• 제25권3호
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• pp.221-228
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• 2015

Background: This study explored the relationship between hospital resources and services uses in outpatient/inpatient-based hospital service area (HSA) in Korea. Methods: Study hospitals included all acute care hospitals except tertiary hospitals. Inpatient and outpatient hospital claims from the Korean National Health Insurance (NHI) program in 2010 were used to identify the service uses. Hospital resources and the degree of insurance premium in study areas were identified with the NHI corporation data. Study variables were computed by summing the service uses or hospital resources of study hospitals in each HSA. Service uses were represented by the total medical charges and number of visits/inpatient days. Hospital resources were measured by number of beds, number of doctors, and number of computed tomography (CT). The economic status of NHI enrollees in each HSA was controlled by the average monthly premium of NHI program per household in each HSA. The degree of using local hospitals was controlled with the localization index. Results: Analysis results showed that hospital resources such as beds, CT were statistically related to the service uses. And also localization index was found to have positive significant relationships with service uses. Conclusion: Hospital resources such as beds, CT had not only positive impacts on inpatient service uses, but also influences on the outpatient setting. Health policy makers will require monitoring and assessing the hospital resources in Korea.

• 대한예방의학회:학술대회논문집
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• 대한예방의학회 1998년도 제50차 추계 학술대회 연제집
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• pp.258-259
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• 1998

• 대한방사선기술학회지:방사선기술과학
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• 제43권1호
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• pp.23-27
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• 2020

In South Korea, female individuals in their forties show a high rate of incidence, with approximately 13% of the patients being <40 years. This statistic is more than twice as high as that in Western countries. It is therefore necessary to identify the risk factors for breast cancer incidence by age and economic activity participation status. Women aged 30 to 59-whether breast cancer patients or those in the control group and having no breast cancer-were appraised from the sample cohort database. The data were analyzed using the statistical software R36.2. To identify the factors affecting breast cancer incidence, the degree of association was determined with HR and 95% CI by means of cox regression analysis. As for the socio-demographic variables, the older the individual, the higher the risk of breast cancer incidence becomes. As for the economic activity variables, those who were dependents (unemployed) and who had higher income (medium and high) were at higher risk of breast cancer incidence, which was statistically significant. The income-adjusted HR (model 1) for breast cancer development associated with the economic activity was 1.452 (95% CI, 1.19-1.77). The body mass index and alcohol intake-adjusted HR (model 2) was 1.431 (95% CI, 1.18-1.74). One needs to pay attention to policy plans regarding women's quality of life, as well as to the risk of breast cancer incidence by their economic activity. In other words, policies need to give post care, instead of focus on early detection and cancer treatment.