• 대한물리치료과학회지
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• 제15권1호
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• pp.39-45
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• 2008

This study was undertaken to identify the influence which affect on gait speed and energy consumption regarding putting on arm sling during gait of the 40 hemiplegic patients selected from University Hospital and rehabilitation center in seoul during two months. The analysis of data was performed using the paired samples ttest to compare the differences of gait velocity, heart rate, oxygen consumption and oxygen cost in gait of preand post－ arm sling. The results of this study were as follows; 1. When comparing the result before putting on arm sling in the gait of hemiplegic patient, gait velocity after putting on arm sling was statistically significantly increased(p<.05). 2. When comparing the result before putting on arm sling in the gait of hemiplegic patient, heart rate after putting on arm sling was statistically significantly decreased(p<.05). 3. When comparing the result before putting on arm sling in the gait of hemiplegic patient, oxygen consumption per weight after putting on arm sling was statistically significantly decreased(p<.05). 4. When comparing the result before putting on arm sling in the gait of hemiplegic patient, oxygen consumption rate per weight after putting on arm sling was statistically significantly decreased(p<.05). When putting together the above result, the gait with arm sling in comparison with the gait without arm sling was to increase gait velocity, decrease heart rate, decrease oxygen consumption and was finally to decrease energy consumption in the gait of hemiplegic patient.

• Asian Pacific Journal of Cancer Prevention
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• 제13권7호
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• pp.3159-3163
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• 2012

Background: For cervical cancer the epidemiological profile is poorly known in Morocco and no data is available concerning the direct medical costs. The purpose of this work is to estimate the direct cost of medical management of invasive cervical cancer during the first year after diagnosis in Morocco. Methods: The estimation of direct costs of medical management of invasive cervical cancer during the first year after diagnosis in Morocco is based on the estimation of individual cost in each stage which covers diagnosis, treatment and follow-up during first year. The cost was estimated per patient and whole cycle-set using the costs for each drug and procedure as indicated by the Moroccan National Agency for Health Insurance. Extrapolation of the results to the whole country was used to calculate the total annual cost of cervical cancer treatments in Morocco. Results: Overall approximately 1,978 new cases of cervical cancer occur each year in Morocco. The majority (82.96%) of these cases were diagnosed at a late stage (stageII or more). The cost of one case of cervical cancer depends on stage of diagnosis, the lowest cost is $382 for stageCis followed by the cost of stageIA1 for young women (< 40 years) which is $2,952. The highest cost is for stageIV, which is $7,827. The total cost of cervical cancer care for one year after diagnosis is estimated at $13,589,360. The share allocated to treatment is the most important part of the global care budget with an annual sum of $13,027,609 whereas other cost components are represented as follows: $435,694 for annual follow-up activity and $126,057 for diagnosis and preclinical staging. Conclusion: This study provides health decision-makers with a first estimate of costs and the opportunity to achieve the optimal use of available data to estimate the needs of health facilities in Morocco.

• 약학회지
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• 제51권5호
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• pp.327-335
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• 2007

This study was to evaluate economic impact of a comprehensive pharmaceutical care intervention provided by community pharmacists on drug-related morbidity and mortality in the elderly population, in a societal perspective. Clinical outcomes of pharmaceutical care included compliance increase, inappropriate medication discontinuation, and subsequent drug-related morbidity and mortality reduction. Economic outcomes included cost savings from direct medical costs reduction such as medication and healthcare resource utilization. Input costs for pharmaceutical care included pharmacist time and computerized prescription review supporting program costs. Model parameters of outcomes were derived from published literatures, and costs were from literatures and health insurance statistical data in Korea. Annual costs and benefits were estimated in the year 2005. Current usual care and standardized pharmaceutical care required 0.3 and 2.0 hours per year respectively, for elderly outpatient using average 4.4 prescription drugs per visit and average annual frequency of 17.8 pharmacy visits. Comprehensive pharmaceutical care provided to overall elderly outpatients at community pharmacies would have cost of \74,994 mil. and benefit of \357,002 mil. per year. Benefit:cost ratio was 4.8:1 and net benefit was \282,008 mil/year. It was corresponded to net benefit of \73,816/year for individual elderly patient. In addition, pharmaceutical care was estimated to reduce 1,531 drug-related deaths/year. Conclusively this study, a first attempt in Korea to evaluate an economic value of pharmaceutical care at community pharmacies, proved that it was a cost-effective intervention having significant economic benefit.

• 한국병원경영학회지
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• 제18권1호
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• pp.59-69
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• 2013

Purpose Patients should have a regular medical check-up, the cost direct and indirect medical expenses to check the results, and revisit the hospital. Some of patients often want to use the telephone for a medical consultation, Method The subjects participating in this study were a selection 485 patients who received outpatient service in Asan Medical Center and Gangbuk Samsung Hospital. The patients's favorite method for medical check-up, time, cost, fatigue, and inconvenience, in regard with the revisit to check the examination results, were researched and analyzed on identical questionnaires about them. Results The average transportation, food expenses and opportunity costs the subjects spent was 90,400 for those from the Seoul and Gyunggi area, and 269,800 from other area. And the average required time per visit was 4.13 hours for those from the Seoul and Gyunggi area, 11.84 hours from other areas, and averagely 7.72 hours for all the subjects. More than 75% of the subjects answered that they felt tired and their work was interrupted. The subjects from both areas preferred the check by phone. Conclusion If the scope of telephone medical consultation is defined and the doctor-patient certification is possible, it can be thought as an efficient alternative of the medical check-up by revisit. It is necessary to discuss an appropriate amount of the medical check-up by phone which the same cost and effort can be allocated in.

• 한국보건간호학회지
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• 제3권2호
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• pp.5-46
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• 1989

The current medical payment Insurance Rates in Korea stipulate charges for medical treatment by the doctor, pharmaceutist, medical technician and maternity nurse. But unfortunately didn't specify those charges for nursing done by the professional nurse. Only basic nursing fee is accounted insufficiently in current medical insurance fee schedule. therefore, Being face with covering entire people by medical insurance by 1991, It seems that the problems pertaining to operating the hospital and medical insurance system would be incessantly expanded in that no mention is made of medical charges rendered by major medical producer service in the current system, For that reason, this study made an attempt to clarify the importance the professional nursing puts of the current medical payment. The purpose of this study was to accounting nursing fee which diveded into the current medical fee schedule. (Method) 1. Data collection; Importance and difficulties in nursing activities was conducted in 'S' National University Hospital. Total nursing activities were selected 72 items which included direct care and indirect care. This study was conducted to evaluating the degree of importance and difficulties according to nursing activities through questionnaire to 204 RN. and so relative difficulties (acuity) were computered because the nursing cost level of each nursing service was differently established by the equivalent coefficient according to degree of relative difficulty and time required. 2. Calculation of cost according to nursing activities; After 47 nursing activities were selected in General surgery nursing units, calculation of nursing cost was as follows Cost of Nursing activity = (relative difficulty X Average hourly wage and benefits of nurse) + material cost of nursing -t- Average nursing administration cost So, Calculated cost by nursing activities was compared to current non-insured and insurance rate. 3. Calculation of nursing cost by K - DRG ; Total of 578 patients who were hospitalized in General Surgery units from January to March 1988 ware classified by K - DRG After estimation of total nursing cost based on the K-DRG, verified the appropriateness of basic nursing fee in medical insurance rate (Results) 1. Analysis of degree of importance and difficulties were 4.16 and 3.67 based on 5 point scale. This score were judged that it is worthy specifying the nursing fee 2. The nursing cost of 47 nursing service items in general surgery patients showed that the average cost of nursing activity was \1374.5 and The lowest cost was \217 of 'oral administration nursing' item, The highest cost was \11,025 of 'saline enematill clear' item 3. The result of comparison between the calculated cost by nursing activities against the current non-insured and insurance rate showed that 13 items(27.7%) involved to payment of insurance rate, 9 items(19.1%) involved to non-insured rate, remainder 25 items (53.2%) were not charged anywhere of total 47 nursing activities 4. When calculated cost by nursing activities was 100. current insurance rate was 62.3, non-insured rate was 176.6. Therefore this showed that most of non-insured rate were higher than calculated nursing cost. The insurance rate, however, were lower than it. Reim-bursement was imputed to non-insured patients. So the current rate system became estrainged from cost system. When Remainder 25 items of nursing activities compared' to \1390 of daily basic nursing fee per patient belonged to payment as a insurance fee schedule, basic nursing fee schedule was 1-2% of calculated cost of nursing activities. Therefore it showed that nursing fee was not counted adequately in it. 5. Nursing cost by K-DRG estimated in chart review based on counting number of nursing activities and length of stay The result showed that average amount of total nursing cost was \183828.1 Comparison of nursing cost calculated by K- DRG and basic nursing fee schedule showed that only 12.3% of nursing cost was charged (Conclusion) From the above research result, It is fact that nursing prime cost should be estimated more accurately and included adequately in current medical payment system. The payment system of nursing activities should be introduced not only nursing activities of drug administration and injection fee belonged to insurance fee schedule but also most nursing activities belonged not to mekical fee schedule. Even if introducing payment system of nursing activities, It should be estimated scientific method of Accounting nursing cost So nurses could offer nursing care of good quality, thereby they could make a great contribution not merely to the convalescence of the patient but to the promotion of the people's health.

• Journal of Preventive Medicine and Public Health
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• 제39권2호
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• pp.149-158
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• 2006

Objectives : We wanted to evaluate the economic value of a pharmaceutical product, Kremezin, for treating patients with chronic renal failure (CRF) by estimating the amount of cost savings due to its effect for delaying the initiation of dialysis treatments. Methods : We defined a conventional treatment for CRF accompanied by Kremezin therapy as 'the treatment group' and only conventional treatment as 'the alternative group.' The types of costs included were direct medical and nonmedical costs and costs of productivity loss. The information on the effect of Kremezin was obtained from the results of earlier clinical studies. Cost information was derived from the administrative data for 20 hemodialysis and 20 peritoneal dialysis patients from one tertiary care hospital, and also from the administrative data of 10 hemodialysis patients from one free-standing dialysis center. Per-capita cost savings resulting from Kremezin therapy were separately estimated for the cases with delay for the onset of hemodialysis and the cases with immediate performance of peritoneal dialysis. By computing the weighted average for the cases of hemodialysis and peritoneal dialysis, the expected per-capita cost savings of a patient with CRF was obtained. Using a discount rate of 5%, future cost savings were converted to the present value. Results : The present value of cumulative cost savings per patient with CRF from the societal perspective would be $18,555,000{\sim}29,410,000$ Won or $72,104,000{\sim}112,523,000$ Won if Kremezin delays the initiation of dialysis by 1 or 4 years. Conclusions : The estimated amount of cost savings resulting from treating CRF patients with Kremezin confirms that its effect for delaying the onset of dialysis treatments has a considerable economic value.

• Journal of Preventive Medicine and Public Health
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• 제9권1호
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• pp.109-116
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• 1976

Reorganization of myun health care service is one of the main issues in health care delivery in rural Korea. The fundamenta, concept of the role and function of the myun health subcenter is that it is the basic unit of rural health care service and is to provide comprehensive health care service through the integration of curative and preventive services. The aim of this study is to analyze the patterns of curative activities in the myun health subcenter in terms of the most prevalent types of diseases, necessary diagnostic methods and required equipment, types of treatment, necessary drugs and materials, and finally the cost of curative services. The population on which this study was done was the 1596 patients who visited the two myun health subcenters (Sunwon Myun and Naega Myun) in Kang Wha County, the area of the Yonsei University Community Health Teaching Project, during period from May 1, 1975 to June 10, 1976. For the patient's record in the clinic, problem oriented medical records were used. Decisions regarding the disease classification, the diagnostic methods used and selection of the most appropriate and adequate medical treatment were made by a group of three experienced physicians after reviewing the medical records which had been written by public physicians who were treating patients in the study area. The records were reviewed by resident staff members of the Department of Preventive Medicine, of Yonsei University College of Medicine. A brief summary of results of the study is as follow: 1. 29.9% of the patients who visited the clinics were ages between 0-4. No sex difference was observed among patients less than 20 years of age. However, among patients over 20 years old, females predominated. Thus it is evident that the majority of patients were either children or mothers and grandmothers. 2. The distance from the individual villages to the myun health subcenter was one of important factors in determining the ratio of clinic visits. However, other factors such as the activities of the health workers also affected the rates substantially. 3. The most common 25 diseases comprised 90.2% of all the diseases recorded. Acute respiratory infection (25.5%), Skin (12.7%) , diarrheal diseases (6.8%), neuralgia and back pain (4.9%) and. all other injuries (3.9%) were the five most common diseases. 4. Of all the diseases diagnosed and treated, 9.2% required simple laboratory tests for diagnosis, 6.5% required X-ray examination, and altogether 13.6% required either laboratory test or X-ray examination. 5. Treatment and management of 42.0% of the cases could be accomplished with simple, inexpensive drugs, 12.8% required the use of more expensive drugs (mostly antibiotics) and injections were required in 19.7% of the cases. Minor surgery and referral were necessary in 5% of the cases. 6. The cost for diagnosis and treatment was estimated with a standard which was set by general concensus. The average cost of diagnosis was 144 per case and the cost of treatment was 726 per case, The Total average cost per visit was 870.

• Perspectives in Nursing Science
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• 제6권1호
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• pp.77-83
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• 2009

The number of nurses per bed at acute-stage hospitals is quite low in Korea compared with other OECD countries. In order to prevent the degradation of the quality of inpatient nursing services due to insufficient nurse staffs, the national health insurance introduced the differentiated nursing care fee system. This did not work as a motive for inducing the employment of nursing staff due to insufficient cost compensation. Because of insufficient nursing staff, family members have to stay with the patient or patients have to hire a personal care attendant. This increases the burden and cost to families. For the activation of hospitals without guardians, there should be policies for raising additional nursing staff such as standardizing jobs among nursing staff, particularly between nurses and nursing assistants, setting adequate standards of staffing in nursing according to medical service, substantiating the cost of nursing under the differentiated nursing care fee system, improving the medical fee system of hospitals without guardians including health insurance payment, supplying nursing staff stably through improving their working conditions such as providing child rearing services and salary increase, clarifying the qualification of personal care attendants working at acute.stage hospitals, developing indexes for assessing the quality of nursing care services, and monitoring for the management of uniform quality.

• Journal of Preventive Medicine and Public Health
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• 제29권2호
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• pp.347-357
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• 1996

Although occupational low back pain accounts for $20\sim40%$ of all occupational illness and injury, there are limited numbers of studies regarding the effectiveness of back school program. The objective of this study was to evaluate the economic benefit of back school program for early return to work of occupational low back pain patients in the current occupational injury compensation and management system. The cost-benefit analysis in this study was conducted to evaluate the relative magnitude of benefit to cost. The total cost was estimated by calculating the value of components in back school program according to governmental budget protocol. The back school program was consisted of three major approaches, pain center, work-hardening program and funcional restoration program and each of components had various facilities and experts. The total amount of cost was estimated as 250,866,220 won per year. The most promising type of back school program were quite intensive (a 3 to 5-week stay in a specialized center), therefore, if we adopted the 5-week stay course, 10 courses could be held in a year. Following to the medical act, 20 patients per doctor could participate in a each course, ie, total 200 patients in a year. As a result, we could estimate the cost of 1,254,331 won a patient. We estimated the benefit by using data of a few local labor offices about average medical treatment beneficiary and off-duty beneficiary of 46 occupational low back pain patients in 1994. Ullman and Larsson (1977) mentioned that the group of chronic low back pain patients who participated in back school program needed less time to recover by 48.4% of beneficiary duration. And in the trying to estimate the benefit, we asked 10 rehabilitation board certificate doctors about reduction proportion of treatment cost by introducing back school program. The answered reduction proportions were in the range of $30\sim45%$, average 39%. As a final result, we could see that the introduction of back school program in treatment of chronic occupational low back pain patients could produce the benefit to cost ratio as 3.90 and 6.28. And we could conclude that the introduction of back school program was beneficial to current occupational injury compensation and management system.

• 한국융합학회논문지
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• 제8권5호
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• pp.61-68
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• 2017

이 연구는 2015년 1월부터 12월까지 1년간의 자동차보험으로 진료 받은 치과와 한방을 제외한 의과 8,589,602건에 대해 자동차보험회사별로 진료특성과 진료비 차이를 분석한 것으로 그 결과는 다음과 같다. 첫째, 일반적 특성 중, 연령에서는 손해보험과 공제조합 모두 50-59세가 22.8%로 가장 높은 것으로 나타났다(p<0.001). 둘째, 진료과별 입원 건당진료비는 손해보험과 공제조합 모두 내과계가 외과계보다 높은 것으로 나타났으며, 외과계 세부과목별로는 손해보험회사와 공제조합 모두 흉부외과가 가장 높게 나타났다. 이상의 연구결과를 볼 때, 심사평가원에서는 자동차보험 청구요양기관에 대한 적정성평가를 실시하여 불필요한 진료비를 증가시키는 문제와 환자의 재활 및 일상생활의 복귀가 지연되어 발생하는 사회적 비용 문제를 해결하여야 할 것으로 사료된다.