Globally, efforts are being made to develop and strengthen a palliative care policy to support a comprehensive healthcare system. Korea has implemented a hospice and palliative care (HPC) policy as part of a cancer policy under the 10 year plan to conquer cancer and a comprehensive measure for national cancer management. A legal ground for the HPC policy was laid by the Cancer Control Act passed in 2003. Currently in the process is legislation of a law on the decision for life-sustaining treatment for HPC and terminally-ill patients. The relevant law has expanded the policy-affected disease group from terminal cancer to cancer, human immunodeficiency virus/acquired immune deficiency syndrome, chronic obstructive pulmonary disease and chronic liver disease/liver cirrhosis. Since 2015, the National Health Insurance (NHI) scheme reimburses for HPC with a combination of the daily fixed sum and the fee for service systems. By the provision type, the HPC is classified into hospitalization, consultation, and home-based treatment. Also in place is the system that designates, evaluates and supports facilities specializing in HPC, and such facilities are funded by the NHI fund and government subsidy. Also needed along with the legal system are consensus reached by people affected by the policy and more realistic fee levels for HPC. The public and private domains should also cooperate to set HPC standards, train professional caregivers, control quality and establish an evaluation system. A stable funding system should be prepared by utilizing the long-term care insurance fund and hospice care fund.
This study examined the influence of the separation of prescribing and dispensing roles(SPD) policy implemented in Korea in July 2000, especially on the change in the net profit of medical institutions. Using the data set from the Korea's National Health Insurance and the previous research, this study elicited the following main results. First, tertiary care institutions was estimated to lose about 631 billion won after the SPD policy. Second, general hospitals and hospitals gained about 557 billion and 564 billion won, respectively. Third, it is shown that clinics also gained 389-659 billion won. Finally, however, the change in net profit of medical institutions after the SPD policy largely depends on different estimation models. Moreover, it also varies from the assumptions on the price differential of a reimbursable drug which worked as cross-subsidy to insufficient physician's fee before the SPD policy. Despite such limitations as lack of data outside of the National Health Insurance's coverage, this study differs from others. This is the first research to explore the effect of the SPD policy on different types of medical institutions and to attempt to purely focus on the SPD policy. In this study, we can draw the policy implication that preparing for a policy change, the government should set up the policy evaluation system to collect the concerned data and develop the methodologies in advance to the policy implementation.
Background: This study aimed to measure the opportunity income by identifying the economic length of stay (ELOS) which is the intersection point of daily revenue and cost on appendectomy and pneumonia cases. Methods: The research subjects were 460 patients of appendectomy and 606 patients of pneumonia, discharged from a general hospital between July 1, 2009 and June 30, 2010. ELOS calculated with both of total revenue on diagnosis-related group (DRG) and fee-for service (FFS). The cost is calculated by activity-based costing system of the hospital. Results: Average length of stay (ALOS) of appendectomy was 4.48 days and its average revenue per case were 1,710,215 (1,989,105) won by DRG (FFS). The variable cost was 491,262 won which was 28.7% (24.7%) of DRG (FFS) total revenue. And 97.2% of the total variable cost was incurred within 2 days from admission. The ELOS was 4 (5) days in DRG (FFS). Shortening three days (two days) would increase opportunity income 52.0% (82.2%) in DRG (FFS). ALOS of pneumonia case was 4.86 days and its average revenue per case were 489,448 (761,426) won by DRG (FFS). The variable cost was 27,230 won which was 5.6% (3.6%) of DRG (FFS) total revenue. Thirty-eight point nine percent of the daily variable cost was incurred in discharge date. The ELOS was 2 (4) days in DRS (FFS). Shortening three days (one day) would increase opportunity income 27.6% (37.2%) in DRG (FFS). Conclusion: The ELOS would be used by strategic index for achieving minimum profit and developing the ways to get there. But we also should not pass over that the opportunity income obtained by the reducing ALOS may cause some problem of quality.
Purpose: This study was performed to compare the costs of nursing interventions implemented for the obstetrical and gynecological patients using Korean Reimbursement System and ABC codes system developed in the US for costing out interventions performed by health care professional. Methods: First, the narrative data on nursing interventions were extracted from electronic medical record system of a tertiary university and mapped with Nursing Intervention Classification (NIC) by two researchers until 100% consent was reached. Narrative nursing interventions mapped with NIC were then remapped with ABC codes system using the electronic program developed in the research. The mapping data were analyzed with real numbers, frequency, percentage, mean, and standard deviation. Results: More nursing interventions were mapped with ABC codes than Korean reimbursement system. Total of 97 different types of narrative interventions could be mapped with NIC, 43 NIC interventions could be reimbursed by ABC code but only 16 NIC interventions were reimbursed by Korea Reimbursement System. Conclusion: Korean medical insurance fee system needs amendment to include more comprehensively interventions performed by nurses which are very important to patient outcomes. Further study is needed to develop strategies to costing out nursing interventions.
Because of the rising healthcare costs, there is a growing need for developing efficiency indicators for medical resources use and measuring efficiency of healthcare providers and healthcare systems using them. In this study, we aimed to develop efficiency indicators for medical resources use by means of Delphi technique. We systematically reviewed the existing measures of medical resource use. Thirty nine indicators were selected as a candidates across the six domains: medical personnel, medical equipment, medical facilities, ethical management, resource efficiency, and drug use. To develop efficiency indicators with professional consensus, a 2-round Delphi survey was conducted among 29 professional experts. The following indicators were selected based on the Delphi survey results: adjusted number of the patient per day and level of the nurse number medical personnel in medical personnel domain; the number of the scan a professional physician and the quality of the scan in medical equipment domain; bed utilization rate in medical facility domain; drug price reported pharmaceutical price by medical institutions, medical fee billing transparency, and medical care appropriateness in ethical management domain; costliness index in resource efficiency domain; and utilization of high cost drug and items per prescription in drug use domain. The efficiency indicators could provide valid information about efficiency of healthcare providers and healthcare systems with respect to their resources use and facilitate policies to improve their efficiency.
Park, So Young;Jung, Jae Yun;Kwak, Young Ho;Kim, Do Kyun;Suh, Dong Bum
Journal of Trauma and Injury
/
v.25
no.4
/
pp.152-158
/
2012
Purpose: To understand the epidemiology of head trauma and the utilization of brain CT in Korea, we analyzed a national sampling data set, the National Patient Sample obtained from the Health Insurance Review and Assessment Service. Methods: We retrospectively collected and analyzed demographic and clinical data on enrolled patients from the National Patient Sample based on medical claims data for 2009. The data included patient's age, sex, treatment date, diagnosis codes, procedure codes related with CT, holiday or night consultation fee, and fee for emergency management services. Results: In 2009, the estimated population with head trauma was 819,059(1.8%), and the rate of brain CT utilization was 22.4%. Children ages 5 to 15 were the most commonly injured group(22.8%), but had the lowest brain CT utilization(16.5%). The mean age of the estimated population with head trauma was $34.9{\pm}0.5years$ old, and male patients accounted for 60.5% of that population. Intracranial injury was found in 8.6% of all head traumas, and the rate of intracranial injury in children was lower than it was in adults(4.1% vs. 10.9%, p<0.001). Twenty- three percent of patients with head trauma visited the emergency department (ED). More patients with head trauma visited medical facilities in the daytime on weekdays(66.5% vs. 33.5%, p<0.001), but head CT was performed more frequently at night or on weekends/holidays(16.1% vs. 34.7%, p<0.001) There is low incidence of head trauma in the winter in children (p<0.001). In the multivariate logistic regression analysis, patients who were adults, female, or ED visitors were more likely to undergo brain CT (odds ratio (OR): 1.65, 95% confidence interval (CI): 1.47-1.84; OR: 1.40, 95% CI: 1.27-1.54; OR: 7.80, 95% CI: 6.91-8.80, respectively). Conclusion: In this study, we analyzed the national epidemiologic trend for head trauma, and the pattern of utilization of brain CT.
More than 4 million women undergo breast cancer (BC) screening with mammography each year in Korea. Digital mammography (DM) was introduced in 2000, and it has been reported to have a higher diagnostic accuracy than screen-film mammography (SFM) or computed radiography (CR) in women with dense breasts. According to a study using data from the National Cancer Screening Program for BC, the diagnostic accuracy of DM was higher than those of SFM and CR, regardless of age, breast density, and screening round. Currently, despite high supply rate among OECD countries, the distribution of DM equipment is approximately 35% in Korea. For quick replacement with DM, it will be necessary to improve its fee for the National Health Insurance and support an educational program for radiologists. In addition, efforts should be made to increase the accessibility of DM.
Park, Sang Jun;Kim, So Hyung;Kim, Kyeong Seok;Kim, Hyo Seon;Lee, A Yeong;Kim, Ho Kyoung;Kim, Yun-Kyung
The Korea Journal of Herbology
/
v.29
no.3
/
pp.35-42
/
2014
Objectives : Since single extract powders was released at 1987, the insurance fee has not been changed, but the price of raw material has been increasing. According to this, Pharmaceutical company couldn't invest on quality of the product, so, the quality of single extracts went down and lost the consumer's trust. We checked the contents of marker ingredients in single extract thereby to recover the reliability of insurance-covered herbal preparations. Methods : we bought total twelve products of eight different single extracts of two main pharmaceutical companies among total 65 kinds of single extract powder stipulated in KHP (The Korean Herbal Pharmacopoeia) monograph III at Jan. 2013. Assays of selected single extract powders are performed by KHP regulation. And we surveyed price fluctuation of relevant herb raw materials from 2005 to 2012. Results : Among twelve products, eight single extract powders were suitable by the KHP regulation. But four products didn't reach the content amount of KHP. Marker contents in the single extracts product of Pueraria Root, Licorice, Peony root and Scutellaria Root of A company were 70%, 1%, 23.7% and 75.1%, respectively. Conclusions : We can acertain whether there's a quality problem in the insurance-covered single extract powders. But, A company is no longer producing these improper single extract powders. As a medicine, single extract powders needs to be strictly quality controlled by the company, and regularly monitored by the KFDA.
Kim, Hye-Kyung;Lee, Jeon-Un;Park, Kang-Won;Moon, Ok-Ryun
Journal of Preventive Medicine and Public Health
/
v.25
no.3
s.39
/
pp.312-329
/
1992
The purpose of this study is to estimate cesarean section rate in Korea and analyze the socioeconomic variables and health resources which affect regional variation in the rate. Samples were drawn from the record of vaginal and cesarean section deliveries based upon insurance claim bills which have been submitted to the National Federation of Medical Insurance for the first three months, January through March, 1991. The results are obtained as follows : It was found that. cesarean section rate was increasing rapidly up to 23.1% in 1991. Cesarean section per 10 thousand insured people was 4.8 and the number of cesarean section per 10 thousand insured eligible($15{\sim}49$ years old) female was 7.6. The fee for normal delivery was 109,489 won and that for cesarean section was 390,024 won. The average days of hospitalization in normal delivery was 2.3 days, and those in cesarean section was 7.6 days. On the average cesarean section has a longer of stay as much as by 4.3 days and cost 3.6 times more than normal deliveries. Cesarean section rates vary among medical facilities 19.8% at clinics 37.6% in small-scale hospitals, and 29.1% in general hospitals. The regional variation of cesarean section rates was also fairly prominent. The South Cheju Gun has the highest rate of cesarean section, 56.2%. Meanwhile no cesarean section cases has been reported in Sunchang Gun during the period of this study. The variation is noted among provinces. The rate for Cheju province has been 3.4 times higher than that for Chunnam. The number of cesarean section per 10 thousand insured people vary greatly among regions, too. This study has found that there exists significant regional variations among various geographic units in terms of average length of stay, average cost, number of obsretricians and number of beds. Multiple regression analysis was done to identify factors explaining the regional variance of various cesarean section rates : In the urban areas, no significant explaining variables were noted except the number of beds for the dependent variable of cesarean section cases per 10 thousand insured eligible females. The smaller the number of bed, the more cases of cesarean section was noted for an urban area. The is mostly because the rate of cesarean section is higher in medium-size hospitals than in large general hospitals. In the rural areas, the factor of education has been found significant for all three deplendent variables. The higher the educational level, the rate of cesarean section is most likely to rise. An income variable measured by the amount of monthly insurance contribution has been identified a powerful predictor in explaining the valiance of cesarean section rates. The same has been noted for the number of obstetricians. Similar findings are observed for the country as a whole. The income level has veen found as the most powerful explaining factor in the regional variance of cesarean section rates. In general the rate is higher in the urban areas, and lower in the area with more small hospitals. As this is the initial attempt to identify the factors relevant to the regional difference in the rates of cesarean section, more elaborated study is urgently required.
The purpose of this study is to figure out the relationship between the residence stories in high-rise condominium and residents' disease patterns throughout the dweller's medical reports. Research basic data are obtained from medical fee request of National Health Insurance Corporation. Data are limited to 'A' high-rise condominium and a medical treatment time to 3 years (2004. 1-2006, 12). Data for analysis are composed of total 346,286 medical records, 43,159 disease records, and 8,999 personal records. Data are stored by sex, age, building story, residence story, visiting year and month, treatment days, main disease type (KCD-4). Treatment number, disease type and asthma in disease records and personal records are statistically analyzed by residence story considering age. Findings are as follows: 1) Women have more medical treatments than men, 40-50 age group is more treated, and the residents of 6-25 stories are more received medical treatments. According to KCD-4, diseases of the respiratory system and diseases of the eye and adnexa are relatively treated higher than other diseases. 2) The diseases of he respiratory system, the eye and adnexa, the skin and subcutaneous issue, the ear and mastoid process, and the asthma have not relation to the high-storied residence through the data of disease records and personal records. But the analysis on the data of children, age 7 and less, showed a significant relation. to conclude, there is no relationship between the residence of high-stories in the condominium and residents' disease patterns, but there is a little probable to the relationship in the pre-school child.
본 웹사이트에 게시된 이메일 주소가 전자우편 수집 프로그램이나
그 밖의 기술적 장치를 이용하여 무단으로 수집되는 것을 거부하며,
이를 위반시 정보통신망법에 의해 형사 처벌됨을 유념하시기 바랍니다.
[게시일 2004년 10월 1일]
이용약관
제 1 장 총칙
제 1 조 (목적)
이 이용약관은 KoreaScience 홈페이지(이하 “당 사이트”)에서 제공하는 인터넷 서비스(이하 '서비스')의 가입조건 및 이용에 관한 제반 사항과 기타 필요한 사항을 구체적으로 규정함을 목적으로 합니다.
제 2 조 (용어의 정의)
① "이용자"라 함은 당 사이트에 접속하여 이 약관에 따라 당 사이트가 제공하는 서비스를 받는 회원 및 비회원을
말합니다.
② "회원"이라 함은 서비스를 이용하기 위하여 당 사이트에 개인정보를 제공하여 아이디(ID)와 비밀번호를 부여
받은 자를 말합니다.
③ "회원 아이디(ID)"라 함은 회원의 식별 및 서비스 이용을 위하여 자신이 선정한 문자 및 숫자의 조합을
말합니다.
④ "비밀번호(패스워드)"라 함은 회원이 자신의 비밀보호를 위하여 선정한 문자 및 숫자의 조합을 말합니다.
제 3 조 (이용약관의 효력 및 변경)
① 이 약관은 당 사이트에 게시하거나 기타의 방법으로 회원에게 공지함으로써 효력이 발생합니다.
② 당 사이트는 이 약관을 개정할 경우에 적용일자 및 개정사유를 명시하여 현행 약관과 함께 당 사이트의
초기화면에 그 적용일자 7일 이전부터 적용일자 전일까지 공지합니다. 다만, 회원에게 불리하게 약관내용을
변경하는 경우에는 최소한 30일 이상의 사전 유예기간을 두고 공지합니다. 이 경우 당 사이트는 개정 전
내용과 개정 후 내용을 명확하게 비교하여 이용자가 알기 쉽도록 표시합니다.
제 4 조(약관 외 준칙)
① 이 약관은 당 사이트가 제공하는 서비스에 관한 이용안내와 함께 적용됩니다.
② 이 약관에 명시되지 아니한 사항은 관계법령의 규정이 적용됩니다.
제 2 장 이용계약의 체결
제 5 조 (이용계약의 성립 등)
① 이용계약은 이용고객이 당 사이트가 정한 약관에 「동의합니다」를 선택하고, 당 사이트가 정한
온라인신청양식을 작성하여 서비스 이용을 신청한 후, 당 사이트가 이를 승낙함으로써 성립합니다.
② 제1항의 승낙은 당 사이트가 제공하는 과학기술정보검색, 맞춤정보, 서지정보 등 다른 서비스의 이용승낙을
포함합니다.
제 6 조 (회원가입)
서비스를 이용하고자 하는 고객은 당 사이트에서 정한 회원가입양식에 개인정보를 기재하여 가입을 하여야 합니다.
제 7 조 (개인정보의 보호 및 사용)
당 사이트는 관계법령이 정하는 바에 따라 회원 등록정보를 포함한 회원의 개인정보를 보호하기 위해 노력합니다. 회원 개인정보의 보호 및 사용에 대해서는 관련법령 및 당 사이트의 개인정보 보호정책이 적용됩니다.
제 8 조 (이용 신청의 승낙과 제한)
① 당 사이트는 제6조의 규정에 의한 이용신청고객에 대하여 서비스 이용을 승낙합니다.
② 당 사이트는 아래사항에 해당하는 경우에 대해서 승낙하지 아니 합니다.
- 이용계약 신청서의 내용을 허위로 기재한 경우
- 기타 규정한 제반사항을 위반하며 신청하는 경우
제 9 조 (회원 ID 부여 및 변경 등)
① 당 사이트는 이용고객에 대하여 약관에 정하는 바에 따라 자신이 선정한 회원 ID를 부여합니다.
② 회원 ID는 원칙적으로 변경이 불가하며 부득이한 사유로 인하여 변경 하고자 하는 경우에는 해당 ID를
해지하고 재가입해야 합니다.
③ 기타 회원 개인정보 관리 및 변경 등에 관한 사항은 서비스별 안내에 정하는 바에 의합니다.
제 3 장 계약 당사자의 의무
제 10 조 (KISTI의 의무)
① 당 사이트는 이용고객이 희망한 서비스 제공 개시일에 특별한 사정이 없는 한 서비스를 이용할 수 있도록
하여야 합니다.
② 당 사이트는 개인정보 보호를 위해 보안시스템을 구축하며 개인정보 보호정책을 공시하고 준수합니다.
③ 당 사이트는 회원으로부터 제기되는 의견이나 불만이 정당하다고 객관적으로 인정될 경우에는 적절한 절차를
거쳐 즉시 처리하여야 합니다. 다만, 즉시 처리가 곤란한 경우는 회원에게 그 사유와 처리일정을 통보하여야
합니다.
제 11 조 (회원의 의무)
① 이용자는 회원가입 신청 또는 회원정보 변경 시 실명으로 모든 사항을 사실에 근거하여 작성하여야 하며,
허위 또는 타인의 정보를 등록할 경우 일체의 권리를 주장할 수 없습니다.
② 당 사이트가 관계법령 및 개인정보 보호정책에 의거하여 그 책임을 지는 경우를 제외하고 회원에게 부여된
ID의 비밀번호 관리소홀, 부정사용에 의하여 발생하는 모든 결과에 대한 책임은 회원에게 있습니다.
③ 회원은 당 사이트 및 제 3자의 지적 재산권을 침해해서는 안 됩니다.
제 4 장 서비스의 이용
제 12 조 (서비스 이용 시간)
① 서비스 이용은 당 사이트의 업무상 또는 기술상 특별한 지장이 없는 한 연중무휴, 1일 24시간 운영을
원칙으로 합니다. 단, 당 사이트는 시스템 정기점검, 증설 및 교체를 위해 당 사이트가 정한 날이나 시간에
서비스를 일시 중단할 수 있으며, 예정되어 있는 작업으로 인한 서비스 일시중단은 당 사이트 홈페이지를
통해 사전에 공지합니다.
② 당 사이트는 서비스를 특정범위로 분할하여 각 범위별로 이용가능시간을 별도로 지정할 수 있습니다. 다만
이 경우 그 내용을 공지합니다.
제 13 조 (홈페이지 저작권)
① NDSL에서 제공하는 모든 저작물의 저작권은 원저작자에게 있으며, KISTI는 복제/배포/전송권을 확보하고
있습니다.
② NDSL에서 제공하는 콘텐츠를 상업적 및 기타 영리목적으로 복제/배포/전송할 경우 사전에 KISTI의 허락을
받아야 합니다.
③ NDSL에서 제공하는 콘텐츠를 보도, 비평, 교육, 연구 등을 위하여 정당한 범위 안에서 공정한 관행에
합치되게 인용할 수 있습니다.
④ NDSL에서 제공하는 콘텐츠를 무단 복제, 전송, 배포 기타 저작권법에 위반되는 방법으로 이용할 경우
저작권법 제136조에 따라 5년 이하의 징역 또는 5천만 원 이하의 벌금에 처해질 수 있습니다.
제 14 조 (유료서비스)
① 당 사이트 및 협력기관이 정한 유료서비스(원문복사 등)는 별도로 정해진 바에 따르며, 변경사항은 시행 전에
당 사이트 홈페이지를 통하여 회원에게 공지합니다.
② 유료서비스를 이용하려는 회원은 정해진 요금체계에 따라 요금을 납부해야 합니다.
제 5 장 계약 해지 및 이용 제한
제 15 조 (계약 해지)
회원이 이용계약을 해지하고자 하는 때에는 [가입해지] 메뉴를 이용해 직접 해지해야 합니다.
제 16 조 (서비스 이용제한)
① 당 사이트는 회원이 서비스 이용내용에 있어서 본 약관 제 11조 내용을 위반하거나, 다음 각 호에 해당하는
경우 서비스 이용을 제한할 수 있습니다.
- 2년 이상 서비스를 이용한 적이 없는 경우
- 기타 정상적인 서비스 운영에 방해가 될 경우
② 상기 이용제한 규정에 따라 서비스를 이용하는 회원에게 서비스 이용에 대하여 별도 공지 없이 서비스 이용의
일시정지, 이용계약 해지 할 수 있습니다.
제 17 조 (전자우편주소 수집 금지)
회원은 전자우편주소 추출기 등을 이용하여 전자우편주소를 수집 또는 제3자에게 제공할 수 없습니다.
제 6 장 손해배상 및 기타사항
제 18 조 (손해배상)
당 사이트는 무료로 제공되는 서비스와 관련하여 회원에게 어떠한 손해가 발생하더라도 당 사이트가 고의 또는 과실로 인한 손해발생을 제외하고는 이에 대하여 책임을 부담하지 아니합니다.
제 19 조 (관할 법원)
서비스 이용으로 발생한 분쟁에 대해 소송이 제기되는 경우 민사 소송법상의 관할 법원에 제기합니다.
[부 칙]
1. (시행일) 이 약관은 2016년 9월 5일부터 적용되며, 종전 약관은 본 약관으로 대체되며, 개정된 약관의 적용일 이전 가입자도 개정된 약관의 적용을 받습니다.