• Journal of Preventive Medicine and Public Health
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• v.30 no.1 s.56
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• pp.195-207
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• 1997

High price equipment is one of the major factors that increases national health expenditure in developed countries. Computerized Tomography(CT), one of the important high price equipment, has been concerns of health service researchers and policy makers in many countries. In Korea, CT, first introduced in 1984, have spreaded nationwide with rapid speed. Though the Committee for Approving Import of High Price Medical Equipment, founded in 1981, tried to regulate the introduction of high price medical equipment including CT, the effort resulted in failure. The exact situation of diffusion of the high price equipment, however, was not yet investigated. We aimed at the description of the diffusion of CT in Korea and analysis of influencing factors on hospitals for the adoption of CT. We mainly used the database of CT, made in 1996 by the National Federation of Medical Insurance for the purpose of insurance payment for CT. Also characteristics of hospitals were gathered from yearbooks published by the central and local governments and by the Korean Hospital Association. We calculated the cumulative number of the CT per one million population year by year. In turn, multiple linear logistic regression was done to find out the contributing factors for the adoption of CT by each hospital. In the logistic regression model, it is regarded as dependent factor whether a hospital retained CT or not in 1988 and 1993. The major categories of the independent factors were hospital characteristics, environmental factors and competitive conditions of hospitals at the period of the adoption. The results are as follows: Number of CT scanners per one million persons in Korea marked more higher level compared with those of most OECD countries. Major influencing factors on the adoption of CT scanners were hospital characteristics, such as hospital referral level, and competitive condition of hospitals, such as number of CT scanners per 10,000 persons in each district where the hospital was located. In Korea, CT diffused with rather rapid speed, comparable with those of the United States and Japan. The major factors contributing on the adoption of CT for hospitals were competitive condition and hospital characteristics rather than regional health care need for CT. In conclusion, a kind of regulating mechanism would be necessary for the prevention of the indiscreet adoption and inefficient use of high price equipment including CT.

• Health Policy and Management
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• v.8 no.1
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• pp.155-182
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• 1998

There exists a remarkable differences in use of MRI scanning among income classes. The poor can hardly utilize it. This is because, among high cost technnologies, MRI is the only equipment not covered under health insurance benefits in Korea. This study was designed 1) to reveal the status of nation-wide MRI installation, customary charges and per unit annual scanning performance, and 2) to analyse factors influencing the above variables. The data for this study came from "MRI Prevalence Survey" conducted by the National Federation of Medcial Insurance(NFMI) in 1997, and were analyzed through SAS packages for T-test, analysis of variance and stepwise multiple regression. Data were collected from 188 hospitals equipped with MRI scanners. Major findings are summarized as follows : The number of MRI scanners has increased from 69 in 994 to 158 in 1996(2.3 times) while per unit annual scanning performance has risen by 11.2% from 2,173 cases in 1994 to 2,417 cases in 1996. Such a rapid increase was made possible mainly due to the inclusion of CT scanning under the health insurance benefit package. The customary charges for MRI scanning with or without contrast media, on average, amounted to 484,000 Won and 402,000 Won, respectively, with the percentile increase of 17.8% and 8.1% each during the same time. Korea ranks the third worldwidely in terms of number of MRI installations, 4.8 scanners per one million persons, only next to Japan and United States. Geographical variation of MRI, however, was rather high, 7.91 unit, in Cheju area compared to 1.82 in Kyongnam area. Variations of customary charges of MRI scanning can be explained as much as by 44.8% by both the total amount of claims to NFMI and geographical variable. The charges were more likely to be higher in metropolitan areas like Seoul and in hospitals with a bigger amount of claims. While those of per unit annual scanning performance can be explained as much as by 30.7% by both MRI installation cost and level of MRI-installed organizations. Per capital scannig performance was higher in tertiary hospitals and hospitals equipped with more expensive scanners than hospitals with less expensive scanners. Two measures are called for the remedying the existing excessive abundance in MRI units in korea : One is to set a ceiling of MRI units in an area like a province or a metropolitan district. The other is to establish a committee on introduction of high cost technologies for reviewing its effective use.ctive use.