• 보건행정학회지
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• 제22권4호
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• pp.497-521
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• 2012

Objectives This study aimed to investigate the effect of social capital, health risk behavior and health status on medical care utilization by the elderly. The data and Research method Data were obtained from the 4th wave survey of the Korea Welfare Panel Study. 4,087 household members aged 65 years and over were subject to analysis. Descriptive statistics are used to describe the basic features of the data in a study. we performed a structural equation modeling(SEM) analysis to evaluate the effect of social capital and mediating effect of health risk behavior and health status. Results Results showed that factors related to medical care utilization of the elderly were different depending on types of service (inpatient and outpatient service) except health status. Age, higher social capital, more health-risk behavior and poorer health status were associated with increased use of inpatient service. Social capital was found to have a positive direct effect on it. Also, social capital had an indirect effect on reducing use of inpatient services by improving health status. On the other hand, lower age and higher household income tended to increase use of outpatient service, while higher social capital and higher health status were inversely related. Social capital had a direct effect and an indirect effect on reducing use of outpatient service and, at that time, health status played a mediating role. Conclusions Social capital may contribute to improve health status and indirectly reduce medical care utilization of the elderly by enhancing their health status. These results provide evidence that more policy and strategy considerations should be needed for the elderly to strengthen their social capital in order to enhance their levels of health and more efficient utilization of medical care.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제27권3호
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• pp.17-26
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• 2021

Purpose: This study is a case study in which the space was improved by applying the design direction derived through the theoretical basis and service design process to the outpatient department and health examination center in mental health facilities used by various stakeholders. And it aims to present implications through this. Methods: The research method is based on the analysis of the service design process with a focus on literature review. Results: As a result of deriving the design direction, it was organized into 1) improvement of spatial arrangement, 2) improvement of wayfinding system, and 3) creation of comfortable environment. The design improvement plan suggested division of areas, change of nurse station location, creation of a pleasant waiting space for the outpatient department, reinforcement of access, improvement of room relocation and flow, and increased comfort of common spaces for the health examination center. Implications: First, it is necessary to expand research and application of spatial planning and environmental design reflecting the characteristics of patients and environments of mental health institutions. Second, in the medical environment, the divided territoriality should be reviewed for various stakeholders as well as the coexistence. Third, it is necessary to promote medical service and environmental improvement through the service design process.

• 보건행정학회지
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• 제32권2호
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• pp.154-163
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• 2022

Background: The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit. Methods: We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. Results: In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated. Conclusion: High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.

• 보건행정학회지
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• 제25권3호
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• pp.185-196
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• 2015

Background: Issues concerning with the classification accuracy of Korean Outpatient Groups (KOPGs) have been raised by providers and researchers. The KOPG is an outpatient classification system used to measure casemix of outpatient visits and to adjust provider risk in charges by the Health Insurance Review & Assessment Service in managing insurance payments. The objective of this study were to refine KOPGs to improve the classification accuracy and to evaluate the refinement. Methods: We refined the rules used to classify visits with multiple procedures, newly defined chemotherapy drug groups, and modified the medical visit indicators through reviews of other classification systems, data analyses, and consultations with experts. We assessed the improvement by measuring % of variation in case charges reduced by KOPGs and the refined system, Enhanced KOPGs (EKOPGs). We used claims data submitted by providers to the HIRA during the year 2012 in both refinement and evaluation. Results: EKOPGs explicitly allowed additional payments for multiple procedures with exceptions of packaging of routine ancillary services and consolidation of related significant procedures, and discounts ranging from 30% to 70% were defined in additional payments. Thirteen chemotherapy drug KOPGs were added and medical visit indicators were streamlined to include codes for consultation fees for outpatient visits. The % of variance reduction achieved by EKOPGs was 48% for all patients whereas the figure was 40% for KOPGs, and the improvement was larger in data from tertiary and general hospitals than in data from clinics. Conclusion: A significant improvement in the performance of the KOPG was achieved by refining payments for visits with multiple procedures, defining groups for visits with chemotherapy, and revising medical visit indicators.

• 한국병원경영학회지
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• 제8권3호
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• pp.143-160
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• 2003

Due to the dramatic and situational change in medical industry, it has became very important to keep existing patients and to attract new patients by monitoring the medical consumer's expectation and various needs and ensuring the patients' satisfaction. This study regards the patients' satisfaction as the final object of medical service. So the object of this study is to provide useful data for the decision making and medical service marketing by exploring the problems generated by the cognition difference for the medical service between inpatients and outpatients, by responding for the problems and by examining the relationship between the satisfaction with the medical service and revisiting. To achieve the object of this study, literature research and empirical analysis were used. I establish the research model based on the existing service marketing and some hypotheses were chosen for the empirical analysis. As a result of empirical analysis for the five hypotheses, two hypotheses were chosen. First, there was cognition difference about accessibility and convenience between inpatient and outpatient. I guess that the satisfaction degree of inpatient is higher than the outpatient because the inpatient has the reliability for the hospital and determines the hospitalization or emergent coming to hospital. Second, the fifth hypothesis, "the satisfaction of patient will influence the revisiting." was chosen. The hypothesis is not only coincident with existing scholars and studies but also it provides the meaningful points for medical service marketing. The result shows that the parties concerned with hospital management should endeavor for the patient satisfaction in medical service, and that hospital management should be medical consumer centered. To measure the quality of medical service, the cognition differences for accessibility, convenience, physical environment, and human service were evaluated and the result shows that the cognition difference for the accessibility and convenience was outstanding. The analysis shows that there was cognition difference in the four categories among six subcategories in the human service -- the attitude of medical technologist, the attitude of doctor, the length of time for doctor's diagnosis for the patient and doctor's explanation. Therefore, I think that further study is required for the cause analysis for service categories which have cognition difference between inpatient and outpatient. I think the result will be very useful. Through this study, the relationship between patient satisfaction with the medical service and revisiting was verified. And it suggests that, to face the changing medical environment actively and to improve the quality of medical service, marketing strategy should be focused not on medical service providers but on medical service consumers and that the further studies for the medical consumer should be continued.

• 한국병원경영학회지
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• 제10권2호
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• pp.26-44
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• 2005

The purpose of this study was to investigate these major factors on patient satisfaction, and to examine the affecting level of major factors in. The subjects in this study was 70 hospitals that were surveyed the hospital evaluation program containing the survey of patient satisfaction by KHIDI(Korea Health Industry Development Institute) from 1997 to 1999. The collected data was analysed SPSS for Windows(Ver 10.0). On basically, frequency analysis, t-test, and ANOVA was performed and, for more analysis, correlation analysis, factor analysis, multiple regression analysis, logistic regression analysis was utilized. According to this study, the major factors of inpatient satisfaction are divided 3 types facility factor, manpower factor, and service factor. And the major factors of outpatient satisfaction are analyzed 5 types; facility factor related direct medical service, facility factor related indirect medical services, manpower factor, pharmacy factor, and facility factor related utilization convenience. The importance of this study lies in the identification of major factors on hospital patient satisfaction.

• 한국노년학
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• 제31권1호
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• pp.171-188
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• 2011

본 연구는 Andersen의 의료서비스 이용에 관한 행동모형을 근거로 2008년 장애인실태조사 자료를 분석하여 만 65세 이상 장애노인의 외래 및 입원이용에 영향을 미치는 요인을 파악하고자 하였다. 연구방법은 two-part 모델을 활용하여 장애노인의 외래 및 입원 이용 여부에 대해서는 로지스틱 회귀분석을, 의료 이용량 및 의료비 지출에 대해서는 다중 회귀분석을 실시하였다. 분석결과 외래와 입원의 이용에 공통적으로 만성질환과 주관적 건강상태 등의 질병요인의 영향이 유의하였고, 의료비 지출에는 의료보장 유형이 결정적 역할을 하고 있었다. 외래에서는 신장장애를 가졌을 때 이용량과 지출이 높았고, 입원에서는 일상생활의 수행에 도움이 필요할 때 입원일수가 증가하였으며, 심장장애와 호흡기장애를 가진 경우 입원료 지출이 유의하게 높았다. 이상의 결과는 장애노인들에게 만성질환 이환이나 일상생활 활동의 전적인 의존을 예방하는 보건의료 서비스의 제공, 의료이용이 높은 내부 장애를 가진 노인에 대한 지속적 보건관리체계의 구축, 그리고 저소득층 장애노인의 보건 의료 접근성 향상을 위한 경제적 지원의 필요성을 시사한다.

• Journal of Preventive Medicine and Public Health
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• 제44권1호
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• pp.48-55
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• 2011

Objectives: The purpose of this study was to examine the impact of Diagnosis-Related Group (DRG)-based payment on the length of stay and the number of outpatient visits after discharge in for patients who had undergone caesarean section. Methods: This study used the health insurance data of the patients in health care facilities that were paid by the Fee-For-Service (FFS) in 2001-2004, but they participated in the DRG payment system in 2005-2007. In order to examine the net effects of DRG payment, the Difference-In-Differences (DID) method was adopted to observe the difference in health care utilization before and after the participation in the DRG payment system. The dependent variables of the regression model were the length of stay and number of outpatient visits after discharge, and the explanatory variables included the characteristics of the patients and the health care facilities. Results: The length of stay in DRG-paid health care facilities was greater than that in the FFS-paid ones. Yet, DRG payment has no statistically significant effect on the number of outpatient visits after discharge. Conclusions: The results of this study that DRG payment was not effective in reducing the length of stay can be related to the nature of voluntary participation in the DRG system. Only those health care facilities that are already efficient in terms of the length of stay or that can benefit from the DRG payment may decide to participate in the program.

• 임상간호연구
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• 제22권3호
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• pp.305-313
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• 2016

Purpose: The purpose of this research was to identify the effects of providing an information service program by media on preoperative anxiety and postoperative educational satisfaction in patients with cataract surgery. Methods: For this study 52 patients who visited the ophthalmology clinic at P Hospital in B metropolitan city and who were scheduled to undergo one-day cataract surgery under local anesthesia were recruited. The 52 patients were assigned to the experimental group (25) or the control group (27). This study was conducted from August 27, 2015 to May 29, 2016. Results: Following the provision of cataract surgery related information service by media, the experimental group had a lower mean score for anxiety and higher mean score for educational satisfaction compared to the control group of patients. Conclusion: Results indicate that information service program by media "Goodbye Cataract" is useful educational materials for cataract patients in outpatient department and outpatient operating rooms.

• 한국산학기술학회논문지
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• 제16권12호
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• pp.8820-8829
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• 2015

최근 질병 치료과정에서 의료서비스에 대한 인식이 부각되면서 의료기관의 서비스 공간과 대기시간에 대한 연구가 활발히 진행되고 있다. 특히 종합병원 이용 시 방문자의 장시간 대기가 불가피하고, 이것은 환자에게 심리적 불안 및 부정적 감정으로 다가 올 것이다. 이는 의료소비자들의 불만을 가중시키고, 병원의 재방문 가능성을 낮추는 요인으로 작용하기 때문에 병원의 마케팅 및 이미지 제고를 위해서 대기시간의 연구가 절실한 실정이다. 따라서 본 연구는 의료서비스과정에서 발생하는 대기시간의 변수인 대기 환경과 대기 환자의 태도가 체감 대기 시간에 어떠한 영향을 주는가를 알아보고 병원 계획의 대안을 제시한 것을 연구목적으로 한다.