• Journal of Preventive Medicine and Public Health
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• 제11권1호
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• pp.123-127
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• 1978

The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are estab-lished for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The 'AUT-OGRP System' was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The 'Departmental Method' was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying patterns of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among the study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables (i. e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death. rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The wei틴fed mean total case cost (TOTC) of the study hospitals for Medicare patients during the study years was $11,27.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($743.45). The weighted mean per diem total cost (DTOC) of the study hospitals for Medicare patients during the sutdy years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the hospital with the lowest average DTOC ($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variance to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of interhospital cost variation: 59.1 percent for TOTC and 44.3 percent for DTOC. Thsee results demonstrate that the casemix index is the most importand determinant of interhospital cost variation Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.

• 기술혁신학회지
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• 제13권1호
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• pp.68-98
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• 2010

본 연구는 2004년부터 5년 동안 우리 경제의 성장잠재력을 확충하기 위한 일환으로 범부처적으로 추진된 차세대 성장동력사업의 추진성과를 분석하는 것을 목적으로 한다. 본 연구는 사업목적 및 설계, 전략적 기획, 사업운영관리, 사업성과, 범부처 협력 및 조정 등 5개 지표를 활용하여 성과분석을 수행하였다. 본 연구의 결과, 첫째, 사업목적 및 설계에서는 동 사업의 추진목적과 당위성은 인정되었지만, 사업추진체계와 재정자원이 부처별로 분산 추진됨에 따라 일관된 사업추진 리더십이 미흡하였다. 둘째, 전략적 기획에서는 사업목표 및 기술개발전략은 사업 초기에 수립되었지만, 기술적 목표에 치중되었고, 기술공급자 위주로 추진되었다. 셋째, 사업운영관리에서는 사업단장이 과제기획에서 제도개선에 이르기까지 총괄 관리하도록 결정되었으나, 이를 실행할 수 있는 부처 간의 협조체제가 미흡하였다. 넷째, 사업성과에서는 짧은 사업기간에도 불구하고 기술적 목표는 달성되었지만, 경제적 목표가 명확히 제시되지 않아 사업성과를 일관성 있게 파악하기에는 어려움이 있었다. 다섯째, 범부처 협력 및 조정에서는 동 사업을 추진하기 위한 조정기구는 과학기술기본법시행령에 법적근거를 두고 시행하였지만, 이를 실질적으로 운영할 수 있는 세부 규정이나 지침을 제정하지 못했다. 향후 차세대 성장동력사업과 유사한 범부처 연구개발사업을 기획하여 효율적으로 추진하기 위해서는 부처간 공동기획과 일원화된 사업설계, 사업목표와 예산배분체계의 명확화, 범부처적 사업운영과 평가 체계의 구축, 연구개발과 표준화 연계전략, 범부처 공동운영 규정의 제정 등이 필요하다.

• Applied Biological Chemistry
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• 제48권1호
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• pp.23-33
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• 2005

우리나라 농수산 분야의 현 여건을 SWOT 분석을 통해 확인해 보면, 강점 요인으로는 두터운 연구활동인력, 연구시설 등 연구 인프라의 구축, 선진국과 거의 격차가 없는 연구능력과 기술수준 등을 들 수 있다. 반면, 약점 요인으로는 관련 학회 및 연구소의 선도적 역할 부족, 차세대 연구인력의 감소, 특정학교 출신 연구인력 중심의 주류집단화, 국가정책 책임자 및 주요의사결정에 관여하는 경우나 인사 등이 적다는 점을 들 수 있다. 또한, 기회 요인으로는 동물복제연구 등 바이오산업에 대한 사회관심도 증가, 최신분야에서의 국제공동연구의 활발, 미개척분야가 많아 개발할 여지가 많다는 점 등을 들 수 있으며, 위협요인으로는 선진 각국의 농수산물 시장개방 압력 증가로 인한 수입 농산물의 증가, 전업농가수 감소로 인해 산업 존립기반이 위협 받고 있다는 점, 연구 결과의 경제적 사회적 효과 요구의 강화 등으로 볼 수 있다. 따라서 농수산 분야의 연구활동 활성화를 위해서는 중 장기 연구전략계획 수립, 농수산전문인력 DB 구축과 타분야 연구진 또는 농수산 세부분야간의 연계활용, 전략적 연구지원 분야의 도출 및 적정 연구지원단가 산출, 농수산 기초연구 특별프로그램 개발, 학회 내 정책기획 분과 신설, 평가문화의 개선 및 농수산 연구활동의 계량적 성과지표 개발 등에 따르는 본 분야의 연구지원을 위한 시스템의 구축과 활용이 필요하다.

• 환경정책연구
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• 제11권3호
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• pp.25-47
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• 2012

송이생산을 고려한 소나무비오톱유형화 및 지도 작성을 통한 송이생산지의 생태적 관리방안을 제시하고자 하였다. 연구대상지는 동서고속도로 신설구간 중 송이가 다량 생산되는 양양군구간을 대상으로 도로노선중앙에서 좌우 700m씩 범위내 총 $19.79km^2$을 설정하였다. 연구의 내용은 4단계로 구분하였으며 첫째, 양양군 송이관련특성, 둘째, 송이관련 선행연구 고찰, 셋째, 송이생산을 고려한 소나무비오톱유형화 기준 및 프로세스 정립, 넷째, 송이생산을 고려한 소나무비오톱지도화 등이다. 송이생산에 적합한 경사도 $30{\sim}40^{\circ}C$ 지역은 24.77%, 남향계열은 17.44%이었고 식생구조는 소나무군락 26.00%, 평균수령, $38{\pm}8.34$ 년생, 교목층 평균식생밀도 $9.55{\pm}4.98$ 주/$100m^2$ 등으로 송이생산에 최적 식생구조였다. 토양산도(pH)는 5.0~5.6(47.96%) > 5.6~7.0(42.90%) > 4.0~5.0(9.14%)로서 송이발생에 적합한 약산성 토양인 pH 4.0~5.6의 면적은 57.10%였다. A0층의 깊이는 평균 $3.39{\pm}2.14cm$이며 4~6cm(78.03%) > 0~2cm(18.10%) > 2~4cm(3.87%)였다. 선행연구와 현장조사 결과를 바탕으로 현존식생(소나무우점비율), 지형(지형특성 및 경사도), 수령, 토양특성(토양산도와 A0층 깊이), 식생밀도를 유형화 기준으로 설정하여 총 6개 송이생산을 고려한 소나무비오톱유형으로 구분하였다. 유형별 분포면적은 송이생산잠재(II)소나무비오톱유형(32.86%) > 송이생산 부적합 소나무비오톱유형(22.17%) > 송이생산적합(II)소나무비오톱유형(17.79%) > 송이생산적합(I)소나무비오톱유형(14.86%) > 송이생산잠재(I)소나무비오톱유형(9.77%) > 송이생산소나무비오톱유형(2.55%) 등의 순이었다.

• 한국인구학
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• 제26권2호
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• pp.1-32
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• 2003

시도의 사망원인별 사망력 분석은 정책수립에 필수적인 정보를 제공하고, 각종 질병 및 사망 원인에 대한 가설을 설정하게 한다. 사회경제적, 문화적, 의료적, 생태학적 이유 등 다양한 원인이 시도의 사망원인별 사망수준에 복합적으로 영향을 주지만, 이 연구에서는 시도의 사망원인별 사망력에 대한 설명보다는 공통점과 차이점 파악을 주 목적으로 하였다. 이를 위하여 1998년 기준 사망신고 및 주민등록인구 자료를 활용하여, 시도별로 지연신고와 영아사망 신고누락을 보완하고, 연령표준화사망률과 생명표를 작성하였다. 모든 사인에 의한 사망수준 관련 주요 결과는 다음과 같다: (1) 남녀전체를 합하여 서울이 가장 낮은 사망수준을 전남은 가장 높은 사망수준을 보였다: (2) 시도간 사망수준의 차이가 여자보다 남자에게서, 65세 이상보다 604세 이하 연령층에서 더 컸다. 사망원인별 사망력 관련 남녀별 및 남녀 전체를 합하여 연령표준화 사망률이나 출생시 사망확률이라는 지표 모두에서 일관된 유형을 보이는 주요 결과는 다음과 같다: (1) 심장질환에 의한 사망수준은 부산에서 최고, 강원도에서 최저를 나타냈고: (2) 간질환에 의한 사망수준은 전남에서 최고를; (3) 운수사고에 의한 사망수준은 충남에서 최고 인천에서 최저로 나타났다. 시도의 사망수준 차이에는 다양한 요인이 관련되어 있으므로 사회경제적 변수를 포함한 25개의 설명 변수와 총90개의 사망력 변수에 대한 탐색적 통계분석을 실시하였다. 모든 사인에 의한 사망력은 사회경제적 변수와 밀접한 관련이 있으며, 사망원인별로는 간질환 및 운수사고에 의한 사망력이 사회경제적 변수와 관련이 있는 것으로 나타났다. 끝으로 사망신고 자료의 질 개선 필요성을 논의하고 있다.

• 보건교육건강증진학회지
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• 제2권1호
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• pp.3-50
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• 1984

The levels of health knowledge, attitude and practice of housewives considerably effect to the health of households, communities and the nation. This study was designed to grasp the levels of health knowledge, attitude and practice of houswives and analyse the various factors effecting to health in order to provide health education services as well as materials for effective formulation and implementation of health policy to improve the health of the nation. This study has been conducted through interviews by trained surveyers for 4,281 housewives selected from 4,500 households throughout the country for 40 days during July 11-August 20, 1983. The results of survey were analysed by stepwise multiple regression and path analysis are summarized as follows; 1. Based on the measurement instrument applied to this study, the levels of health knowledge, attitude and practice of housewives were extremely low with 54.5 points out of 100 points in full. Higher level with 72 points and above was approximately 21 percent and lower level with 39 points and below was approx. 24 percent. The middle level was approx. 55 percent. In order to implement health programs successively, health education should be more strengthened and to improve the level of health knowledge, attitude and practice (KAP) of the nation, political consideration as a part of spiritual reformation must be concentrated on health. 2. The level of health knowledge indicated the highest points with 57.3 the level of attitude was the second with 55.0 points and the practice level was the lowest with 50.0 point. Therefore, planning and implementation of health education program must be based on the persuasion and motivation that health knowledge turn into practice. 3. Housewives who had higher level of health knowledge, showed their practice level was relatively lower and those who had middle or low level of it practice level was the reverse. 4. Correlations among health knowledge, attitude and practice (KAP) were generally higher and statistically significant at 0.1 percent level. Correlation between total health KAP level and health knowledge was the highest with r=.8092. 5. Health KAP levels showed significant differences according to the age, number of children, marital status, self-assessed health status and concern on health of the housewives interviewed (p<0.001) 6. Health KAP levels also showed significant differences according to the education level, economic status, employment before marriage and grown-up area of the housewives interviewed. (p<0.001) 7. Heath KAP levels showed significant differences according to health insurance benificiary and the existence of patients in the family. (p<0.001). 8. Health KAP levels showed significant differences according to distance to government organizations, schools, distance to health facilities, telephone possession rate, television possession rate, newspaper reading rate and activities of Ban meeting and Women's club. (p<0.001) 9. Health KAP levels showed significant differences according to electric mass communication media such as television, radio and village broadcasting etc. and printed media such as newspaper, magazine and booklets etc., IEC variables such as individual consultation and husband-wife communication, however, there was no significance with group training. 10. Health KAP of the housewives showed close correlation with personal characteristics variables, i.e., education level (r=.5302), age (r=-.3694) grown-up area (r=.3357) and employment before marriage. In general, correlation of health knowledge level was higher than the levels of attitude or practice. In case of health concern and health insurance, correlation of practice level was higher than health knowledge level. 11. Health KAP levels showed higher correlation with community environmental characteristics, Ban meeting and activity of Women's club, however, no correlation with New-village movement. 12. Among IEC variables, husband-wife communication showed the highest correlation with health KAP levels and printed media, electric mas communication media and health consultation in order. Therefore, encouragement of husband-wife communication and development of training program for men should be included in health education program. 13. Mass media such as electric mass com. and printed media were effective for knowledge transmission and husband-wife communication and individual consultation were effective for health practice. Group training was significant for knowledge transmission, however, but not significant for attitude formation or turning to health practice. To improve health KAP levels, health knowledge should be transmitted via mass media and health consultation with health professionals and field health workers should be strengthened. 14. Correlation of health KAP levels showed that knowledge level was generally higher than that of practice and recognized that knowledge was not linked with attitude or practice. 15. The twenty-five variables effecting health KAP levels of housewives had 41 per cent explanation variances among which education level had great contribution (β=.2309) and electric mass com. media (β=.1778), husband-wife communication (β=.1482), printed media, grown-up area, and distance to government organizations in order. Variances explained (R²) of health KAP were 31%, 15%, and 30% respectively. 16. Principal variables contributed to health KAP were education level (β=.12320, β=.1465), electric mass comm. media (β=.1762, β=.1839), printed media, (β=.1383, β=.1420) husband-wife communication (β=.1004, β=.1067), grown-up area and distance to government organizations, in order. Since education level contributes greatly to health KAP of the housewives, health education including curriculum development in primary, middle and high schools must be emphasized and health science must be selected as one of the basic liberal arts subject in universities. 17. Variences explained of IEC variables to health KAP were 19% in total, 14% in knowledge, 9% in attitude, and 10% in health practice. Contributions of IEC variables to health KAP levels were printed media (β=.3882), electric mass comm media (β=.3165), husb-band wife com. (β=.2095,) and consultation on health (β=.0841) in order, however, group training showed negative effect (β=-.0402). National fund must be invested for the development of Health Program through mass media such as TV and radio etc. and for printed materials such as newspaper, magazines, phamplet etc. needed for transmission of health knowledge. 18. Variables contributed to health KAP levels through IEC variables with indirect effects were education level (Ind E=0.0410), health concern (Ind E=.0161), newspaper reading rate (Ind E=.0137), TV possession rate and activity of Ban meeting in order, however, health facility showed negative effect (Ind E=-.0232) and other variables showed direct effect but not indirect effect. 19. Among the variables effecting health KAP level, education level showed the highest in total effect (TE=.2693) then IEC (TE=.1972), grown-up city (TE=.1237), newspaper reading rate (TE=.1020), distance to government organization (TE=.095) in order. 20. Variables indicating indirect effects to health KAP levels were; at knowledge level with R²=30%, education level (Ind E=.0344), newspaper reading rate (Ind E=.0112), TV possession rate (Ind E=.0689), activity of Ban meeting (Ind E=.0079) in order and at attitude level with R²=13%, education level (Ind E=. 0338), activity of Ban meeting (Ind E=.0079), and at practice level with R²=29%. education level (Ind E=.0268), health facility (Ind E=.0830) and concern on health (Ind E=.0105). 21. Total effect to health KAP levels and IEC by variable characteristics, personal characteristics variables indicated larger than community characteristics variables. 22. Multiple Correlation Coefficient (MCC) expressed by the Personal Characteristic Variable was .5049 and explained approximately 25% of variances. MCC expressed by total Community environment variable was .4283 and explained approx. 18% of variances. MCC expressed by IEC Variables was .4380 and explained approx. 19% of variances. The most important variable effected to health KAP levels was personal characteristic and then IEC variable, Community Environment variable in order. When the IEC effected with personal characteristic or community characteristic, the MCC or the variances were relatively higher than effecting alone. Therefore it was identified that the IEC was one of the important intermediate variable.