• Journal of Korean Academy of Nursing Administration
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• v.3 no.2
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• pp.151-165
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• 1997

A cost analysis for hospitalized patients was performed based on the KDRG classification in order to determine an appropriate nursing fee under the PPS(Prospective Payment System). The data was collected from 20 nursing units of three tertiary hospitals and two secondary hospitals from August 26 to September 15, 1996. The study consisted of 148 inpatients diagnosed for lens procedures(KDRG 03900), tonsillectomy &/or adenoidectomy(KDRG 16100), Cesarean section(KDRG 37000), or vaginal delivery(KDRG 37300) without any complications. The direct or indirect nursing hours of each patients were measured. Then, direct or indirect nursing expenditures of four nursing units, operating room and delivery room were computed. Finally, the resources used including average total nursing hours, average length of stay and average nursing cost of each KDRG were estimated as follows; 1) The average total nursing hours were 640 minutes for lens procedures, 403 minutes for tonsillectomy &/or adenoidectomy, 934 minutes for appendectomy with complicated principal diagnosis, 1,094 minutes for Cesarean section and 631 minutes for vaginal delivery. Significant differences were found in average total nursing hours among hospitals. 2) The average length of stay in lens procedures were 5 days, 4 days for tonsillectomy &/or adenoidectomy, 6 days for appendectomy with complicated principal diagnosis, 8 days for Cesarean section and 3 days for vaginal delivery. All results were within normal determined by the Ministry of Health and Welfare although significant differences existed among hospitals, especially with average length of stay for leng procedures between tertiary hospitals and secondary hospitals which was greater than for those of others. 3) The average nursing cost were 87,146 Won for lens procedures, 69,600 Won for tonsillectomy &/or adenoidectomy, 128,337 Won for appendectomy with complicated principal diagnosis, 151,769 Won for Cesarean section and 85,403 Won for vaginal delivery. These costs were 7.6%, 13.0%, 13.0%, 16.0% and 22.0%, respectively, of the official price fixed by the Ministry of Health and Welfare under the prospective payment system. Research for the analysis of nursing costs according to the severity of illness for those KDRGs shoud be carried out within the period of the PPS pilot project. In addition, a proper nursing fee schedule for a new reimbursement system based upon the result of the above research should be prepared in the near future.

• Proceedings of the KSR Conference
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• 2010.06a
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• pp.1148-1158
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• 2010

This paper addresses prospect of the technology for development of NxTIS (NeXt generation Transport Information System) that is targeted to shifting Korean public transit framework to railway-centered one. The Seoul metropolitan area has adopted the smart-card as a payment system for the public transportation since 2004. The transportation record can be used as quite useful information for better planning and operating of the railway system, particularly when the smart-card based payment system is extended to whole nation. This paper introduces technologies to develop Real OD DB and NxTIS, and presents road-map for them. A variety of benefits from the development of the system are estimated both in quantitative and qualitative. The Real OD DB based NxTIS will work to highly prospective for creating a novel value in the railway as a public transportation system.

• Journal of Preventive Medicine and Public Health
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• v.27 no.1 s.45
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• pp.107-116
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• 1994

The United States adopted DRG based prospective payment system (PPS) in order to control the inflation of health care costs. No study used statistical test while many studies reported the cost containing effect of the PPS. To study impacts of the PPS on the Medicare expenditure, this study set the following three hypotheses (1) The PPS decelerated the increase in the hospital expenditure (Part A), (2) the PPS accelerated the increase in the expenditure of outpatients and physicians (Part B), (3) the increase in total expenditure was decelerated inspite of the spill over (substitution) effect because saving in the Part A expenditure were greater than losses in the Part B expenditure. The dependent variables are per capita hospital expenditure, per capita Part B expenditure, and per capita total expenditure for the Medicare beneficiaries. An intervention analysis, which added intervention effect to the time series variation on the Box-Jenkins model, was used. The observations included 120 months from 1978 to 1987. The results are as follows : (1) The annual increase in the per capita Part A expenditure was $5.11 after the implementation of DRG where as that before the PPS had been $11.1. The effect of the reduction ($5.99) was statistically significient (t=-3.9). (2) The spill over (substitution) effect existed because the annual increase in the per capita Part B expenditure was accelerated by $1.73 (t=1.91) after the implementation of the PPS. (3) The increase in the total Medicare expenditure per capita was reduced by $4.26 (t=-2.19) because the spill over effect was less than cost savings in the Part A expenditure.

• Journal of Korean Clinical Nursing Research
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• v.19 no.3
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• pp.321-332
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• 2013

Purpose: Korean health insurance extended application of the Diagnosis Related Groups (DRG) payment system to tertiary and general hospitals from July, 2013. This study was done to develop a DRG fee adjustment mechanism applied to levels of nurse staffing to assure quality nursing service. Methods: Nurse stafffing grades among hospitals in Korea were analyzed. Differences and ratio of inpatient costs by nurse staffing grades in DRG fees and differences of DRG fee between tertiary and general hospitals were compared. Results: In 2013, nurse staffing grades in tertiary and general hospitals had improved, but other hospital nurse staffing grades remained at the 2001 level. Gaps of inpatient costs between first and seventh nurse staffing grades were over 10% in 4 out of 7 DRG diagnosis; However differences of DRG fee between tertiary and general hospitals were only 4.51% and 4.72% respectively. A DRG fee adjustment mechanism was developed that included nurse staffing grades and hospitalization days as factors of the formula. Conclusion: Current DRG fees motivate hospitals to decrease nurse staffing grades because cost reduction is bigger than compensation. This DRG fee adjustment mechanism reflects nurse staffing supply to motivate hospitals to hire more nurses as a reasonable compensation system.

• Health Policy and Management
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• v.10 no.4
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• pp.20-56
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• 2000

The purpose of this article was to evaluate the effects of reimbursement system on the basis of diagnosis-related groups(DRGs). We searched articles which was published from 1970 to 2000 using MEDLINE ； Key words "diagnosis-related groups, DRGs, prospective payment system, PPS. Then we reviewed 97 articles on classifying them into several categories of contents. It seems that the effects of DRGs in controlling hospitals cost in the U.S. was not clear cut. The U.S. Medicare PPS using DRGs remains vulnerable to compensatory increases in ambulatory care and long-term care facilities utilization despite cost per case and cost per admission being reduced. Also some research indicated the possibilities of deterioration in health care service quality. So putting theses results together, much more consideration is needed before the application of DRGs reimbursement system in Korea. Particularly there is the crucial difference between U.S. health care system and Korean, we must be aware of the limitations of DRGs and revise the DRG system to applicable in Korea.orea.

• Quality Improvement in Health Care
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• v.12 no.2
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• pp.75-83
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• 2006

Background : Utilization review has been adopted as a vehicle for cost and utilization control of health care services. Its role was further stressed and expanded through the establishment of Health Insurance Review Agency in 2001. This article is to introduce concept, activities, and effect of utilization review based on the experiences of U.S. and to suggest important characteristics for ideal utilization review activities at the national level in Korea. Method : Twenty-five articles related with utilization review were reviewed after being selected through web site search through Med Line and Richis. Result : Utilization review was introduced mainly for health care expenditure control either by insurer, provider or the third parties under the pressure of increasing health care cost. It's activities can be categorized to prospective, concurrent and retrospective review according to the time of service provision. Based on most of studies, utilization review has been effective in controling rising health care cost and utilization. However it's effectiveness assumes a reimbursement structure of managed care like capitation payment. More worse, it is still unknown it's effectiveness on quality of care. Conclusion : Utilization review should be employed to increase the cost effectiveness of medical care by optimizing quality and patient's outcomes while also attempting to reduce the use of resources. So, it should consider outcomes before expenditures, check for both under and over-use, and construct an structure in which consumption is reduced equitably. Aggressive adoption of utilization review in Korean health care setting with fee-for-service reimbursement structure might not be a cost-effective approach before adoption of prospective payment system such as D.R.G. and capitation.

• 대한예방의학회:학술대회논문집
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• 2001.10a
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• pp.199-200
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• 2001

• Korea Journal of Hospital Management
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• v.12 no.3
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• pp.1-19
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• 2007

This study focused on finding the variation of medical service utilization and medical payments of the patients died by three, cancers, stomach, breast, and colon cancer. For this study, data of the one-year episodes of the health insurance subscribers died in 2004 were selected. The frequency of medical visits, the lengths of slays, the days of outpatient visits, the total period of medical services and the total medical payments were compared by the characteristics of the suppliers and utilizers. The data of the patients died by cerebrovascular diseases and cancer in 2004 were selected. To select the dead by cerebrovascular diseases and cancer in 2004, were matched the 2004 reimbursement data of all medical institutions to the data of funeral fee payment by the National Health Insurance Corporation from January 2004 to May 2005 for the death in 2004. The results of the analysis were as follow. The variation of medical service utilization of the dead by cancers were not small in Korea. The current study found that the variation of medical care utilization was influenced by the factors of suppliers, such as types and locations of medical institutions and the factors of users, such as sex and age. It was suspected that the reimbursement by fee-for-service contributed to the variation quite a lot, but we could not compare the variation between the different reimbursement systems in Korea. The results of the study suggested that tile factors of suppliers and utilizers should he reviewed to reduce the under use and over use expressed by variations of medical service utilization. The processes of care, effective communication and management system should be investigated for the equity of medical service utilization. Additionally, prospective payment could he recommended to reduce the high variation of medical service Use. To find the variation caused by under use and over use, further study need to control the severity of diseases, socio-economic status of the users and the system factors.

• Health Policy and Management
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• v.14 no.1
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• pp.121-147
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• 2004

Since the pilot program for a DRG-based prospective payment system was introduced in 1997, the performance of KDRGs has been one of hotly debated issues. The objectives of this study are to refine the classification algorithm of the KDRGs and to assess the improvement achieved by the refinement. The U.S. Medicare DRGs version 17.0 and the Australian Refined DRGs version 4.1 were reviewed to identify areas of possible impro-vement. Refined changes in the classification and result of date analyses were submitted to a panel of 48 physicians for their reviews and suggestions. The refinement was evaluated by the variance reduction in resource utilization achieved by the KDRG The database of 2,182,168 claims submitted to the Health Insurance Review Agency during 2002 was used for evaluation. As the result of the refinement, three new MDCs were introduced and the number of ADEGs increased from 332 to 674. Various age splits and two to four levels of severity classification for secondary diagnoses were introduced as well. A total of 1,817 groups were defined in the refined KDRGs. The variance reduction for charges of all patients increased from 48.2％ to 53.6％ by the refinement, and from 65.6％ to 73.1％ for non-outlier patients. The r-square for length of stays of all patients was increased from 28.3％ to 32.6％, and from 40.4％ to 44.9％ for non-outlier patients. These results indicated a significant improvement in the classification accuracy of the KDRG system.

• Korean Journal of Construction Engineering and Management
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• v.22 no.4
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• pp.59-65
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• 2021

Since the 2016 "Housing Act Partial Amendment" and the "2018 Housing Comprehensive Amendment Plan", interest in the pre sale system and post sale system of apartment houses has been on the rise. In order to compare the advantages and disadvantages of the pre sale system and the post sale system of apartment houses, and to establish the basis for the institutional policy of the post sale system, a questionnaire survey method was used for tenants of the apartment house from the public side, and issues of time and cost. The time series analysis method is intended to suggest an appropriate time for payment of contributions. Accordingly, through a review of existing theories and literature, the post sale system of public and private institutions was organized, and through a questionnaire survey, the path to securing pre sale money, product information of the model house, and the degree of awareness of the effect of the post sale system were investigated. For the post sale fund support and payment method, it is necessary to increase the commercial line for existing financiers from the user's point of view, and it is necessary to operate in consideration of the economic power of the pre sale market by region. Both 60% post sale and 80% post sale have a price range of up to KRW 10 million, and the total interest rate is 5.0%, and the annual interest rate is about 2.8% for 60% post sale, and about 2.1% for 80% post sale, which is lower than the current 3.1%. I need an interest rate. The research is a perception survey targeting a total of 5,213 households in a sample of after sale apartments in public institutions. As the actual values are analyzed using a time series on the effects of market supply and demand and market prices, there is a limit to applying them to prospective residents of private apartments. In addition, to respond to first time tenants, a questionnaire survey was conducted on five complexes that have moved in within the last five years.