• Journal of Preventive Medicine and Public Health
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• 제42권4호
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• pp.267-273
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• 2009

Objectives : To compare the performance of three comorbidity measurements (Charlson comorbidity index, Elixhauser s comorbidity and comorbidity selection) with the effect of different comorbidity lookback periods when predicting in-hospital mortality for patients who underwent percutaneous coronary intervention. Methods : This was a retrospective study on patients aged 40 years and older who underwent percutaneous coronary intervention. To distinguish comorbidity from complications, the records of diagnosis were drawn from the National Health Insurance Database excluding diagnosis that admitted to the hospital. C-statistic values were used as measures for in comparing the predictability of comorbidity measures with lookback period, and a bootstrapping procedure with 1,000 replications was done to determine approximate 95% confidence interval. Results : Of the 61,815 patients included in this study, the mean age was 63.3 years (standard deviation: ${\pm}$10.2) and 64.8% of the population was male. Among them, 1,598 2.6%) had died in hospital. While the predictive ability of the Elixhauser's comorbidity and comorbidity selection was better than that of the Charlson comorbidity index, there was no significant difference among the three comorbidity measurements. Although the prevalence of comorbidity increased in 3 years of lookback periods, there was no significant improvement compared to 1 year of a lookback period. Conclusions : In a health outcome study for patients who underwent percutaneous coronary intervention using National Health Insurance Database, the Charlson comorbidity index was easy to apply without significant difference in predictability compared to the other methods. The one year of observation period was adequate to adjust the comorbidity. Further work to select adequate comorbidity measurements and lookback periods on other diseases and procedures are needed.

• 보건행정학회지
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• 제21권4호
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• pp.527-540
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• 2011

Some patients tend to visit tertiary hospitals instead of non-tertiary hospitals for minor illnesses, which is a chronic problem within the Korean health care delivery system. In order to reduce the number of patients with minor severity diseases unnecessarily utilizing the tertiary medical services in Korea, the Ministry of Health and Welfare raised the outpatient co-insurance rate for the tertiary hospitals in July, 2009. Another increase in the prescription drug co-insurance rate by the general and tertiary hospitals is scheduled to take place in the second half of 2011. An increase in copayments may discourage the utilization rate of medical services among the underprivileged or patients who require complicated procedures. This study aims to analyze the diabetic patients' utilization rates of tertiary hospitals according to the Comorbidity score. Diabetic patients' data was gathered from the Health Insurance Claims Records in the Health Insurance Review & Assessment Service between 2007-2009. Comorbidity scores are measured by the Charlson Comorbidity Index and the Elixhauser Index. Chi-square and logistic regressions were performed to compare the utilization rates of both insulin-dependents (n=94,026) and non-insulin-dependents (n=1,424,736) in tertiary hospitals. The higher Comorbidity outcomes in the insulin-dependent diabetic patients who didn't visit tertiary hospitals compared to those who did, was expected. However, after adjusting the gender, age, location, first visits and complications, the groups that scored >=1 on the comorbidity scale utilized the tertiary hospitals more than the O score group. Non-insulin-diabetic patients with higher Comorbidity scores visited tertiary hospitals more than patients who received lower grades. This study found that patients suffering from severe diabetes tend to frequently visit the tertiary hospitals in Korea. This result implied that it is important for Korea to improve the quality of its primary health care as well as to consider a co-insurance rate increase.

• 경영정보학연구
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• 제24권3호
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• pp.1-21
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• 2022

최근 모바일 플랫폼 기반 비즈니스의 증가와 함께 온라인 숙박 예약 시장이 커지고 있다. 본 연구에서는 서비스 품질에 대한 불확실성이 높은 온라인 숙박 예약 플랫폼에서 부정적 리뷰의 대응 전략이 숙박 업체의 성공에 미치는 영향을 살펴보았다. 국내 최대 숙박 예약 플랫폼에 등록된 856개의 모텔을 대상으로 호스트의 대응 전략의 숙박시설 성공에 대한 효과를 확인한 결과, 부정적 리뷰에 대한 호스트의 답변수가 많고(적극성), 답변 속도(적시성)가 빠를수록 성공에 정(+)의 영향을 주는 것으로 확인되었다. 또한 두 가지 대응 전략에는 정(+)의 상호작용 효과가 있음을 보였다. 마지막으로 평판 하락에 따른 호스트의 대응 전략을 확인한 결과, 평판 하락 발생 시 부정적 리뷰에 대한 대응 적극성의 효과는 증가하였다. 본 연구는 숙박업체의 성공에 효과적인 호스트의 대응 전략을 규명하였으며, 평판 하락에 따른 호스트의 대응 전략의 효과성을 확인한 연구라는 점에서 학술적, 실무적 의의가 있다.

• 보건행정학회지
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• 제22권1호
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• pp.29-48
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• 2012

The purpose of this study is to analyze medical expenses by decedents in their last year of life and compare them with those by survivors during the year 2008. This study is conducted firstly in Korea, except some studies focusing on medical cost of decedents from specific diseases. To study this, national health insurance(NHI) claims data was used with medicaid claims data. The study group(decedents) was selected from the insurance entitlement file who were dropped out from January to December of 2008. The control group(survivors) was selected from the entitlement file by stratified sampling with keeping age-sex composition of the study group. The medical expenses of decedents during one year before death were measured and compared with those of survivors by sex and age. And the medical expenses were analyzed by causes of death, and also the expenses were examined by each item of medical services. On average, the medical expense amounted to 11 million Korean Won per decedent during their last year of life in 2008. The medical expense per decedent was 9.3 higher than that of survivor. The death-related expense of under the age 35 was about 16 million Won, compared with 4 million Won in the case of over the age 95, in average. The death-related expense is higher in younger ages. This means that more medical resources are put in to save life in younger ages. Total death-related expenditure took 8.3 percent in total NHI expenditures. Of the death-related medical expenses, the largest one was injection-related cost which shares twenty five percent, and the second largest one was hospitalization charges, and then the third one was surgery cost. The results of this study suggested that we should pay attention to the medical expenses in the last of year of life when we study health care expenditure in Korea. In addition, we have to deliberate health care policy to cope with medical expenditures before death in more efficient way.

• 동의신경정신과학회지
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• 제29권3호
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• pp.135-144
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• 2018

Objectives: The purpose of this study was to analyze the medical cost for patients with vertigo and to examine associations between chronic vertigo and mental disorder using 2014 Health Insurance Review & Assessment Service-National Patients Sample (HIRA-NPS). Methods: We analyzed sociodemographic characteristics, medical cost and medical care use pattern for vertigo patients. We used hierarchical multiple logistic regression analysis to examine odds ratio between chronic vertigo and mental disorder. Results: A total of 46,502 people and 118,504 claims data were identified for vertigo cases. Characteristics of vertigo patients have significant differences on proportion of female patients (68.36%), patients' average age (54.98) and proportion of medical assistance (5.76%) compared with non-vertigo patients. Results revealed that Korean medicine are one of frequent methods among total treatments for vertigo patients. Total days of medical care and total costs are 2.78 days and 111,362 won, respectively, and days for outpatients in Korean medical care (mean: 2.26 days) are more than those (mean: 5.05 days) in Western medical care. There is significant difference relative to sex between acute vertigo and chronic vertigo. The odds ratio between chronic vertigo and mental disorder is estimated as 1.34, that means risk of becoming chronic is 34% higher for vertigo patients with mental disorder. Conclusions: This study assessed socio-demographic characteristics, medical care use and expenses related to vertigo, and estimated associations between chronic vertigo and mental disorder. Findings provide a basis for economic evaluation studies on vertigo patients and development of clinical practice guidelines for vertigo patients with mental disorder.

• Journal of Preventive Medicine and Public Health
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• 제42권2호
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• pp.135-142
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• 2009

Objectives : An appropriate sampling strategy for estimating an epidemiologic volume of diabetes has been evaluated through a simulation. Methods : We analyzed about 250 million medical insurance claims data submitted to the Health Insurance Review & Assessment Service with diabetes as principal or subsequent diagnoses, more than or equal to once per year, in 2003. The database was re-constructed to a 'patient-hospital profile' that had 3,676,164 cases, and then to a 'patient profile' that consisted of 2,412,082 observations. The patient profile data was then used to test the validity of a proposed sampling frame and methods of sampling to develop diabetic-related epidemiologic indices. Results : Simulation study showed that a use of a stratified two-stage cluster sampling design with a total sample size of 4,000 will provide an estimate of 57.04%(95% prediction range, 49.83 - 64.24%) for a treatment prescription rate of diabetes. The proposed sampling design consists, at first, stratifying the area of the nation into "metropolitan/city/county" and the types of hospital into "tertiary/secondary/primary/clinic" with a proportion of 5:10:10:75. Hospitals were then randomly selected within the strata as a primary sampling unit, followed by a random selection of patients within the hospitals as a secondly sampling unit. The difference between the estimate and the parameter value was projected to be less than 0.3%. Conclusions : The sampling scheme proposed will be applied to a subsequent nationwide field survey not only for estimating the epidemiologic volume of diabetes but also for assessing the present status of nationwide diabetes control.

• Journal of Preventive Medicine and Public Health
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• 제43권6호
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• pp.496-504
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• 2010

Objectives: The purpose of this study was to analyze the effect of outpatient cost-sharing on health care utilization by the elderly. Methods: The data in this analysis was the health insurance claims data between July 1999 and December 2008 (114 months). The study group was divided into two age groups, namely 60-64 years old and 65-69 years old. This study evaluated the impact of policy change on office visits, the office visits per person, and the percentage of the copayment-paid visits in total visits. Interrupted time series and segmented regression model were used for statistical analysis. Results: The results showed that outpatient cost-sharing decreased office visits, but it also decreased the percentage of copayment-paid visits, implying that the intensity of care increased. There was little difference in the results between the two age groups. But after the introduction of the coinsurance system for those patients under age 65, office visits and the percentage of copayment-paid visits decreased, and the 60-64 years old group had a larger decrease than the 65-69 years old group. Conclusions: This study evaluated the effects of outpatient cost-sharing on health care utilization by the aged. Cost sharing of the elderly had little effect on controlling health care utilization.

• 한국병원경영학회지
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• 제25권3호
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• pp.53-66
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• 2020

This study is aimed at investigated and compared the differences in the affect of hospital specialization according to hospital size using claims data of the Health Insurance and Review Assessment National Inpatient Sample in 2018 for diseases of the musculoskeletal system and connective tissue. To this end, we used multivariate hierarchical linear models(a.k.a., multi-level models) using two-tier data from 106,599 patients discharged after diseases of the musculoskeletal system and connective tissue from 734 hospitals. Multivariate results indicate that patients who were discharged with diseases of the musculoskeletal system and connective tissue from specialized hospitals with 200 beds or less stayed shorter and paid less inpatient charge than those who were discharged from less specialized hospitals. But for hospitals with 201-300 beds, no positive impact relationship was found between hospital specialization and operational performance. This finding may be limited evidence that the affect of a hospital's specialization strategy may vary depending on the size of the hospital. We discussed several managerial and health policy implications below.

• 한국임상약학회지
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• 제29권3호
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• pp.202-208
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• 2019

Objective: Suicide has recently become an important social problem. Thus, we analyzed prescription drugs that cause suicidal ideation. Methods: Of 156 drugs on the the Minister of Food and Drug Safty (MFDS) EZ-Drug site that had "suicide" listed as a side effect, 78 had "suicide" listed as a warning or contraindication; those 78 drugs were analyzed using data from the 2016 Health Insurance and Review and Assessment Services National Patient Sample (HIRA-NPS). Results: 51 "suicide risk" drugs was identified. Of all patients, 5.2% had received such drugs. The prescription rate was 0.8% of all prescriptions, accounting for 1.6% of all prescription days. From logistic regression analysis, the prescription rate for the drugs was approximately 1.1 times higher for women than for men. With regard to age, the prescription rate for patients 66 years and older was 15.5 times higher than those for patients 25-years and lower. With regard to medical departments, the prescription rates in psychiatry and dermatology departments were 8.1 times higher and 0.6 times lower than those in internal medicine departments, respectively. With regard to region, the prescription rates in Daegu and Jeju were 1.3 times higher and 0.79 times lower than those in Seoul, respectively. Conclusion: Drug-induced suicidal behavior is possible, and therefore efforts are needed to prevent it.

• 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.