• Journal of Preventive Medicine and Public Health
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• v.22 no.4 s.28
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• pp.542-554
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• 1989

The skyrocketing inflation of medical costs has become a major health problem among most developed countries. Korea, which recently covered the entire population with National Health Insurance, is facing the same problem. The proportion of health expenditure to GNP has increased from 3% to 4.8% during the last decade. This was remarkable, if we consider the rapid economic growth during that time. A few policy analysts began to raise cost containment as an agenda, after recognizing the importance of medical cost inflation. In order to Prepare an appropriate alternative for the agenda, it is necessary to find out reasons for the cost inflation. Then, we should focus on the reasons which are controllable, and those whose control are socially desirable. This study is designed to articulate the theory of medical cost inflation through literature reviews, to find out reasons for cost inflation, by analyzing aggregated data with a deterministic model. Finally to identify determinants of changes in both medical demand and service intensity which are major reasons for cost inflation. The reasons for cost inflation are classified into cost push inflation and demand pull inflation, The former consists of increases in price and intensity of services, while the latter is made of consumer derived demand and supplier induced demand. We used a time series (1983-1987), and cross sectional (over regions) data of health insurance. The deterministic model reveals, that an increase in service intensity is a major cause of inflation in the case of inpatient care, while, more utilization, is a primary attribute in the case of physician visits. Multiple regression analysis shows that an increase in hospital beds is a leading explanatory variable for the increase in hospital care. It also reveals, that an introduction of a deductible clause, an increase in hospital beds and degree of urbanization, are statistically significant variables explaining physician visits. The results are consistent with the existing theory, The magnitude of service intensity is influenced by the level of co-payment, the proportion of old age and an increase in co-payment. In short, an increase in co-payment reduced the utilization, but it induced more intensities or services. We can conclude that the strict fee regulation or increase in the level of co-payment can not be an effective measure for cost containment under the fee for service system. Because the provider can react against the regulation by inducing more services.

• Korean Chemical Engineering Research
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• v.52 no.4
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• pp.467-474
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• 2014

Preliminary design in chemical process furnishes economic feasibility through calculation of both mass balance and energy balance and makes it possible to produce a desired product under the given conditions. Through this design stage, the process possesses unchangeable characteristics, since the materials, reactions, unit configuration, and operating conditions were determined. Unique characteristics could be very economic, but it also implies various potential risk factors as well. Therefore, it becomes extremely important to design process considering both economics and safety by integrating process simulation and quantitative risk analysis during preliminary design stage. The target of this study is LNG liquefaction process. By the simulation using Aspen HYSYS and quantitative risk analysis, the design variables of the process were determined in the way to minimize the inherent explosion risks and operating cost. Instead of the optimization tool of Aspen HYSYS, the optimization was performed by using stochastic optimization algorithm (Covariance Matrix Adaptation-Evolution Strategy, CMA-ES) which was implemented through automation between Aspen HYSYS and Matlab. The research obtained that the important variable to enhance inherent safety was the operation pressure of mixed refrigerant. The inherent risk was able to be reduced about 4~18% by increasing the operating cost about 0.5~10%. As the operating cost increases, the absolute value of risk was decreased as expected, but cost-effectiveness of risk reduction had decreased. Integration of process simulation and quantitative risk analysis made it possible to design inherently safe process, and it is expected to be useful in designing the less risky process since risk factors in the process can be numerically monitored during preliminary process design stage.