• 보건행정학회지
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• 제3권1호
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• pp.25-52
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• 1993

Variation in the utilization of medical services is a very important issue in cost containment and quality assurance of health care. Practice variation directly affects health care expenditure especially in fee-for-service system, which is the payment system of health insurance in Korea. In addition to cost issue it is generally accepted that variations in medical practice and the cost of inpatient care suggest the possibility of inappropriate quality of care. This study is to closely examine the patterne and degrees of variation in cost structure of inpatient care among types of hospital and individual hospitals in some tracer diseases, and also to inquire into the service items which contribute much to the variation of total medical care cost. Foru common diseases, i.e. Cesarean Section, appendectomy, cataract extraction and pediatric pneumonia, were selected as tracer diseases. In most tracer diseases there were statistically significant differences in total medical care cost among hospitals in same type of hospital as well as among types of hospital(p<0.01). When total medical care cost were subdivided into the types of service, cost of medication and diagnostic examination varied the most prominenly. When the cost of medication were subdivided again, cost of parenteral antibiotics showed the most prominent variation. Of total medical care cost, medication was most contributory to the variation of total medical care cost(58.1~82.3%), and cost of antibiotics was most contributory to the variation of medication cost(63.9~92.2%). The results of study implicated that reducing the variation of medication may plays a significant role in containing the cost of inpatient care. In order to sort out the factors affecting practice variations including drug prescription pattes further researches are required.

• 한국사회복지학
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• 제56권3호
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• pp.5-35
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• 2004

본 연구는 의료비 지출이 가입자에게 미치는 경제적 영향을 의료비지출자의 종사상 지위변화와 가구내 소득 소비실태 변화를 중심으로 살펴보았다. 또한 의료비지출에 미치는 요인과 이와 같은 의료비가 종사상 지위변화 및 소득변화에 영향을 미쳤는지 분석하였다. 분석자료는 '한국노동패널'의 4차 연도 부가조사인 '건강과 은퇴' 응답자 가운데 의료비 지출자 4,215명의 자료를 5차 연도와 병합하였다. 분석결과 의료비지출자의 근로소득대비 의료비는 평균 5.5%로 나타났으나, 저지출 집단과 고지출 집단과의 격차가 크게 발생하였다. 또한 상대적 저소득그룹의 의료비 부담이 가구근로소득의 1/3을 차지하여 저소득계층은 의료적으로 취약할 뿐만 아니라 의료비부담이 과중함을 알 수 있었다. 한편 의료비 고지출 집단은 사적이전소득이 높아, 의료비가 발생할 경우 가족 및 친지로부터 의료비 등의 지원이 있는 것으로 보인다. 그러나 의료비가 발생할 경우 금융소득 및 부동산을 처분하여 의료비를 충당하는지에 대해서는 통계적으로 유의한 결과가 나타나지 않았다. 또한 의료비 지출자 가운데 종사상 지위는 14.4%만이 변화하였으며, 의료비 지출의 평균이상 여부가 종사상 지위변화의 주요 요인이 되었다. 즉, 의료비 저지출 집단은 건강이 상대적으로 나쁘지 않음을 의미하여 의료비의 비중이 낮을 뿐 아니라, 이와 같은 요인이 종사상 지위변화에 미치는 영향은 미미한 것으로 보인다. 그러나 의료비지출이 높은 그룹은 건강이 악화되어 종사상 지위까지 변화시킨 것으로 보인다. 나아가 이와 같은 종사상 지위변화는 총소득 변화에 부(-)적인 영향을 미쳐, 종사상 지위가 변화된 경우 총소득이 감소하여 가구내 경제상황이 더 악화된 것으로 보인다. 따라서 우리나라 건강보험은 질병으로 인하여 발생하는 비용과 함께, 경제활동 축소 및 중지에 따라 발생하는 소득손실을 보장하는데 미흡한 것으로 판단된다.

• 한국보건간호학회지
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• 제3권2호
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• pp.47-76
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• 1989

The objectives of this study was to analyze the major causes of decreasing utilization rate of health care institutios in pilot-project area of regional medical insurance, Kwang-hwa and Kun-wi country. After the implementation of medical insurance, utilization rate of health institutions turned out' to be lower than it was estimated, when the pilot-project of regional medical insurance was planned. It might be due to changes in inhabitant's behavioral attitude toward medical insurance. So this study was made to find measures for financial stability by increasing utilization rate of health care institutions and to be available for basic demand-supply program of medical care. The hypothesis of this study was as follows; First. there is difference in understanding health care institutions between Kun-wi and Kwang-hwa. Second. respondesnts of inquiry survey have exact knowledge of their past experience of treatment taken prior to enforcement of medical insurance, Questionaire survey was made as to each 700 household among total 11, 884 households in Kun-wi and 20,919 households in Kwang-hwa. In case of Kun-wi, 70% of inquired households (491) gave their answers. In Kwang-hwa, the number was 560 households (80% of inquireds). Dollected data was processed and analyzed by way of using SPSS batch system. To evaluate facto rs distribution aspects of data and to make comparison between two area, percentage and $X^2$ distribution were applied. The results were as follows; L The utilization rate of health care institutions in Kun-wi and Kwang-hwa was lower than it was estimated. when pilot-project of medical insurance was planned. 2. Prior to the implementation of medical insurance. inhabitants in two area chose the medical institutions considering such factors. First was medical care fee cheap. second in habitant's residence, Third was the institutions conveniently easy of access. 3. After the implementation of medical insurance. 26.1% of inqurieds in Kun-wi and 41.6% in Kwang-hwa, changed medical institutions. In case of Kwn-wi, from health care institution (p 0.05), and in case of Kwang-hwa, vice versa, from general medical institutions to health care institutions. 4. Evaluation by factors were made such as follows. Inquired gave high marks to following facts: In case of Kun-wi, general medical institutions were difficult of access and relation between patients: was not friendly, but burden of medical expenditure was light. Effects of treatment and facilities was good. In case of Kwang-hwa, inquired gave high evaluation marks to the follow ing facts; facilities of medical institutions was not good, but the burden of medical expenditure was light. 5. After the implementation of medical insurance, the services was evaluated as good, but inquired hopec for lessening the burden of medical expenditure. 6. In case of exact understanding of cost-sharing, the evaluation rate in Kwang-hwa was higher than that of Kun-wi (p < 0.005). And positive attitude toward necessity of medical insurance was also good in Kwang-hwa (p < 0.05). 7. In case of inquired's attitude toward medical institutions, Kwang-hwa showed positive response (p < 0.05) 8. In the case of comparison between general medical institution and health care institution, two area showed similar positive response; medical manpower, facilities of medical institutions and effest: of treatement was good. 9. In comprehensive evaluation of benefit-service; the general medical institution's positiveness was higher than that of health care institutions in Kun-wi. But in Kwang-hwa vice-versa. 10. If the medical expenditure of general medical institution and health care institutions was equal 77% of inquireds in Kun-wi and 59.1% in Kwang-hwa answered that they chose general medical insurance. Considering results above mentioned, the conclusion of this study was made as follows. 1. In Kwang-hwa county, where the understanding of health care institutions's was good, the utilization's of health care institutions was shown high. Therefore, in case of Kwang-hwa, betterment: should be made to induce increasing utilization rate for negative factors of health care institutions. 2. In case of Kun-wi, where the understanding of health care institutions was on the decrease, measures for changing such negative factors should be taken by way of strengthening public relations. And cases of Kwang-hwa should also be studied. 3. On the side of financial stabilization and establishing health care delivery system, primary health care should be available. Therefore, the major cause of inhabitant's avoiding health care institutions should be known. And measures for activating that institutions have to be taken. So, the facilities of health care institution have to be improved up to the level of clinic. And supportive measures for securing equipment and improving health care services should also be taken. It is necessary that strategy for public relations should be employed with policy considerations and supports.

• 보건행정학회지
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• 제28권3호
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• pp.257-262
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• 2018

This study reviews the advent of long-term care (LTC) hospitals and its key issues in Korea. For analysis, enforcement ordinances and enforcement rules related to LTC hospitals were reviewed. Official statistic data were used for quantitative analysis and Organization for Economic Cooperation and Development data were utilized for comparative analysis. Various references and expert interviews were conducted for status analysis. As of 2016, the number of LTC hospitals was 1,386 and the number of beds were 246,373. It showed the trend of increasing medical care costs and the cost of care at LTC hospitals increasing from 998.8 billion Korean won in 2008 to 4,745.6 billion Korean won in 2016, accounting for 7.3% of the total National Health Insurance expenditure. From the societal perspective, several issues were pointed out within the current health care system related to LTC hospitals: establishment of roles, concerns about the increase in medical expenses, and the quality of medical personnel.

• Journal of Preventive Medicine and Public Health
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• 제32권4호
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• pp.546-555
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• 1999

Objectives : To determine the prevalence, pattern. and out-of-pocket expenditure of complementary and alternative medicine (CAM) utilization in Korean adult population. Methods : We conducted a representative telephone survey of 2,042 persons aged 18 or older. Data about any health problem, details of their use of medical doctors(MDs) offices/hospitals/pharmacies services and CAM during the preceding 12 months were collected with structured questionnaire. Results : The utilization rate of CAM among Korean adults was 29% in one year. A total of 231 kinds of CAM was identified from this survey. Annual out-of-pocket expenditure associated with CAM use in 1998 amounted to ${\xi}{\S}1.88$ billion and was comparable to 40.8% of out-of-pocket expenditure paid for MDs offices/hospitals/pharmacies services. Among those(N=424) who paid for both MDs offices/hospitals/pharmacies services an d CAM, 35.8% paid more for CAM. CAM gave more satisfaction than western medicine to those who had experience of both types of therapy. About half of CAM users were willing to recommend CAM to others. Disclosure rate to physician among CAM users was not high(40.6%). Conclusion : CAM became a popular source of health care in Korea, Korean spent a substantial amount of out-of-pocket money on CAM without any public control. Because CAM use is likely to be increased rapidly through lay referral system, health policy makers and health professionals should pay more attention to CAM for making appropriate utilization of CAM.

• Nutritional Sciences
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• 제5권4호
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• pp.221-227
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• 2002

The objective of this study was to examine the effects of a weight loss program on the degree of obesity and levels of resting energy expenditure (REE) in overweight subjects according to their mitochondrial uncoupling protein 2 (UCP 2) genotype. Twenty-three subjects with a body mass index (BMI) greater than 27 were recruited from the Obesity Clinic of the Kyung-Hee University Hospital during the period of December 2000 - August 2001. The subjects were genotyped for the exon 8 allele; 15 subjects were found to be of del/del genotype, 8 were del/ins, and none were of ins/ins genotype. No significant association was found between the different UCP 2 genotypes and the initial levels of weight, fat mass (FM), lean body mess (LBM), BMI, REE, and REE/LBM ratio. After 12 weeks of a weight loss program, body weight and FM were significantly decreased, while LBM, total body water (TBW), and REE were not changed, irrespective of UCP 2 genotype. Initial fasting plasma levels of albumin, glucose, triglyceride, lipoprotein cholesterol, insulin, free triiodo-thyronine (T3), free fatty acid (FFA), and leptin were not different according to the UCP 2 genotype; furthermore, these blood parameters were not changed after the 12-week weight loss program. However, plasma levels of leptin decreased in both the del/del and ins/del genotypes, from 18.7 ng/ml to 13.4 ng/ml (p<.05), and from 18.1 ng/ml to 13.9 ng/ml (p＜.05), respectively, after the weight loss program. In conclusion, this study found no significant association between the del/del or del/ins UCP 2 genotypes and differing levels of REE or differing degrees of obesity, either before or after a weight loss program. This study provided evidence that a well- managed weight loss program could maintain levels of REE, which plays an important role in the maintenance of energy balance.

• 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.

• 한국식품영양학회지
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• 제7권4호
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• pp.307-317
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• 1994

The study analyzes relationship between Increasing tendency of urinary stone patients and changes of food intake through statistical data during recent 10 years(1982∼1991) in Korea. In four university hospitals, the number of urinary stone patients increased 2.5 times during the period. Study statistics showed sex ratio of male and female patient as 2.1 : 1.The types of the urinary stone of each patient were broad and mostly Ca and others(85.8%), and Ca oxalate stones were 65.2%. The incidence of patients with hypercalciuria and hyperuricosuria was observed in the Ca stone patients than in normal person. The same period showed increase of total monthly household expenditure as 3.2 times, food as 2.5 times and medical expenses as 2.4 times : The food expenditure decreased relatively In the expenditure composition. Daily hood consumption (g/person) increased as 3 times in meat, 4 times in milk, 2.4 times in seaweeds. Daily total Ca nutrition consumption was undulant and became 1.1 times during the same period. Daily food supply (g/person) was increased 1.9 times in meat, 1.4 times in spinach. However, anchovy, laver, brown seaweed, herring and makerel showed undulant tendency. Relationship (correlation coefficient) between the increase of urinary stone patients and of food intake were studied as follows. In the case of food intake, the relative index was 0.923 in seaweeds, 0.865 in meat and 0.대27 In milk And In food supply, the relative index was 0.855 in purine group which constitute meat, anchovy, herring and makerel. The relative index of Ca components which constitute anchovy, laver, brown seaweed and shrimp was 0.270. In the case of nutrition intake, the relative index was medium in protein(r: 0.443) and In animal protein (r: 0.488) but was negative in Ca(r: -0.028).

• Journal of Preventive Medicine and Public Health
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• 제18권1호
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• pp.41-50
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• 1985

To find out the differences in medical practice according to the environment of patient care and managerial situation of the medical care institutions, normal spontaneous vaginal delivery and acute appendicitis were selected, which is suitable for comparison because of their high comparability. A total of 473 cases of normal spontaneous vaginal delivery and 408 cases of acute appendicitis was sampled from the claims to Korea Medical Insurance Cooperations during January to June 1984. Complicated cases were excluded from population and sampling was restricted from 40 to 60 percentile for total charges by the type of medical care facility in order to rule out the influence originating from case mix. Important items representing type and quantity of medical care service were compared by type of facility. Major findings are as follows : 1. University hospital shows the highest in charges per case and decrease in order of general hospital, and clinic. 2. In case of normal spontaneous vaginal delivery, average length of stay shows statistically significant difference by type of facility. 3. Charge amount for each service item affected by practice pattern shows statistically significant difference mostly by type of facility. It is suggested that medical practice pattern is different by type of facility for medical services. 4. Difference in total medical expenditure by type of facility is affected more with charges for materials, consumables and drugs than with fee for service activity. 5. In administering drugs to patients, hospital and clinic show higher injection rate than university and general hospital. 6. Clinical Laboratory tests were common in order of uninalysis, hemoglobin, hematocrit, white blood cell count, urine microscopic examination in cases of normal spontaneous vaginal delivery; white blood cell count, urinalysis, hemoglobin, hematocrit, urine microscopic examination, white blood cell differential count, in cases of acute appendicitis. 7. The result for Laboratory test and Radiologic study shows extreme difference by type of facility. Test rate is lowest in clinic and increase hospital, general hospital, and university hospital in order, both in type and frequency.

• 한국산학기술학회논문지
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• 제17권6호
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• pp.106-112
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• 2016

본 연구의 목적은 지역 주민들의 신체활동 수준이 직접 의료비 지출에 미치는 영향을 분석 하는데 있다. 연구 대상자는 경상북도에 있는 G시의 청소년 수련원, 노인 복지회관, 문화회관, 그리고 체육센터 이용자들을 모집단으로 설정한 후, 각각의 시설별로 이용자들을 250명씩 할당표집 하여 총 773부의 설문지들을 수집 하였으며, 이들 중에서 불충분한 내용의 57부를 제외한 총 716부를 최종분석 하였다. 연구도구는 인구사회학적 요인, 신체활동 수준, 개인의 직접 의료비 지출 항목으로 구성된 설문지를 이용하였다. 연구 결과, 신체활동 수준이 매우 높은 집단은 한 달에 7,500원을, 신체활동이 높은 수준의 집단은 26,299원을, 신체활동 수준이 보통인 집단은 47,517원을, 신체활동 수준이 낮은 집단은 9,314원을, 그리고 신체활동 수준이 매우 낮은 집단은 9,997원을 직접 의료비로 지출한 것으로 나타났다. 지역주민들의 신체활동 수준에 따른 직접 의료비용 지출 차이를 분석한 결과, 외래진료에 대한 지불 비용에는 유의미한 차이가 없는 것으로 나타났다. 이러한 결과는, 신체활동 수준이 높다고 하여도 개인이 지불하는 직접 의료비용은 감소되지 않음을 나타내고 있다.