• 제목/요약/키워드: admission fee

검색결과 42건 처리시간 0.026초

간호사 확보수준이 입원 환자의 병원사망과 입원 30일 이내 사망에 미치는 영향 (Effects of Nurse Staffing Level on In-hospital Mortality and 30-day Mortality after Admission using Korean National Health Insurance Data)

  • 김윤미;이경아;김현영
    • 임상간호연구
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    • 제28권1호
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    • pp.1-12
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    • 2022
  • Purpose: The purpose of this study is to investigate the association between the nurse staffing level and the patient mortality using Korean National Health Insurance data. Methods: The data of 1,068,059 patients from 913 hospitals between 2015 and 2016 were analyzed. The nurse staffing level was categorized based on the bed-to-nurse ratio in general wards, intensive care units (ICUs), and hospitals overall. The x2 test and generalized estimating equations (GEE) multilevel multivariate logistic regression analyses were used to explore in-hospital mortality and 30-day mortality after admission. Results: The in-hospital mortality rate was 2.9% and 30-day mortality after admission rate was 3.0%. Odd Ratios (ORs) for in-hospital mortality were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.72, 95% CI=0.63~0.84) and in ICUs with a bed-to-nurse ratio of less than 0.88 compared to that with 1.25 or more (OR=0.78, 95% CI=0.66~0.92). ORs for 30-day mortality after admission were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.83, 95% CI=0.73~0.94) and in ICUs with a bed-to-nurse ratio of less than 0.63 compared to that with 1.25 or more (OR=0.85, 95% CI=0.72~1.00). Conclusion: To reduce the patient mortality, it is necessary to ensure a sufficient number of nurses by improving the nursing fee system according to the nurse staffing level.

자원기준 상대가치를 이용한 정신과의 간호활동비용 산정 (Estimation of Psychiatric Nursing Costs by Using the Resource-Based Relative Value Scale(RBRVS))

  • 김은경;권영대;김윤
    • 대한간호학회지
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    • 제30권6호
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    • pp.1580-1591
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    • 2000
  • This study was conducted to assess the amount of nursing services for psychiatric inpatients and to estimate psychiatric nursing costs by using the RBRVS. Full details of medical services, including physician and nursing services, for psychiatric inpatients were surveyed and data of general characteristics of hospitals and patients were also collected. The cost of nursing activities was estimated by the multiple conversion factor which was drawn from the Korean RBRVS Development Project to the RBRVS score of each nursing activities, which was drawn from the results of Korean Nurses Association (KNA)'s projects about nursing RBRVS development and cost of nursing activities. The data about 89 inpatients from 3 general hospitals with psychiatric departments were analyzed. The total cost of nursing activities for each patient per admission day was from KRW 22,185 to KRW 27,954 by hospital, and KRW 25,220 in average. The percent of nursing cost to the total cost of medical services was from 36% to 48% by characteristics of patients and 41.4% in average. The cost of nursing activities estimated in this study was between the existing NHI fee schedule and the one suggested by KNA. It is considered as appropriate and acceptable level compared to the total amount of medical services. In the process of KNA's activities to get nursing fee in NHI fee schedule, results of additional studies to estimate the cost of nursing activities balanced with total cost of medical services in every departments should be found and utilized.

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유료노인전문요양원 입주의사 결정요인에 관한 연구 (Factors Influencing the Intention of Admission into a Charged Nursing Home for the Elderly)

  • 유영순;조은희;유병철;정귀원;엄상화;김성준;전진호
    • Journal of Preventive Medicine and Public Health
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    • 제34권1호
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    • pp.1-8
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    • 2001
  • Objectives : To gather information about the factors which influence the interest and intention of admission into charging nursing hones for the elderly(CNH), as these homes represent an important method for resolving the problems related to the rapid population aging occurring in Korea. Methods : A face-to-face interview survey was carried out with 320(men 159, women 165) patients over 60 years old who were admitted at 2 university hospitals and 5 general hospitals in the Busan area between December 1998 and March 1999. Data were analyzed through t-test, ANOVA, correlation and multiple regression analysis. Results : The mean age and years of education of the study population was 67.0 and 7.7 years, and the types of chronic degenerative disease included musculoskeletal disorders(20.1%), cerebrovascular disease(17.1%), and diabetes(14.3%). The major forms of household living arrangement prior to admission were elderly alone(22.6%), and elderly couple(33.5%), while about half of them(55.5%) didn't want to live with their children id the future. Almost half were paying medication fees by themselves(46.6%). The level of actual intention of admission$(3.07{\pm}1.39)$ into a CNH was lower than that of interest$(3.22{\pm}1.33)$(p<0.01). Multiple analysis revealed that the intention of admission increased with decreasing number of future supportive persons$(\beta=-0.107)$, lower level of activity in daily life$(\beta=-0.447)$, and longer years of education$(\beta=-0.447)$ with 32.7% of $R^2$. As for the factors which determined the admission into a CNH, the fee and facilities were considered to be most important, and professional nursing and physician's care were the most desired services. In nomenclature, they preferred 'elderly hospital' or 'elderly health center' to CNH. Conclusions : Interest in CNH is increasing recently, but existing studies about patient experiences in CHN are still limited. This study may form a basis for future examinations of the needs and uses for CNH. Active financial support and public information are considered by the authors to be important factors for the induction of welfare services for the elderly, though CNH.

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신생아실 의료인력의 적정성 및 신생아관리료의 타당성 분석 (Adequacy of Medical Manpower and Medical Fee for Newborn Nursery Care)

  • 박정한;김수용;감신
    • Journal of Preventive Medicine and Public Health
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    • 제24권4호
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    • pp.531-548
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    • 1991
  • 신생아의 질적 관리를 위해 신생아실 의료인력과 의료수가의 타당성을 파악하고자 영남지역내 24개 소아과 수련병원 가운데 신설병원과 모(母)병원의 수련프로그램에 의존해 있는 병원을 제외한 20개 병원의 신생아실을 대상으로 1991년 7월 29일에서 8월 14일 사이에 각 병원을 방문하여 자료를 수집하였다. 자료는 신생아실 대장에서 1991년 6월 한달동안 입.퇴원한 정상 및 환아수를 조사하고 신생아실 수간호사와 소아과 의사를 면담하여 정상신생아 관리에 소요되는 최소한의 간호시간, 인력현황, 인력의 적정성, 그리고 인력확보의 문제점을 조사하였고 자 병원 보험심사과에서 정상 질분만시와 제왕절개분만시 산모 1인당 평균 산모 및 신생아관리분의 의료비를 조사하였다. 정상신생아 1명당 하루에 필요한 최소한의 간호시간은 평균 179.5분(${\pm}58.6$)이었고 대학병원은 202.3분(${\pm}50.7$), 종합병원은 164.2분(${\pm}60.5$)이었다. 최소한의 간호 요구시간 대 제공가능한 간호시간 비는 평균 1.42였고 환아에 대한 간호 요구량을 감안했을 때는 평균 비가 2.06으로 간호인력이 매우 부족하였다. 미국 소아과학회가 권장한 신생아실 간호인력을 기준으로 할 경우 간호사는 31%, 간호조무사는 17%가 충원된 상태였다. 신생아실 수간호사의 90%와 소아과 의사의 85%가 간호사가 부족하다고 했고 간호조무사는 각각 75%가 부족하다고 했다. 간호인력 보충이 안 되는 주된 이유는 재정사정이라고 하였다. 간호조무사의 경우는 인력구하기 힘든 것이 재정사정 다음으로 중요한 이유였다. 그러나 국립대학병원의 경우는 의사와 간호사는 T.O.의 제한이 주된 이유라고 했다. 정상 질분만으로 2박 3일만에 퇴원하는 경우 총 의료비는 평균 219,430원이었고 이 중 신생아분은 20,323원(9.3%)이었으며, 제왕절개분만으로 6박 7일만에 퇴원할 경우 평균 732,578원이었고 이 중 신생아분은 76,937원(12.0%)이었다. 원가계산방식에 의한 신생아관리에 대한 최소한의 원가는 3차진료기관의 경우 1일 16,141원, 기타 종합병원은 14,576원으로 원가가 의료보험수가의 각각 5.0배, 4.9배나 되었다. 오늘날의 의료인력의 인건비 수준과 병원시설 및 관리비를 감안할 때 현행 의료수가로 양질의 신생아관리를 기대하기 어려운 것으로 생각된다.

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광복이후 한국 공공도서관사 연구 -일제하 공공도서관제도의 영향을 중심으로- (A Study of the History of Korean Public Library after the Korean Liberation Day - An Emphasis on the influence of public Libraries System under the Japanese Imperialism-)

  • 김포옥
    • 한국문헌정보학회지
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    • 제20권
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    • pp.65-125
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    • 1991
  • The study has tried to analize and appraise how did public library system under the Japanese imperialism affect the establishment and managemant of Korean public libraries. To achieve the purpose of the above-mentioned study, the contents of $\ulcorner$Japanese library statute$\lrcorner$ under Japanese imperialism and the current $\ulcorner$Korean library law$\lrcorner$ have been mutually compared, at the same time, the vestiage of Japanese imperialism in view of the establishment, personnel administration and reading systems have been concretely investigated, analyzed and compared. The conclusions obtained from the above are as followings. 1. In those days of the Korean Liberation, the situation of Korean public libraries was such as it under the Japanese rule and so, their names were only changed. However, as a part of its independent activities, the national library have once carried out the various programs such as the training of professional librarians, the establishment of the new classification schedule and the chief Librarian and deputy Librarian from the professional librarians in the office regulations, and they were well worth being the good examples for today's Korean library circle. Though the Goverment of the Republic of Korea had been formally established, the situation of the library circle was very dull owing to the Korean war for a long time. In 1963, $\ulcorner$The Korean library law$\lrcorner$ was promulgated, but the establishment of public libraries did not give satisfactory results because of the institutional fragility. In the 1980's the importance of library was embossed from the viewpoint of life-long education and the number of libraries was increased. However, there were still the remaining vestiges of Japanese library system in the practical library services. 2. After the Korean Liberation, the influnces of public library system under the Japanese imperialism showed in the office regulation of national library and the Korea library Law were also in the legal mechanism. In particular, the regulations of $\ulcorner$The staff-member of public library$\lrcorner$ and $\ulcorner$Admission fee of public library$\lrcorner$ including the chief librarian have referred to the library system under the Japanese imperialism since the liberation day to date. 3. At that time of the Korean Liberation, the U.S.Military Government Office had decided that the public library administration should be attached to the administration of local and internal affairs in accordance with the Japanese administative system. As a result, the public libraries had been forced to be indirectly affected by public library system under the Japanese imperialism for twenty years since the Liberation. 4. Since the Liberation, the personnel adminstration of public library has been so far on the steps of model under the Japanese imperialism. As the result of the field survey, the position standards of local chief librarians, non-professional character, the extra post system and the preponderant appointment of non-professional offices have analyzed by the influence of Public library system under the Japanese imperialism. Therefore, the Government authorities-concerned must readjust the standards of qualification and the divided duties corresponding to the position of public library staff members and to stipulate expressly in the revised library law. In addition, the regulation of the admission fee should be also actively detected for the free adminssion of library users. 5. Since the Liberation Day, the reading methods of public library have been so far similar to reading method under the Japaness imperialism. For example, the admission fee levied, the complicated procedures of using books including entrance and exit of a library, no-admission system, the limited lending books, the deposit system of outdoor lending books and the surety liable jointly and severally are originally caused by bureaucracy of under the Japanese imperialism. Therefore, the public libraries should make an offer space and opportunities which can enjoy freedom to the gull in future. The procedures and standards of library users will be simplified, if possible. As the above-mentioned, the actual conditions of Korean public libraries have been examined and analyzed. As the result of it, there are still the remaining vestiges of public library system under the Japanese imperialism in the establishment and management of the nation-wide public libraries. Such the remnants are an obstacle to the democratic development of public libraries and so, the authorities-concerned should take the proper-measures as soon as possible.

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다중클래스 통신망을 위한 동적 과금 기반의 호수락 제어 알고리즘 (Dynamic Price-Based Call, Admission Control Algorithm for Multi-Class Communication Networks)

  • 공성용;이장원
    • 한국통신학회논문지
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    • 제33권8B호
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    • pp.681-688
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    • 2008
  • 본 논문에서는 다중클래스 통신망을 위한 새로운 과금 (pricing) 기반의 호수락 제어 (call admission control) 알고리즘 제안한다. 본 알고리즘에서는 통신망에 새롭게 호가 도착하게 되면, 요청 회선의 수와 필요로 하는 최소 시간을 통신망에 알려준다. 통신망은 기대 수익 (expected revenue)을 최대화하는 최적의 과금을 계산하여 호에 제안한다. 이때, 최적 과금은 도착한 호의 정보와 현재 그리고 미래에 추정되는 호 예약시간 동안의 망내 정체(congestion) 정도를 기반으로 동적으로 조정된다. 호가 제안된 과금을 수락하면 호는 연결이 되고 그렇지 않으면 연결이 되지 않는다. 본 논문에서는 제안된 동적 과금 기반 호수락 제어 알고리즘의 성능을 Courcoubetis와 Reiman[1] 그리고 Paschalidis와 Tsitsiklis [2]의 정적 과금 기반 호수락 제어 알고리즘의 성능과 비교한다. 비록 두 알고리즘은 거의 같은 수익 결과를 보이지만, 동적 알고리즘이 정적 알고리즘에 비해 더 높은 호 수락율과 각 호에 낮은 과금을 제안하는 측면에서 더 뛰어난 성능을 나타냄을 보인다. 이는 경쟁 상황에서 정적 가격 알고리즘에 비해 동적 가격 알고리즘이 더 많은 사용자를 끌어들여 수익을 더 낼 수 있음을 의미하며 더 나아가 접속 요금이 과금에 고려된다면, 동적 과금 호수락 제어 알고리즘이 더 많은 수익을 낼 수 있음을 보인다.

입.퇴원 수속창구 중앙화와 분산화에 따른 이용자의 만족도와 재이용 의사 (The Study of Comparison Satisfaction and Re-use Intention between Central and Ward Reception Desk Users)

  • 함태훈;이경우;손태용;유승흠
    • 한국병원경영학회지
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    • 제14권4호
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    • pp.149-162
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    • 2009
  • The purpose of this study is to design strategic hospital service based on each hospital's features. For this study, an assessment was conducted by 398 in-patents of one university hospital located in Seoul. The self-questionnaires, which were investigated from Oct. 15th to 29th in 2008, compared central reception desk with ward reception desk in satisfaction and re-use rate of patients. The major results of this study are as follow. First, according to each reception desk user, they have different satisfaction of it. As for the staff kindness, admission procedure, discharge procedure and manner of staff, those made patients be gratified as well. Second, when it comes to the intention of re-use, there were no significant features between them. Only convenience in admission and discharge procedure, however, was an attractive factor for the recommendation. Third, this study found out the reasons for higher re-use rate of central reception desk users. Regarding service, they were contented with the time for test and treatment. As for the hospital service, they would like to re-use this hospital because of convenient steps of paying interim fee and getting certificates. Forth, this study found out the reasons for higher re-use rate of ward reception desk users. As a point of hospital service view, they responded that respected privacy, hospital facility and general service were good for staying. As for the manner of staff, they mentioned nurses and staff in charge and whole staff members were kind. When it comes to the procedures of patient management, steps of discharge and paying interim fee were convenience. In conclusion, the results of this study suggest that providing a ward reception desk service can boost the satisfaction and re-use rate of in-patients. Furthermore, this strategic management method would be good for not only cutting the moving line but also efficient in-patient care system. These results can be used for the strategic hospital marketing field, as well. Even though this study has a limitation of the targeted populations which were only in a ward reception desk running hospital, it can say that having competitiveness in satisfaction of hospital service is good for promoting and differencing each hospital. Consequently, whole general management system would be adjusted first for differencing each hospital; however, this sort of additional factor should be concerned as well. I expect that this study would give meaningful data for designing strategic and differencing marketing method to lots of hospitals.

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Participation Determinants in the DRG Payment System of Obstetrics and Gynecology Clinics in South Korea

  • Song, Jung-Kook;Kim, Chang-Yup
    • Journal of Preventive Medicine and Public Health
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    • 제43권2호
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    • pp.117-124
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    • 2010
  • Objectives: The Diagnosis Related Group (DRG) payment system, which has been mplemented in Korea since 1997, is based on voluntary participation. Hence, the positive impact of this system depends on the participation of physicians. This study examined the factors determining participation of Korean obstetrics & gynecology (OBGYN) clinics in the DRG-based payment system. Methods: The demographic information, practice-related variables of OBGYN clinics and participation information in the DRG-based payment system were acquired from the nationwide data from 2002 to 2007 produced by the National Health Insurance Corporation and the Health Insurance Review & Assessment Service. The subjects were 336 OBGYN clinics consisting of 43 DRG clinics that had maintained their participation in 2003-2007 and 293 no-DRG (fee-for-service) clinics that had never been a DRG clinic during the same period. Logistic regression analysis was carried out to determine the factors associated with the participation of OBGYN clinics in the DRG-based payment system. Results: The factors affecting participation of OBGYN clinics in the DRG-based payment system were as follows (p<0.05): (1) a larger number of caesarian section (c/sec) claims, (2) higher cost of a c/sec, (3) less variation in the price of a c/sec, (4) fewer days of admission for a c/sec, and (5) younger pregnant women undergoing a c/sec. Conclusions: These results suggest that OBGYN clinics with an economic practice pattern under a fee-for-service system are more likely to participate in the DRG-based payment system. Therefore, to ensure adequate participation of physicians, a payment system with a stronger financial incentive might be more suitable in Korea.

한국 요양시설을 이용하는 직장인 가족의 노인 돌봄 부담감에 영향을 미치는 요인 (Factors Influcing Elderly Care Burden of A Working Family in Korean Nursing Facilities: A Convergence Approach)

  • 성경미;김은정
    • 디지털융복합연구
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    • 제18권2호
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    • pp.333-342
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    • 2020
  • 본 연구의 목적은 직장인을 대상으로 요양시설 노인의 돌봄 부담감을 조사하고 이에 영향을 미치는 특성들을 파악하는 것이다. 연구방법은 서술적 상관관계 연구로 5개 요양시설에 노인을 입소시킨 153명의 직장인 가족이었다. 자료는 2019년 7월부터 10월까지 자가보고형 설문지를 통해 수집하였다. 자료는 SPSS WIN 25.0 프로그램을 이용하여 독립표본 t-test, one-way ANOVA, Pearson's correlation, 그리고 hierarchical multiple regression으로 분석하였다. 연구결과 직장인 가족의 노인 돌봄 부담감에 유의하게 영향을 미치는 요인은 노인과의 관계, 요양비 부담정도, 요양시설 서비스에 대한 만족으로 나타났으며 이들의 설명력은 20.8%였다. 또한 직장인 가족의 노인 돌봄 부담감에 유의하게 영향을 미치는 개인의 특성들을 심리적, 사회적, 경제적 및 신체적 부담영역별로 확인하였으며 이러한 결과는 돌봄 가족의 부담감을 줄이기 위한 중재방안에 활용될 수 있다.

실물옵션을 활용한 새만금 환경생태용지사업 분석 (Real Options Analysis for the Eco-Environment Area Project in Saemangeum)

  • 김경석
    • 한국건설관리학회논문집
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    • 제22권6호
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    • pp.87-95
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    • 2021
  • 본 연구는 새만금에 조성되는 환경생태용지사업의 실물옵션기법을 사용하여 경제성분석을 하였다. 30년 동안 운영하는 동안 수익에 영향을 주는 주요 요소들을 정의하였다. 수익의 변동성을 시나리오 분석방법으로 계산하여, 경영적 유연성을 적용할 수 있는 옵션 기반 분석방법을 제시하였다. 환경생태공원 경제성분석에 필요한 이용객수, 입장요금, 체험프로그램요금, 유지관리비용 등은 국내 유사한 환경생태공원의 사례를 분석하였다. 운영 중 포기할 수 있는 옵션권리를 가지는 것으로 가정하여 옵션가치를 계산하였다. B/C는 1미만의 값이 나오고, NPV는 음수로 나와 전통적인 경제성분석방법으로는 사업을 진행할 수가 없으나, 실물옵션분석으로 평가하면 사업의 가치가 상승하여 수익성을 확보할 수 있다. NPV(-466억원)과 옵션가치(281억원)의 가격차이 747억원의 가치상승이 발생하였다. 본 연구를 통해서 환경생태용지사업을 계획하려는 공공기관 및 민간사업자의 투자담당자는 본 연구에서 제시된 실물옵션기법을 활용하여 상황에 적절한 옵션을 선택하여 경제성분석을 할 수 있도록 도움을 줄 수 있을 것이다.