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Economic Length of Stay and Opportunity Income of Appendectomy and Pneumonia Using Activity-based Costing (활동기준원가를 이용한 충수절제술과 폐렴의 경제적 재원일과 재원일 단축에 따른 기회이익)

  • Kim, Sang Mi;Lee, Hae Jong;Shin, Dong Gyo
    • Health Policy and Management
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    • v.23 no.2
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    • pp.124-131
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    • 2013
  • Background: This study aimed to measure the opportunity income by identifying the economic length of stay (ELOS) which is the intersection point of daily revenue and cost on appendectomy and pneumonia cases. Methods: The research subjects were 460 patients of appendectomy and 606 patients of pneumonia, discharged from a general hospital between July 1, 2009 and June 30, 2010. ELOS calculated with both of total revenue on diagnosis-related group (DRG) and fee-for service (FFS). The cost is calculated by activity-based costing system of the hospital. Results: Average length of stay (ALOS) of appendectomy was 4.48 days and its average revenue per case were 1,710,215 (1,989,105) won by DRG (FFS). The variable cost was 491,262 won which was 28.7% (24.7%) of DRG (FFS) total revenue. And 97.2% of the total variable cost was incurred within 2 days from admission. The ELOS was 4 (5) days in DRG (FFS). Shortening three days (two days) would increase opportunity income 52.0% (82.2%) in DRG (FFS). ALOS of pneumonia case was 4.86 days and its average revenue per case were 489,448 (761,426) won by DRG (FFS). The variable cost was 27,230 won which was 5.6% (3.6%) of DRG (FFS) total revenue. Thirty-eight point nine percent of the daily variable cost was incurred in discharge date. The ELOS was 2 (4) days in DRS (FFS). Shortening three days (one day) would increase opportunity income 27.6% (37.2%) in DRG (FFS). Conclusion: The ELOS would be used by strategic index for achieving minimum profit and developing the ways to get there. But we also should not pass over that the opportunity income obtained by the reducing ALOS may cause some problem of quality.

Multilevel Analysis of Factors Related to Cost and Length of Stay in Acute Myocardial Infarction Patients with Coronary Stenting: Based on Korean National Health Insurance Service's Customized Database in 2010 and 2015 (관상동맥 스텐트를 삽입한 급성 심근경색 환자의 진료비 및 재원일수 관련 요인에 대한 다수준분석: 2010년과 2015년 국민건강보험공단 맞춤형 데이터베이스 자료를 바탕으로)

  • Choi, Boyoung;Lee, Hae-Jong
    • Health Policy and Management
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    • v.30 no.3
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    • pp.418-429
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    • 2020
  • Background: This study aims to analyze the cost and the length of stay (LOS) of acute myocardial infarction (AMI) patients with coronary artery stenting according to the characteristics of individuals and institutions. Methods: The data was collected from Korean National Health Insurance Service's customized database in 2010 and 2015. Chi-square test, t-test, analysis of variance, and multilevel analysis were performed. Results: The intraclass correlation coefficients for cost were 7.02% in 2010, 5.61% in 2015 and for LOS were 3.17%, 1.40%, respectively. The average costs were 9,067,000 won in 2010 and 9,889,000 won in 2015 (p<0.0001). However, the cost in 2015 was lower than the cost applying increased fee. The costs increased in aged 50-59 years, 60-69 years, and aged ≥70 years versus in aged under 49 years. The cost was higher in Charlson comorbidity index (CCI) 3 to 4 and ≥5 than in CCI 0. The costs were lower in male, medical aid recipients, metropolises, and local hospitals in other regions in 2010. LOS decreased from 8.1 days in 2010 to 7.4 days in 2015. It decreased in male, high income group, and the group of admission via emergency room. However, it increased in higher ages and medical aid recipients, and it also increased when CCI rose. The Internal Herfindahl Index was related to LOS in 2010. Conclusion: The variation of hospital level was small compared to the patient level. Therefore, it is important to implement applicable policies at the patient level in order to reduce cost and LOS of AMI patients.

A study of Simulations on the Changes of Physician's Practice Patterns in University Hospitals after the Introduction of DRG in Obstetrics and Gynecology (산부인과 포괄수가제 도입에 따른 일개 대학병원의 진료행태 변화 모의실험 연구)

  • Shin, Sam-Chul;Kim, Jong-Soo
    • Journal of Digital Convergence
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    • v.11 no.6
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    • pp.289-298
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    • 2013
  • The objective of this study was to predict the changes in the duration of hospital stay, hospital admission fee, costs of drugs, changes in laboratory cost, material cost, total medical cost, adjusted amount of treatment and the efficacy of obstetrics and gynecology DRG system. The cost of drugs showed the greatest change and was followed by materials for medical examinations and the change in methods of medical examinations. In the analysis of the quantity of medical service the profit of medical examinations were influenced mostly by the duration of hospital stay. The results and data in this study could be used as a basis of future DRG system protocols and will be utilized so that hospitals can build a efficient medical system.

A Study on the Needs of Health & Community Services Among the Disabled at Home in Rural Areas (지체 및 뇌병변 장애인의 보건 복지 서비스 요구도 조사)

  • Kim, Hyeon-Ok;Joung, Kyoung-Hwa
    • Research in Community and Public Health Nursing
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    • v.18 no.3
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    • pp.480-491
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    • 2007
  • Purpose: This study was to investigate the needs of health & community services among the disabled at home in rural areas. Methods: The subjects were 146 persons with disabilities living in J-gun. The questionnaire was based on the needs of 8 categorical services. Data were analyzed using frequency, percentage, mean, standard deviation, minimum, maximum, t-test, one-way ANOVA and Scheffe test. Results: Among the respondents, 27.4% visited the public health center in community for rehabilitation therapy. The average score of need was $2.62{\pm}.79$: education services $(2.92{\pm}1.05)$; medical services $(2.81{\pm}.82)$ nursing care services $(2.75{\pm}1.08)$; connection services $(2.62{\pm}1.20)$;, housing services $(2.60{\pm}1.09)$; emotional services $(2.41{\pm}1.03)$; other services $(2.24{\pm}1.06)$; and support of self-sustenance service $(1.92{\pm}1.15)$. The items in highest need were medical checkup (70.7%), medication (62.1%), traditional oriental therapy (60.4%) and physical therapy (58.9%), and those of lowest need were device repair (8.7%) and guidance of facility admission (7.1%). Needs were significantly different according to age (F=4.751. p=.001), employment status (t=2.108, p=.037) and medical fee payer (F=5.061, p=.002). Conclusion: The needs of education & medical services were relatively high. Demographic factors were statistically significant in determining needs. For the disabled at home in rural areas, more various services or programs should be executed based upon the needs and characteristics of based upon the needs and characteristics of the subjects.

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An Analysis on the Characteristics of High Cost Patients in the Regional Medical Insurance Program (의료보험 고액진료비 환자의 특성연구)

  • 문옥륜;강선희;이은표;좌용권;이현실
    • Health Policy and Management
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    • v.3 no.1
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    • pp.53-83
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    • 1993
  • A small number of high cost patients usually spend a larger proportion of scarce health resources. Korea is no exception. Under the national health insurance, 12% of the insured persons have consumed approximately half of the national health insurance expenditures. Therefore, it is necessary to identify the characteristics of the high cost patient group, if we would like to reduce them. This study has defined high cost patients as those who have spent one and half million won and over per 6 months. The study reveals that high cost users are those who have a longer length of stays(LOS), 40days of LOS in the 6 months, have multiple admissions, 2 to 3 admissions per 6 months and are the elderly patients. They have spent 814.126won per on the average, and commonly suffered from malignant neoplasms, circulatory diseases, fracture, diabetes mellitus, etc. Unlike the case of western developed countries, early readmissions are not the major causes of high cost spending in Korea. Undoubtedly, a lengthy admission is the main cause of large spending. Health policies should vigorously be explored to respond appropriately. There are evidences that hospital beds are often misused. As the Korean health care system is lacking in a mechanism of patient evaluation under the fee-for-service remuneration system, an idea of progressive patient care needs to be tested. The Goverment should set up health policy to diversify the role of long-term care facilities and encourage people to establish them. Further studies are needed to identify factors influencing large medical bills necessary for formulating the health policy on cost containment.

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Determination of Nursing Activities for Estimation of Nursing Fees Based on 9 KDRGs (Korean Diagnosis-Related Groups) (한국형 진단명 기준 환자군(KDRG)별 간호수가 산정을 위한 간호행위 규명;9개 질환군을 대상으로)

  • Lee, Eun-Young
    • Journal of Korean Academy of Nursing Administration
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    • v.5 no.3
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    • pp.547-561
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    • 1999
  • The purpose of this study was to determine which nursing activities are performed for patients in each of the nine KDRGs and to examine common nursing activities between patients with the nine KDRGs and special nursing activities which were not common to patients with the nine KDRGs. The study will provide basic data for estimation of nursing fees. The nine KDRGs in model project are Lens procedures, tonsillectomy, &/or adenoidectomy, appendectomy &/or not complicate principal diagnosis, vaginal delivery, cesarean section, anal & stomal procedures, inguinal & femoral hernia, uterine & adneza procedure for nonmalignancy, and simple pneumonia & pleurisy. To determine the nursing activities for each of the nine KDRG, checklists of nursing activities in each nine KDRG were developed from the literature and a total of 115 records of patients 'who were diagnosed and discharged between January and April, 1999 from a tertiary medical center. Nursing activities for each of the nine KDRG were verified through two consecutive content analyses. The results of study are followed as: 1. The checklists of nursing activities developed included direct and indirect nursing activities, for a total of 241 nursing activities. Direct nursing consisted of physical, educational, emotional-socioecomomic-spiritual nursing in 17 areas. Indirect nursing had four areas. 2. Through the two consecutive content analyses, 197 nursing activities were selected, having item CVIs of .83 or more. Those included 81 nursing activities for Lens procedures, 95 for Tonsillectomy &/or Adenoidectomy. 93 in Appendectomy &/or not complicated principal diagnosis, 155 for vaginal delivery, 172 for cesarean section, 89 for anal & stomal procedures, 93 for inguinal & femoral hernia, 108 for uterine & adneza procedures for non-malignancy, and 68 for simple pneumonia & pleurisy. 3. Nursing activities for each of the nine KDRG were compared. Activities with 80% or higher commonality within the nine KDRGs consisted of 86 of 197 nursing activities for the total designated common nursing activities, 30 common nursing activities for patients in the operation group, 45 common activities for patients in the delivery Group. Special nursing activities not common within the nine KDRGs were : 3 for Lens procedures, 1 for Tonsillectomy &/or Adenoidectomy. 2 for Appendectomy &/or not complicated principal diagnosis, 27 for vaginal delivery, 21 for Cesarean section, 6 for anal & stomal procedures, 3 for inguinal & femoral hernia, 16 for uterine & adneza procedure for non-malignancy, 8 for simple pneumonia & pleurisy. In this study, nursing activities for each of the nine KDRGs verified through two consecutive content analyses are those that are performed in the hospital. And, nursing activities for each of the nine KDRGs included all nursing activities from hospital admission to discharge. So. the checklists consisted of nursing activities that allow for an estimation of nursing fees under PPS. The classification of nursing activities in the study will provide a reference for the development of a nursing activity classification.

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Radiologic Equipment and Technicians according to the Distribution of the Population (인구 분포에 따른 방사선 장비 및 종사자에 관한 고찰)

  • Yoon, Chul-Ho;Choi, Jun-Gu
    • The Journal of Korean Society for Radiation Therapy
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    • v.21 no.2
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    • pp.57-65
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    • 2009
  • Purpose: The purpose of this paper is to provide basic data in order to systemize the management of demand and supply of radiologic technicians, to pursue a fair regional distribution of educational institutions, and furthermore to keep reasonable medical treatment and fee. This research was carried out through the investigation of radiologic equipments and technicians according to the distribution of the population. Materials and Methods: We compared and analyzed the correlation between regional population, the number of clinics and hospitals, the number of medical imaging devices, and the number of radiologists and radiologic technicians in 5 cities without "Gu" administrative units in 2008. Results: 27,317 radiologic technicians have been produced since the administration of the national qualifying exam for radiologic technicians. About 18,000 radiologic technicians are currently working. There are 39 colleges or universities with Departments of Radiology and the admission quota is 2,120 students excluding one college. The ratio of radiologic equipments to radiologic technicians is 2.6 to 1. Conclusion: There is a dilemma in which some radiologic technicians fail to find appropriate jobs while some clinics or hospitals are in need of radiologic technicians. This dilemma is due to unreasonable regional discrepancies in pay system and welfare situation, and excessive profit-oriented recruiting system of clinics and hospitals. The increase of students of Radiologic Departments and approval of additional departments will end up with producing superfluous high academic degree holders, which is on the contrary to the government policy to produce more job opportunities. So the policy of increasing Radiologic Departments should be reconsidered.

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A Study on Determinants of Trade Show's Participation Fees (무역전시회 참가비용의 결정요인에 관한 연구)

  • Cho, Yun-Sil
    • Management & Information Systems Review
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    • v.28 no.3
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    • pp.99-115
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    • 2009
  • This research analyzed determining factors of expenditure for processing fee by targeting trade show participants under a microeconomic approach in order to analyze determining factors of the participations of trade shows. As a result, with regard to the participation fees, income and the level of education seemed to be the socioeconomic factors that positively affected visitors in paying admission fees: and age and gender were negative elements. With regard to the participating businesses, the sales and the corporate history of the businesses were the positive elements to their willingness to pay the participation fees: however, the ratio of male and female personnel turned out to be a negative element in incurring the participation fees. The purchase of ticket was a positive mode-of participation factor to the visitors: however, distance tended to be a negative element for the visitors. For the participating businesses, the number of participation tended to be a positive element: however, distance was a negative one. The positive satisfaction factors that affected visitors' willingness to pay the participation fees included exhibited items, location, and schedules for events of the convention: for the participating businesses, the actual sales at the convention, the effects of advertisement and the level of satisfaction for location tended to play positive parts.

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Analysis of Domestic Patent Information on Hydroponics Field (수경재배 분야의 국내 특허 정보 분석)

  • Yu, Sung-Oh;Bae, Jong-Hyang;Park, Yun-Jum;Cho, Ja-Yong;Jang, Hong-Gi;Heo, Buk-Gu
    • Journal of Bio-Environment Control
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    • v.16 no.1
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    • pp.13-20
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    • 2007
  • This study was conducted to collect the basic data fo the development ot hydroponic technique and the efficient promotion of water culture. We have also analysed the water culture associated domestic patent application informations searching for on-line internet site with an admission fee (http://www2.wips.co.kr) from the year 1983 to January, 2006. Fifty nine patent applications related to the hydroponics were searched for in this study. Main patent contents applied were as followed in the order of that nineteen applications about the hydroponic equipments by 32.2%, thirteen applications about the materials used in water culture by 22.0%, eleven applications about the composition of nutrient solution by 18.6%, nine applications about the cultural methods by 15.3%, and seven applications about the cultural media by 11.9%. The compositions of nutrient solution and the cultural methods intended for specific crops were increased in number following five applications about tomato plants and four applications about potatoes. Thirty three patents (55.9%) were mainly applied before the year 2000. Main patent contents were the compositions of nutrient solution before the year 2000 in contrast to the cultural methods and substrates after the year 2000.

Status of Infectious Disease Inpatients at Long-Term Care Hospitals in Korea (국내 요양병원의 감염병 입원환자 실태 분석)

  • Bang, Ji Ya;Lee, Hanju;Son, Yedong
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.21 no.9
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    • pp.134-143
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    • 2020
  • This study investigated the status of infectious disease inpatients at long-term care hospitals in Korea. A descriptive study was conducted on patients with 14 infectious diseases at 798 long-term care hospitals during 2016-2017. The number of infected patients, total admission days, and total medical expenses were higher in 2017 than in 2016. The most common infectious diseases were enterocolitis due to Clostridium difficile, influenza, and scabies. The number of hospitals with patients who had enterocolitis due to C. difficile and resistance to carbapenem was higher in 2017 than in 2016. Hospitals with 150-299 beds had higher numbers of infectious disease patients than those with under 150 or over 300 beds. Therefore, intensive efforts are needed to control the most common diseases at long-term care hospitals, such as enterocolitis due to C. difficile, influenza, and scabies. It is recommended to apply relevant guidelines related to infection control management as well as implement educational programs. It will also be necessary to develop applicable infection monitoring standards and support the facilities and health workforce of long-term care hospitals under 300 beds through an effective infection surveillance system.