• Health Policy and Management
• /
• v.23 no.2
• /
• pp.103-111
• /
• 2013

Seven diagnosis-related groups (DRGs) prospective payment system is going to expand to all hospitals including university hospitals this year. However there are few studies on the change of practice pattern under prospective payment system in the university hospital setting. So This study was intended to predict the practice pattern change after the introduction of 7 DRGs prospective payment system in a university hospital setting. To predict the change of practice pattern, this study used simulation technique. Five hundred and nineteen patients classified as 5 DRGs in a university hospital were selected for simulation. The change of practice pattern were predicted based on clinicians' opinion. We also predicted payment change by service items. Major findings of this study are as follows. First, the total medical payment was reduced by 14.4%. The drug payment change (8.8%) took most of total payment reduction. The followings are the change of treatment material cost (3.2%), the change of laboratory tests cost (1.8%), the change of room charge (0.5%), and other payment change (0.1%), respectively. Second, most of the reduction in total medical payment resulted from the decreased amount of medical services themselves. The transfer of medical services to outpatient setting took up only 4.9% of the total payment reduction. The change of unit price or composition took up 5.5% of the total payment reduction. In this study we found that it is possible to reduce the inpatient services through practice pattern change in university hospital setting. However, it needs to be careful to adjust DRG payment after the reduction of provided services, because most of reduction was not due to service transfer but to service volume reduction. It is desirable to utilize the saving from practice pattern change as incentive to improve quality of care.

• Journal of Preventive Medicine and Public Health
• /
• v.46 no.2
• /
• pp.74-81
• /
• 2013

Objectives: The objective of this study was to evaluate the performance of risk-adjusted mortality models for colorectal cancer surgery. Methods: We investigated patients (n=652) who had undergone colorectal cancer surgery (colectomy, colectomy of the rectum and sigmoid colon, total colectomy, total proctectomy) at five teaching hospitals during 2008. Mortality was defined as 30-day or in-hospital surgical mortality. Risk-adjusted mortality models were constructed using claims data (basic model) with the addition of TNM staging (TNM model), physiological data (physiological model), surgical data (surgical model), or all clinical data (composite model). Multiple logistic regression analysis was performed to develop the risk-adjustment models. To compare the performance of the models, both c-statistics using Hanley-McNeil pair-wise testing and the ratio of the observed to the expected mortality within quartiles of mortality risk were evaluated to assess the abilities of discrimination and calibration. Results: The physiological model (c=0.92), surgical model (c=0.92), and composite model (c=0.93) displayed a similar improvement in discrimination, whereas the TNM model (c=0.87) displayed little improvement over the basic model (c=0.86). The discriminatory power of the models did not differ by the Hanley-McNeil test (p>0.05). Within each quartile of mortality, the composite and surgical models displayed an expected mortality ratio close to 1. Conclusions: The addition of clinical data to claims data efficiently enhances the performance of the risk-adjusted postoperative mortality models in colorectal cancer surgery. We recommended that the performance of models should be evaluated through both discrimination and calibration.

• Health Policy and Management
• /
• v.4 no.2
• /
• pp.1-26
• /
• 1994

As the hospital environment is changing rapidly, management is therefore obligated to use new ways to provide better service to patients. For example information system is introduced to some hospitals in Korea. Information system has several benefits such a soperational efficiency by on-line delivery and processing of data, accurate and rapid information production, continuous monitoring of performance and feedback, improvement of work process and better service quality. Still, many hospitals cannot be sure that information system is useful for improving organization performance. Because only one or two area of hospital information system were considered for development and with limited development hospital information system cannot be used effectively. The purpose of this study is to suggest the model of information system utilizaton and to analyze the hospital in formation system in Korea. The results are following; 1. In Korea, proportion of operating system of comuter is 31% of UNIX, 11% of IBM OS and 10% of PC LAN. 2. As we expect, scope of application software and amounts of heardware and software invest ments are affected by concern of CEO. 3. Many CIO(chief information officer) say that the biggest problems are lack of after-service and obsolescence of computer equipments in terms of hardware and shortage of application software for hospital in terms of software. 4. Personnel of information system department is so small that hospital information system can't be improved. 5. During the development of information system, full-time participation of end user is only 20% hospital with almost less than 12 person-month. This study was accomplished by survey through mail questionnaires. Response to the survey was only 55% and it was hard to generalize all the result obtained from this survey. However, We hope that this study would be helpful for helth care organization to acknowlege hospital information system in korea and to design the future architecture and frame of information system.

• Journal of The Korea Institute of Healthcare Architecture
• /
• v.20 no.4
• /
• pp.81-89
• /
• 2014

Purpose : An aging phenomenon was recognized as only negative aspect, which impediment a development with the decrease of a developing population and increase of social burden. Nevertheless, the problem of aging cannot be treated as a problem of individuals or social burden. Because Every mankind sometime will be the person directly involved the aging. Methods : Korea, predict to reach the aging society with over 20 percent of elderly in the whole population in 2020, should find an active political plan for responding. Because a previous discussion about the aging phenomenon focused on social welfare, the housing plan for the elderly with a consideration of the physical environment for sustaining elderly's life with happiness will be primary task. Results : This research considers housing policy, focusing on the medical service. It is because statistics, which 85 percent of elderly people suffer from chronic diseases because of physical aging signify the importance of medical service to the elderly in every-day-life. Implications : We prescribe the elderly as a population over 65. In this duration, the elderly retirees from the workplace e and spend the majority of time in their home. Thus, for the elderly, the residential space is a field of action and passageway connecting with the surroundings For the solution of physical space preparing the aging phenomenon, the combination of residential and medical function creates a new type of a lifestyle.

• Health Policy and Management
• /
• v.9 no.3
• /
• pp.70-94
• /
• 1999

This paper was performed for a cost-effectiveness analysis of pharmacologic treatment of hypercholesterolemia. Agents modeled were cholestyramine, gemfibrozil. bezafibrate, lovastatin, pravastatin, simvastatin. Pharmacologic effectiveness was estimated by regression from reported clinical trials. Pharmacologic effects were expressed as the percent change of blood cholesterol level. Cost estimates included patients' travel expenses and time loss as well as resource consumption in the health care sector. Bezafibrate was the most efficient agent for reducing total cholesterol levels, having an cost over 1 year of ￦31.400 per percent reduction in total cholesterol. Simvastatin (10mg/d) was also efficient(￦33,100 per percent reduction). Chole styramine(8g/d) was least efficient at ￦90,200. For low-density lipoprotein cholesterol. simvastatin(10mg/d) was most efficient, at ￦23,200 per percent reduction, followed by lovastatin(20mg/d) at ￦28,000. Gemfibrozil was least efficient at ￦77,800 per percent reduction. For high-density lipoprotein cholesterol. bezafibrate(400mg/d) was most efficient at ￦39,300 per percent increase of high-density lipoprotein cholesterol. Cholestyramine was least efficient at ￦514,700. Analyses combining low-density lipoprotein cholesterol and high-density cholesterol effects suggest that bezafibrate(600mg/d) and simvastatin (10mg/d) were most efficient for reducing cardiovascular risk. The cost-effectiveness analysis results show that both simvastatin and bezafibrate could be efficient treatment. Simvastatin provide more effective treatment at higher cost, whereas bezafibrate is more cost-effective, as it may be less effective, at lower cost. Therefore, clinicians should choose reasonable treatment according to the patient's needs This pharmacoeconimc analysis will provide a guideline for efficient pharmacologic treatment and also be reference data for pricing new drugs.

• Health Policy and Management
• /
• v.30 no.3
• /
• pp.345-354
• /
• 2020

Background: This study purposed to examine the difference in the prevalence of obesity at each stage among people with and without disabilities considering the severity and type of disability. Methods: The study targeted a total of 1,315,967 people, including 68,418 disabled and 1,247,549 non-disabled, who completed the national health screenings. Logistic analysis and average marginal effect analysis were conducted in three stages (pre-obesity, obesity, severe obesity). Those analyses were conducted considering the severity and type of disabilities. Results: People with disabilities were more likely to be at all stages of obesity than non-disabled people. In severely disabled people, the probability of obesity was higher than non-disabled people at all stages of obesity, but mildly disabled people had a higher only in the severe obesity stage, no difference in obesity stage, and a low in the pre-obesity stage. In physical and mental disabilities, the probability of obesity was higher than non-disabled people at all stages of obesity, but external physical function and internal organs disabled had a lower in the obesity and pre-obesity stage, and no difference in severe obesity stage. Conclusion: This study found that people with disabilities had a higher relationship with obesity than people without disabilities. In addition, severity and types of disabilities have different effects on the stage of obesity. Therefore, it is necessary to care about the health inequality and health of disabled people considering their severity and types of disabilities.

• Health Policy and Management
• /
• v.30 no.3
• /
• pp.355-365
• /
• 2020

Background: This study is aimed to verify individual and regional-level factors affecting the depression of Koreans and to develop social programs for improving the depressive status. Methods: This study used individual-level variables from the Korean Community Health Survey (2018) and used the e-regional index of the Korean Statistical Information Service as the regional-level variable. A multi-level logistic regression was executed to identify individual and regional-level variables that were expected to affect the extent of depressive symptoms and to draw the receiver operating characteristic curve to compare the volume of impact between variables from both levels. Results: The results of the multi-level logistic regression analysis in regards to individual-level factors showed that older age, female gender, a lower income level, a lower education level, not having a spouse, the practice of walking, the consumption of breakfast higher levels of stress, and having high blood pressure or diabetes were associated with a greater increase in depressive symptoms. In terms of regional factors, areas with fewer cultural facilities and fewer car registration had higher levels of depressive symptoms. The comparison of area under the curve showed that individual factors had a greater influence than regional factors. Conclusion: This study showed that while both, individual and regional-level factors affect depression, the influence of the latter was relatively weaker as compared to the first. In this sense, it is necessary to develop programs focused on the individual, such as social prescribing at the local or community-level, rather than the city and nation-level approach that are currently prevalent.

• Journal of Korean Library and Information Science Society
• /
• v.46 no.4
• /
• pp.21-44
• /
• 2015

This study is to propose the directions of LGBTQ Friendly Library policies based on LGBTQ's human rights. To accomplish this purpose, this study comparatively analyzed key concepts from UN UDHR, ALA LBR, and IFLA statements up to scholarly library-articles related to LGBTQ with the inductive approach for qualitative data analysis. The result suggests the 7 directions of the library services policy-making for LGBTQ in practice : 1) Recommendations on the enhancement of the LGBTQ's human rights and library obligations, 2) Enforcement of librarians' education and training on LGBTQ subject matters, 3) Convergency on the various LGBTQ's information needs and the enlargement of library collections, 4) Development of search instruments on LGBTQ, 5) Secure library moods and no-distinctive use of its accommodations, 6) Cooperation system with NGO on LGBTQ, 7) Care and support on children and young adults experienced with LGBTQ.

• Safety and Health at Work
• /
• v.7 no.3
• /
• pp.213-217
• /
• 2016

Background: The objective of this study is to identify high-risk groups for industrial accidents by setting up 2003 as the base year and conducting an in-depth analysis of the trends of major industrial accident indexes the index of industrial accident rate, the index of occupational injury rate, the index of occupational illness and disease rate per 10,000 people, and the index of occupational injury fatality rate per 10,000 people for the past 10 years. Methods: This study selected industrial accident victims, who died or received more than 4 days of medical care benefits, due to occupational accidents and diseases occurring at workplaces, subject to the Industrial Accident Compensation Insurance Act, as the study population. Results: According to the trends of four major indexes by workplace characteristics, the whole industry has shown a decreasing tendency in all four major indexes since the base year (2003); as of 2012, the index of industrial accident rate was 67, while the index of occupational injury fatality rate per 10,000 people was 59. Conclusion: The manufacturing industry, age over 50 years and workplaces with more than 50 employees showed a high severity level of occupational accidents. Male workers showed a higher severity level of occupational accidents than female workers. The employment period of < 3 years and newly hired workers with a relatively shorter working period are likely to have more occupational accidents than others. Overall, an industrial accident prevention policy must be established by concentrating all available resources and capacities of these high-risk groups.

• Journal of Digital Convergence
• /
• v.12 no.6
• /
• pp.481-490
• /
• 2014

This study aims to identify depressive symptoms status and factors to affect depressive symptoms in the elderly. The research selected 1,429 adults aged over 65, who appeared with depressive symptoms, from the fifth Korea National Health and Nutrition Examination Survey 2012. We analyzed states of depressive symptoms using descriptive statistics. Logistic regression analysis was used to examine the main factors associated with depressive symptoms in the elderly. The result shows that depressive symptoms in the elderly is significantly associated with gender, age, income level, subjective health status, smoking and the number of chronic diseases. Females, higher age, lower income, lower subjective health status, smoking and the higher the number of chronic diseases were the significant factors of higher depressive symptoms. Therefore, it is necessary to develop effective social programs and individualized approach to improve the quality of life in the elderly. In the future, these findings can be used as important data for health care policy and assessment.