• Health Policy and Management
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• v.27 no.4
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• pp.359-365
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• 2017

Background: Computed tomography (CT) is one of the most efficient diagnostic methods for stroke patients. The number of CT scanners in South Korea, however, is higher than in other countries, and may cause the overuse of this tool in healthcare. We aim to study the relationship between using CT and various patient and hospital characteristics among patients with cerebral infarction. Methods: We analyzed nationwide health insurance claims data for patients due to cerebral infarction during the second half of 2013 for up to 3 months. We performed multilevel analysis, including both inpatient and hospital-level variables, to determine how factors affect CT spending and utilization. Results: The data used in our study consisted of 17,046 hospitalizations at 583 hospitals. Inpatients who visited more than one hospital had higher CT utilization numbers and cost (number: ${\geq}3$: ${\beta}$ hospitals, 2.27; p < 0.05; 2 hospitals: ${\beta}$, 0.70; p < 0.05; cost: ${\geq}3$ hospitals: ${\beta}$, 251,108; p < 0.05; 2 hospitals: ${\beta}$, 77,299; p < 0.05). People who visited a general hospital had higher numbers and cost of CT utilization than people who visited a smaller hospital. Conclusion: Increased sharing of records and improved continuity of care between hospitals are needed to help curb the overuse of CT.

• Quality Improvement in Health Care
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• v.2 no.1
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• pp.126-135
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• 1995

Background: Korean Hospital Standardization Program(KHSP), as a hospital accreditation program initiated and promoted by Korean Hospital Association since 1981, has played a key role in the hospital quality improvement in structural aspect particularly. Recently, however, KHSP has been critisized by hospitals and health personnels in that it is unpractical to be utilized as an initiative to improve hospital quality. In particular, the section of quality assurance in KHSP, strongly influenced by old version of Hospital Accreditation of Joint Commission in U.S.A., has been required to be fundamentally revised. For design of new criteria in quality assurance section, a survey for evaluation of existing program and collection of opinions for ideal one was conducted. Methods: For a month in 1994, structured questionnaires were administered by mailing to 470 hospital staffs from 200 hospitals, participated in the survey for the 1994 KHSP in each hospital. The total number of respondents was 116. Results: Less than half of the respondents(34.5%) value positively on the impact of current KHSP in general on the quality improvement of their hospitals. Moreover, most responses indicated that KHSP should be reorganized towards more practical and applicable one. Current KHSP criteria for quality activities in hospitals were regarded as a unpractical one which should be basically renewed. For new criteria and standards, most respondents emphasized the importance of applicability of those in real situations. Conclusion: For the KHSP to be effective, new evaluation criteria for quality activities should be more practical and fully accommodated to hospital situations in reality.

• Journal of Korean Critical Care Nursing
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• v.8 no.2
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• pp.66-79
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• 2015

Purpose: This study aimed to derive the elements for effectively improving the management of emerging infectious diseases in the emergency room in large general hospitals. Methods: This research involved an analytic hierarchy process analysis of 10 experienced nurses working in a large general hospital located in the Seoul metropolitan area. The weighted values of the criteria for evaluating the importance of the management elements of patients with emerging infectious diseases in the emergency room of large general hospitals were derived using an analytic hierarchy process survey. Results: The results of the analytic hierarchy process analysis showed that experts considers responsiveness (0.291) as most important with respect to the criteria for the policy for isolation and control of infectious patients. The order of importance of the criteria for the policy for isolation and control of infectious patients were as follows: responsiveness (0.291), economical efficiency (0.257), feasibility (0.242), and sustainability (0.209). Subsequently, the weighted values of the management of the policy elements were determined based on the derived importance of the criteria mentioned above. These were, in order of priority, the construction of communication channels with the government authorities when dealing with emerging infectious diseases (15.9%), the equipment and provision of personal protective equipment to protect nurses from infection and dissemination of material (14.6%), and the operation of the isolation room and patient separation systems (14.1%). Conclusion: This study suggests critical strategies for infection control during a pandemic of emerging infectious disease.

• Health Policy and Management
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• v.18 no.1
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• pp.1-20
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• 2008

How health care providers compete and how competition among them affects their behavior are crucial questions in theory and health policy. In ordinary markets, competition improves social welfare, However in health care markets facing uncertainty and information asymmetry, competition can take the form of wasteful quality competition and result in cost increase. The purpose of this study is to examine the characteristics of hospital service markets and examine the impact of hospital competition on hospital behavior, more specifically hospital cost and the size of personnel. Based on patient discharge data of 2002 by the Ministry of Health and Welfare and Korea Institute for Health and Social Affairs, and health insurance EDI claims data of 2002, this study measures the degree of competition in the inpatient service market of hospitals, using variable radius method and Herfindahl index. The result of the study shows that the hospital service market consists of on average 3.13 government administrative units(shi, gun, or gu). Compared with hospitals, general or general specialized hospitals cover larger markets and operate in more competitive markets. Nearly 60% of patients use hospitals, which are not located in their government administrative units, meaning that market definition based on variable radius is better than the conventional method of market definition based on government administrative units. The results of multivariate analysis show that competition is not associated with high cost index of hospitals. But hospitals in more competitive markets employ larger(more intensive) input of personnel per 100 beds, implying that hospital competition in Korea can have the form of quality and cost-increasing competition.

• Health Policy and Management
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• v.18 no.4
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• pp.170-184
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• 2008

Objectives: The aim of this analysis was to investigate factors associated with dental visits in terms of getting diagnosis and receiving care for diagnosed dental diseases among Korean adults. Methods: Data used in this analysis were from the 2005 Korean National Health and Nutrition Examination Survey which involved a representative sample of 25,487 adults nineteen years of age and older who resided in Korea. This analysis used data of adults who had completed health interview survey (n = 25,215). Uni- and bi-variate analysis, Chi-square test, and logistic regression analyses. were conducted using SAS. Results: The percentages of people diagnosed (treated) dental canes, periodontal disease. and temporomandibular joint disorder were 70.4(77.1), 16.1 (55.7), and 0.6(37.4), respectively. The reception of treatment for diagnosed dental caries and periodontal disease was significantly associated with older age, high monthly household income, and high education attainment. Logistic regression model indicated that age, monthly household income, education attainment, type of health insurance, and chewing problem were significantly associated with getting diagnosis and treatments of dental diseases. Most frequently answered reason for non - or delayed treatments of diagnosed dental diseases during the last one year was cost of treatments. Conclusions: The findings indicated that socio-economic-status still significantly affected reception of needed dental treatments among Korean adults despite the national health insurance system. Oral health policy and programs should be augmented to provide further support to adults of low socio-economic-status who are more prone to dental diseases yet lack resources for needed dental treatments.

• Journal of the Korean housing association
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• v.24 no.5
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• pp.9-16
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• 2013

The purpose of this study is to analyze local-based social welfare facilities to respond to secular change of the UR rental housing estates in Japan. The selected case studies for the analysis are Hibarigaoka, Hamakousien, Turumai UR rental housing estates constructed around 1960's. The analysis was done through UR website, MLIT (Ministry of Land, Infrastructure, Transport and Tourism) and MHLW (Ministry of Health, Labour and Welfare) policy report, and related literature. These case studies are connected with housing policy as well as welfare policy and performed to Stable Living Creation Project by Business Entry System for Stable Living. The types of local-based social welfare facilities are classified by welfare corporation and medical corporation. The results are as follows: 1) The implementation of cooperative and participative system not only the private sector (welfare and medical Corporation, etc.) but also the public (MLIT, MHLW, UR Renaissance Agency, Local government, etc.). 2) Repurposed of land through rent and transfer of land for local-based social welfare facilities in the process of housing stock renewal utilization. 3) The pursue of regional revitalization through attached to multi-generation facility or local community space for elderly in local-based social welfare facilities.

• Journal of Preventive Medicine and Public Health
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• v.30 no.4 s.59
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• pp.884-892
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• 1997

Currently, there are 100 community emergency centers which expect to provide professional emergency care like Level 1 trauma centers in U.S.A. To evaluate perforance of emergency centers, most studies have been widely adopted death rate based methods such as Trauma and Injury Severity Score(TRISS) and A Severity Characterization of Trauma(ASCOT). However, these methods are only applicable in situation where registration process of trauma patients is well established. Therefore, an alternative method should be applied to evaluate performance of emergency centers in Korea which does not have well-developed registration scheme. This study aims to develop new performance measures which are applicable to Korea and evaluate performance of 35 community emergency centers through new measures. The new measures are included that 'W-statistic' ; death rate calculated on the basis of International Classification based Injury Severity Score(ICISS), and 'the degree of severity' ; rate of severe trauma patients of each emergency medical centers. The study results can be summarized as follows. First, about 34% of sample emergency centers show they provide proper care in terms of their function. Second, tertiary hospitals, university hospitals, and hospitals located in Seoul show higher severity degree of patients and lower severity-adjusted death rate.

• Health Policy and Management
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• v.8 no.2
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• pp.110-124
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• 1998

Determining of Strategic Business Units in the organization is a major critical process for improving the organizational performance. On increasing the demands for extension in function of health center, many health centers are trying to provide the various services. But most health center determined the kind and level of service without scientific considerations. The purposes of this study are to develope the model for determination of strategic business units in health center and to test the availability of implementation for it. Our model is rooted from the McKinsey matrix analysis of Product Portfolio Analysis which used widely in marketing field. We modified the evaluation criteria of the McKinsey matrix analysis for health care field appropriately. Our evaluation criteria are categorized into two concepts; contribution of service, availability of service. At first, in terms of contribution of service, market size, market growth rate, needs and demands of regional people, existences of alternative services in that region, correspondence with health policy. The other component, availability of service are included the availability of manpower, financial availability, the level of knowhow on service, acceptance of health care manpower. In the result of analysis, we could conclude that antismoking and antialcoholics education programs, health screening program are important strategically in that aspects of contributions and availability of services. Also, vaccination program is important in that aspect of service availability and diet and exercise program, health library are meaningful in the aspect of service contribution. Therefore, we think that efforts to investigate the evaluation criteria for priority setting or determination of service area in health center are useful challenges.

• Health Policy and Management
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• v.23 no.4
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• pp.434-444
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• 2013

Background: Regional Cardiocerebrovascular Centers (RCC) were established for the prevention and treatment of cardiocerebrovascular disease and funded by the Ministry of Health and Welfare. The purpose of this study was to develop and validate the measurement tool of public benefits in RCC. Methods: Through the intensive literature review, experts surveys and their repetitive feedback, we selected the 46 items about the public benefits in RCC. Development of measurement tool involved content validity test using Content Validity Index (CVI), construct validity test through factor analysis and reliability test. Results: Thirty-five items were selected by content validity test, which CVI was 0.08 or higher. Through the construct validity test, 32 items in 7 factors were derived. And Cronbach's alpha was 0.951. Finally, public benefits measurement tool is composed of 32 items in 7 factors which are comprehensiveness of health care services, market complement, emergency care, cost, governance, quality improvement, and government control. Conclusion: Though we developed the measurement tool of public benefits in RCC, it would be utilized to measure the public benefits of various health agencies.

• The Korean Journal of Health Service Management
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• v.7 no.4
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• pp.289-303
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• 2013

This study looks at priorities in managing public hospitals by figuring out categories needed to examine the quality of each hospital. In order to analyze priorities and relative importance of valuation indicator in Seoul municipal hospitals, surveys were sent via e-mail to medical professionals who have participated in evaluation of municipal hospitals. The analytic hierarchy process (AHP) was conducted using the Expert Choice 11.5 program. The results show that 'providing public service' is considered to be the most important category for all kinds of public hospitals, followed by 'improving the quality of medical care', 'hospital management and governance', and 'efficient hospital management'. The importance of 'hospital management and governance' and 'efficient hospital management' is different depending on the types of hospitals, but the importance of 'providing public service' and 'improving the quality of care' remains the same regardless of the types of hospitals. Based on these results, the study comes to a conclusion that public hospitals should place high value on certain categories and their management purposes should differ depending on their specific fields and characteristics. This study will help furthering discussions on the identity and roles of public hospitals.