• Health Policy and Management
• /
• v.26 no.2
• /
• pp.135-147
• /
• 2016

Background: The voluntary diagnosis-related groups (DRG)-based payment system was introduced in 2002 and the government mandated participation in the DRG for all hospitals from July 2013. The main purpose of this study is to examine the independent effect of mandatory participation in DRG on various outcomes of patients. Methods: This study collected 1,809,948 inpatient DRG data from the Health Insurance Review and Assessment database which contains medical information for all patients for the period 2007 to 2014 and examined patient outcomes such as length of stay (LOS), total medical cost, spillover, and readmission rate according to hospital size. Results: LOS of patients decreased after DRGs (large hospitals: adjusted odds ratio [aOR], 0.87; 95% confidence interval [CI], 0.78-0.97; small hospitals: aOR, 0.91; 95% CI, 0.91-0.92). The total medical cost of patients increased after DRGs (large hospitals: aOR, 1.22; 95% CI, 1.14-1.30; small hospitals: aOR, 1.22; 95% CI, 1.21-1.23). The results reveals that spillover of patients increased after DRGs (large hospitals: aOR, 1.27; 95% CI, 0.70-2.33; small hospitals: aOR, 1.18; 95% CI, 1.16-1.20). Finally, we found that readmission rates of patients decreased significantly after DRGs (large hospitals: aOR, 0.28; 95% CI, 0.26-0.29; small hospitals: aOR, 0.59; 95% CI, 0.56-0.63). Conclusion: The DRG payment system compared to fee-for-service payment in South Korea may be an alternative medical price policy which can reduce the LOS. However, government need to monitor inappropriate changes such as spillover increase. Since this study also is the results based on relatively simple surgery, insurer needs to compare or review bundled payment like new DRG for expansion of various inpatient-related diseases including internal medicine.

• The Journal of Korean Medicine
• /
• v.18 no.2
• /
• pp.187-198
• /
• 1997

The degree of KAP study on Chinease traditional medicine and doctor was examined with some chinease living yenbian district(延邊) from July 1st to August 30th in 1996. The result of the study for predicting health and ill patterns runs as fellows. 1. It is understand to strength and variety about role of chinease traditional medicine doctors and the curable disease. 2. Although most patients go to chinease traditional medicine clinic for the purpose of medicine herbs in package, acupuncture and industry-made pharm, they think the medical fee a little high(70.6%). 3. The 66.7% of respondents recognize chinease traditional medicine doctors as a profession and others think them only abundant works ; therefore it is rather low to ink chinease traditional doctors a profession. 4. Most respondents think that chinease traditional medicine should improved in the inside ; such as scientific reinforcement of theory, lack of univerality, improvment and enlargement of insurance, unkindness, shortage of publicity, dropped equipment, system of medical specialist, lack of integration with westem medicine, exact diagnosis and confidence of remedy, and low efficacy, etc. 5. Chinease likes more experienced-traditional doctor than beginner(78.3%) 6. The policy of korean government against 100 herbal prescription right by western pharmacy has taken the negative recognition(74.6%), 7. The degree that acknowleges of chinease traditional medicine through thease basic contents is average 47.3 mark. To be brief, although the step of the recognition and attitude of oriental medicine is less or very affirmative aspect, actully considerable positive factors is in the last chosen step. In conclusion KAP study connected chinease traditional medicine and doctor has very much postive factors.

• Journal of the Korea Safety Management & Science
• /
• v.16 no.2
• /
• pp.203-210
• /
• 2014

The purpose of this study is to understand the meaning and essence of concrete and practical experience on a series of debates to reveal factors that could be exposed when middle or old-aged people are in the process of re-employment process when they were unemployed by exploring the phenomenon of experience on the courses for the unemployed focusing on middle or old-aged people for employment support program. Depth consultation interviews were conducted and the structure of this phenomenon was revealed and described by applying Giorgi's phenomenology technical as a procedure for analyzing participants' statements by concentrating on the essence of the experience in this study. The meaning of the experience of the unemployed re-employment process structure as a result of analysis on the nature of re-employment experience on the basis of research participants and the information stated through this study showed respectively such as , , , , , and "Reemployment Success Factors>. It is a significant meaning that middle and old-aged people were able to confirm that they experienced Dynamic pursuit of hopes and dreams and got the chance to participate in society Toward a new life By strengthening employ ability skills by undertaking vocational training, obtaining licenses, and regaining confidence and employment determination, and a lot of desire using the card for learning tomorrow, government support system.

• Tuberculosis and Respiratory Diseases
• /
• v.83 no.4
• /
• pp.303-311
• /
• 2020

Background: If the duration of mechanical ventilation (MV) is related with the intensive care unit (ICU) readmission must be clarified. The purpose of this study was to elucidate if prolonged MV duration increases ICU readmission rate. Methods: The present observational cohort study analyzed national healthcare claims data from 2006 to 2015. Critically ill patients who received MV in the ICU were classified into five groups according to the MV duration: MV for <7 days, 7-13 days, 14-20 days, 21-27 days, and ≥28 days. The rate and risk of the ICU readmission were estimated according to the MV duration using the unadjusted and adjusted analyses. Results: We found that 12,929 patients had at least one episode of MV in the ICU. There was a significant linear relationship between the MV duration and the ICU readmission (R²=0.85, p=0.025). The total readmission rate was significantly higher as the MV duration is prolonged (MV for <7 days, 13.9%; for 7-13 days, 16.7%; for 14-20 days, 19.4%; for 21-27 days, 20.4%; for ≥28 days, 35.7%; p<0.001). The analyses adjusted by covariables and weighted with the multinomial propensity scores showed similar results. In the adjusted regression analysis with a Cox proportional hazards model, the MV duration was significantly related to the ICU readmission (hazard ratio, 1.058 [95% confidence interval, 1.047-1.069], p<0.001). Conclusion: The rate of readmission to the ICU was significantly higher in patients who received longer durations of the MV in the ICU. In the clinical setting, closer observation of patients discharged from the ICU after prolonged periods of MV is required.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.22 no.4
• /
• pp.350-357
• /
• 2019

Purpose: This study aimed to evaluate a possible association between the anti-tissue transglutaminase antibody (anti-tTG) titer and stage of duodenal mucosal damage and assess a possible cut-off value of anti-tTG at which celiac disease (CD) may be diagnosed in children in conjunction with clinical judgment. Methods: This observational study was conducted at a gastroenterology clinic in a tertiary hospital from April 2012 to May 2013. Seventy children between 6-months and 18-years-old with suspected CD underwent celiac serology and duodenal biopsy. Statistical analyses were done using SPSS 16. Diagnostic test values were determined for comparing the anti-tTG titer with duodenal biopsy. An analysis of variance and Tukey-Kramer tests were performed for comparing the means between groups. A receiver operating characteristics curve was plotted to determine various cut-off values of anti-tTG. Results: The mean antibody titer increased with severity of Marsh staging (p<0.001). An immunoglobulin (Ig) A-tTG value at 115 AU/mL had 76% sensitivity and 100% specificity with a 100% positive predictive value (PPV) and 17% negative predictive value (NPV) for diagnosis of CD (p<0.001, 95% confidence interval [CI], 0.75-1). Conclusion: There is an association between the anti-tTG titer and stage of duodenal mucosal injury in children with CD. An anti-tTG value of 115 AU/mL (6.4 times the upper normal limit) had 76% sensitivity, 100% specificity, with a 100% PPV, and 17% NPV for diagnosing CD (95% CI, 0.75-1). This cut-off may be used in combination with clinical judgment to diagnose CD.

• Health Policy and Management
• /
• v.30 no.4
• /
• pp.451-459
• /
• 2020

Background: Although Korean government have been adopting several policies to expand coverage of National Health Insurance (NHI) program, the coverage rate is still below average across Organization for Economic Cooperation and Development countries. This study was to identify public perception on appropriateness of coinsurance rate and factors associated with coinsurance rate in National Health Insurance. Methods: For this cross-sectional study, 507 participants over aged 20 years were recruited from telephone surveys. Respondents experienced at least one and more visiting medical facilities due to medical problems in last 12 months. Demographic factors, socioeconomic positions, and experiences on medical utilization were measured in order to identify factors associated with perception appropriateness of coinsurance rate. Results: The 49.9% (n=209) of the public responded that the coinsurance rate of NHI program was appropriate. There were no differences in positive perception according to socio-demographic factors and experiences on medical utilization except for gender, residential area, and felt expensive when using medical services. People who felt burden of medical expenditure were more likely to perceive coinsurance rate inappropriate (odds ratio, 2.33; 95% confidence interval, 1.52-3.58) Conclusion: In spite of the relatively low coverage rate of NHI, this study identified that 49.9% of the public perceived the current coinsurance rate was adequate. However, people who felt the burden of medical expenditure were still had a negative perception of the coinsurance rate needed to decrease the coinsurance rate.

• Structural Engineering and Mechanics
• /
• v.87 no.3
• /
• pp.221-229
• /
• 2023

Urbanization and industrialization have significantly increased the amount of solid waste produced in recent decades, posing considerable disposal problems and environmental burdens. The practice of waste utilization in concrete has gained popularity among construction practitioners and researchers for the efficient use of resources and the transition to the circular economy in construction. This study employed Lytag aggregate, an environmentally friendly pulverized fuel ash-based lightweight aggregate, as a substitute for natural coarse aggregate. At the same time, fly ash, an industrial by-product, was used as a partial substitute for cement. Concrete mix M20 was experimented with using fly ash and Lytag lightweight aggregate. The percentages of fly ash that make up the replacements were 5%, 10%, 15%, 20%, and 25%. The Compressive Strength (CS), Split Tensile Strength (STS), and deflection were discovered at these percentages after 56 days of testing. The concrete cube, cylinder, and beam specimens were examined in the explorations, as mentioned earlier. The results indicate that a 10% substitution of cement with fly ash and a replacement of coarse aggregate with Lytag lightweight aggregate produced concrete that performed well in terms of mechanical properties and deflection. The cementitious composites have varying characteristics as the environment changes. Therefore, understanding their mechanical properties are crucial for safety reasons. CS, STS, and deflection are the essential property of concrete. Machine learning (ML) approaches have been necessary to predict the CS of concrete. The Artificial Fish Swarm Optimization (AFSO), Particle Swarm Optimization (PSO), and Harmony Search (HS) algorithms were investigated for the prediction of outcomes. This work deftly explains the tremendous AFSO technique, which achieves the precise ideal values of the weights in the model to crown the mathematical modeling technique. This has been proved by the minimum, maximum, and sample median, and the first and third quartiles were used as the basis for a boxplot through the standardized method of showing the dataset. It graphically displays the quantitative value distribution of a field. The correlation matrix and confidence interval were represented graphically using the corrupt method.

• Journal of Environmental Health Sciences
• /
• v.38 no.2
• /
• pp.166-174
• /
• 2012

Introduction: After 17 years since the first production of humidifier disinfectants in Korea, Korea Centers for Disease Control and Prevention (KCDC) announced that the odds ratio of lung injury related with humidifier disinfectant usage was 47.3 (95% confidence interval 6.0-369.7) according to a case-control study with 18 adult cases, including 8 pregnant women at a university hospital in Seoul. Results: From September 2011 to April 2012, one-hundred and seventy four victim cases have been reported to an environmental non-governmental group (NGO). We summarized timetable of humidifier disinfectants accidents, analyzed health outcomes (death, lung or lung and heart transplantation, pulmonary disease) of reported victims, and classified some information for humidifier disinfectants with health outcomes, and government action for this accident. Among the victims, number of death cases are 52 (30.0%), including 26 babies less than 3 years old. Sixty-nine victims come from twenty-seven family with 2 to 4 members per family. About twenty types of humidifier disinfectant products and about 600,000 product items a year have been sold. Fifty-two death cases used 7 different types of disinfectant products, including imported goods and some private brands of well-known supermarkets. KCDC confirmed inhalation toxicity of 6 products through an animal experimental test, and based on this observation recalled disinfectants containing PHMG (polyhexamethylene guanidine) and PGH (Oligo(2-(2-ethoxy)ethoxyethyl guanidinium chloride). Discussions: The use of these biocides involved highly fatal consequences among biologically vulnerable victims, such as pregnant women, several family member victims after semi-acute exposure. This is the first biocide disaster in Korea with non-specific targets, and unknown scale of victims, warranting concerns on use of biocides in the living environment. Conclusions: Special administrative agency for chemical safety and compensation act for environmental health victims are needed to prevent similar problems.

• Journal of Preventive Medicine and Public Health
• /
• v.51 no.1
• /
• pp.41-50
• /
• 2018

Objectives: To explore alcohol perceptions and their association hazardous alcohol use in the populations of Alberta, Canada and Queensland, Australia. Methods: Data from 2500 participants of the 2013 Alberta Survey and the 2013 Queensland Social Survey was analyzed. Regression analyses were used to explore the association between alcohol perceptions and its association with hazardous alcohol use. Results: Greater hazardous alcohol use was found in Queenslanders than Albertans (p<0.001). Overall, people with hazardous alcohol were less likely to believe that alcohol use contributes to health problems (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.27 to 0.78; p<0.01) and to a higher risk of injuries (OR, 0.54; 95% CI, 0.33 to 0.90; p<0.05). Albertans with hazardous alcohol use were less likely to believe that alcohol contributes to health problems (OR, 0.48; 95% CI, 0.26 to 0.92; p<0.05) and were also less likely to choose a highly effective strategy as the best way for the government to reduce alcohol problems (OR, 0.63; 95% CI, 0.43 to 0.91; p=0.01). Queenslanders with hazardous alcohol use were less likely to believe that alcohol was a major contributor to injury (OR, 0.39; 95% CI, 0.20 to 0.77; p<0.01). Conclusions: Our results suggest that people with hazardous alcohol use tend to underestimate the negative effect of alcohol consumption on health and its contribution to injuries. In addition, Albertans with hazardous alcohol use were less in favor of strategies considered highly effective to reduce alcohol harm, probably because they perceive them as a potential threat to their own alcohol consumption. These findings represent valuable sources of information for local health authorities and policymakers when designing suitable strategies to target alcohol-related problems.

• Journal of Society of Preventive Korean Medicine
• /
• v.1 no.1
• /
• pp.27-41
• /
• 1997

The degree of KAP study on oriental traditional medicine was examined with some korean from July 1st to August 30th in 1996. The result of the study for predicting health and ill patterns runs as fellows. 1) It is too weak to understand and adertise oriental traditional medicine doctors and the curable disease; moreover cured diseases rather preponderate. 2) Although most patients go to oriental traditional medical clinic for the purpose of medical herbs in package and acupuncture, they think the medical fee a high expensive. 3) The 77.9% of respondents recognize oriental traditional medical doctors as a profession and others think them only abundant workers; therefore it is rather low to think oriental traditional doctors a profession. 4) Most respondents ink that oriental traditional medicine should improved in the inside; such as the expensive fee, scientific reinforcement of theory, lack of univerality, improvement and enlargement of insurance, unkindness, shortage of publicity, dropped equipment, system of medical specialist, lack of integration with western medicine, exact diagnosis and confidence of remedy and low efficacy, etc. 5) The struggle against the government (1995-1996 about herbal prescription right by western pharmacy) has taken the change of affirmative recognition. 6) The degree that acknowleges of oriental traditional medicine through these basic contents is average 61.65 mark. To be brief, although the step of recognition and attitude of oriental me야cine is very affirmative aspect, actually considerable difficult factors is in the last chosen step.