• Journal of Preventive Medicine and Public Health
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• 제49권4호
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• pp.230-239
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• 2016

Objectives: We aimed to evaluate the effect of geographic units of analysis on measuring geographic variation in medical services utilization. For this purpose, we compared geographic variations in the rates of eight major procedures in administrative units (districts) and new areal units organized based on the actual health care use of the population in Korea. Methods: To compare geographic variation in geographic units of analysis, we calculated the age-sex standardized rates of eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee-replacement surgery, caesarean section, hysterectomy, computed tomography scan, and magnetic resonance imaging scan) from the National Health Insurance database in Korea for the 2013 period. Using the coefficient of variation, the extremal quotient, and the systematic component of variation, we measured geographic variation for these eight procedures in districts and new areal units. Results: Compared with districts, new areal units showed a reduction in geographic variation. Extremal quotients and inter-decile ratios for the eight procedures were lower in new areal units. While the coefficient of variation was lower for most procedures in new areal units, the pattern of change of the systematic component of variation between districts and new areal units differed among procedures. Conclusions: Geographic variation in medical service utilization could vary according to the geographic unit of analysis. To determine how geographic characteristics such as population size and number of geographic units affect geographic variation, further studies are needed.

• 한국산학기술학회논문지
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• 제19권2호
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• pp.561-574
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• 2018

본 논문에서는 건강 불평등의 해소를 위하여 지리적 가중 회귀를 이용한 대사증후군 유병률의 지역별 변이 요인 및 관련 요인을 파악하고, 이를 통하여 지역의 효율적인 대사증후군 관리 사업 개발을 위한 적용방안을 마련하였다. 국민건강 보험공단 2015년 건강보험 통계연보 및 지역사회건강조사 등 기타 국가 기관 자료를 통하여 대사증후군 유병률과 사회경제적 수준의 사회구조적 요인, 그리고 물리적 환경, 건강행태, 이환, 정신건강, 예방관리, 의료이용의 중재 요인 지표를 수집하였다. 먼저 수집된 데이터를 바탕으로 대사증후군 유병률의 변이수준을 측정하는 지표인 EQ (Extremal Quotient)와 CV(Coefficient of Variations)를 이용하여 지역 간 변이가 존재함을 확인한 후, 공간적 이질성 및 의존성 등의 공간적 변이 고려가 가능한 지리적 가중 회귀(Geographically Weighted Regression)를 이용하여 대사증후군 유병률의 지역 간 변이 관련 요인을 분석하였다. 지리적 가중 회귀 분석 결과 대사증후군 유병률의 수준에 따라 주요 요인의 크기와 관리의 우선순위가 다름을 알 수 있었으며, 향후 지역별 대사증후군 관리의 목표와 우선순위 설정을 통한 관리 사업의 효과를 증대시킬 수 있는 방안마련이 가능함을 확인하였다.

• 한국임상보건과학회지
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• 제1권1호
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• pp.9-17
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• 2013

Purpose. This study is to find the degree of variations and trends of hospital services utilization for hypertensive disease, and have done the comparative analysis of the factors affecting occurring some variations. For this, this study uses the data for patients-survey and health-survey of a regional society by Korea Institute for Heath and Social Affairs in 2008; The regional units are classified into 160 of medium size medical service areas. Methods. I understand the level of variation by using index of Extremal Quotient(EQ) and Coefficient Variation(CV), and analyze critical factors influencing some differences in hospital services utilization by using multi-regression model. Results. The main results are followed:The first, in case of rate of hospital services utilization according to standarization of sex and age by small area, I find the variations of EQ 5.3 and CV 0.3; In Ho-nam, especially, the variation of high rank of 10 of age shows higher distribution. The second, the results analyzing the factors influencing on hospital services utilization by multi regression model are that a number of bed hospitals is significant positive relationship and EQ-5D of health behavior is significant negative one. Conclusions. To increase equity of hospital services utilization for hypertensive disease, this study requests the appropriate supply management of bed hospitals by region, efficient allocation of resources, and revitalization of the health promotion program.

• Journal of Preventive Medicine and Public Health
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• 제27권3호
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• pp.609-626
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• 1994

This study was conducted to investigate whether variations in hospital services utilization across small geographic areas in Korea existed, and if so, what factors are responsible for the variation. The claims data of the fiscal year 1992 obtained from the regional health insurance societies were used for the study. Main findings of the research can be summarized as follows: 1 Extremal Quotients (EQ) of hospital expenditure per capita and hospital days per capita were 2.69 and 2.73, and Coefficient of Variation (CV) were 0.14, both, respectively. The EQ and the CV of admission rate were also 2.71, 0.15. The EQ and the CV of expenditure per admission were 1.73, 0.10 and those of hospital days per admission were 1.29, 0.06. All these statistics were statistically significant and this result provides strong evidence for the existence of small area variations. 2. Comparing patterns of variation among areas, the area which showed higher utilization amounts is Chansungp'o. Koje area, whereas the areas which showed lower utilization amounts are Yongju, Changhung, Miryang, Mokp'o, Koch'ang area. 3. Multivariate analytic methods were used to examine factors related to the variation across areas. In terms of the health resource availability variables, beds per capita or physicians per capita were positively associated with all utilization indices. As for the health service market structure variables, the proportion of health care institutions operating for less than f years was positively related to the expenditure per capita, hospital days per capita and expenditure per admission. In addition the proportion of the private health care institutions also had a negative relationship with total utilization amount and admission rate and the proportion of physicians under age 40 was negatively associated with expenditure per capita and expenditure per admission. With regard to the socio-demographic characteristics, proportion of medicaid population was positively related to hospital days per capita, and percentage of paved road was positively related to hospital days per admission. As a conclusion, wide variations existed across small areas in Korea and supply factors were found to be important in explaining the variation.

• 보건행정학회지
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• 제4권1호
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• pp.49-76
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• 1994

Small area variations in health care utilization have long been studied as an important issue related to boto cost containment and quality assurance. This study was conducted to investigate if variations in hospital services across small geographic areas in Korea existed. The claims data of the fiscal year 1992 obtained from the regional health insurance societies were used for the study. Main findings of the research can be summarized as follows : 1. Extremal Quotients(EQ) of hospital expenditure per capita and hospital days per capita varied among diagnosis types. The EQ ranged from 2.05(cataract) to 41.67(pneumonia) in hospital expenditure per capita and from 1.86(cataract) to 45.89(pneumonia) in hospital days per capita. The diagnosis groups which showed high variation were pneumonia, cephalo-pelvic disproportion, gastritis and duodenitis, fracture of rib, and acute bronchitis. Those which showed low variation were acute appendicitis and cataract. 2. The EQ level of admission rate was different in terms of diagnosis types, ranging from 2.57(catarct) to 44.45(pneumonia). The variations were high in medical disorders such as pneumonia, oephalo-pelvic disproportion, gastritis and duodenitis and acute bronchitis, while relatively low in surgical conditions such as acute appendicitis and cataract. 3. As an indicator of service intensity, the EQ of expenditure per admission ranged from 1.67(acute appendicitis) to 31.27(essential hypertension). The diagnoses which had high variation were essential hypertension, gastric ulcer, whereas those which had low variation were cephalopelvic disproportion and acute appendicitis. With regard to hospital days per admission, the EQ ranged from 1.55(acute appendicitis) to 28.13(gastric ulcer) by diagnosis types. The diagnosis groups with showed high variation were gastric ulcer, essential hypertension, and acute bronchitis, whereas those with low variation were cephalo-pelvic disproportion, intervertebral disc disorders, and acute appendicitis. Both the expenditure and hospital days per admission showed lewwer variations than the expenditure per capita, hospital days per capita and admission rate. 4. Comparing patterns of variation in utilization indices, diagnoses such as essential hypertension, gastric ulcer, fracture of rib showed higher variations in expenditure per admission than in admission rates, whereas diagnoses such as pneumonia, cephalo-pelvic disproportion and gastric ulcer showed higher variations in admission rate than expenditure per admission. These findings suggest that wide variations existed in several diagnoses groups across small areas in Korea. Further research should be performed to investigate factors related to small area variations including provider behavior.

• 보건행정학회지
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• 제9권1호
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• pp.72-109
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• 1999

This study is conducted to investigate the current status on the utilization of health care and plan for solving this problem. The claims data of the fiscal tear 1995 obtained from the regional health insurance society are used for the study. The main findings of the study are summarized as follows. Indexes(The Extremal Quotient(EQ), coefficients of variance(CV's))which represent the regional difference in the admission rate of the tertiary medical diagnosis group report that there is difference in quantity and quality of utilization of health care. The admission rate is lower in the big city areas, Kyoungkido, Kangwondo and Chunlapukdo. Even after age-sex adjustment, the admission rate is still low in Kangwondo, Chunlapukdo and Kyoungsangpukdo. The big city areas tend to have higher rates in the expenses per claim, hospital days per claim, and daily expenses but the rates are still low in some area in Kangwondo, Chunlanamdo and Kyoungsangpukdo. This result remains as same after age-sex adjustment. There is a large regional difference in average utilization rate for the tertiary hospital of the tertiary medical diagnosis group: 57.2%(SD 11.53). The utilization rates for the tertiary hospital in their large catchment area are 96.34%, 83.19% and 73.22% in each Kyoungin, Kyoungnam and Kyoungpuk areas whereas it is lower in a Chungpuk and Chungnam areas. The regional differences of health care utilization of the tertiary medical diagnosis group gave some relationships with their geographical characteristics such as socio-economic characteristics and supply factors of medical services. It is important that many medical policies should be developed in order to minimize and balance out the regional differences of health care utilization. The service allocation policy should include the reconstruction of manpower policy, developing the resource allocating formula, finding the self-sufficient catchment area and reforcing of public health services. Moreover, in order to achieve the balanced development by region, they should investigate and consider each county's microscopic properties under the consistent macrocopic policy. The further studies to find causes of regional difference are needed.

• 디지털융복합연구
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• 제10권7호
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• pp.193-200
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• 2012

본 연구는 2008년 환자조사 자료를 이용하여 위장질환과 충수염질환을 대상으로 지역간 입원의료이용의 변이정도와 양상을 파악하고, 변이 발생에 영향을 미치는 관련 요인을 분석한 후, 이를 기초로 변이를 최소화하여 의료 이용을 적정화 시킬 수 있는 방안을 모색하기 위해 수행하였다. Extremal Quotient(EQ)와 변이계수(CV) 지표를 사용하여 변이수준을 파악하였고, 다중회귀분석을 통해 입원의료이용의 차이에 영향을 미치는 주요 요인들을 분석하였다. 주요 연구결과는 다음과 같다. 첫째, 위장질환의 소규모 지역별 성 연령 표준화에 따른 입원율의 경우 EQ 15.1, CV 0.4의 변이를 보였으며, 특히 농어촌 지역에서 변이 10대 상위군이 높은 분포를 나타냈다. 또한, 인구만명당 병상수, 의사수, 특수의료장비수에 따라 입원의료이용량이 통계적으로 유의한 양의 관계를 보였다. 둘째, 충수염질환에서는 EQ 12.41, CV 0.4를 나타냈고, 회귀분석을 통해 입원의료이용의 차이에 영향을 미치는 요인을 분석한 결과 통계적으로 유의하지 않았다. 본 연구 결과의 정책적인 함의로는 급성질환자의 입원의료이용의 형평성을 제고할 수 있도록 지역별 병상의 적정한 공급 관리와 효율적인 자원배분 및 의료서비스의 질적 차이를 감소시킬 수 있는 다각적인 정책 방안이 추진되어야 함을 시사해 준다.

• 보건의료기술평가
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• 제6권2호
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• pp.100-105
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• 2018

Objectives: The purpose of this research is to investigate regional variations of mastication difficulty rates in the elderly over 65 in 229 primary autonomous districts in Korea and explore relevant characteristics. For the research data, local community health survey conducted in 2015 and data from Ministry of the Interior and Safety, Ministry of Health & Welfare, National Health Insurance Service and Statistics Korea were used. Methods: Frequency analysis was conducted for general characteristics and mastication difficulty rates of each region, and distribution of mastication difficulty rates was displayed for each town, city and province by mapping them. Extremal quotient (EQ), coefficient of variation (CV) values were calculated for regional variations, and logistic regression analysis was performed to reveal the relationship between each independent variable and mastication difficulty rates. Results: The average of standardized mastication difficulty rate was 46.78%, and regional variations were significant with EQ 3.46, CV 0.18. Characteristic factors that have significant effects on mastication difficulty rate included sex ratio, elderly population and the number of dentists per 10000 people. Conclusion: As a result, there were variations among mastication difficulty rates in 229 primary local governments across the country, and the distribution of health care resources by the characteristics of the local environment by region affected mastication difficulty rates. Accordingly, it is required to provide political supports to overcome regional inequality of oral health levels and develop cooperative system between local governments and local dentists.

• Journal of Preventive Medicine and Public Health
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• 제32권1호
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• pp.80-87
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• 1999

Objectives. The Study of Small Area Variation(SAV) is most interesting issue in the health care researches. Most studies of SAV have been concluded the existences of variation on the basis of the magnitude of variation without statistical testing. But it is difficult to explain the existence of variation with this way because variation indicies are easily influenced by several parameters and also their distribution are skewed. So, it needs for the study to investigate the distribution of these indices and develop the statistical testing model. Methods. This study was planned to analyze on the distribution of variation indices such as Extremal Quotient(EQ), Coefficient of Variation(CV), Systematic Component of Variation(SCV) and compare the statistical power among indicies. The simulations was performed on the basis of several assumptions and compared to the empirical data. Results. Main findings can be summarized as follows. 1. If other conditions are constant, the more number of regions, the larger 95 percentile of EQ. But under same situation, 95 percentile of CV and SCV were slightly decreased. 2. If the size of regional population or utilization rate were increased, 95 percentile of all statistics were decreased. Also in the cases of small population size and low utilization rate, 95 percentiles of EQ showed various change contrast to the little change of CV. 3. If the difference at the size of regional population were increased, 95 percentiles of EQ and SCV were increased contrast to the little different of CV. 4. If the utilization rate were increased, 95 percentiles of all indicies were increased. But under the same difference of utilization rate, the power of CV and SCV were increased comparing to no change of the power of EQ. 5. Usually the power of EQ were lower than that of CV or SCV and it is similar between CV and SCV. Conclusions. Therefore, we suggest that in selecting the variation indicies at the SAV, CV or SCV are superior than EQ in terms of significance level and power.

• 보건행정학회지
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• 제23권1호
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• pp.35-43
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• 2013

Background: Diagnosis procedure combination (DPC) has recently been introduced in Korea as a demonstration project and it has aimed the improvement of accuracy in bundled payment instead of Diagnosis related group (DRG). The purpose of this study is to investigate that the model of end-stage liver disease (MELD) score as the severity classification of liver diseases is adequate for improving reimbursement of DPC. Methods: The subjects of this study were 329 patients of liver disease (Korean DRG ver. 3.2 H603) who had discharged from National Health Insurance Corporation Ilsan Hospital which is target hospital of DPC demonstration project, between January 1, 2007 and July 31, 2010. We tested the cost differences by severity classifications which were DRG severity classification and clinical severity classification-MELD score. We used a multiple regression model to find the impacts of severity on total medical cost controlling for demographic factor and characteristics of medical services. The within group homogeneity of cost were measured by calculating the coefficient of variation and extremal quotient. Results: This study investigates the relationship between medical costs and other variables especially severity classifications of liver disease. Length of stay has strong effect on medical costs and other characteristics of patients or episode also effect on medical costs. MELD score for severity classification explained the variation of costs more than DRG severity classification. Conclusion: The accuracy of DRG based payment might be improved by using various clinical data collected by clinical situations but it should have objectivity with considering availability. Adequate compensation for severity should be considered mainly in DRG based payment. Disease specific severity classification would be an alternative like MELD score for liver diseases.