• Title/Summary/Keyword: fee for service

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A Study on Sociomedical Characteristics of Homeless People Reflected in Medical Records (의무기록에 반영된 부랑인 환자의 사회의료적 특성에 관한 고찰)

  • Park Hyo-Sook
    • Journal of Korean Public Health Nursing
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    • v.10 no.2
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    • pp.74-89
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    • 1996
  • It hasbeen individual and social problems that mattoids, alcohols and old people alienated from their families have wandered about the streets for rapid urbanzation, industrialization and nuclear families. In our country, measures for proper guidance for the tramps under the supports of government in 1982 have been carried out. But it has been difficult that we protected without Welfare Acts for them. According to those the study has aimed to provide for the fundamental data to advance public utilities as needs of an administrative organ with focus on contents of nursing records charts, furthermore general traits of subjects perceived details related to diseases. Medical record service has been a 'D' municipal hospital. All the subjects were a total of 4,855 persons, 2.436 in 1992, 2.419 in 1994. 1. Social Traits They mainly have attended a hospital, especially Thursday and Friday from a week and winter from the seasons. They equally have attended a hospital in the beginning, middle and end of the month. They equally have attended a hospital in the months. Government and public offices such as police stations and district offices have trusted them to a hospital. After they left a hospital. their residence has been their home confirmed in the ratio of $59.2\%$. 2. Controling Characteristics of a Medical Institution The proportion of males to females was 7 to 1. In the ages, the adults at the first of adulthood from 25 years to 44 years were $52.6\%$ mostly entered a hospital. In the observations the percentage of patients should be entered total was $8.8\%$. In general. the proportion of changes by fee was about $4\%$. Then the number of patients were on an average from 30. 76 to 32, 55 persons in 1992. It was from 25. 63 to 26. 87 in 1994. But the numbers were 5 to 6. It showed that the number was decreased. 3. Medical Traits The number of days by measured and the number of days which have been entered to a hospital have not made differences. The kinds of diseases were 1.11 in 1992. but were 1. 16 in 1994. In terms of 17 kinds of international diseases divided. the diseases recorded probably have been accidents. poisoning and violence( XVII). digestive trouble(IX). endoctrin disoders. metabolism and dystrophy(III) in orders, then they have been measured $51.0\%,\; 12.7\%,\; 6.8\%$. All patients who have been entered to a hospital severly have been drinking. As the seriousness of drinking and the kinds of diseases have indicated positively correlated. It have indicated that the more serious drinking have been. the more the number of diseases have been. As we have known according to abover results. the Acts for Homeless People related to special medical problems been have revised. furthemore they need to support the basic medical adds in order to maintaim their lives.

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Review of 2015 Major Medical Decisions (2015년 주요 의료판결 분석)

  • Yoo, Hyun Jung;Lee, Dong Pil;Lee, Jung Sun;Jeong, Hye Seung;Park, Tae Shin
    • The Korean Society of Law and Medicine
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    • v.17 no.1
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    • pp.299-346
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    • 2016
  • There were also various decisions made in medical area in 2015. In the case that an inmate in a sanatorium was injured due to the reason which can be attributable to the sanatorium and the social welfare foundation that operates the sanatorium request treatment of the patient, the court set the standard of fixation of a party in medical contract. In the case that the family of the patient who was declared brain dead required withdrawal of meaningless life sustaining treatment but the hospital rejected and continued the treatment, the court made a decision regarding chargeable fee for such treatment. When it comes to the eye brightening operation which received measure of suspension from the Ministry of Health and Welfare for the first time in February, 2011, because of uncertainty of its safety, the court did not accept the illegality of such operation itself, however, ordered compensation of the whole damage based on the violation of liability for explanation, which is the omission of explanation about the fact that the cost-effectiveness is not sure as it is still in clinical test stage. There were numerous cases that courts actively acknowledged malpractices; in the cases of paresis syndrome after back surgery, quite a few malpractices during the surgery were acknowledged by the court and in the case of nosocomial infection, hospital's negligence to cause such nosocomial infection was acknowledged by the court. There was a decision which acknowledged malpractice by distinguishing the duty of installation of emergency equipment according to the Emergency Medical Service Act and duty of emergency measure in emergency situations, and a decision which acknowledged negligence of a hospital if the hospital did not take appropriate measures, although it was a very rare disease. In connection with the scope of compensation for damage, there were decisions which comply with substantive truth such as; a court applied different labor ability loss rate as the labor ability loss rate decreased after result of reappraisal of physical ability in appeal compared to the one in the first trial, and a court acknowledged lower labor ability loss rate than the result of appraisal of physical ability considering the condition of a patient, etc. In the event of any damage caused by malpractice, in regard to whether there is a limitation on liability in fee charge after such medical malpractice, the court rejected the hospital's claim for setoff saying that if the hospital only continued treatments to cure the patient or prevent aggravation of disease, the hospital cannot charge Medical bills to the patient. In regard to the provision of the Medical Law that prohibit medical advertisement which was not reviewed preliminarily and punish the violation of such, a decision of unconstitutionality was made as it is a precensorship by an administrative agency as the deliberative bodies such as Korean Medical Association, etc. cannot be denied to be considered as administrative bodies. When it comes to the issue whether PRP treatment, which is commonly performed clinically, should be considered as legally determined uninsured treatment, the court made it clear that legally determined uninsured treatment should not be decided by theoretical possibility or actual implementation but should be acknowledged its medical safety and effectiveness and included in medical care or legally determined uninsured treatment. Moreover, court acknowledged the illegality of investigation method or process in the administrative litigation regarding evaluation of suitability of sanatorium, however, denied the compensation liability or restitution of unjust enrichment of the Health Insurance Review & Assessment Service and the National Health Insurance Corporation as the evaluation agents did not cause such violation intentionally or negligently. We hope there will be more decisions which are closer to substantive truth through clear legal principles in respect of variously arisen issues in the future.

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Improvement of Construction Management System in Public Construction Projects - Focused on the Total Project Cost Management Guidelines - (공공 건설사업의 효율적 건설사업관리수행을 위한 제도개선방안 - 총사업비관리지침을 중심으로 -)

  • Cho, Youngjun
    • Korean Journal of Construction Engineering and Management
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    • v.21 no.1
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    • pp.3-11
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    • 2020
  • In large public construction projects with a certain size or larger that need to be carried out over a number of years, the Authority must secure a budget for construction project management activities by the construction manager. There is no problem if the project management budget secured by the issuing Authority and the project management budget executed by the issuing Authority are the same, but if not, various problems will arise. Therefore, in this study, the following measures were proposed to improve the system for efficient operation of construction project management: First, the construction project management terms and tasks specified in the statutes and the guidelines of government agencies should be unified and the standard for calculating consideration should be unified. Second, the total project cost management guideline should be specified so that the missing construction project manager can receive compensation for the technical proposal. Third, if the project cost is changed in the long-term continuous construction project, the construction project management expense should be adjusted accordingly. Fourth, if construction project management service is required from the Authority, the basis for consignment to a specialized institution should be specified in the total project cost management guideline.

The Effect of Mandatory Diagnosis-Related Groups Payment System (포괄수가제도 당연적용 효과평가)

  • Choi, Jae-Woo;Jang, Sung-In;Jang, Suk-Yong;Kim, Seung-Ju;Park, Hye-Ki;Kim, Tae Hyun;Park, Eun-Cheol
    • Health Policy and Management
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    • v.26 no.2
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    • pp.135-147
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    • 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.

A Study on the Reasonable Personnel Management of Radiology Department -Centering around the General Hospitals in Seoul- (진단방사선과(診斷放射線科)의 적정인력(適正人力) 관리(管理)에 관(關)한 연구(硏究) -서울시내 종합병원(綜合病院) 중심(中心)으로-)

  • Chung, Soon-Kuy
    • Journal of radiological science and technology
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    • v.11 no.2
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    • pp.27-64
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    • 1988
  • Most hospital administrators in our country have doubted whether or not the size of their hospital personnel staffs, and the personnel management styles implemented are efficient or not. Actually, increased personnel expenditures due to sophisticated specialization of medical practices has become the biggest hospital expense. Therefore, it is said that hospitals can be run move efficiently by implementing reasonable management strategies for hospital personnel management. In this paper, the departments of diagnostic radiography in 16 general hospitals in Seoul, which were classified into 4 groups by the scale of hospital beds, were used as sample cases. Then, the data for the number of X-ray examination by diagnostic item was collected from sample hospitals. The unit hour spent on X-ray examinations in each diagnostic service was quoted from "A Study on setting-up of the relative value units of medical services and on the structure of current fee schedules" written by Mr. Ik Je Seong. The data analysis results are as follows; First, the number of hours per day spent on X-ray examinations in 13 hospitals out of 16 hospitals, was shorter than the general daily working hours (8 hours). Second, in the morning there was not enough time to work for X-ray examinations required, with the available manpower. In the afternoon, however, the situation was diametrically opposed to that in the morning. Third, in light of above results, though most hospitals employ sufficient personnel for the quantity of the actural work, they were always short-handed where their works were performed Fourth, this study tells us that there is a maldistribution of the work in the schedule : too much work for the available personnel in the morning. The following recommendations are resulted from the data analysis described above. First, it is recommended that all out-patients coming again, except specific patients(G. B. or I.V.P. etc) who have to have their X-ray examinations on an empty stomach in the morning among out-patients, be required to visit the hospital in the afternoon. Second, it is recommended that all new out-patients be required to make a reservation in order to equalize the number of patients throughout the day. Third, it is recommended that all in-patients, except specified patients, be arranged to have their X-ray examinations in the afternoon. Fourth, it is recommended that part time workers be employed during peak hours. This recommendation, if applied in a wider scale, would allow hospitals to overcome the problem of the maldistribution of work and personnel, and then more efficient hospital management through the appropirate personnel management procedures could be expected.

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Factor Analysis on Citizen's Motives to Tree Burial and Choice Conditions to Tree Burial Site (수목장의 동기와 수목장지 선호조건에 대한 요인 분석)

  • Woo, Jae-Wook;Byun, Woo-Hyuk;Park, Won-Kyung;Kim, Min-Soo;Yim, Min-Woo
    • Journal of Korean Society of Forest Science
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    • v.100 no.4
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    • pp.639-649
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    • 2011
  • The purpose of this study aimed to analyze factors on motives to tree burial and choice conditions to tree burial site in order to suggest policy direction for the desirable settlement of tree burial. For those purpose, this study performed questionnaire, targeting 522 visitors of funeral hall all around Korea. As the result, the factors of motives to tree burial were extracted as follows: funeral ceremony progressed along with trees, simplicity, memorial site's easy insurance, environmental friendliness and consideration toward descendants. The factors on choice conditions to tree burial sites were extracted as follows: beauty of natural scenery, emotional mood as a memorial site, convenience, stability and economic feasibility. Based on the results of factor analysis, this study suggested policies related to motives to tree burial as follows: develop various types of tree burial sites, develop a funeral ceremony suitable for tree burial, come into wide use of tree burial as a social welfare service, develop tree burial methods capable of many burials, and improve professionalism to manage tree burial system. In addition, this study proposed related choice conditions to tree burial sites as follows: establish natural forest scenery, convert existing graveyards into tree burial sites, select easily accessible places for tree burial sites, form tree burial sites as places for both rest and memory, and reduce using fee of tree burial site.

Evaluation of the Behavior and Satisfaction of College Students for Family Restaurants in Seoul.Kyunggi Area (수도권 대학생들의 패밀리 레스토랑에 대한 이용 성향과 만족도 평가)

  • Shin, Mee-Hye;Lee, Ki-Yup;Kang, Kun-Og
    • Journal of the East Asian Society of Dietary Life
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    • v.17 no.3
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    • pp.445-455
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    • 2007
  • This study surveyed university students in the Seoul area regarding their awareness of family restaurants and visiting experiences. Frequency analysis was used to study the data. Most of the repliers (92.0%) had visiting experiences and visited on weekends (72.4%), paying \$10,000{\sim}15,000$ for meals. In correlation analysis of the general characteristics and reasons for visiting, there were significant differences according to gender (p<0.01) and major study area (p<0.005). During visits the factor considered most important relative to the surroundings was food styling. The factors valued most highly when selecting a family restaurant were "good taste" (43.5%) and "good discounts" (26.3%) respectively. The favorite family restaurant was Outback Steakhouse (34.7%), and 86.4% of repliers had used a membership card, with 46.9% being satisfied with using the membership card. The conditions for using a family restaurant and satisfaction differences in each category, included: the amount of food (p<0.1) for the number of visits, taste (p<0.01), food shape and styling (p<0.05), surroundings (p<0.1), and interior (p<0.05): and for the meal fee per person, price (p<0.05) and sanitation (p<0.05), all showing significant differences as reasons for using the restaurants. In the factor analysis of nine categories, three factors: service, food, and economics were acquired, and their Cronbach's ${\alpha}$ values were 0.778, 0.671, and 0.587. Satisfaction toward food and service had a positive correlation of 0.457. Satisfaction toward food and economics increased a family restaurant's overall satisfaction score, and satisfaction toward service did not have a significant influence.

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A Study on the Online Newspaper Archive : Focusing on Domestic and International Case Studies (온라인 신문 아카이브 연구 국내외 구축 사례를 중심으로)

  • Song, Zoo Hyung
    • The Korean Journal of Archival Studies
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    • no.48
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    • pp.93-139
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    • 2016
  • Aside from serving as a body that monitors and criticizes the government through reviews and comments on public issues, newspapers can also form and spread public opinion. Metadata contains certain picture records and, in the case of local newspapers, the former is an important means of obtaining locality. Furthermore, advertising in newspapers and the way of editing in newspapers can be viewed as a representation of the times. For the value of archiving in newspapers when a documentation strategy is established, the newspaper is considered as a top priority that should be collected. A newspaper archive that will handle preservation and management carries huge significance in many ways. Journalists use them to write articles while scholars can use a newspaper archive for academic purposes. Also, the NIE is a type of a practical usage of such an archive. In the digital age, the newspaper archive has an important position because it is located in the core of MAM, which integrates and manages the media asset. With this, there are prospects that an online archive will perform a new role in the production of newspapers and the management of publishing companies. Korea Integrated News Database System (KINDS), an integrated article database, began its service in 1991, whereas Naver operates an online newspaper archive called "News Library." Initially, KINDS received an enthusiastic response, but nowadays, the utilization ratio continues to decrease because of the omission of some major newspapers, such as Chosun Ilbo and JoongAng Ilbo, and the numerous user interface problems it poses. Despite these, however, the system still presents several advantages. For example, it is easy to access freely because there is a set budget for the public, and accessibility to local papers is simple. A national library consistently carries out the digitalization of time-honored newspapers. In addition, individual newspaper companies have also started the service, but it is not enough for such to be labeled an archive. In the United States (US), "Chronicling America"-led by the Library of Congress with funding from the National Endowment for the Humanities-is in the process of digitalizing historic newspapers. The universities of each state and historical association provide funds to their public library for the digitalization of local papers. In the United Kingdom, the British Library is constructing an online newspaper archive called "The British Newspaper Archive," but unlike the one in the US, this service charges a usage fee. The Joint Information Systems Committee has also invested in "The British Newspaper Archive," and its construction is still ongoing. ProQuest Archiver and Gale NewsVault are the representative platforms because of their efficiency and how they have established the standardization of newspapers. Now, it is time to change the way we understand things, and a drastic investment is required to improve the domestic and international online newspaper archive.

What Can Koreans Learn from the Dutch Experiences in Reforming the Health Insurance System? (한국의료보험제도(韓國醫療保險制度)의 개혁필요성(改革必要性)과 네덜란드의 경험(經驗)이 주는 교훈(敎訓))

  • Kwon, Soon-won;Sunwoo, Duk
    • KDI Journal of Economic Policy
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    • v.12 no.3
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    • pp.47-69
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    • 1990
  • The measures taken to reform the Dutch health insurance system hold valuable lessons for countries such as Korea, where there has been increased concern regarding the efficiency and effectiveness of the health services provided. The growing literature on comparative health insurance policies suggests that nations can learn from each other. In addition, Korean policymakers have shown great interest in the health insurance systems of foreign countries, particularly in Japan. The development of Korea's health insurance scheme during the past 12 years has made a significant contribution to the increased accessibility of health care services. Although the insurance coverage is universal, the health insurance system today in Korea is by no means a product of systematic and planned efforts. Moreover, it lacks due considerations of insured's needs as well as the long-term objectives of the social security health care system. There are growing gaps in premium burdens and benefits between the rural health insurance program and the employee's health insurance programs. Furthermore, the regional health insurance program is experiencing financial difficulties in spite of the fact that the amount of the government subsidy has been sharply increased in recent years. Under the present payment method solely based on the fee-for-service schedule, both consumers and providers are encouraged to utilize and prescribe more services. The combination of the utilization-inducing reimbursement system and continuous pushes for expanding health insurance has played a crucial role in raising the country's medical bills. Current trends in Korea's health care sector and those anticipated in the near future necessitate changes in the structure and funding of health care. As indicated in the above, there are various shortcomings in this context, the health policy authority in Korea can draw valuable lessons from the Dutch experiences in reforming their health insurance system. The main elements of the Dutch reform measures are a restructuring of the insurance system and a greater role for market forces in the health care system. On this basis a new system will be created which reflects the social nature of health care while at the same time containing sufficient mechanisms to allow the health care sector to operate in a cost-effective and efficient manner.

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Impacts of DRG Payment System on Behavior of Medical Insurance Claimants (DRG 지불제도 도입에 따른 의료보험청구 행태 변화)

  • Kang, Gil-Won;Park, Hyoung-Keun;Kim, Chang-Yup;Kim, Yong-Ik;Ha, Beom-Man
    • Journal of Preventive Medicine and Public Health
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    • v.33 no.4
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    • pp.393-401
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    • 2000
  • Objectives : To evaluate the impacts of the DRG payment system on the behavior of medical insurance claimants. Specifically, we evaluated the case-mix index, the numbers of diagnosis and procedure codes utilized, and the corresponding rate of diagnosis codes before, during and after implementation of the DRG payment system. Methods : In order to evaluate the case-mix index, the number of diagnosis and procedure codes utilized, we used medical insurance claim data from all medical facilities that participated in the DRG-based Prospective Payment Demonstration Program. This medical insurance claim data consisted of both pre-demonstration program data (fee-for-service, from November, 1998 to January, 1999) and post-demonstration program data (DRG-based Prospective Payment, from February, 1999 to April, 1999). And in order to evaluate the corresponding rate of diagnosis codes utilized, we reviewed 820 medical records from 20 medical institutes that were selected by random sampling methods. Results : The case-mix index rate decreased after the DRG-based Prospective Payment Demonstration Program was introduced. The average numbers of different claim diagnosis codes used decreased (new DRGs from 2.22 to 1.24, and previous DRGs from 1.69 to 1.21), as did the average number of claim procedure codes used (new DRGs from 3.02 to 2.16, and previous DRGs from 2.97 to 2.43). With respect to the time of participation in the program, the change in number of claim procedure codes was significant, but the change in number of claim diagnosis codes was not. The corresponding rate of claim diagnosis codes increased (from 57.5% to 82.6%), as did the exclusion rate of claim diagnosis codes (from 16.5% to 25.1%). Conclusions : After the implementation of the DRG payment system, the corresponding rate of insurance claim codes and the corresponding exclusion rate of claim diagnosis codes both increased, because the inducement system for entering the codes for claim review was changed.

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