• Tuberculosis and Respiratory Diseases
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• 제52권6호
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• pp.579-589
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• 2002

Since the inception of the National Tuberculosis Control Program in 1962, the incidence of tuberculosis and its associated mortality has declined dramatically due to effective anti-tuberculosis drugs and a systematic control program. The prevalence of radiographically active tuberculosis has fallen from 5.1% in 1965 to 1.0% in 1995. However, tuberculosis is still a major problem, as the mortality rate is still higher compared to other developed countries. Furthermore, tuberculosis is currently re-emerging in HIV/AIDS epidemic countries. In order to lower the tuberculosis death rate to the levels of developed countries, the tuberculosis control efforts in private healthcare institutions and the national tuberculosis control program in the public sector, need to work together more effectively and efficiently. In this paper, the quthor reviewed the current situation regarding tuberculosis management in private healthcare institutions of Korea based on the literature and the National Health Insurance Claim data, and the future tasks of tuberculosis management are suggested.

• 대한안전경영과학회지
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• 제23권1호
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• pp.1-8
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• 2021

The purpose of this study is to investigated occupational accidents of child care worker. We surveyed 392 childcare worker to investigate their experience of occupational accidents. Fifteen percent of the respondents from occupational accdients survey for child care workers reported that they had experienced more than one occupational accident, but mostly did not claim Occupational Safety and Health Insurance. We suggested policy tasks to improve system for protecting child care workers.

• 보건행정학회지
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• 제25권3호
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• pp.185-196
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• 2015

Background: Issues concerning with the classification accuracy of Korean Outpatient Groups (KOPGs) have been raised by providers and researchers. The KOPG is an outpatient classification system used to measure casemix of outpatient visits and to adjust provider risk in charges by the Health Insurance Review & Assessment Service in managing insurance payments. The objective of this study were to refine KOPGs to improve the classification accuracy and to evaluate the refinement. Methods: We refined the rules used to classify visits with multiple procedures, newly defined chemotherapy drug groups, and modified the medical visit indicators through reviews of other classification systems, data analyses, and consultations with experts. We assessed the improvement by measuring % of variation in case charges reduced by KOPGs and the refined system, Enhanced KOPGs (EKOPGs). We used claims data submitted by providers to the HIRA during the year 2012 in both refinement and evaluation. Results: EKOPGs explicitly allowed additional payments for multiple procedures with exceptions of packaging of routine ancillary services and consolidation of related significant procedures, and discounts ranging from 30% to 70% were defined in additional payments. Thirteen chemotherapy drug KOPGs were added and medical visit indicators were streamlined to include codes for consultation fees for outpatient visits. The % of variance reduction achieved by EKOPGs was 48% for all patients whereas the figure was 40% for KOPGs, and the improvement was larger in data from tertiary and general hospitals than in data from clinics. Conclusion: A significant improvement in the performance of the KOPG was achieved by refining payments for visits with multiple procedures, defining groups for visits with chemotherapy, and revising medical visit indicators.

• 농촌의학ㆍ지역보건
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• 제27권2호
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• pp.75-86
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• 2002

의약분업실시 전후 보건소 투약환자의 특성변화, 질병양상변화 그리고 진료내용변화를 알아보기 위해 의약분업 전인 2000년 3월과 의약분업 후인 2001년 3월 각각 한 달 동안 경상남북도에 소재한 4개 보건소(도농복합형 시보건소 2개소, 군보건소 2개소)를 의약분업 전과 후에 이용한 투약환자 5,890명(의약분업 전)과 3,496명(의약분업 후)을 대상으로 건강 보험 및 의료급여 청구서를 이용하여 투약환자의 성, 연령, 주 진단명, 의료보장종류, 내소일수, 투약일수를 조사하였다. 또한 의약품 처방의 변화를 알기 위해 급성 호홉기질환 및 근골격계 질환자에 처방한 약제 종류수, 주사제 사용률, 항생제 사용률, 고가소염제 사용률를 조사하였다. 투약환자의 질환별로는 분업 전에 비해 급성호흡기 질환자는 49.7%, 고혈압환자는 18.1%, 근골격계질환자는 70.5%, 당뇨병환자는 8.5%, 소화기계질환자는 71.2%, 만성호흡기질환자는 76.4% 감소하였으며, 요도감염질환자는 의약분업 전에 비해 66.7% 증가하였다. 의약분업 전후 평균 내소일수의 변화는, 성별로는 남녀 모두 의약분업 전 보다 후가 유의하게 감소하였고(p<0.01), 의료보장형태별도는 건강보험은 유의하게 감소하였으나(p<0.01), 의료급여는 유의한 변화가 없었다. 질환별로는 고혈압, 당뇨병, 근골격계질환에서 유의하게 감소하였다(p<0.01). 의약분업 전후 평균 투약일수는 유의하게 증가하였다(p<0.01). 질환별로는 요도감염을 제외한 다른 질환들은 유의하게 증가하였으며(p<0.01), 요도감염은 증가는 하였으나 통계적으로 유의하지는 않았다. 의약분업 전후 급성호흡기질환자에 대한 평균 처방 약제 종류수는 4.9개에서 4.7개로 유의하게 감소하였고, 주사제 사용률은 63.8%에서 7.7%로 유의하게 감소하였으며, 항생제 사용률은 33.7%에서 19.1%로 유의하게 감소하였 다(p<0.01). 의약분업 전후 근골격계질환자에 대한 평균 처방약제 종류수는 3.7개에서 3.2개로 유의하게 감소하였으며, 주사제 사용률은 64.9%에서 1.7%로 유의하게 감소하였고, 고가 소염제 사용률은 29.1%에서 39.7%로 유의하게 증가하였다(p<0.01). 이상의 결과 의약분업 후 내소환자의 평균 내소일수는 감소한 반면 평균 투약일수는 증가하였다. 의사의 처방형태의 변화로는 평균 약재 종류수는 감소하였고 주사제나 항생제 처방률은 급격히 감소하였으나, 고가 소염제의 처방률은 증가하였다.

• 보건행정학회지
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• 제28권2호
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• pp.178-185
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• 2018

Background: We investigated association between introduction of the diagnosis-related groups (DRG) system for anal operation and length of stay. Also, we investigated how it is different among hospitals with longer length of stay and among hospitals with shorter length of stay before introduction of the DRG system. Methods: We used data from Health Insurance Review and Assessment which were national health insurance claim data. Total 13,111 cases of anal surgery cases were included which were claimed by hospitals since July 2012 to June 2014. Two-level multivariable regression was conducted to analysis the association between length of stay and characteristics of hospital and patient. Results: Before introducing DRGs, the average length of stay was 5.41 days. After introducing DRGs, average length of stay was decreased to 3.92 days. After introducing DRGs, length of stay has decreased (${\beta}=-1.0450$, p<0.0001) and it was statistically significant. Among hospitals which had short length of stay (shorter than mean of length of stay) before introducing DRGs, effect of introducing DRGs was smaller (${\beta}=-0.4282$, p<0.0001). On contrary, among hospitals which had long length of stay (longer than mean of length of stay) before introducing DRGs, effect of introducing DRGs was bigger (${\beta}=-1.8280$, p<0.0001). Conclusion: Introducing DRGs was more effective to hospitals which had long length of stay before introducing DRGs.

• 디지털융복합연구
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• 제18권9호
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• pp.265-275
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• 2020

손상부담은 우리사회에서 매우 심각한 것으로 널리 인식되고 있다. 그럼에도 불구하고 손상감시에 필요한 데이터가 충분하지 않다. 이 연구의 목적은 손상감시를 위해 핵심 데이터를 선택하고 보완하는 것이다. 이를 위해 본 연구에서는 통계품질 6가지 차원에 따라 '사망원인통계', '건강보험통계', '퇴원손상조사'에 대한 품질평가보고서 등의 문헌을 분석 하였다. 분석결과는 '사망원인통계'와 '건강보험통계'가 손상감시를 위한 핵심데이터로서 유용성이 있다는 것이다. 그러나 '건강보험통계'에는 손상외인에 대한 데이터가 부족하다는 단점이 있다. 단점을 보완하기 위해, 본 연구에서는 국민건강보험 의료비 청구 시 의료기관이 손상외인을 의무적으로 신고하도록 하는 제도를 제안한다. 이 제도의 결과로서 우리는 '손상 피라미드 구축', '국민연금과의 데이터 연계', '손상 데이터의 시의성 향상'을 기대할 수 있다. 그리고 이 제도 실현을 위한 후속 연구를 기대한다.

• Journal of Preventive Medicine and Public Health
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• 제42권2호
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• pp.135-142
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• 2009

Objectives : An appropriate sampling strategy for estimating an epidemiologic volume of diabetes has been evaluated through a simulation. Methods : We analyzed about 250 million medical insurance claims data submitted to the Health Insurance Review & Assessment Service with diabetes as principal or subsequent diagnoses, more than or equal to once per year, in 2003. The database was re-constructed to a 'patient-hospital profile' that had 3,676,164 cases, and then to a 'patient profile' that consisted of 2,412,082 observations. The patient profile data was then used to test the validity of a proposed sampling frame and methods of sampling to develop diabetic-related epidemiologic indices. Results : Simulation study showed that a use of a stratified two-stage cluster sampling design with a total sample size of 4,000 will provide an estimate of 57.04%(95% prediction range, 49.83 - 64.24%) for a treatment prescription rate of diabetes. The proposed sampling design consists, at first, stratifying the area of the nation into "metropolitan/city/county" and the types of hospital into "tertiary/secondary/primary/clinic" with a proportion of 5:10:10:75. Hospitals were then randomly selected within the strata as a primary sampling unit, followed by a random selection of patients within the hospitals as a secondly sampling unit. The difference between the estimate and the parameter value was projected to be less than 0.3%. Conclusions : The sampling scheme proposed will be applied to a subsequent nationwide field survey not only for estimating the epidemiologic volume of diabetes but also for assessing the present status of nationwide diabetes control.

• 약학회지
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• 제59권6호
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• pp.278-283
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• 2015

The computerized prospective Drug Utilization Review (DUR) program supported by the Korean government has provided alerts to physicians and pharmacists since December 2010. This study aims to propose and apply the tiering system in "drug combinations to avoid (DCA)" and "age-precaution" alerts based on severity to improve the compliance of users. To propose the severity and clinical importance of 647 DCA alerts and 140 age precautions, a Delphi evaluation survey was conducted. An expert panel comprising 5 clinical pharmacists and 5 physicians were participated in mail surveys. Based on the results of Delphi survey, DCA pairs were classified into 3 groups; group 1 (70.6%), 2 (26.9%), and 3 (2.8%). Drug-age precaution ingredients were also classified into three groups; group 1 (53.6%), group 2 (40.7%), and group 3 (5.7%). When this grouping was applied to claim data from 2011 to 2013, the majority of alerts had occurred in the groups of high severity. Presenting DUR alerts with severity level is expected to improve the compliance of clinicians. The implementation of tiering system in DUR criteria should be considered.

• 한국임상약학회지
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• 제31권1호
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• pp.27-34
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• 2021

Objective: To analyze osteoporosis treatment patterns and teriparatide prescription-associated factors in Korea by using a national health insurance claims database. Methods: We utilized the Health Insurance Review & Assessment Service National Patients Sample claims database to identify patients (aged ≥50 years) with at least one osteoporosis claim (International Classification of Disease 10th revision code: M80, M81, M82) and at least one prescription for osteoporosis medication (antiresorptive agents: bisphosphonates, selective estrogen receptor modulators, denosumab, and calcitonin; bone-forming agent: teriparatide) in 2018. Demographic characteristics and healthcare utilization patterns were analyzed. Factors associated with teriparatide prescriptions were assessed using a multivariate logistic regression model. Results: Records showed that 44,815 patients were prescribed osteoporosis medications in 2018; the percentage of patients prescribed each treatment was as follows: 86.6% bisphosphonates, 13.9% selective estrogen receptor modulators, 3.1% calcitonin, 2.1% denosumab, and 0.7% teriparatide. A greater proportion of patients prescribed teriparatide were ≥75 years (53.4% vs. 33.8%) and had fractures (63.9% vs. 12.8%) compared to the same for antiresorptives (p<0.001). Patients prescribed teriparatide had higher Charlson comorbidity index values (1.2±1.3 vs. 0.9±1.2) and were more frequently hospitalized (0.8±1.3 vs. 0.1±0.5) than those prescribed antiresorptives (p<0.001). Elderly patients (≥75 years old; adjusted OR=1.66; 95% CI 1.16-2.38) and those with fractures (adjusted OR=6.23; 95% CI 4.76-8.14) were more likely to be prescribed teriparatide than antiresorptives. Conclusion: Patients prescribed teriparatide were older and more likely to have severe osteoporosis than those prescribed antiresorptives.

• 보건행정학회지
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• 제29권2호
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• pp.237-244
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• 2019

Background: Weekend admission is known for having association with increased mortality attributed by poor quality of care and severe patients. We investigated the association between hospital admission on weekends and the in-hospital mortality rates of patients with cardiovascular disease. Furthermore, we examined this association stratified by admission via emergency room or not. Methods: We analyzed claim data provided by the Health Insurance Review & Assessment in 2013. In total, 80,817 cardiovascular patients were included in this study, which treated in-hospital mortality (early and during total length of stay) as a dependent variable. A generalized linear mixed effects model was used. We conducted subgroup analyses stratified by admission via emergency room or not. Results: Patients who admitted on weekend showed higher in-hospital mortality both early (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.23-1.78) and during total length of stay (OR, 1.17; 95% CI, 1.02-1.33) compared to those admitted on weekdays. Patients who were admitted to the hospital on a weekend by emergency room were more likely to experience early in-hospital mortality compared to those admitted on weekdays. Furthermore, we found that patients not admitted to the hospital through the emergency department were more likely to experience both early and total length of stay in-hospital mortality. Conclusion: Our study shows higher in-hospital mortality rates for cardiovascular patients admitted on weekends. Efforts to improve the quality of care on weekend are important to mitigate the 'weekend effect' and improve patient outcomes.