• 한방재활의학과학회지
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• 제31권4호
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• pp.105-116
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• 2021

Objectives Lumbar herniated intervertebral disc (L-HIVD) is common disease in which Western-Korean collaborative treatment is performed in Korea. This study aimed to analyze Western-Korean collaborative treatment utilization of Korean patients with L-HIVD using Health Insurance Review & Assessment Service's Patients Sample Data. Methods This study used the Health Insurance Review & Assessment Service-National Patient Sample (HIRA-NPS) in 2018. Claim data of L-HIVD patients were extracted. The claim data were rebuilt with the operational concept of 'episode of care' and divided into Korean medicine episode group (KM), Western medicine episode group (WM) and collaborative treatment episode group (CT). General characteristics, medical expenses and healthcare utilization were analyzed. In addition, the difference of average visit day and average medical expenses between non-collaborative group (KM plus WM) and CT were analyzed by the propensity score matching method. Results A Total of 64,333 patients and 365,745 claims were extracted. The number of episodes of WM, KM and CT was 69,383 (92.97%), 3,903 (5.23%), and 1,341 (1.80%) respectively. The frequency of collaborative treatment episode was higher in women and the age of 50s. The most frequently described treatment in CT was acupuncture therapy. As a result of the propensity score matching, the number of visit days and medical expenses in the collaborative treatment group was higher than in the non-collaborative group. Conclusions The analysis of healthcare utilization of Korean-Western collaborative treatment may be used as basic data for establishing medical policies and systematic collaborative treatment model in the future.

• 의료법학
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• 제24권2호
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• pp.79-117
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• 2023

2002년 의료 관련 선고된 판결들 중에는 , 환자의 자기결정권 행사를 보장하기 위하여 구체적인 상황에서 환자에게 의료행위의 위험성과 부작용 등에 관하여 충분히 숙고한 후 결정할 수 있는 시간적 여유가 주어져야 한다는 점을 명시하면서 설명의무의 이행시기와 관련된 의미 있는 판결이 있었다. 또한 보험회사가 실손보험상품 가입자들을 대위하여 의료기관에 대해 부당이득반환을 청구한 사례에서 채권자대위권의 보전의 필요성 관련 적극적 요건과 소극적 요건을 분설하여 명확한 기준을 제시한 판결이 있었다. 의료행정 영역에서는, 국민건강보험법에 따른 요양기관 업무정지처분의 성격을 대물적처분으로 명확히 한 판결, 코로나 백신투여 부작용에 대한 보상 인정 사례에서 인과관계를 폭 넓게 인정한 판결 및 한의사의 초음파 의료기기 사용 등 의료인의 면허범위 관련 판결이 있었다. 환자에 대한 의료기관의 퇴거 청구 사례에서 의료법 제15조 제1항과 관련하여 입원진료계약의 해지에 관한 정당한 사유에 대한 판결을 검토하였다.

• 한국병원경영학회지
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• 제6권2호
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• pp.37-69
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• 2001

A new cost management system, called Activity Based Costing (ABC) system, has arisen to solve the limitation of a Traditional Cost Accounting (TCA) system until last two decades and ABC has been applied by many companies. TCA systems have limitation in tracing cost because they arbitrarily allocate overhead cost to the cost objects without standard for direct cost distribution. ABC is an accounting system that assigns costs to products or services based on the resources they consume. The costs of all activities are traced to the products for which they are performed. Therefore ABC is a cost management system that provides a matrix to accurately quantify consumed resources triggered by activities and activities triggered by products and services. There is little implementation of ABC in the health services field, one of service industries, due to complicated and many activities, and volatile cost object. However, the necessity for applying reasonable cost accounting system is largely issuing as strategy responding hostile environment, and financial pressure, and it is imperative to implement the Activity Based Costing (ABC) system. Therefore, this study presents the framework to develop ABC system for total health service organizations. Cost objects in this study base on medical service activities per health insurance claim from one general hospital located in Metropolitan Statistical Areas (MSAs). Medical service activities include all health insurance claims in the hospital. The purpose of the study is presenting useful tools and basic frame to develop Activity Based Costing system for health service organizations which want to use ABC system. The steps to develop ABC system for health service organizations are following: 1. Identifying of activity centers; 2. Definition of cost objects and activity by activity center; 3. Analysis of activity and tracing activity contribution; 4. Allocation of direct cost for specific activity; 5. Allocation of indirect cost for specific activity; 6. Allocation of depreciation for facilities, applicants, and consumption goods; 7. Allocation of administration cost; 8. Allocation of cost among activity centers; and 9. Tracing cost of cost objects by activity center. This study identified necessary information from existing reports which hospitals generally made by each step, and defined outcome which had to be produced in each step using this information. The steps of this study had limitation to apply all different size hospitals because the steps were structured ABC system by one hospital, however, this study used similar basic framework and methods with general cases. When a health service organization want to apply Activity Based Costing (ABC) system on all activities of it in future days, this study is very useful to design system structure in the health service organization.

• 한국임상약학회지
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• 제22권1호
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• pp.73-80
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• 2012

This study was to determine the inappropriate drug use in pediatric outpatients who received 2 or more prescriptions on the same day. Retrospective drug utilization reviews (DURs) were implemented to samples obtained from national health insurance claims data during December 2008 to February 2009, using 5 DUR criteria (duplication, drug-drug interaction, drug-disease interaction, drug-age contraindication, incorrect dosage) established in the Drug Information Framework (DIF)-$Korea^{TM}$, DUR program. Among 38,451 claims analyzed in the study, 74.7% had more than one conflicts in the 5 DUR modules. Among 16,472 patients analyzed, 49.6% had conflicts with duplication criteria composing of ingredient duplication (23.3%) and therapeutic class duplication (39.6%). Incorrect dosages were found in 73.6% of patients and under-dosage conflicts accounted for 59.9%, which was higher than over-dosage conflicts (38.3%). In this study, inappropriate drug prescriptions such as under-dose, pediatric contraindication and therapeutic duplication were prevalent in pediatric outpatient settings, suggesting much more awareness to the society, to prevent drug related problems in a vulnerable pediatric group.

• 한국임상약학회지
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• 제25권3호
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• pp.159-165
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• 2015

Objective: Polypharmacy is one of the main causes of inappropriate medication use, adverse drug-related events and cost. It aimed to investigate the status of polypharmacy and potentially inappropriate medication (PIM), the factors affecting polypharmacy and cost in elderly outpatients. Method: A pharmacy claim data were retrospectively analyzed with elderly patients prescriptions at a pharmacy located near a top tier general hospital. The numbers of medications per person, prevalence of polypharmacy and PIM according to the 2012 Beers criteria and Korea PIM list, medication cost and the factors affecting polypharmacy were investigated. Results: Forty-six percentages of the elderly outpatients received polypharmacy and over 21% of them had medications listed in Beers or Korean PIM. In multiregressional analysis, we found that age, gender and insurance types were affective factors of polypharmacy. (p < 0.001, 0.047, 0.009, respectively). The cost of polypharmacy with PIM in elderly outpatients was increased with age. Various approaches of interventions would be further required.

• Journal of Preventive Medicine and Public Health
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• 제41권5호
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• pp.295-299
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• 2008

Objectives : The Korean government in January 2006 instigated an exemption policy for hospitalized children under the age of six years old. This study examines how this policy affected the utilization of medical care in Korea. Methods : A total of 1,513,797 claim records from the Health Insurance Review Agency were analyzed by complete enumeration methods. The changes of medical utilization were compared from 2005 to 2006. In addition, the changes of medical utilization between 2004 and 2005 were compared as a pseudo-control group. Results : The admission rate increased 1.14-fold from 15.20% in 2004 to 17.32% in 2005, and this further increased 1.08-fold to 18.65% in 2006. The increase of patients with a common cold (1.2-fold) was higher than that of both the general patients (1.08-fold) and the patients, with the top 10 fatal diseases (0.91-fold). The average length of stay per case for clinics showed the highest increase rates (1.06-fold). The rates of patients with the common cold showed a higher increase (1.05-fold) than that of the general patients. The average medical expense per case was increased by 1.10-fold from 2005 to 2006, which was higher than that from 2004 to 2005 (1.04-fold). The increase rate for patients with the common cold was higher at 1.18-fold than that of the general patients. Conclusions : The cost exemption policy has especially led to an increase in the utilization of clinics and the utilization by patients with a common cold.

• 경영정보학연구
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• 제7권1호
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• pp.275-295
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• 2005

경제의 세계화와 지식정보화 사회로의 진입과 함께 초래된 경영환경의 급속한 변화는 의료기관들에게도 경쟁력강화를 위한 변신을 강요하게 되었다. 다시 말하면, 의료기관들은 선진 의료기술의 확보, 환자들에 대한 서비스제고와 함께 경영의 효율성 증대라는 세가지 목표를 동시에 달성해야만 하는 상황에 놓이게 된 것이다. 본 연구는 의료기관들이 당면하고 있는 이러한 세가지 과제 중 병원의 경영효율성 증대를 위한 한가지 대안으로 진료비 청구삭감의 빈도 및 발생 가능성을 낮추기 위한 해법의 마련이 시도되었다. 진료비청구삭감이란 의료기관들이 환자들에 대한 의료서비스에 대한 진료비 중 의료보험으로 인해 환자들이 감면 받은 진료비를 건강보험심사원에 청구하면, 심사원이 의료기관의 청구내역의 적정여부를 심사하여 적정하지 않은 내용에 대한 청구금액을 삭감하는 제도를 이른다. 청구금액에 삭감이 발생하면 해당 의료기관의 수입이 감소하는 것은 물론 원인분석이나 재청구 작업등에 비용과 인력이 이중으로 투입되게 되어 의료기관의 경영에 부담을 주게 되고, 이러한 상황이 빈발하게 되면 해당 의료기관에 대한 환자와 건강보험심사평가원의 신뢰에 문제가 발생하게 된다. 그러므로, 효과적인 진료비 청구삭감분석시스템에 의한 사전대비의 필요성이 높아지게 되는 것이다. 이를 위하여 본 연구에서는 진료비 청구삭감분석을 위한 프로토타입의 개발이 시도되었다. 프로토타입은 데이터마이닝 기법 중 연관분석 알고리즘을 적용하여 개발되었으며, 이렇게 개발된 프로토타입을 D의료원에서 10개월간 발생한 실제 진료데이타를 사용하여 성능을 시험하였다.

• 대한한의학회지
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• 제37권3호
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• pp.112-122
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• 2016

Objectives: This study aimed to assess the validity of 'Korean Diagnosis Related Groups-Korean Medicine (KDRG-KM)' which was developed by Health Insurance Review & Assessment Service (HIRA) in 2013 Methods: Among inpatient EDI claim data issued by hospitals and clinics in 2012, the data which included Korean medicine procedures were selected and analyzed. We selected control targets in the Korean medicine hospitals which had longer Episodes-Costliness index (ECI) and Lengthiness index (LI) than average of total Korean medicine hospitals, and compared the results of selection between the major diagnosis-based patient classification system and the KDRG-KM system. Finally, the explanation power (R2) and coefficient of variation (CV) of the KDRG-KM system using practice expenses were calculated. Results: The numbers of control target in Korean medicine hospitals changed from 36 to 32 when patient grouping adjustment method was changed from major diagnosis to KDRG-KM. For expenses of all outpatient claim data on Korean medicine, explanation power of KDRG-KM system was 66.48% after excluding outliers. CVs of expenses of patient groups in Korean medicine hospitals were gathered from under 70% to under 90%, and those in long-term care hospitals mostly belonged under 70%. Conclusions: The validity of KDRG-KM system was assured in terms of explanation power. By adapting KDRG-KM system, fairness of control targets selection for costliness management in Korean medicine hospitals can be enhanced.

• 한국임상약학회지
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• 제31권2호
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• pp.153-159
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• 2021

Background: With increasing economic evaluation studies on the treatment of or screening tools for liver diseases that cause hepatocellular carcinoma (HCC), interest in the analysis of the medical utilization and costs of HCC treatment is increasing. Therefore, we aimed to estimate the medical utilization and costs of HCC patients, and calculate the cost of main procedures for HCC treatment, including liver transplant (LT), hepatic resection (HR), radiofrequency ablation (RFA), and transarterial chemoembolization (TACE). Methods: We analyzed claim data from January to December 2018 from the Health Insurance and Review and Assessment Service-National Patient Sample (HIRA-NPS-2018) dataset, including data of patients diagnosed with HCC (Korean Standard Classification of Diseases code C22.0) who had at least one inpatient claim for HCC. Results: A total of 715 HCC patients were identified. In 2018, the yearly average medical cost per HCC patient was ₩18,460K (thousand), of which ₩14,870K was attributed to HCC. Among the total medical costs of HCC patients, the inpatient cost accounted for the largest portion of both the total medical and HCC-related costs. The major procedures of HCC treatment occurred most frequently in the order of TACE, RFA, HR, and LT. The average medical cost per treatment episode was the highest for LT (₩87,280K), followed by HR (₩10,026K), TACE (₩4,047K), and RFA (₩2,927K). Conclusion: By identifying the medical costs of HCC patients and the costs of the main procedures of HCC treatment, our results provide basic information that could be utilized for cost estimation in liver disease-related economic evaluation studies.

• 한국의료질향상학회지
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• 제5권1호
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• pp.58-75
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• 1998

Background : In Korea, the rational use of antibiotics are rarely controlled, and their patterns of utilization are not understood. In order to reduce the excessive use and to improve the appropriate use of antibiotics, it is necessary to accurately determine present uses of antibiotics in hospitals. Methods : Analysis of the use of prescription drugs was performed on NFMI(National Federation of Medical Insurance) 1994 medical expense claim data. A stratified sampling by types of hospitals, departments, and diseases was obtained from 1994 August data. Patients with secondary diseases were excluded. In this study, 2,697 adults with URI, 6,397 children with URI, 704 adults with bronchitis, and 1,838 children with bronchitis were included. Results : Most patients were prescribed medication (95.2-99.6%). Of the patients prescribed medication, more than 85% of URI patients and more than 91% of bronchitis patients were prescribed antibiotics. Antibiotics expenses accounted for 14% of total medical expenses in adults and 9% of total medical expenses in children. In adults with URI, antibiotics expenses accounted for 52% of drug expenses. Of the patients prescribed antibiotics, average number of antibiotics used was 1.6-1.7. For patients who are prescribed antibiotics, drug expenses were 62-97% greater than patients not prescribed antibiotics. When children were prescribed antibiotics, the highest price of drugs prescribed were 3.4-fold greater. In addition, the number of drugs prescribed also increased by more than one. Elderly patients, more than 60 years, were prescribed antibiotics less frequently. Children less than 10 years and elderly patients greater than 60 years old were prescribed fewer antibiotics than other patients. And they were prescribed medications for longer days than other patients. Conclusion : This study demonstrated that the average rate of prescribing antibiotics was higher in Korea than other countries. Measures to reduce overuse of antibiotics and to improve the appropriate prescription of antibiotics must be considered for cost effective treatment and overall health of people.