• Health Policy and Management
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• v.18 no.1
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• pp.1-20
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• 2008

How health care providers compete and how competition among them affects their behavior are crucial questions in theory and health policy. In ordinary markets, competition improves social welfare, However in health care markets facing uncertainty and information asymmetry, competition can take the form of wasteful quality competition and result in cost increase. The purpose of this study is to examine the characteristics of hospital service markets and examine the impact of hospital competition on hospital behavior, more specifically hospital cost and the size of personnel. Based on patient discharge data of 2002 by the Ministry of Health and Welfare and Korea Institute for Health and Social Affairs, and health insurance EDI claims data of 2002, this study measures the degree of competition in the inpatient service market of hospitals, using variable radius method and Herfindahl index. The result of the study shows that the hospital service market consists of on average 3.13 government administrative units(shi, gun, or gu). Compared with hospitals, general or general specialized hospitals cover larger markets and operate in more competitive markets. Nearly 60% of patients use hospitals, which are not located in their government administrative units, meaning that market definition based on variable radius is better than the conventional method of market definition based on government administrative units. The results of multivariate analysis show that competition is not associated with high cost index of hospitals. But hospitals in more competitive markets employ larger(more intensive) input of personnel per 100 beds, implying that hospital competition in Korea can have the form of quality and cost-increasing competition.

• Korea Journal of Hospital Management
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• v.22 no.4
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• pp.33-49
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• 2017

Background: Health care utilizations and costs of the patients with degenerative lumbar spine disease in Korea increased dramatically. We analyzed whether hospital market competition is associated with charges and length of stay for patients with degenerative lumbar spine disease. Methods: We used Medical claims data of 2002 and 2010 from the nationwide representative sample of National Health Insurance Service of Korea. The study subjects were inpatients with degenerative lumbar spine disease (N=24,768) in 2002 and 2010. We employed a multilevel linear mixed model that included patient- and hospital-level variables in hierarchical data. Results: Higher hospital competition was associated with lower charges (${\beta}=57.5$, p<.0001 in 2002; ${\beta}=353.7$, p<.0001 in 2010) and shorter length of stay (${\beta}=0.3$, p<.0001 in 2002; ${\beta}=0.9$, p<.0001 in 2010) in both 2002 and 2010. Compared to 2002, the magnitude of such association became greater in 2010. However, subgroup analyses show that the influence of competition on charges and length of stay differed by hospital size. Conclusions: This study showed that hospital market structure (e.g., hospital competition) affects hospital efficiency (i.e., hospital charges and length of stay). It is necessary to continue to monitor how changing market structure influences hospital outcomes, including more detailed outcomes such as patient satisfaction.

• Journal of Digital Convergence
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• v.13 no.10
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• pp.405-413
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• 2015

The purpose of this study is to measure the level of competition in the degree of Regional Public Hospital that can provide a basis for establishing an effective management strategy and analysis of the financial performance. Investigation period of the Regional Public Hospital HHI(Herfindahl-Hirschman Index) over three years from 2010, which was unknown until 2012, index and management performance evaluation criteria, a total of 31 were selected as Regional Public Hospital surveyed. In the conclusions, it showed that the most concentrated market with high financial performance, a significant correlation between the degree of local competition and financial indicators showed. The Regional Public Hospital for trends according to the degree of competitive local medical market and therefore is required to establish policies and practices to ensure competitiveness and public interest in the region. The Regional Public Hospital in order to preempt the lead for the competitiveness of other institutions will be considered in the strategy, such as improving medical services and capital investment.

• Journal of The Korea Institute of Healthcare Architecture
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• v.27 no.4
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• pp.15-27
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• 2021

Purpose: This study compares and analyzes the design drawing changes that occur during the design process between hospital design competition and the final detailed design. Based on this, factors that can reduce the rate of changes in drawings are derived. The purpose is to provide basic data to lessen the rate of the changes in the process of architecture design and can be reflected in the design competition guidelines. Methods: In this study, cases of hospitals are selected which are built in 5 recent years. Then compare and analyze the drawings which was drawn in the process from submission of competition to final design. After investigating the design changes that occur after the design competition, analyze the fixed-elements which are the main causes of design changes. Fixed-elements can be narrow down into few architecture-factors such as vertical-core, shafts, public-corridor, HAVC, and mechanical/electrical spaces. Results: Result of the rate of changes in each selected hospital floors can be sorted into variable-elements and fixed-elements which tells that the higher the rate of changes of the fixed-elements, the higher the rate of changes of the variable-elements. Implications: In other words, it can be said as the lower the change rates of the fixed-element, lower changes in whole design changes which represents that the greater the efficiency can be shown in the design process.

• Journal of The Korea Institute of Healthcare Architecture
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• v.1 no.2
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• pp.91-101
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• 1996

This study is intended to summarize the contents and process of an architectural basic planning for the design competition of K University Hospital. Especially a design of low-rise and compact type hospital in sloped suburb is suggested. The major contents consists of proposed premise of planning, goal of planning, site analysis, site plan, and architectural basic plan To realize the concept of low-rise and compact type hospital which reconciles to the natural environment of the site, 4 nursing units per typical floor and hospital street system are introduced. And to design a "hospital unlike hospital", streamline form of hospital building is proposed.

• Journal of The Korea Institute of Healthcare Architecture
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• v.9 no.1
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• pp.53-60
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• 2003

In this study, I investigate the critical evaluation elements at the architectural competition held nationwide in Germany. These evaluation elements, which can be regarded as the important design evaluation criteria, are selected by the design competition committee. Generally, in Germany the design competition committee consist of professors and famous architects who have theoretical and practical abilities with their own office. I classify and analyze the critical evaluation elements of seventy committee members, working on the selected nine prize-winners in Germany from 1997 to 2001. I conclude that the critical evaluation elements, ordered by frequency are : (1)circulation, (2)context, (3)function, (4)landscape & outside space, (5)organization of space, (6)arrangement of building, (7)form, arrangement of building, (7)form, (7)growth & change, (9)elevation design, (10)utilization of natural light. These design evaluation growth & change, (9)elevation design, (10)utilization of natural light. These design evaluation criteria for Hospital Architecture in Germany also can be applied to the evaluation methods of the korean Healthcare facility design.

• Journal of The Korea Institute of Healthcare Architecture
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• v.7 no.2
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• pp.47-58
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• 2001

As one designs a building, one should have to consider its characters and functions according to its own use. Recently many professional buildings used to be designed by specialized design firms with their own experience and specialty to vitalize the functions of the buildings. Especially the design of the hospital is really needed more concern from the beginning of design ordering because it is pursuing the most specialty in architectural designs and therefore it can not be managed with general architects. The purpose of this study is to present the references for resonable promotions of hospital design in the future with the analysis of the suitability in hospital design ordering and the process after design competition in Korea.

• Korean System Dynamics Review
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• v.11 no.4
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• pp.5-23
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• 2010

The competition between hospitals has become an issue for many hospitals because of the sudden increased number of health providers. As the marketing or customer management have become important factors as means of competition, a number of hospital have been considered or already adopted the coordination system. A system dynamics model is developed to see the effect of the hospital coordination system. This paper after briefly explaining the structure of the system dynamics model, discusses the roles of the hospital coordination system with examples. The system dynamics model quantifies through simulations the process of effects of coordination system on the number of customers, productivities of employees (nurses and doctors), and finally the financial status. As a conclusions of the simulations and their analysis, it is concluded that coordination system could be more effective than the investment to the facilities. Since the study is based on only one hospital case, it is limited. However, it explains the mechanism of the coordination system quantitatively as well as qualitatively.

• KDI Journal of Economic Policy
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• v.30 no.2
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• pp.129-155
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• 2008

The rate of antibiotics prescription for an acute airway infection significantly varies depending upon the diagnosis type, specialty, and the location of the hospital along with many other related factors. The objective of this study is to empirically investigate the possible relationship between the antibiotics prescription rates for an acute airway infection and the degree of competition in the hospital market regions of mainly the providers of primary medical care services such as clinics, internal medicines, pediatrics and otorhinolaryngology department. Using the data from Health Insurance Review and Assessment Service (HIRA) regarding the hospitals' antibiotics prescription rates for the acute airway infection and controlling for selected variables of demand and supply sectors, this study tries to figure out that the degree of competition in the hospital market, regardless of what type of competition indexes we employed, has a statistically significant effect on the variations of antibiotics prescription rate of the clinics in local areas. This result implies that as an economic consideration itself, the change in the degree of competition in the hospital market can play a crucial role influencing the treatment behaviors of the medical doctors. More specifically, this study reveals that as the degree of competition increases the antibiotics prescription rate goes up. This result means that if the market becomes more competitive in a specific region so that it might cause a reduction in doctor's income, doctors with rational decision-making process, recognize that the benefit created from inducing patients' seemingly unnecessary demand for medical care (income effect) would be higher than the costs associated with sustaining their targeted income (substitution effect). It is because that the doctors are more likely to prescribe antibiotics which create relatively higher margins than other medical care services in order to sustain their targeted income when the hospital market competition becomes tighter. Even though this study empirically confirms that antibiotics prescription can be affected by the economic incentives, it still raises following issues as limitations of the study: first issue is about the representativeness of the hospital regions segregated for this study, which might be weak in explaining whether these regions are mutually exclusive in reality. Patients actually consider the quality of services, transportation cost, time costs, and any other related factors choosing the doctors or hospitals, and in that sense, this study rules out 'border-crossing' in using the medical care services. Second issue arises in capturing the data of antibiotics prescription rate. Since we use the average rate for each medical institution, we cannot figure out the average rate for each patient so that we are not able to control for the variation of patients' medical conditions. It is because of the unavailability of data regarding each patient's medical condition from HIRA. Thirdly, since this study mainly analyzes the medical institutions providing primary care such as clinics, internal medicines, pediatrics, and otorhinolaryngology department, it is skeptical of whether those institutions can represent the hospital market in respective regions and truly reflect the degree of competition. It needs to extend the study areas and disease types as well as any micro data for future studies.

• Korean Architects
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• s.470
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• pp.36-39
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• 2008