• Journal of Preventive Medicine and Public Health
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• v.22 no.4 s.28
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• pp.542-554
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• 1989

The skyrocketing inflation of medical costs has become a major health problem among most developed countries. Korea, which recently covered the entire population with National Health Insurance, is facing the same problem. The proportion of health expenditure to GNP has increased from 3% to 4.8% during the last decade. This was remarkable, if we consider the rapid economic growth during that time. A few policy analysts began to raise cost containment as an agenda, after recognizing the importance of medical cost inflation. In order to Prepare an appropriate alternative for the agenda, it is necessary to find out reasons for the cost inflation. Then, we should focus on the reasons which are controllable, and those whose control are socially desirable. This study is designed to articulate the theory of medical cost inflation through literature reviews, to find out reasons for cost inflation, by analyzing aggregated data with a deterministic model. Finally to identify determinants of changes in both medical demand and service intensity which are major reasons for cost inflation. The reasons for cost inflation are classified into cost push inflation and demand pull inflation, The former consists of increases in price and intensity of services, while the latter is made of consumer derived demand and supplier induced demand. We used a time series (1983-1987), and cross sectional (over regions) data of health insurance. The deterministic model reveals, that an increase in service intensity is a major cause of inflation in the case of inpatient care, while, more utilization, is a primary attribute in the case of physician visits. Multiple regression analysis shows that an increase in hospital beds is a leading explanatory variable for the increase in hospital care. It also reveals, that an introduction of a deductible clause, an increase in hospital beds and degree of urbanization, are statistically significant variables explaining physician visits. The results are consistent with the existing theory, The magnitude of service intensity is influenced by the level of co-payment, the proportion of old age and an increase in co-payment. In short, an increase in co-payment reduced the utilization, but it induced more intensities or services. We can conclude that the strict fee regulation or increase in the level of co-payment can not be an effective measure for cost containment under the fee for service system. Because the provider can react against the regulation by inducing more services.

• Korean Journal of Acupuncture
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• v.37 no.1
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• pp.54-62
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• 2020

Objectives : Acute low back pain syndrome causes pain and poor quality of life. There are various studies of SBV (Sweet bee venom) pharmacopuncture, but few have identified the therapeutic effects for patients unable to walk due to acute back pain. This case series report three cases of acute low back pain syndrome treated with SBV pharmacopuncture combined with Korean Medicine (KM) treatments. Methods : Three acute low back pain syndrome patients with no other acute abnormalities in the imaging were treated by KM treatments including SBV pharmacopuncture, acupuncture, cupping, herbal medicine and physical therapy. The improvement of symptoms was evaluated using Numerical rating scale (NRS), Oswestry disability Index (ODI), EuroQol-5 dimension index (EQ-5D) and EuroQol-visual analogue scale (EQ-VAS). Results : Patients who were unable to walk due to acute back pain were able to walk. There were significant improvements of NRS, ODI, EQ-5D and EQ-VAS after treatment. The patients experienced an average 90% decrease in low back pain after inpatient KM treatment for about 8 days. NRS decreased by an average of 78.9%, ODI decreased by an average of 49.4%, and EQ-VAS increased by an average of 92.6%. In the case 1, EQ-5D decreased in all categories, but in the case 2, it decreased in all categories except for pain/discomfort and anxiety/depression, but in the case 3, it decreased in all categories except anxiety/depression. There was no serious side effect after treatment of SBV pharmacopuncture. Conclusions : KM treatments including SBV pharmacopuncture may be effective for acute low back pain syndrome patients. However, randomized controlled trials are needed in the future to confirm the clinical effects of these interventions.

• Health Policy and Management
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• v.17 no.3
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• pp.87-105
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• 2007

The purpose of this study was to analyze whether nonemergency, isolated coronary artery bypass graft (CABG) surgery for high- or low-risk patients biases the assessment of the risk-adjusted mortality rates of hospitals. This study used 2002 National Health Insurance claims data for tertiary hospitals in Korea. The study sample consisted of 1,959 patients from 23 tertiary hospitals. The risk-adjustment model used the patients' biological, admission, and comorbidity data identified in the claims. The subjects were classified into high- and low-risk groups based on predicted surgical risk. The crude mortality rates and risk-adjusted mortality rates for low-risk, high-risk, and all patients in a hospital were compared based on the rank and the four intervals defined by quartile. Also, the crude mortality rates of the three groups were compared with their 95% confidence intervals of predicted mortality rates. The C-statistic (0.83) and Hosmer-Lemeshow test ($X^2$=11.47, p=0.18) indicated that the risk-adjustment model performed well. Presenting crude mortality rates with their 95% confidence intervals of predicted rates showed higher agreements among the three groups than using the rank or intervals of mortality rates defined by quartile in the hospital performance assessment. The crude mortality rates for the low-risk patients in 21 of the 23 hospitals were located on the same side of their 95% confidence intervals compared to that for all patients. High-risk patients and all patients differed at only one hospital. In conclusion, the impact of risk selection by hospital on the assessment results was the smallest when comparing the crude inpatient mortality rates of CABG patients with the 95% confidence intervals of predicted mortality rates. Given the increasing importance of quality improvements in Korean health policy, it will be necessary to use the appropriate method of releasing the hospital performance data to the public to minimize any unwanted impact such as risk-based hospital selection.

• Journal of Hospice and Palliative Care
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• v.7 no.1
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• pp.49-63
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• 2004

Purpose: The Hospice Oriented Medical Record (HOMR) was developed for assessing the pain and symptoms of terminal cancer patients. Methods and Results: The HOMR consists of an instruction for users and 2 assessment pages which include the graph showing vital signs (temperature, blood pressure, pulse, respiration rate and pain score), current problem lists, performance status, laboratory data, pain characteristics and management, sedation score, associated symptoms and drug side effects, etc. Pilot study was performed in the inpatient Hospice Care Unit in Guro Hospital, Korea University Medical Center. Because an one-week progress data was recorded in HOMR as a flow sheet, the patient's condition and pain control status could be seen at a glance. Conclusion: The HOMR is useful for assessing the terminal cancer patients because it is simple and convenient to use. Further research is needed before it can be universally used in the clinical settings.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.12 no.11
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• pp.4951-4958
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• 2011

The purpose of this study was availability for the classical test method. The test were called CLSI(Clinical and Laboratory Standards Institute) that was disk diffusion method, the newly designed E-test(made use disk diffusion method) can estimate the MIC and modified broth microdilution method that was standardized. Those tests were observed by MicroScan MicroSTREP plus panel. Target strains were 53 strains of S.pneumoniae and 51 strains of ${\alpha}$-hemolytic streptococci which were separated from the inpatient in university hospital for 6 months from February to August, 2009. The 9 antimicrobial agent of target evaluation were cefotaxime, chloramphenicol, clindamycin, erythromycin, levofloxacin, penicillin, tetracycline, trimethoprim/sulfamethoxazole, and vancomycin. researched comparative analysis both S.pneumoniae and ${\alpha}$-hemolytic streptococci. The result of the high concordance rates in ${\alpha}$-hemolytic streptococci was recognized formally in clinical microbiology laboratory.

• The Journal of Internal Korean Medicine
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• v.40 no.5
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• pp.990-998
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• 2019

Introduction: Stroke refers to a sudden brain disease that results in disorders in the anatomy of the brain. The cause is a sudden circulatory disorder of the cerebrovascular system that creates a consciousness disorder and hemiplegia. Despite aggressive treatment after the onset, stroke is a social problem because the patient has difficulty in recovering from sequelae that can include limb movement disorders, language disorders, and emotional disorders. In this study, we describe the effect of traditional Korean medicine treatment on the sequelae in a subacute cerebral infarction patient admitted to a Korean medical hospital. Case presentation: A 67-year-old male patient was diagnosed with cerebral infarction circa 2005, and his condition had not improved. Around March 15, 2018, he experienced the sudden onset of a cerebral infarction in his daily life. This was confirmed by a brain MRI, and he was hospitalized at other hospitals, but he showed no improvement. We conducted a manual muscle test (MMT) to evaluate the patient's exercise and strength. His gait level was measured to evaluate his degree of walking. He was treated with Bojungikgi-tang and acupuncture twice a day. After 34 days of inpatient treatment, the patient's exercise strength improved from Grade 2+~Grade 3 to Grade 3+ determined by the MMT, and his walking ability improved from Gait Level 3 to Gait Level 4. Conclusion: The findings of this study indicate that acupuncture and herbal medicine treatment can help treat patients with hemiplegia due to cerebral infarction.

• Journal of the Korean Society of Radiology
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• v.15 no.2
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• pp.117-123
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• 2021

This paper is to establish a basis for a dose reduction strategy by confirming correlations with the factors that may affect the radiation dose based on the dose records in low-dose chest CT and abdominal non-contrast CT. In order to find out the causes of unnecessary exposure, the correlation between seven factors (age, gender, height, weight, BMI, patient status [inpatient and outpatient], and use of dose modulation) and CT dose were identified. Logistic regression was used as the statistical analysis for correlation verification. In the low dose chest CT, as the higher values of height and BMI and dose modulation off were associated with lowering the risk exceeding Diagnostic Reference Levels(DRL) (odds ration<1, p<0.05). However, as woman compared to man and the higher values of weight were associated with highering the risk exceeding DRL (odds ration>1, p<0.05). In the abdomen CT, as dose modulation off were associated with lowering the risk exceeding DRL (odds ration<1, p<0.05). Therefore It is necessary to conduct research on the relationship between various factors affecting radiation exposure and patient radiation dose for reducing the dose.

• Journal of Acupuncture Research
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• v.36 no.1
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• pp.12-20
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• 2019

Background: This study was conducted to verify the effectiveness and effectiveness-related factors of Korean medicine (KM) treatment for patients who have been involved in traffic accidents (TA). Methods: The medical records of 150 TA patients hospitalized in Dongguk University Bundang Oriental Medicine Hospital from September 2017 to May 2018 were reviewed. Medical records included information on patient demographic characteristics, TA situations, use of KM treatment, clinical characteristics, 4 scales [numeric rating scale (NRS), visual analogue scale (VAS), EuroQol-visual analogue scale (EQ-VAS) and neck disability index (NDI)]. Statistical analyses were performed to determine the effectiveness and effectiveness-related factors of treatment. Results: The 150 patients (almost 1:1 gender ratio) were typically in their 40's (26.67%), had rear impact to their vehicle (37.33%), were in the driver's seat (70.00%), and without head trauma and loss of consciousness (83.33%). The main symptoms were neck pain (60.66%) and lower back pain (54.00%). All 150 patients showed significant improvement after KM treatment. 4 scales significantly improved when the treatment started within 3 days from the accident and patients were hospitalized longer and took more diverse treatments. The patients experiencing a higher initial pain level (NRS 8-10, $VAS{\geq}70$) showed significant improvement of NRS and VAS scores with faster and longer inpatient treatments than the other patients. The patients with higher initial pain levels ($VAS{\geq}70$) also showed significant improvement in EQ-VAS scores. Conclusion: KM treatment was effective for TA patients in this study. Treatment initiation time, hospitalization period, treatment diversity and initial pain level are related to the degree of improvement of a patient's symptoms.

• Journal of the Korean Society of Radiology
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• v.12 no.7
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• pp.869-877
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• 2018

This study analyzed the current status of MRI (frequency, amount of treatment) based on the history of application of the MRI health insurance benefit standard and health insurance claim data. MRI examinations began as a health insurance benefit in 2005. In 2005, the indications were restricted for some diseases, but coverage for benefits in 2010, 2013, 2016, and 2018 was expanded. In 2021, the Ministry of Health and Welfare decided to apply health insurance for all MRI examinations. From 2010 to 2017, the number of MRI examinations increased by 86.7% in 2017 compared to 2010, and the amount of treatment increased by 53.5%. According to general characteristics, the number of MRI examinations was higher in women than in men. By age, the number of examinations was the highest among ages 70-79. Outpatient examinations were more frequent than inpatient examinations, and the number of examinations in the tertiary hospitals was the highest among the types of hospitals. The number of brain MRI examinations was the highest in each exam site. In December 2013, the standard of MRI was expanded for heart disease and Crohn's disease, the number of cardiac MRI and abdominal MRI examinations increased in 2014 compared to 2013. However, the number of examinations is small and not associate with the disease, it would be difficult to say that it affected the increase in the total number of MRI examinations. To assess health insurance sustainability and policy effectiveness, monitoring will be necessary.

• 재활복지
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• v.20 no.1
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• pp.113-130
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• 2016

The purpose of this study is to determine the effects of guided imagery activities using music on both mood states and physiological responses of psychiatric inpatients. The experimental group was consisted of 27 psychiatric patients participating in the guided imagery activities using music for 11 minutes. Also, the control group was formed with 27 psychiatric patients with non-musical intervention. Mood states, blood pressure, pulse and skin temperature were checked before and after session. We could see the significant difference in the score of five areas-tension, depression, anger, vigor, fatigue-showed most differences in score. Also, the score of skin temperature of both experimental group and between two groups showed significant differences, too. Therefore, we can conclude that these results were showing that guided imagery activities using music was an effective nursing intervention method for altering mood state of psychiatric patients. Besides, it seemed to have physiological impact to make patients relax tension backed up by change of skin temperature.