• 보건의료산업학회지
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• 제3권2호
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• pp.65-75
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• 2009

This study aims at deriving any useful information necessary to strengthen the competitiveness for growth through empirical analyses on a general hospital located in a province in order to countermeasure the opening and competition of medical markets. The characteristics of user were identified on the basis of disease groups under KCD in the research method. In addition, the analysis on the expenses of diagnosis and treatment was divided into the treatment progress and degree of hospital resource utilization. And the regression was carried out to identify the impacts of characteristics of inpatient users on the degree of hospital resource utilization. As a result of major research, the inpatient users of the general hospital located in the provincial area in consideration of inpatient users were formed around the inpatient disease groups representative for Korea. And it was understood that most of residents within a distance of 40 minute by the public transportation were using. Although there are restrictions that the analyses were carried out for a general hospital in a province, the findings of this study can be considered a generalized model for the management of provincial general hospitals when we consider the current circumstance that the diagnosis and treatment are carried out by provincial medical institutions primarily for patients in general within the province, along with implications that any general hospital in Korea should be equipped with the facilities, equipments and human resources under the Medical Treatment Act.

• 보건행정학회지
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• 제18권1호
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• pp.21-42
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• 2008

This study investigates economies of scale, cost complementarity and economies of scope for healthcare organizations using econometric approaches. The economies of scale appear to exist in each service provided by a hospital such as inpatient treatment services, outpatient treatment services, and other patient treatment services, respectively. When we test all services in aggregate level, it also indicates that the healthcare industry on average exhibits the economies of scale of 6 percent, which implies that scaling up hospital sizes will bring substantial cost savings to them Evidence shows that cost complementarity exists between outpatient services and other services for patients and, i.e., these other services for patients experience the reduction in marginal costs as the outputs of the outpatient services increase. For the economies of scope, they are present in most service areas; aggregate level services, outpatient services, and other services for patients, respectively. Inpatient treatment services, however, do not show any evidence of the economies of scope. Results show that the economies of scope are achieved by the general hospital type that provides all service areas such as inpatient treatments, outpatient treatments, and other services for patients. The existence of the economies of scope provides the rationale for extending the existing line of business in a hospital into more diverse areas of services where its benefit comes in the form of cost savings. In sum, it overall provides evidence that the M&As in this industry are encouraged to achieve cost reductions from the economies of scale and scope by changing the size and the output mix.

• 보건행정학회지
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• 제13권3호
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• pp.104-128
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• 2003

Equity in health care has taken priority in the Korean government's policy agenda after the government-led national health insurance achieved universal coverage in 1989 along with the final inclusion of the self-employed as beneficiary. The purpose of this study is to examine the extent to which there exists difference or inequality in the utilization of health care, especially cancer inpatient services among income classes. We analysed the utilization of cancer inpatient services of residents in Jeju Island for a year of 2000, using the national health insurance data for qualification of beneficiaries and utilization of health care. The independent variable are 10 income classes based on the national health insurance fee imposed on each household for a year of 2000. The dependent variables of this study are an amount of cancer inpatient health care utilization measured by cancer admission days and cancer treatment costs. Also, cancer inpatient health care utilization is analysed by three categories divided into utilization in medical care institutions (1) within Jeju Island, (2) outside Jeju Island, and (3) all within and outside Jeju Island. We measured concentration index of cancer inpatient health care utilization. This analysis showed negative concentration index within Jeju Island and positive outside Jeju Island, and positive in all within and outside Jeju Island. This results suggest inequality against the relatively poor income groups in utilization of cancer inpatient health care services. Especially, inequity of cancer inpatient health care would be more serious in Jeju Island of Korea, considering that lower income groups reportedly have higher incidence rates in most of cancer and thus use more health services.

• Nuclear Medicine and Molecular Imaging
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• 제42권4호
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• pp.261-266
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• 2008

We established a model to calculate radioactive waste from sewage disposal tank of hospitals to optimize the number of patients receiving inpatient radioiodine therapy within the safety guideline in our country. According to this model and calculation of radioactivity concentration using the number of patients per week, the treatment dose of radioiodine, the capacity and the number of sewage tanks and the daily amount of water waste per patient, estimated concentration of radioactivity in sewage waste upon disposal from disposal tanks after longterm retention were within the safety guideline (30 Bq/L) in all the hospitals examined. In addition to the fact that we could increase the number of patients in two thirds of hospitals, we found that the daily amount of waste water was the most important variable to allow the increase of the number of patients within the safety margin of disposed radioactivity. We propose that saving the water amount be led to increase the number of patients and they allow two patients in an already furnished hospital inpatient room to meet the increasing need of inpatient radioiodine treatment for thyroid cancer.

• 보건행정학회지
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• 제33권1호
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• pp.19-28
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• 2023

Background: With the enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act in February 2018, legal guidelines for physician orders for life-sustaining treatment (POLST) were presented. This study was conducted to analyze the association of writing POLST on the use of health care before death. Methods: The study analyzed the electronic medical records and POLSTs of 1,003 adult patients who died at a tertiary hospital located in Seoul from February 4, 2018 to February 4, 2019. Results: Of the deaths, 80% (n=804) completed POLST. Among patients who completed POLST before death, 51% (n=412) were written 1-7 days before death, and only 31% (n=246) were completed by patients themselves. 99% (n=799) decided to withdraw or withhold cardiopulmonary resuscitation. As a result of analyzing the effect of POLST on medical use before death, it was found that POLST and inpatient cost had a significant negative correlation, and POLST completion significantly reduced death in the intensive care unit (ICU). However, both inpatient costs and death at ICU increased when the POLST was completed by surrogate decision-makers rather than patients themselves. Conclusion: The enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act provided a legal basis for withdrawing and withholding meaningless life-sustaining treatment. By specifying the treatment to be received at the end of one's life through the POLST, inpatient treatment costs and death at the ICU were decreased. However, the frequent decision-making by the surrogates and completion of POLST close to death may hinder the original purpose of the law.

• 사회복지연구
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• 제39호
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• pp.57-81
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• 2008

알코올 중독자의 동기가 치료의 효과에 미치는 영향은 매우 중요한 것으로 알려져 왔다. 본 연구는 알코올 중독문제를 가진 개인들의 치료에 대한 동기를 나타내는 지표로서 입원치료에 대해 환자자신이 동의하였는지의 여부에 주목하였다. 자의입원환자와 타의입원환자는 치료에 대한 동기수준이 다르다고 볼 수 있으므로 치료의 효과성에 대한 지표로서 퇴원후 단주기간에도 차이가 있을 것으로 생각되었다. 이러한 연구목적을 가지고 알코올문제로 진단을 받고 입원치료중인 환자 66명을 대상으로 조사를 실시하였다. 이들의 퇴원후 단주기간은 1차 조사후 8개월 시점에서 전화로 추적조사 하였다. 연구결과, 자의입원환자가 타의입원환자에 비하여 유의미하게 오랜 기간 동안 단주를 유지하는 것으로 나타났으며, 단주기간을 예측하는 요인으로 자의입원 외에 환자가 인지하는 가족지지 역시 유의미한 요인임을 알 수 있었다. 이러한 연구결과는 알코올 중독자들의 입원치료에 있어서 환자들의 자발적 의지가 매우 중요함을 다시 한번 보여주는 것이라 하겠다.

• Journal of Oral Medicine and Pain
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• 제33권2호
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• pp.111-120
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• 2008

다양한 전신질환으로 입원한 환자들의 전신질환별 구강질환의 주소와 치료내용을 조사하여 기본적인 구강질환의 실태를 파악하고자 본 연구를 시행하였는데, 전신질환으로 입원하여 구강질환의 진단과 치료를 위하여 내원한 환자를 대상으로 연구한 결과 다음과 같은 결론을 얻었다. 1. 주된 전신질환인 내분비, 영양 및 대사 질환의 경우 구강질환은 치은염 및 치주질환 44.9%, 타액선의 질환 22.4%, 치아우식증 12.2%, 치수 및 치근단주위의 질환 4.1%, 매몰치와 매복치, 치아경조직의 기타질환 각각 2% 순서로 나타났다. 2. 주된 구강질환인 치은 및 치주질환의 경우 전신질환은 인슐린-비의존성 당뇨 39.2%, 뇌경색 29.4%, 신경근 및 신경총장애 5.6%, 뇌내출혈 3.9%, 위의 악성 신생물, 갑상선기능항진증, 정신분열증, 알콜성 간질환, 신증후군 각각 2% 순서로 나타났다. 이상의 결과로 전신질환이 있는 환자의 구강질환과 구강질환이 있는 환자의 전신질환에 대해서는 일정부분 파악이 되었으나 향후 전신질환으로 입원한 환자의 구강질환과 전신질환과의 상관관계에 대한 연구가 이루어져야 한다고 사료된다.

• 대한간호학회지
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• 제38권3호
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• pp.363-371
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• 2008

Purpose: This analysis was conducted to evaluate the cost-effectiveness of gemcitabine-cisplatin chemotherapy for non small-cell lung cancer patients in an outpatient setting compared with the traditional inpatient setting. Methods: A cost-effective analysis was conducted from a societal perspective. The effects of treatment, which was measured as an adverse event rate, were abstracted from a published literature search and empirical data from one university hospital. The costs included both direct and indirect costs. Direct costs included hospitalizations, outpatient visits, and lab tests. Pharmaceutical costs were excluded in analysis because they were same for both options. Indirect costs included productivity loss of patients as well as care-givers. In order to determine the robustness of the results, sensitivity analysis on treatment protocol was conducted. Results: Literature search showed no difference in adverse effect rates between inpatient treatment protocol and outpatient treatment protocol. Therefore, this analysis is a cost-minimization analysis. Cost-savings in the outpatient setting was 555,936 won for one treatment cycle. Our sensitivity analysis indicated that the outpatient chemotherapy still showed cost-savings, regardless of changes in treatment protocol. Conclusion: The outpatient gemcitabine-cisplatin chemotherapy for non small-cell lung cancer resulted in cost savings compared to inpatient chemotherapy. More importantly, outpatient chemotherapy could improve the utilization of health service resources in terms of available beds.

• 보건행정학회지
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• 제32권2호
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• pp.154-163
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• 2022

Background: The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit. Methods: We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. Results: In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated. Conclusion: High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.

• 보건행정학회지
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• 제32권2호
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• pp.125-136
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• 2022

The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit. We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated. High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.