• Journal of Preventive Medicine and Public Health
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• v.45 no.4
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• pp.219-226
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• 2012

Objectives: To evaluate the risk of fractures related with zolpidem in elderly insomnia patients. Methods: Health claims data on the entire South Korean elderly population from January 2005 to June 2006 were extracted from the Health Insurance Review and Assessment Service database. We applied a case-crossover design. Cases were defined as insomnia patients who had a fracture diagnosis. We set the hazard period of 1 day length prior to the fracture date and four control periods of the same length at 5, 10, 15, and 20 weeks prior to the fracture date. Time independent confounding factors such as age, gender, lifestyle, cognitive function level, mobility, socioeconomic status, residential environment, and comorbidity could be controlled using the case-crossover design. Time dependent confounding factors, especially co-medication of patients during the study period, were adjusted by conditional logistic regression analysis. The odds ratios and their 95% confidence intervals (CIs) were estimated for the risk of fracture related to zolpidem. Results: One thousand five hundred and eight cases of fracture were detected in insomnia patients during the study period. In our data, the use of zolpidem increased the risk of fracture significantly (adjusted odds ratio [aOR], 1.72; 95% CI, 1.37 to 2.16). However, the association between benzodiazepine hypnotics and the risk of fracture was not statistically significant (aOR, 1.00; 95% CI, 0.83 to 1.21). Likewise, the results were not statistically significant in stratified analysis with each benzodiazepine generic subgroup. Conclusions: Zolpidem could increase the risk of fracture in elderly insomnia patients. Therefore zolpidem should be prescribed carefully and the elderly should be provided with sufficient patient education.

• The Journal of Health Technology Assessment
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• v.6 no.2
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• pp.123-132
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• 2018

Objectives: Maternal morbidity and mortality are important healthcare issues. However there have been few studies on cost of illness (COI) from maternal disorders. This study aimed to estimate the COI due to maternal disorders in Korea. Methods: By reviewing previous studies and consulting expert we determined the scope of maternal disorders. We operationally defined maternal disorders as maternal hemorrhage, maternal sepsis, hypertensive disorders of pregnancy, obstructed labor, and abortion for maternal disorders. The reference period of this study is the year 2015. Main source of data were the National Health Insurance Service claims data, cause of death statistics from the Korea National Statistical Office, and the Korea Health Panel study. We classified the total costs into direct and indirect costs. The direct costs cover healthcare costs and non-healthcare costs. The indirect costs consist of productivity losses due to morbidity and premature death. Results: The cost of maternal disorders in 2015 was 229.7 billion won. The direct and indirect costs of maternal disorders were 165.2 billion won and 64.5 billion won respectively. The largest cost item for maternal disorders was healthcare cost (138.3 billion won, 60.2%). By age groups, the COI in 30-39 years old women were the highest (165.1 billion won, 71.9%). Abortion was the disorder with the highest COI among maternal disorders (71.9 billion won, 31.3%). Conclusion: The COI due to maternal disorders in Korea is quite substantial. Economic burden of maternal disorder increased when being compared with the year 2012 data despite the continued low birth rate in Korea. Therefore, it is necessary to continuously monitor the social costs of the maternal disorders in Korea.

• International Neurourology Journal
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• v.22 no.4
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• pp.305-312
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• 2018

Purpose: The aim of this study was to analyze the efficacy and to estimate the complication rate of incontinence surgery according to the surgeon's specialty and whether a preoperative urodynamic study (UDS) was performed, using a nationally representative dataset. Methods: We enrolled 356,155 women over 20 years old who had undergone surgery for stress urinary incontinence between 2006 and 2015. Patients were followed for up to 3 years to analyze the reoperation and complication rates. Data were obtained from the National Health Claims Database of the National Health Insurance Service (NHIS) of Korea. Multiple Cox regression analysis was conducted to examine the efficacy and safety of incontinence surgery according to the surgeon's specialty and whether a preoperative UDS was performed. Results: The hazard ratio (HR) for reoperation was significantly higher for procedures performed by nonurologists than for procedures performed by urologists (HR, 1.174; 95% confidence interval [CI], 1.103-1.249). Acute urinary retention, postoperative infections, procedure-associated pain, and other complications were also more common in procedures performed by nonurologists than in those performed by urologists. When stratified by whether a preoperative UDS was performed, the HR for reoperation according to the surgeon's specialty varied by performance of a preoperative UDS. While the reoperation rate was significantly higher in procedures performed by non-urologists when a preoperative UDS was performed (HR, 1.208; 95% CI, 1.122-1.3), there was no significant difference in the HRs for reoperation according to specialty when a preoperative UDS was not performed. Conclusions: This population-based study showed that the postoperative outcomes of incontinence surgery were dependent upon the surgeon's specialty and that the reoperation rate according to the surgeon's specialty varied based on whether a preoperative UDS was performed.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.30 no.4
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• pp.353-363
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• 2020

Objectives: Occupational diseases that occur due to or aggravated by work have commonly been recognized in the manufacturing industry, but there are now more incidences happening in the service industry due to changes in the industrial structure. Health workers are exposed to direct factors and various other causes of occupational disease at work, such as physical, chemical, biological, and psyco-social factors. This study aims to identify work-related diseases affecting health workers that are recognized as occupational diseases. Methods: The research is based on the data of workers whose diseases were accepted as work-related by the Industrial Accidents Compensation Insurance, and filed by the Korean Occupational Safety and Health Agency. Amongst the approved claims during 2011 to 2015, we focused on healthcare workers and health-related workers of the Korean Standard Classification of Occupations. Descriptive statistics were performed. Results: The number of health workers(HWs) with approved work-related disease was 1,707 over 5 years. The number of healthcare workers(HCWs) excluding caregivers was 370 (21.7%) and of health-related workers (HRWs) it was 736 (43.1%). Out of HWs who were approved for their illnesses, females were 80% of HCWs and 88% of HRWs. The most common occupational disease in HWs was musculoskeletal diseases, while that of nurses was infectious disease. Conclusions: HWs are exposed to various risks from their profession and are affected by occupational diseases. It is necessary to focus on this issue and provide preventive measures.

• International Journal of Computer Science & Network Security
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• v.22 no.3
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• pp.135-140
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• 2022

Scientific and technological progress is also fundamental to the evolving merchant shipping industry, both in terms of the size and speed of modern ships and in the level of their technical capabilities. While the freight performance of ships is growing, the number of crew on board is steadily decreasing, as more work processes are being automated through the implementation of information technologies, including ship management systems. Although there have been repeated appeals from international maritime organizations to focus on building effective maritime security defenses against cyber attacks, the problems have remained unresolved. Owners of shipping companies do not disclose information about cyberattack attempts or incidents against them due to fear of commercial losses or consequences, such as loss of image, customer and insurance claims, and investigations by independent international organizations and government agencies. Issues of cybersecurity of control systems in the world today have gained importance, due to the fact that existing threats concern not only the security of technical means and devices, but also issues of environmental safety and safety of life at sea. The article examines the implementation of cyber risk management in the shipping industry, providing recommendations for the safe ship operation and its systems in order to improve vulnerability to external threats related to cyberattacks, and to ensure the safety and security of such a technical object as a seagoing ship.

• Korea Journal of Hospital Management
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• v.28 no.1
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• pp.14-23
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• 2023

Purposes: The Specialty hospital designation policy had launched in 2011 and 110 designated specialty hospitals have been operating nationwide in 2022. This study was to estimate the market share of specialty hospitals for the specific diseases compared to other types of hospitals. Methodology: Data were derived from the National Health Insurance Claim data from 2018 to 2019. Subjects were all the inpatients with MDC(Major Disease Category) that specialty hospitals specialized in. A total of 34,231,387 claims were analyzed to estimate the market share. Findings: 90 specialty hospitals were responsible for 2.4 percent of inpatient care with specific diseases for specialty hospitals. There were regional variations in the market share of the specialty hospitals as the number of specialty hospitals in regions. Specialty hospitals' market shares were relatively high in burn(31.3%), ophthalmology(16.4%), obstetrics and gynecology(7.1%), alcohol(6.0%), joint(3.7%), spine(2.7%). After adjusting the number of inpatients per hospital, hospitals specialized in burn, alcohol, ophthalmology, breast, joint, obstetrics and gynecology, and hand replantation had treated more patients than tertiary hospitals. Practical Implications: Although specialty hospitals' market share was small, some types of specialty hospitals had an impact on the regional market as well as the national level market. To improve patients' accessibility to a specialty hospital, it is necessary to government supports non-specialized hospitals to change into specialty hospitals in certain fields and regions where the number of specialty hospitals is insufficient.

• Health Policy and Management
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• v.11 no.2
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• pp.141-168
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• 2001

Healthcare service organizations can apply the cost of quality(COQ) model as a method to evaluate a service quality improvement project such as Total Quality Management (TQM). COQ model has been used to quantify and evaluate the efficiency and effectiveness of TQM project through estimation between cost and benefit in intervention for a quality Improvement to provide satisfied services for a customer, and to identify a non value added process. For estimating cost of quality, We used activities and activity costs based on Activity Based Costing(ABC) system. These procedures let the researchers know whether the process is value-added by each activity, and identify a process to require improvement in TQM project. Through the series of procedures, health care organizations are service organizations can identify a problem in their quality improvement programs, solve the problem, and improve their quality of care for their costumers with optimized cost. The study subject was a quality improvement program of the department of radiology department in a hospital with n bed sizes in Metropolitan Statistical Area (MSA). The principal source of data for developing the COQ model was total cases of retaking shots for diagnoses during five months period from December of the 1998 to April of the 1999 in the department. First of the procedures, for estimating activity based cost of the department of diagnostic radiology, the researchers analyzed total department health insurance claims to identify activities and activity costs using one year period health insurance claims from September of the 1998 to August of the 1999. COQ model in this study applied Simpson & Multher's COQ(SM's COQ) model, and SM's COQ model divided cost of quality into failure cost with external and internal failure cost, and evaluation/prevention cost. The researchers identified contents for cost of quality, defined activities and activity costs for each content with the SM's COQ model, and finally made the formula for estimating activity costs relating to implementing service quality improvement program. The results from the formula for estimating cost of quality were following: 1. The reasons for retaking shots were largely classified into technique, appliances, patients, quality management, non-appliances, doctors, and unclassified. These classifications by reasons were allocated into each office doing re-taking shots. Therefore, total retaking shots categorized by reasons and offices, the researchers identified internal and external failure costs based on these categories. 2. The researchers have developed cost of quality (COQ) model, identified activities by content for cost of quality, assessed activity driving factors and activity contribution rate, and calculated total cost by each content for cost for quality, except for activity cost. 3. According to estimation of cost of quality for retaking shots in department of diagnostic radiology, the failure cost was ￦35,880, evaluation/preventive cost was ￦72,521, two times as much as failure cost. The proportion between internal failure cost and external failure cost in failure cost is similar. The study cannot identify trends on input cost and quality improving in cost of qualify over the time, because the study employs cross-sectional design. Even with this limitation, results of this study are much meaningful. This study shows possibility to evaluate value on the process of TQM subjects using activities and activity costs by ABC system, and this study can objectively evaluate quality improvement program through quantitative comparing input costs with marginal benefits in quality improvement.

• Journal of Korean Medicine Rehabilitation
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• v.31 no.4
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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.

• Journal of Arbitration Studies
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• v.20 no.2
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• pp.173-198
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• 2010

The purpose of this paper is to research on the liability for the space damage and the settlement of the dispute with reference to the space activity under the international space treaty and national space law of Korea. The United Nations has adopted five treaties relating to the space activity as follows: The Outer Space Treaty of 1967, the Rescue and Return Agreement of 1968, the Liability Convention of 1972, the Registration Convention of 1974, and the Moon Treaty of 1979. All five treaties have come into force. Korea has ratified above four treaties except the Moon Treaty. Korea has enacted three national legislations relating to space development as follows: Aerospace Industry Development Promotion Act of 1987, Outer Space Development Promotion Act of 2005, Outer Space Damage Compensation Act of 2008. The Outer Space Treaty of 1967 regulates the international responsibility for national activities in outer space, the national tort liability for damage by space launching object, the national measures for dispute prevention and international consultation in the exploration and use of outer space, the joint resolution of practical questions by international inter-governmental organizations in the exploration and use of outer space. The Liability Convention of 1972 regulates the absolute liability by a launching state, the faulty liability by a launching state, the joint and several liability by a launching state, the person claiming for compensation, the claim method for compensation, the claim period of compensation, the claim for compensation and local remedy, the compensation amount for damage by a launching state, the establishment of the Claims Commission. The Outer Space Damage Compensation Act of 2008 in Korea regulates the definition of space damage, the relation of the Outer Space Damage Compensation Act and the international treaty, the non-faulty liability for damage by a launching person, the concentration of liability and recourse by a launching person, the exclusion of application of the Product Liability Act, the limit amount of the liability for damage by a launching person, the cover of the liability insurance by a launching person, the measures and assistance by the government in case of occurring the space damage, the exercise period of the claim right of compensation for damage. The Liability Convention of 1972 should be improved as follows: the problem in respect of the claimer of compensation for damage, the problem in respect of the efficiency of decision by the Claims Commission. The Outer Space Damage Compensation Act of 2008 in Korea should be improved as follows: the inclusion of indirect damage into the definition of space damage, the change of currency unit of the limit amount of liability for damage, the establishment of joint and several liability and recourse right for damage by space joint launching person, the establishment of the Space Damage Compensation Review Commission. The 1998 Final Draft Convention on the Settlement of Disputes Related to Space Activities of 1998 by ILA regulates the binding procedure and non-binding settlement procedure for the disputes in respect of space activity. The non-binding procedure regulates the negotiation or the peaceful means and compromise for dispute settlement. The binding procedure regulates the choice of a means among the following means: International Space Law Court if it will be established, International Court of Justice, and Arbitration Court. The above final Draft Convention by ILA will be a model for the innovative development in respect of the peaceful settlement of disputes with reference to space activity and will be useful for establishing the frame of practicable dispute settlement. Korea has built the space center at Oinarodo, Goheung Province in June 2009. Korea has launched the first small launch vehicle KSLV-1 at the Naro Space Center in August 2009 and June 2010. In Korea, it will be the possibility to be occurred the problems relating to the international responsibility and dispute settlement, and the liability for space damage in the course of space activity. Accordingly the Korean government and launching organization should make the legal and systematic policy to cope with such problems.

• The Korean Journal of Air & Space Law and Policy
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• v.26 no.1
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• pp.177-213
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• 2011

The purpose of this paper is to research on the liability and cases for space damage with reference to the space activity under the international space treaty and national space law of major countries. The United Nations has adopted two treaties relating to the liability for space damage as follows: the Outer Space Treaty of 1967 and the Liability Convention of 1972. Korea has enacted the Outer Space Damage Compensation Act of 2008 relating to the liability for space damages. The Outer Space Treaty of 1967 regulates the international responsibility for national activities in outer space, and the national tort liability for damage by space launching object. The Liability Convention of 1972 regulates the absolute liability by a launching state, the faulty liability by a launching state, the joint and several liability by a launching state, the person claiming for compensation, the claim method for compensation, the claim period of compensation, the claim for compensation and local remedy, the compensation amount for damage by a launching state, and the establishment of the Claims Commission. The Outer Space Damage Compensation Act of 2008 in Korea regulates the definition of space damage, the relation of the Outer Space Damage Compensation Act and the international treaty, the non-faulty liability for damage by a launching person, the concentration of liability and recourse by a launching person, the exclusion of application of the Product Liability Act, the limit amount of the liability for damage by a launching person, the cover of the liability insurance by a launching person, the measures and assistance by the government in case of occurring the space damage, and the exercise period of the claim right of compensation for damage. There are several cases with reference to the liability for damage caused by space accidents as follows: the Collision between Iridium 33 and Cosmos 2251, the Disintegration of Cosmos 954 over Canadian Territory, the Failure of Satellite Launching by Martin Marietta, and the Malfunctioning of Westar VI Satellite. In the disputes and lawsuits due to such space accidents, the problems relating to the liability for space damage have been settled by the application of absolute(strict) liability principle or faulty liability principle. The Liability Convention of 1972 should be improved as follows: the clear definition in respect of the claimer of compensation for damage, the measure in respect of the enforcement of decision by the Claims Commission. The Outer Space Damage Compensation Act of 2008 in Korea should be improved as follows: the inclusion of indirect damage into the definition of space damage, the change of the currency unit of the limit amount of liability for damage, the establishment of joint and several liability and recourse right for damage by space joint launching person, and the establishment of the Space Damage Compensation Review Commission. Korea has built the space center at Oinarodo, Goheung Province in June 2009. Korea has launched the first small launch vehicle KSLV-1 at the Naro Space Center in August 2009 and June 2010. In Korea, it will be the possibility to be occurred the problems relating to the international responsibility and the liability for space damage in the course of space activity. Accordingly the Korean government and launching organization should make the legal and systematic policy to cope with such problems.