• Journal of Preventive Medicine and Public Health
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• v.11 no.1
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• pp.123-127
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• 1978

The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are estab-lished for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The 'AUT-OGRP System' was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The 'Departmental Method' was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying patterns of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among the study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables (i. e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death. rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The wei틴fed mean total case cost (TOTC) of the study hospitals for Medicare patients during the study years was $11,27.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($743.45). The weighted mean per diem total cost (DTOC) of the study hospitals for Medicare patients during the sutdy years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the hospital with the lowest average DTOC ($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variance to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of interhospital cost variation: 59.1 percent for TOTC and 44.3 percent for DTOC. Thsee results demonstrate that the casemix index is the most importand determinant of interhospital cost variation Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.

• Korean Journal of Radiology
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• v.21 no.1
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• pp.42-57
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• 2020

Appropriate use and analysis of neuroimaging techniques is an inevitable aspect of clinical trials for patients with acute ischemic stroke. Neuroimaging examinations were recently used to define the core eligibility criteria and outcomes in acute ischemic stroke research. Recent clinical trials for endovascular treatment in acute ischemic stroke have also demonstrated the efficacy or safety of endovascular treatment using various imaging modalities as well as clinical indices. Furthermore, independent imaging reviews and imaging core laboratory assessments are essential to manage and analyze imaging data in order to enhance the reliability of the outcomes. Therefore, we systematically reviewed the use of neuroimaging in recent randomized clinical trials for endovascular treatment of acute ischemic stroke in order to provide a thorough summary, which would serve as a resource guiding the use of appropriate imaging protocols and analyses in future clinical trials for acute ischemic stroke. This review will help researchers select appropriate imaging biomarkers among the various imaging protocols available and apply the selected type of imaging examination for each study in accordance with the academic purpose.

• Journal of Communications and Networks
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• v.14 no.5
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• pp.487-494
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• 2012

A standard paradigm for the allocation of wireless resources in communication demands symmetry, that is, all users are assumed to be on equal footing and hence get equal shares of the system's communication capabilities. However, there are situations in which "prime users" should be given priority, as for example in the transmission of emergency messages. We examine prioritization policies that could be implemented at the physical layer and propose a new one, termed interference priority (IP), which is shown to have excellent performance. We evaluate the performance of these prioritization techniques both in controlled settings and within the context of a full cellular system and discuss the impact of prioritized use of resources on the unprioritized users.

• Parasites, Hosts and Diseases
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• v.53 no.5
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• pp.553-559
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• 2015

Research on micro-level assessment of the changes of socio-economic status following health interventions is very scarce. The use of household asset data to determine wealth indices is a common procedure for estimating socio-economic position in resource poor settings. In such settings information about income is usually lacking, and the collection of individual consumption or expenditure data would require in-depth interviews, posing a considerable risk of bias. In this study, we determined the socio-economic status of 213 households in a community population in an island in the north-western Tanzania before and 3 year after implementation of a participatory hygiene and sanitation transformation (PHAST) intervention to control schistosomiasis and intestinal worm infections. We constructed a household 'wealth index' based housing construction features (e.g., type of roof, walls, and floor) and durable assets ownership (e.g., bicycle, radio, etc.). We employed principal components analysis and classified households into wealth quintiles. The study revealed that asset variables with positive factor scores were associated with higher socio-economic status, whereas asset variables with negative factor scores were associated with lower socio-economic status. Overall, households which were rated as the poorest and very poor were on the decrease, whereas those rated as poor, less poor, and the least poor were on the increase after PHAST intervention. This decrease/increase was significant. The median shifted from -0.4376677 to 0.5001073, and the mean from -0.2605787 (SD; 2.005688) to 0.2605787 (SD; 1.831199). The difference in socio-economic status of the people between the 2 phases was highly statistically significant (P<0.001). We argue that finding of this study should be treated with caution as there were other interventions to control schistosomiasis and intestinal worm infections which were running concurrently on Kome Island apart from PHAST intervention.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.8
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• pp.3645-3651
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• 2012

Conventional pap smear (CPS) examination has been the mainstay for early detection of cervical cancer. However, its widespread use has not been possible due to the inherent limitations, like presence of obscuring blood and inflammation, reducing its sensitivity considerably. Automated methods in use in developed countries may not be affordable in the developing countries due to paucity of resources. On the other hand, manual liquid based cytology (MLBC) is a technique that is cost effective and improves detection of precursor lesions and specimen adequacy. Therefore the aim of the study was to compare the utility of MLBC with that of CPS in cervical cancer screening. A prospective study of 100 cases through MLBC and CPS was conducted from October 2009 to July 2010, in a Medical College in India, by two independent pathologists and correlated with histopathology (22 cases). Morphological features as seen through MLBC and CPS were compared. Subsequently, all the cases were grouped based on cytological diagnosis according to two methods into 10 groups and a subjective comparison was made. In order to compare the validity of MLBC with CPS in case of major diagnoses, sensitivity and specificity of the two methods were estimated considering histological examination as the gold standard. Increased detection rate with MLBC was 150%. The concordance rate by LBC/histopathology v/s CPS/histopathology was also improved (86% vs 77%) The percentage agreement by the two methods was 68%. MLBC was more sensitive in diagnosis of LSIL and more specific in the diagnosis of inflammation. Thus, MLBC was found to be better than CPS in diagnosis of precursor lesions. It provided better morphology with increased detection of abnormalities and preservation of specimen for cell block and ancillary studies like immunocytochemistry and HPV detection. Therefore, it can be used as alternative strategy for cervical cancer prevention in limited resource settings.

• KDI Journal of Economic Policy
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• v.33 no.1
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• pp.125-148
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• 2011

Although the patient's problem with access to health information has been improved due to rapidly developing information technologies, such as the internet, some patients still do not have enough ability to understand, interpret, and analyze the health information. Given this view on the patient's asymmetric information problem, if a doctor provides sufficient effort to help patients understand and interpret medical information, the efficiency of patient's medical care use could be improved. This paper shows firstly that the patient's inefficient use of medical care originates from his information problems, such as the misperception of the effectiveness of medical care and secondly suggests that if the doctor makes sufficient effort to correct patient's information problems, the inefficiency can be ameliorated. This paper also suggests the manipulation of a doctor's payment method can lead a doctor to provide optimal level of efforts which can in turn lead patients to use the optimal level of medical care. With an optimal level of effort, a doctor can more easily achieve a patient's compliance with the newly recommended amount of medical care.

• Laboraroty Animal Research
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• v.34 no.4
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• pp.311-316
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• 2018

Laboratory inbred mice are used widely and commonly in biomedical research, but inbred mice do not have a big enough gene pool for the research. In this study, genetic and morphometric analyses were performed to obtain data on the characteristics of a newly developing inbred strain (KWM/Hym) captured from Chuncheon, Korea. All of five Korean wild male mice have the zinc-finger Y (ZfY) gene. Also, all of 19 Korean wild mice used in this analysis have the AKV-type murine leukemia virus gene, indicating that Korean wild mice might be Mus musculus musculus. To identify the genetic polymorphism in KWM/Hym, SNP analysis was performed. In a comparison with 28 SNP markers, there was a considerable difference between KWM/Hym and several inbred strains. The homogeneity between KWM/Hym and the inbred strains was as follows: C57BL/6J (39.3%), BALB/c AJic (42.9%), and DBA/2J (50%). KWM/Hym is most similar to the PWK/PhJ inbred strain (96.4%) derived from wild mice (Czech Republic). To identify the morphometric characteristics of KWM/Hym, the external morphology was measured. The tail ratio of male and female was $79.60{\pm}3.09$ and $73.55{\pm}6.14%$, respectively. KWM/Hym has short and agouticolored hairs and its belly is white with golden hair. Taking these results together, KWM/Hym, a newly developing inbred mouse originated from wild mouse, might be use as new genetic resources to overcome the limitations of the current laboratory mice.

• Korean Journal of Social Welfare Studies
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• no.37
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• pp.5-33
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• 2008

This study examines the use of medical care by the poor through analysing KNHANES III databases, and the focus of the study is on under-satisfaction of medical needs and the impact of the medicare system. The results of analysis are summerized as follows; the poor had generally suffered from poor health condition, and did not have economic resoure to satisfy the medical needs. But, the beneficiaries of the medicare used much more medical care than non-poor. The result of logistic regression suggest that the medicare affected significantly on increase of uses. Consquently, the medicare system effectively made up the lack of economic resoure of the poor. However, the Medicare did not sufficient to satisfy all the medical needs of the poor. Over 20% of the poor had experinced the abandonment of meical care uses, "the lack of econmic resource" was most important reason. The result of logistic regression suggest that all the poor such as Medicare I and Medicare II beneficiaries, and near-poor class had much more probabilities of giving up the use of medical care than non-poor. It is necessary to raise up the benefit level of the current medicare system such as the reduction of non-secured medical cost, the alleviation of user's burden etc.

• The Journal of Society for e-Business Studies
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• v.20 no.3
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• pp.89-112
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• 2015

Recently, the business environment of healthcare has changed rapidly due to the entering the mobile era, the intensifying global competition, and the explosion of healthcare needs. Despite of necessity in expanding new IT-based medical services and investing IT resources to respond environmental changes, the small and medium sized hospitals could not realize these requirements due to the limited management resources. CHISSMH is designed and presented in this research to provide high valued clouding medical services with reasonable price. CHISMH is designed and presented in this research to provide high valued medical services with reasonable price through cloud computing. CHISME is designed to maximize resource pooling and sharing through the visualization. By doing so, Cloud Service provider could minimize maintenance cost of cloud data center, provide high level services with reasonable pay-per-use price. By doing so, Cloud Service provider could minimize maintenance cost of cloud data center, and could provide high level services with reasonable pay-per-use price. CHISME is expected to be base framework of cloud HIS services and be diffusion factor of cloud HIS services Operational experience in CHISSMH with 15 hospitals is analyzed and presented as well.

• Iberoamérica
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• v.22 no.1
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• pp.111-148
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• 2020

One way for phatic communication to be linguistically realized involves ritual activities, such as greetings and leave-takings. These conventionalized acts in medical contexts can significantly influence both transactional and interpersonal goals. The analysis in this paper confirms that exchanging rituals such as greeting and leave-taking between doctors and patients is not a simple exchange of conventionalized linguistic symbols. In addition, the use of discursive strategies means that to determine whether an expression is phatic or not, it is necessary to analyze it from the multidimensional perspective. The phaticity is established based on the negotiation between the participants during the interaction. We have found that the interrogative form of greeting like "¿Qué tal?" (How are you?) becomes a versatile resource in the medical context. Thus, professionals need to be attentive to the discourse progress, because the phaticity of the interrogative greetings (illocutionary force) is linked, in the vast majority, with the reaction of the patients. Also, the data confirms that when participants coordinate closings, the exchange of turns lengthens and the intervention of various discursive strategies for phatic communion becomes more prominent.