• 보건행정학회지
• /
• 제29권2호
• /
• pp.195-205
• /
• 2019

Background: The food and food service influence the quality of life and the general health condition of older persons living in long-term care (LTC) facilities. Purchasing good food materials is a ground of good food service. In Korea, the residents in LTC facilities should pay for the cost of food materials and ingredients out of their pocket because it is not covered by LTC insurance. This study explored what factors affect the cost of food materials paid by LTC facility residents and which factor affects most. Methods: We used data from the study on out-of-pocket payment on national LTC insurance, which surveyed 1,552 family caregivers of older residents in LTC facilities. We applied conditional multi-level model, of which the first level represents the characteristics of care receivers and caregivers and its second level reflects those of LTC facilities. Results: We found that the facility residents with college-graduated family caregivers paid 11,545 Korean won more than those with less than elementary-graduated ones. However, the income level of family caregivers did not significantly affect the amount of the food material cost of the residents. The residents in privately owned, large, metropolitan-located facilities were likely to pay more than those in other types of facilities. The amount of the food material cost of the residents was mainly decided by the facility level factors rather than the characteristics of care recipients and their family caregivers (intra-class correlation=82%). Conclusion: These findings suggest that it might be effective to design a policy targeting facilities rather than residents in order to manage the cost of food materials of residents in LTC facilities. Setting a standard price for food materials in LTC facilities, like Japan, could be suggested as a feasible policy option. It needs to inform the choice of LTC users by providing comparable food material cost information. The staffing requirement of nutritionist also needs to be reviewed.

• 한국의료질향상학회지
• /
• 제22권1호
• /
• pp.11-26
• /
• 2016

The Organization for Economic Cooperation and Development, which has continuously evaluated the performance of healthcare systems, has recently invested much effort into hospital performance measurement. The purpose of this paper is to introduce the hospital performance measurement programs operated by international organizations or at the national level based on the OECD's hospital performance project. Health Insurance Review & Assessment service (HIRA)'s quality assessment was analyzed based on the analytical framework of the OECD's hospital performance project. The hospital performance measurement programs of WHO, Canada, Australia, United States and United Kingdom are briefly explored, in view of the conceptual framework, key performance dimensions and indicators that are currently in use. The OECD suggested seven key dimensions of hospital performance: timeliness, efficiency, continuity, effectiveness and appropriateness, staff orientation, patient orientation and safety. The analysis of the quality assessment program of HIRA, which operates 36 diseases and procedures and 347 indicators, shows that the numbers of indicators are relatively small in the areas of safety, patient centeredness and efficiency. Continuity of care and staff orientation are not fully developed also, but the situations are similar in other countries. In conclusion, hospital performance measurement using stable and comprehensive data should be developed to improve overall system performance, and discussions on a conceptual framework that can lay out directions and key performance domains need to take into place.

• KDI Journal of Economic Policy
• /
• 제30권2호
• /
• pp.99-128
• /
• 2008

민간보험은 공적보험과 보완적인 관계를 형성함에도 불구하고 우리나라의 민간보험은 소득계층에 따른 접근성 차이로 인한 사회적 불평등, 도덕적 해이로 인한 공적보험 재정악화 등의 우려를 낳고 있다. 그러나 이에 관한 실증적 분석은 그간 이루어지지 못하여 정책적인 방향을 정립하는 데 장애가 되어 왔다. 본 연구는 건강보험공단, 심사평가원, 민간보험사, 행정자치부 주민등록세대정보 등의 관련 정보를 종합하여 이에 대한 실증분석을 시도했다. 그 결과, 우리나라의 민간보험 가입률은 전 국민의 64%에 달하고 있으며, 고소득층과 저소득층 간에 민간보험 가입률의 차이가 나타나지 않았다. 이는 공적보험의 보장성이 미흡한 상황에서 저소득층 역시 갑작스런 의료지출에 대비하고 있으며, 민간보험이 의료접근성의 계층화를 초래하지 않고 있다는 것을 시사한다. 또한 민간보험 가입자는 평균적으로 미가입자에 비해 의료이용량이 높지 않았으며, Two-Part Model을 통해 다양한 변수를 통제했을 경우에도 동일한 결과가 나타났다. 연령대에 따른 차이로 미루어 이러한 결과는 노동시장과 연관된 한시적인 성격일 것으로 추측되나, 현재로서는 민간보험 가입에 따른 도덕적 해이가 강하게 나타나고 있다는 근거는 발견되지 않았다.

• The Korean journal of internal medicine
• /
• 제39권4호
• /
• pp.625-639
• /
• 2024

Background/Aims: Intensive care unit (ICU) quality is largely determined by the mortality rate. Therefore, we aimed to develop and validate a novel prognostic model for predicting mortality in Korean ICUs, using national insurance claims data. Methods: Data were obtained from the health insurance claims database maintained by the Health Insurance Review and Assessment Service of South Korea. From patients who underwent the third ICU adequacy evaluation, 42,489 cases were enrolled and randomly divided into the derivation and validation cohorts. Using the models derived from the derivation cohort, we analyzed whether they accurately predicted death in the validation cohort. The models were verified using data from one general and two tertiary hospitals. Results: Two severity correction models were created from the derivation cohort data, by applying variables selected through statistical analysis, through clinical consensus, and from performing multiple logistic regression analysis. Model 1 included six categorical variables (age, sex, Charlson comorbidity index, ventilator use, hemodialysis or continuous renal replacement therapy, and vasopressor use). Model 2 additionally included presence/absence of ICU specialists and nursing grades. In external validation, the performance of models 1 and 2 for predicting in-hospital and ICU mortality was not inferior to that of pre-existing scoring systems. Conclusions: The novel and simple models could predict in-hospital and ICU mortality and were not inferior compared to the pre-existing scoring systems.

• 보건행정학회지
• /
• 제23권4호
• /
• pp.358-368
• /
• 2013

Background: There are some data to support the theory of a protective effect of parenthood against suicide, as proposed by Durkheim in 1897. We conducted this study to examine the relationship between children characteristics and suicidal ideation among Korean married women. Methods: The data were obtained from the Korean National Health and Nutrition Examination Surveys IV, conducted in 2007-2009, respectively (3,202 married women aged 20-49 years). The children characteristics are the age of the youngest child and the number of children living with subject. Data were analyzed by using logistic regression with SAS 9.2. Results: The risk for suicidal ideation was higher among married women having a young child (aged <7 years). It had strong effect on suicidal ideation in non-employee subjects. The odds ratio for suicidal ideation of women having a youngest child aged 2-3 years compared with reference groups was 1.673 with statistical significance. But the association of suicidal ideation with number of children shows insignificant. Conslusion: The findings suggest a different result with the theory, the protective effect of being a parent of young child on suicide risk for women, first suggested by Durkheim and supported by previous studies and the need for further prospective investigation that lead to policies according children characteristics aimed at improving married women's life.

• 보건의료산업학회지
• /
• 제9권4호
• /
• pp.131-144
• /
• 2015

Objectives : This study investigated the health care utilization patterns and length of stay (LOS) determinants of fracture patients with workers' compensation insurance (WCI) and national health insurance (NHI). Methods : The discharge summary data of 4,394 WCI fracture patients were compared to 28,874 NHI patients. Health care utilization characteristics were compared with a logistic regression analysis, and the LOS determinants were identified with linear regression analysis. Results : The average LOS of the WCI fracture patients was 2.4 times higher than that of the NHI patients. WCI patients used more small or medium sized hospitals, and were more frequently admitted through the emergency room. Females, older patients and patients admitted through emergency room had a significant positive impact on LOS. Conclusions : Healthcare utilization by the WCI fracture patients may include medically unnecessary hospital stays. Therefore, policy makers need to respond appropriately to the inefficient use of health resources by WCI patients.

• 척추신경추나의학회지
• /
• 제7권2호
• /
• pp.1-14
• /
• 2012

Objectives : The aim of this study was to prepare the validity and relevance for National Health Insurance of Chuna manual therapy through measurement of resource-based relative value scale(RBRVS) scores. Methods : To prepare for National Health Insurance, we studied it about standardized classification of the practice and definition, and speciality by difficulty and safety of Chuna manual therapy. Results : Classification of the practice could be classified to 7 of Chuna manual therapy and 24 traditional manual therapy, it also categorized as one of 3 kinds(basic, simple, special). The RBRVS scores of Chuna manual therapy were measured to 283.28, 566.57 and 1133.14. Conclusions : This study could be used to basis data for National Health Insurance of Chuna manual therapy, but further studies must be needed more objective investigation and data to calculate RBRVS scores.

• 보건행정학회지
• /
• 제23권2호
• /
• pp.132-144
• /
• 2013

Background: The purpose of this study was to analyze the medical expense change and influencing factors after introducing longterm care insurance system. The study period was 2 years before and after introduction of the system. Methods: We analyzed data collected from two divided group lived in Incheon. Four hundred and eighty-five elderly who received long-term care wage for one year were selected for experimental group. For control group, 1,940 elderly were selected by gender and age stratified random sampling. Difference-In-difference analyses was used for evaluating policy effectiveness. Also multiple regression analyses were conducted to identify the factors associated with total medical expenditures. The control variables were demographic variables, economic status, diseases, and medical examination variables. Results: Difference-in-difference analyses showed that total average medical expenses among long-term patients has decreased by 61.85%. Of these, the hospitalization expenses have decreased by 91.63% and the drug expenses have increased by 31.85%. Multiple regression analyses results showed that total average medical expenses among long-term patients have significantly decreased by 46.5% after introducing the long-term care insurance. The hospitalization expenses have significantly decreased by 148.5%, whereas the drug expenses have increased by 53.6%. And outpatient expenses have increased by 10.4%, but the differences were not statistically significant. Conclusion: The results showed that total medical expenses and hospitalization expenses have decreased after introducing the long-term care insurance. These results could support the opinion that the health insurance spending among long-term patients will be reduced gradually by long-term care insurance through changing medical demand.

• Asian Pacific Journal of Cancer Prevention
• /
• 제13권8호
• /
• pp.3767-3772
• /
• 2012

Objective: We estimated the total medical costs incurred during the 5 years following a cancer diagnosis and annual medical use status for the six most prevalent cancers in Korea. Methods: From January 1 to December 31, 2006, new patients registered with the six most prevalent cancers (stomach, liver, lung, breast, colon, and thyroid) were randomly selected from the Korea Central Cancer Registry, with 30% of patients being drawn from each cancer group. For the selected patients, cost data were generated using National Health Insurance claims data from the time of cancer diagnosis in 2006 to December 31, 2010. The total number of patients selected was 28,509. Five-year total medical costs by tumor site and Surveillance, Epidemiology, and End Results (SEER) stage at the time of diagnosis, and annual total medical costs from diagnosis, were estimated. All costs were calculated as per-patient net costs. Results: Mean 5-year net costs per patient varied widely, from $5,647 for thyroid cancer to $20,217 for lung cancer. Advanced stage at diagnosis was associated with a 1.8-2.5-fold higher total cost, and the total medical cost was highest during the first year following diagnosis and decreased by the third or fourth year. Conclusions: The costs of cancer care were substantial and varied by tumor site, annual phase, and stage at diagnosis. This indicates the need for increased prevention, earlier diagnosis, and new therapies that may assist in reducing medical costs.

• 한국임상약학회지
• /
• 제31권4호
• /
• pp.268-277
• /
• 2021

Background: Most antipsychotic drugs studies have been mainly conducted on side effects, randomized clinical trials, utilization rates, and trends. But there have been few studies on the influencing factors in elderly patients. The purpose of this study was to analyze the influencing factors on the outpatient prescription of antipsychotic drugs in the elderly patients. Methods: Active ingredients of antipsychotic drugs in Korea were selected according to the Korean Pharmaceutical Information Center (KPIC)'s classification. Data source was Korean Health Insurance Review and Assessment Service (HIRA) claims data in 2020 and target patient group was the elderly patient group. We extracted patients who have been prescribed one or more antipsychotic drugs and visited only one medical institution. Data were analyzed using descriptive statistics, chi-square, t-test, negative binomial regression. Results: A number of outpatients were 245,197 and prescriptions were 1,379,092. Most characteristics of patients were 75-85 year's old, female, health insurance type, no disease (dementia, schizophrenia), atypical drugs, cci score (>2) and characteristics of medical institution were neurology in specialty, rural region, general hospitals. Results of regression showed that patient's characteristics and medical center characteristics had significant effect on the outpatient prescription of antipsychotic drugs in the elderly patients. Conclusion: This study suggests that national policy of antipsychotic drugs in the elderly patients, with the consideration of the patients' and medical institutions' characteristics, is needed.