• Health Policy and Management
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• v.32 no.2
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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.

• Quality Improvement in Health Care
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• v.3 no.1
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• pp.144-152
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• 1996

Background : Because of introduction of nationwide health care system in 1989 and the improvement of socioeconomic status of population the number of outpatient visiting university hospital has good facilities and manpower has increased. So the waiting time for medical service at university hospital are lengthened. Particularly outpatients complain that waiting for prescribed drugs at pharmacy depart are long. Reducing waiting time at pharmacy depart door-to-door delivery system that the patients applying for door-to-door delivery receive prescribed drug at home without waiting at pharmacy depart were studied. The objective of this study is to analysis the opinion of outpatients for door-to-door delivery system, to study the appropriateness of adopting the system and to produce ideal model for the system. Method : Outpatients waiting drug at pharmacy depart were questioned about door-to-door delivery system. to find the factors affect utilizing the system the logistic regression was used. Result : 83.3% of the patients want to utilize the system without charging, and 72.9% of the patients want to utilized system with charging. 68.3% of patients with charging want to use this system because of long waiting time at pharmacy depart. 50% of patients who do not want to use door-to-door do not use this system because of incorrect delivery. The affecting factors to utilize the system were sex, waiting time, fee. Conclusion : The model for door to door delivery system. 1. door-to-door personnel reside in hospital and the patient want to utilize the system apply for the delivery with charging. 2. The applied drugs dispense at spare time. 3. Delivery company gathers drug at appointed time and delivers. 4. The delivery fee is 2,000-3,000 won. 5. To prevent from loss and changing the drug the name of patient on packet are printed and drug packet are sealed. 6. The company submit the confirm sheet which are written that the patient received drug correctly to hospital. 7. The delivery time of drug is reserved for the convenience of receiving.

• Health Policy and Management
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• v.2 no.1
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• pp.147-166
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• 1992

The purpose of this study is to analyze the effects of the health center hospital on the health service utilization pattern of the rural population in a county. Two field studies had been conducted in Yonchon County, Kyunggi Province, on February 1989 and on August 1991 before and after the establishment of the Yonchon health center hospital. This study revealed that Yonchon health center hospital occupied 7.3% of total outpatient visits and 16.8% of hospitalization of the county population and the self-sufficient rate of the outpatient visit and hospitalization of Yonchon County between two field studies increased by 1.7% and 20.9% each. Yonchon health center hospital contributed to the growth of the public health sector but it weakened the role of health sub-centers. For the efficient health service utilization of the population in that County, more investment to health center hospital would be needed and the primary health activities of the health subcenter should be enforced.

• Journal of The Korea Institute of Healthcare Architecture
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• v.13 no.2
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• pp.27-36
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• 2007

Recently, hospital patients experience anxiety, confusion, and stress about wayfinding as the spacial layout and treatment circulatory system of hospitals have become complicated due to their oversized and complex structure. As part of finding a solution to the problem, this study seeks to examine what are the essential elements of the wayfinding planning of O.P.D. in general hospitals, to develop the model of wayfinding, and to suggest the methods of improving the wayfinding system. The research methods of this study adopted were literature review in wayfinding cognition, plan analysis of ten general hospitals, space analysis of these hospitals through space syntax, analysis of the system of visual-perceptual information through a field study, and analysis of surveys and follow-up surveys conducted to support the results. Based on these results, the proposals for finding decision points, providing the information, and developing a model planning are listed as follows. 1) The comprehensive understanding of O.P.D. spacial layout and the visual-perceptual information system is necessary to find the essential elements of wayfinding. 2) The decision points are found through the full understanding of spacial functions, circulation systems, and facility configuration, considering the spacial layout, the bound of the visual-perceptual information system, and the circulatory system. Furthermore, the information decision points could be confined by space syntax. 3) The checklist and color compound & color codes, developed through the planning of signage system and color system could be applied to the methods of providing the information. 4) The planning of wayfinding system according to the whole process of practices for outpatients was mentioned above. The system of visual-perceptual information developed through the process of this study should be integrated in the spacial layout of the whole O.P.D.

• Health Policy and Management
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• v.27 no.2
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• pp.128-138
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• 2017

Background: The purpose of this study is to analyze the effects of differential coinsurance policy on prescription drug coverage of outpatients by types of medical institutions. Methods: In this study, we used a sample cohort database of the National Health Insurance Service and frequency analysis and marginal logistic regression model using generalized estimating equation were used for statistical analysis. Results: The summary on the major research is followed. First, about 16% of patients who used only tertiary or general hospital due to 52 ambulatory care sensitive conditions before policy implementation moved to hospitals and clinics. However, about 57% of them still use tertiary or general hospital. Second, the factors influencing the utilization of hospitals and clinics after the implementation of the policy were gender, age, and income level. As a result, the policy is effective to reduce the medical use of outpatient mental patients in tertiary or general hospital, but the effect is not significant. Conclusion: Therefore, in order to achieve the purpose of the policy for establishing the health care delivery system, it is necessary to adjust the co-payment so as to feel the burden on the co-payment when the outpatient for 52 ambulatory care sensitive conditions is used at the tertiary or general hospital.

• Journal of Korea Multimedia Society
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• v.22 no.4
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• pp.480-490
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• 2019

Nowadays, Electronic Medical Record (EMR) has just implemented at few hospitals for Outpatient Department (OPD). OPD is the diversified data, it includes demographic and diseases of patient, so it need to be clustered in order to explore the hidden rules and the relationship of data types of patient's information. In this paper, we propose a novel approach for unsupervised clustering of patient's demographic and diseases in OPD. Firstly, we collect data from a hospital at OPD. Then, we preprocess and transform data by using powerful techniques such as standardization, label encoder, and categorical encoder. After obtaining transformed data, we use some strong experiments, techniques, and evaluation to select the best number of clusters and best clustering algorithm. In addition, we use some tests and measurements to analyze and evaluate cluster tendency, models, and algorithms. Finally, we obtain the results to analyze and discover new knowledge, meanings, and rules. Clusters that are found out in this research provide knowledge to medical managers and doctors. From these information, they can improve the patient management methods, patient arrangement methods, and doctor's ability. In addition, it is a reference for medical data scientist to mine OPD dataset.

• Health Policy and Management
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• v.22 no.4
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• pp.561-578
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• 2012

This study was performed in order to compare a change in pharmaceutical expenditures per outpatient of clinic and to analyze factors relevant to a systems as part of evaluating policies for the incentive scheme to reduce total prescribed drug expenditure and for the drug utilization review system("DUR system" hereafter). For this, it had finally analytical subjects as 21,320 clinics nationwide without a change in location, clinics symbol and signed subject during both terms of the first half of 2010 and the first half of 2011. As a result, the odds ratio with reduction in pharmaceutical expenditures of clinic was statistically higher significantly in the shorter year number of opening clinic, in the larger number of doctors, when the classification of establishment is other, not individual, and when the signed subject is surgical division. Also, the odds ratio was significantly higher in the less patient number of clinic and in the lower ratio of patients aged over 65. Finally, the odds ratio was significantly high when a clinic had been located in DUR system demonstrative project area. Through this, a case of policy for improvement in doctor's autonomous prescription behavior like DUR system can be known to be effective for reduction in pharmaceutical expenditures. A future research on evaluation of policy for pharmaceutical expenditure management system will need to be performed in-depth analysis in consideration of diverse characteristics on the participatory entities.

• The Journal of the Korea Contents Association
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• v.14 no.10
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• pp.10-19
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• 2014

In recent, hospital information systems are widely used to electronically record, manage and share the data collected in hospitals. Such systems have contributed greatly to improving the work efficiency in modern hospitals, however, the collected data concerning the patients should be appropriately processed and reused to provide the healthcare service providers with decision supports. Especially, this paper proposes the patient flow monitoring system for the operations management of the outpatient department for patients with chronic diseases, and discusses the related issues. The proposed system visualizes the standard process model extracted from the patient history data and various performance measures, and this enables the managers to evaluate and enhance the operations of the outpatient clinic. In this paper, the patient flow monitoring system is applied to the rheumatology clinic, and the prototype system optimized for I-pad is illustrated.

• Quality Improvement in Health Care
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• v.1 no.2
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• pp.60-72
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• 1994

Background: The number of outpatients visiting large university teaching hospitals has increased drastically with the introduction of a nationwide health care insurance in 1989 and the improvement of the socio-economic status of the population. This resulted in long waiting times for services, particularly prescribed drugs, which have been patients' chief complaints. Hospitals have tried to solve the problem with limited success because their approach lacked comprehensive research. The objective of this study is to investigate associations between waiting times and variables defining a total work system. Methods: Data for the outpatient pharmacy department in a tertiary care university teaching hospital located in Seoul was analyzed to achieve the study objective. Associations of pharmacy system variables -- work load, work force, pharmacist work schedule, machine problems, and inventory control -- with mean and 99th percentile of waiting times were examined by the hierarchical stepwise regression method. Day was a unit of the analyses. Results: The regression models explained 65.8% of variance in the mean waiting time and 61.34% in the 99th percentile of waiting times. The break-down of the printer for drug envelops, Automatic Tablet Counters (ATCs), and main computer system lasted longer than 30 minutes increased the mean for 7.7 minutes, 4.5 minutes, and 7.0 minutes, respectively, and the 99th percentile for 14.8 minutes, 9.0 minutes, and 15.7 minutes, respectively. Concerning the work force, study results showed that there were significant differences in the productivity of pharmacists with work experience more than three years, one to three years, and less than one year, and showed that peak time aid work by pharmacists at job assignments other than the outpatient pharmacy, part-time pharmacists, and the installation of ATCs were effective in reducing waiting times, Finally, study findings indicated that the operational policy of work assignment and rotation schedule, supply and inventory of drugs at work tables, and readiness for undisrupted work during the work hours could have a significant effect on waiting times. Conclusion: The study results indicated that efforts to reduce waiting times for prescribed drugs should be geared toward every components of the pharmacy work system ranging from work schedule of pharmacists and supply of dugs at work tables. These findings should provide hospital managers with right directions in battling the problem.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.17 no.4
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• pp.340-350
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• 2016

The Medical Service Act of Korea describes a clinic as providing services primarily to outpatients, while a large general hospital provides specialized medical services requiring a high level of expertise for treating serious diseases. The portion of medical revenue for clinics has been decreasing gradually compared with large hospitals. This article proposes two fundamental medical policies to fix the distorted medical delivery system of Korea. Firstly, uniform additional medical remuneration rates based on the type of medial institution should be divided into outpatient additional rates and inpatient additional rates. Secondly, to normalize the function of clinics and large general hospitals, an outpatient medical target budget system should be introduced. Finally, to properly implement the proposal, it is important to establish healthcare policy-making governance. The success of policy implementation strongly depends on the participation and incentives of the government, suppliers, and patients. Healthcare policy-making governance must be designed to encompass this fact and improve quality of care.