• Journal of Preventive Medicine and Public Health
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• v.26 no.4 s.44
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• pp.614-627
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• 1993

It is well known that a physician's personal characteristic affects his practice pattern. Furthermore, a physician's specialty has powerful influences on his practice pattern. However, despite the fact that specialization has received the most attention for its influence on physician's service behavior, few studies have been conducted on the variations of contents and volume of physician's services. This study has intended to identify factors influencing the practice variations according to various physician characteristics. There are some other evidences that medical care providers are different in using of health services and resources in Korea. Four physician characteristics were selected for the analysis, two demographical factors, age and sex, and two practice factors, place of practice and medical specialty. Also, three indicators of service amount (total amount of insurance claim bill, number of visits per case, number of prescriptions per case) were selected. From the pool of insurance claims for ambulatory care received by the Korean National Federation of Medical Insurance(NFMI), 84,898 cases were randomly sampled. In the meantime using physician database of NFMI, 613 general practitioners (GP), 107 regular family physicians (FP), 483 'grandfather' family physicians(GFP), and 1,157 specialist practitioners(SP) were randomly sampled. Their different practice contents were compared concerning the specialty, age groups, sex, and practice sites (urban-rural) Specialist physicians tend to provide more costly care than do generalists. General practitioners and family physicians usually make fewer following visits and prescriptions. Age is also the important factor in determining the amount of services, which is highest at the physician's age group of 40's. Female doctors and urban practitioners use much more resources than their counterparts respectively. Research findings suggest that physician's characteristics particularly the specialty can affect practice patterns and resource utilizations. Other characteristics such as age and sex are not controllable but physician's specialty is relatively easily controllable during the entire phases of policy implementation. This is all the more true in the individual's initial decision of his specialty. Specialization therefore should receive policymaker's attention for its potential influence on medical care utilization and health care expenditure.

• Health Policy and Management
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• v.19 no.3
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• pp.125-141
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• 2009

The purpose of this study was to examine the role of provider practice patterns in the difference in health expenditure between the two types of patients: Health Insurance and Medical Aid type 1. The study used the outpatient claim data for all Medicaid and health insurance patients of hypertension who received medical services from 8,454 primary care physicians during the first half of 2006. The data were stratified by patient's gender and age for the two groups of patients who received care from the same physician. The dependent variables were the differences in medical expenditure per case, patient days per case and medical expenditure per patient day between Medicaid patients and health insurance patients. Empirical results showed that physician characteristics, such as physicians under age 50, greater proportion of pediatric Medicaid patients, lower proportion of new Medicaid patients and the greater number of comorbidity of Medicaid patients are associated with the greater difference between the two types of patients (i.e., greater expenditure of Medicaid patients relative to health insurance patients). This study shows that factors associated with provider practice patterns need to be taken into account in Medicaid policy.

• Health Policy and Management
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• v.14 no.4
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• pp.48-74
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• 2004

Considering the existence of asymmetric information between doctor and patient, the doctor's reimbursement method has been considered as a desirable policy device of improving efficiency of patient's use of medical care in terms of its affecting doctor's practice pattern by determining doctor's practice revenue. By using the Community Tracking Study (CTS) physician data set, which includes not only various information on doctors practice arrangements and sources of practice revenue, but also vignettes of various clinical presentations, this paper investigates doctor's reaction to the financial incentive under the control of patient's specific medical situation. Under the econometric model for exploring the effect of doctor's reimbursement method on his/her practice patterns; referring patients, recommend doctor-visit or medical tests, the Hausman's specification test was used for checking out the possibility of the doctor's reimbursement method being endogeneized explanatory variable. In the case where the endogeneity problem of doctor's reimbursement method exists, the 2SLS method was used for correcting that problem, and the multiple regression method was used in the case where the problem is found to be nonexistent. Based on the empirical results, this paper finds that doctors do appear to respond to financial incentive. The empirical results show that the doctor's reimbursement method statistically significantly affects doctor's practice pattern and are coincident with the theoretical result proposed by previous researches, This results suggest, as doctor's practice revenues are mainly determined by prospective method, such as capitation, doctors would more refer their patients to specialists, and hesitate in recommending doctor-visit or medical exam.

• Journal of Digital Convergence
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• v.11 no.6
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• pp.289-298
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• 2013

The objective of this study was to predict the changes in the duration of hospital stay, hospital admission fee, costs of drugs, changes in laboratory cost, material cost, total medical cost, adjusted amount of treatment and the efficacy of obstetrics and gynecology DRG system. The cost of drugs showed the greatest change and was followed by materials for medical examinations and the change in methods of medical examinations. In the analysis of the quantity of medical service the profit of medical examinations were influenced mostly by the duration of hospital stay. The results and data in this study could be used as a basis of future DRG system protocols and will be utilized so that hospitals can build a efficient medical system.

• The Korean Journal of Pain
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• v.27 no.2
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• pp.152-161
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• 2014

Background: According to the reports of the World Health Organization 20% of world population suffer from pain and 33% of them suffer to some extent that they cannot live independently. Methods: This is a cross-sectional study which was conducted in the emergency department (ED) of Valiasr Hospital of Arak, Iran, in order to determine the causes of delay in prescription of analgesics and to construct a model for prediction of circumstances that aggravate oligoanalgesia. Data were collected during a period of 7 days. Results: Totally, 952 patients participated in this study. In order to reduce their pain intensity, 392 patients (42%) were treated. Physicians and nurses recorded the intensity of pain for 66.3% and 41.37% of patients, respectively. The mean (SD) of pain intensity according to visual analogue scale (VAS) was 8.7 (1.5) which reached to 4.4 (2.3) thirty minutes after analgesics prescription. Median and mean (SD) of delay time in injection of analgesics after the physician's order were 60.0 and 45.6 (63.35) minutes, respectively. The linear regression model suggested that when the attending physician was male or intern and patient was from rural areas the delay was longer. Conclusions: We propose further studies about analgesics administration based on medical guidelines in the shortest possible time and also to train physicians and nurses about pain assessment methods and analgesic prescription.

• Health Policy and Management
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• v.16 no.2
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• pp.49-76
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• 2006

The aim of this study was to explore the effects of a computerized review program which was introduced in August 1, 2003, using claims data for acute respiratory infection related diseases. National Health Insurance (NHI) claims data on respiratory infection related diseases before and after the introduction, with six month intervals respectively, were used for the analysis. Clinic was the unit of observation, and clinics with only one physician whose specialty was internal medicine, pediatrics, otorhinolaryngology and family medicine and clinics with a general practitioner were selected. The final sample had 7,637 clinics in total. Indices used to measure practice pattern was prescription rates of antibiotics, prescription rates of injection drug per visit, treatment costs per claim, and total costs per claim. Changes in the number of claims for major disease categories and upcoding index for disease categories were used to measure claiming behavior. Data were analysed using descriptive analysis, t-test for indices changes before and after the introduction, analysis of variance (ANOVA) for practice pattern change for major disease categories, and multiple regression analysis to identify whether new system influenced on provider' practice patterns or not. Prescription of antibiotics, prescription rates of injection drug, treatment costs per claim, and total costs per claim decreased significantly. Results from multiple regression analysis showed that a computerized review system had effects on all the indices measuring behavior. Introduction of the new system had the spillover effects on the provider's behavior in the related disease categories in addition to the effects in the target diseases, but the magnitude of the effects were bigger among the target diseases. Rates of claims for computerized review over total claims for respiratory diseases significantly decreased after the introduction of a computerized review system and rates of claims for non target diseases increased, which was also statistically significant. Distribution of the number of claims by disease categories after the introduction of a computerized review system changed so as to increase the costs per claims. Analysis of upcoding index showed index for 'other acute lower respiratory infection (J20-22)', which was included in the review target, decreased and 'otitis media (H65, H66)', which was not included in the review target, increase. Factors affecting provider's practice patterns should be taken into consideration when policies on claims review method and behavior changes. It is critical to include strategies to decrease the variations among providers.

• Journal of Preventive Medicine and Public Health
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• v.26 no.2 s.42
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• pp.293-309
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• 1993

With expanded and extended coverage of the national medical insurance and fast growing health care expenditures, appropriateness of health service utilization and quality of care are concerns of both health care providers and insurers as well as patients. An accurate patient classification system is a basic tool for effective health care policies and efficient health services management. A classification system applicable to Korean medical information-Korean Diagnosis Related Groups (K-DRGs)-was developed based on the U.S. Refined DRGs, and the performance of the developed system was assessed in this study. In the process of the development, first the Korean coding systems for diagnoses and procedures were converted to the systems used in the definition of the U.S. Refined DRGs using the mapping tables formulated by physician panels. Then physician panels reviewed the group definition, and identified medical practice patterns different in two countries. The definition was modified for the differences in K-DRGs. The process resulted in 1,199 groups in the system. Several groups in Refined DRGs could not be differentiated in K-DRGs due to insufficient medical information, and several groups could not be defined due to procedures which were not practiced in Korea. However, the classification structure of Refined DRGs was retained in K-DRGs. The developed system was evaluated fur its performance in explaining variations in resource use as measured by charges and length of stay(LOS), for both all and non-extreme discharges. The data base used in this evaluation included 373,322 discharges which was a random sample of discharges reviewed and payed by the medical insurance during the five-month period from September 1990. The proportion of variance in resource use which was reduced by classifying patients into K-DRGs-r-square-was comparable to the performance of the U.S. Refined DRGs: .39 for charges and .25 for LOS for all discharges, and .53 for charges and .31 for LOS for non-extreme discharges. Another measure analyzed to assess the performance was the coefficient of variation of charges within individual K-DRGs. A total of 966 K-DRGs (87.7%) showed a coefficient below 100%, and the highest coefficient among K-DRGs with more than 30 discharges was 159%.

• Journal of Hospice and Palliative Care
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• v.20 no.1
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• pp.18-25
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• 2017

Purpose: Adequate control of breakthrough pain is essential for patients with cancer. Managing breakthrough pain mainly depends on understanding the concept of breakthrough pain and the proper usage of rescue medication by physicians. This study aims to assess the attitudes and practice patterns of palliative physicians in managing breakthrough pain for patients in Korea. Methods: This study was based on data from the 2014 breakthrough cancer pain survey conducted by the Korean Society for Hospice and Palliative Care. One hundred physicians participated in the online survey. Among total 33 self-reported questionnaires, twelve items were selected in this analysis. Results: Rapid onset of action is the main influencing factor in selecting rescue opioids. Oral oxycodone (65%) and parenteral morphine (27%) are commonly used. A few physicians (3%) prefer to use transmucosal fentanyl. The percentage of physicians prescribing oral oxycodone due to its rapid onset of action is just 21.5%, whereas the percentage of physicians using parenteral morphine is 81.5%. Two thirds of respondents (66%) answered that breakthrough pain is not well controlled with rescue medications. Conclusion: There is a gap between the needs of physicians in terms of the perceived difficulties of managing breakthrough cancer pain and their practice patterns selecting rescue medications.

• Nutrition Research and Practice
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• v.9 no.6
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• pp.658-666
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• 2015

BACKGROUND/OBJECTIVES: The current study examined trends in adherence to dietary recommendations and compared the levels of adherence between diagnosed and undiagnosed subjects with type 2 diabetes mellitus (T2DM) in Korea over the past 14 years. SUBJECTS/METHODS: Data were collected from the 1998-2012 Korea National Health and Nutrition Examination Surveys (KNHANES). Diagnosed diabetes was defined as giving a positive response to questions about awareness of the disease, a physician's diagnosis of diabetes, or medical treatment for diabetes, whereas undiagnosed diabetes was defined as having a fasting glucose level ${\geq}126mg/dl$. Assessment of adherence level was based on 6 components of dietary guidelines, considering meal patterns and intake levels of calories, carbohydrates, vegetable/seaweed, sodium, and alcohol. The participants received 1 point if they met the criteria for each of the 6 components, and the total possible score ranged from 0 to 6 points. Multivariate generalized linear regression was performed, taking into account the complex survey design. RESULTS: Among all diabetic patients aged 30 years or older, the proportion of diagnosed diabetes increased dramatically, from 40.9% in 1998 to 75.9% in 2012 (P for trend < 0.001). The overall adherence levels to dietary recommendations were low and did not significantly differ between diagnosed and undiagnosed subjects with T2DM for all survey years. Several improvements were observed, including increased adherence to maintaining sufficient vegetable/seaweed consumption (increased from 0.12 to 0.16 points) and limiting sodium intake (increased from 0.12-0.13 points to 0.19-0.24 points; P for trend < 0.001), while adherence to maintaining moderate alcohol consumption decreased. CONCLUSIONS: Analysis of data collected by the KNHANES indicates that Korean T2DM patients have poor adherence to dietary recommendations and maintenance of a healthy lifestyle, regardless of disease awareness. This finding suggests that development of practical, evidence-based guidelines is necessary and that provision and expansion of educational programs for T2DM patients is critical after diagnosis.

• Radiation Oncology Journal
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• v.31 no.4
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• pp.177-184
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• 2013

Purpose: The aim of this study was to analyze the patterns of care and treatment outcomes in patients with primary thyroid lymphoma (PTL) in a single institution. Materials and Methods: Medical records of 29 patients with PTL treated between April 1994 and February 2012 were retrospectively reviewed. Diagnosis was confirmed by biopsy (n = 17) or thyroidectomy (n = 12). Treatment modality and outcome were analyzed according to lymphoma grade. Results: The median follow-up was 43.2 months (range, 3.8 to 220.8 months). The median age at diagnosis was 57 years (range, 21 to 83 years) and 24 (82.8%) patients were female. Twenty-five (86.2%) patients had PTL with stage IEA and IIEA. There were 8 (27.6%) patients with mucosa-associated lymphoid tissue (MALT) lymphoma and the remaining patients had high-grade lymphoma. Patients were treated with surgery (n = 2), chemotherapy (n = 7), radiotherapy (n = 3) alone, or a combination of these methods (n = 17). Treatment modalities evolved over time and a combination of modalities was preferred, especially for the treatment of high-grade lymphoma in recent years. There was no death or relapse among MALT lymphoma patients. Among high-grade lymphoma patients, 5-year overall survival (OS) and 5-year progression-free survival (PFS) were 75.6% and 73.9%, respectively. Complete remission after initial treatment was the only significant prognostic factor for OS (p = 0.037) and PFS (p = 0.003). Conclusion: Patients with PTL showed a favorable outcome, especially with MALT lymphoma. Radiotherapy alone for MALT lymphoma and chemotherapy followed by radiotherapy for high-grade lymphoma can be effective treatment options for PTL.