• Journal of agricultural medicine and community health
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• v.37 no.2
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• pp.76-83
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• 2012

Objectives: The purpose of this study was to define the underserved emergency medical services (EMS) areas in Daejeon metropolitan city, as well as to identify their distinctive characteristics in public health perspectives. Methods: An underserved EMS area was operationally defined as an area in which it is difficult to arrive at an emergency medical center within 30 minutes. Using a cost-weighted distance algorithm with a geographic information system (GIS), the underserved EMS area was calculated. The characteristics of the underserved areas were analyzed by the Chi-square test. The SPSS statistical software package was used to perform the statistical analysis. All statistical tests were two-sided, and a p-value<0.05 was considered statistically significant. Results: Twelve administrative sectors ('Dong' in Korean) were included in the underserved areas, accounting for a population of approximately 8,100 citizens. The relationships between underserved EMS area and populations of agriculture, fishery, and forestry; citizens who are recipients of national basic livelihood security program; disabled; or aged 65 or older were statistically significant. Conclusion: It was found that 12 administrative sectors were included in the underserved EMS areas. Revealing underserved EMS areas using GIS analysis based on a cost-weighted distance algorithm of road data was an effective analytic method. However, as this study was confined to Daejeon City, South Korea, a nation-wide study should be performed to provide a more accurate conclusion.

• Journal of Korean Public Health Nursing
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• v.18 no.1
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• pp.154-166
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• 2004

The purpose of this study was to design and implementation of database for school health activity. This database system was designed stand-alone application for college school health center without a hospital affiliation and the database system was made of relational database management system, Microsoft access 2000 to be made GUI (Graphic user interface) type design and made up 7 tables: patients. symptoms. departments, income and outgo. medical cures. and medicine. The construction of this database system was patient management. code management. medicine management. and statistics management. The results of the database system were as follows; 1) This database system could be used for college school health center. 2) This database system could be made correct statistic data. 3) This database system could be managed income and outgo. 4) This database system could be changed for the better activity of community health service. 5) This database system could be simply attired administrative system. This database system will be used for students and employees to protect and promote health to measure for health level and quality of health service. In conclusion. this database system can be applied for unit health center to manage the college school health activity and advanced data management can be applied for health profession to do quality improvement. cost containment. management information system. and decision support system.

• Journal of Obesity & Metabolic Syndrome
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• v.27 no.4
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• pp.238-247
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• 2018

Background: We aimed to estimate the proportion of patients with diabetes who achieved target glycemic control, to estimate diabetes-related costs attributable to poor control, and to identify factors associated with them in the United Arab Emirates. Methods: This retrospective cohort study used administrative claims data handled by Abu Dhabi Health Authority (January 2010 to June 2012) to determine glycemic control and diabetes-related treatment costs. A total of 4,058 patients were matched using propensity scores to eliminate selection bias between patients with glycosylated hemoglobin (HbA1c) <7% and HbA1c ${\geq}7%$. Diabetes-related costs attributable to poor control were estimated using a recycled prediction method. Factors associated with glycemic control were investigated using logistic regression and factors associated with these costs were identified using a generalized linear model. Results: During the 1-year follow-up period, 46.6% of the patients achieved HbA1c <7%. Older age, female sex, better insurance coverage, non-use of insulin in the index diagnosis month, and non-use of antidiabetic medications during the follow-up period were significantly associated with improved glycemic control. The mean diabetes-related annual costs were $2,282 and $2,667 for patients with and without glycemic control, respectively, and the cost attributable to poor glycemic control was $172 (95% confidence interval [CI], $164-180). The diabetes-related costs were lower with mean HbA1c levels <7% (cost ratio, 0.94; 95% CI, 0.88-0.99). The costs were significantly higher in patients aged ${\geq}65$ years than those aged ${\leq}44$ years (cost ratio, 1.45; 95% CI, 1.25-1.70). Conclusion: More than 50% of patients with diabetes had poorly controlled HbA1c. Poor glycemic control may increase diabetes-related costs.

• Korean Journal of Health Education and Promotion
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• v.19 no.2
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• pp.155-167
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• 2002

This study was carried out to grasp visiting nurses' perception of the service referral between health and welfare with a view to providing the basic data for the visiting nursing activities. A questionnaire survey was conducted on public health nurses in 25 health centers in Seoul from Feb. 12, 2001 to Mar. 15, 2001. A total of 151 questionnaires were collected and they were analysed by use of SPSS/WIN 7.5. The results of the survey are as follows. 1. In general, visiting nurses were burdened with heavy workloads. On average, a visiting nurse covered 5 ‘dong's(the smallest administrative unit), 564 households, and 1223 persons. They spent almost a quarter of their working hours moving from home to home and recording the charts after home visiting. They took 30-60 minutes to provide their services when visiting homes. As for the frequency of home visiting, they were following the instructions recommended by the government. However, their services were still wasteful, not skill-oriented, in that they spent more time assessing ‘subjects’ rather than providing their ‘services’ for them. 2. As for the degree of service performance, visiting nurses scored average 2.94 and 2.28 on the four-point scale in the area of health and welfare respectively. The Pearson coefficient between the two variables was high(.56). According as the health services increased, the welfare services increased as well, which showed that the service referral between the two areas should be essential. 3. ‘The necessity of cooperation with social welfare staff’ scored average 4.49, and ‘the degree of cooperation with social welfare staff’ scored average 3.16 on the five-point scale; There was a statistically significant difference (average 1.33) between the two variables. Such a big difference between perception and practice results from the lack of political support that connects the two service areas comprehensively. Therefore it is recommendable to establish a so-called ‘Visiting Nursing Center’ in the ‘dong’ office in order to provide integrated services of health and welfare at once in cooperation with social welfare staff. That's the way to meet the public needs directly and it's more efficient as well in terms of cost-saving.

• Korea Journal of Hospital Management
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• v.25 no.3
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• pp.78-86
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• 2020

Purposes: This study purposed to identify factors influencing the composite quality score from the quality assessment program for long-term care hospitals Methodology: The study variables was obtained from HIRA(Health Insurance Review and Assessment Service): the composite quality scores and hospital variables such as number of doctors, nurses, beds, medical technicians, medical equipments, administrative region, ownerships from 3rd (2010) to 7th (2018) quality assessment program. National Statistical Portal(www.kosis.go.kr) provided the number of senior citizens aged over 65 in city·county·district area. SAS 9.4 was used for the data processing and used to analyze the data. Findings: The results showed that composite quality score increased past 9 years. Hospital variables such as number of doctor, nurse, medical technicians, bed and public hospitals had significant positive relationship with the composite quality score. Administrative region(district) showed higher scores compare to that of city. Compare to the score of quality assessment year(2010), as the assessment year move to 2012, 2013, 2015, 2018, results showed higher significant positive coefficients. Practical Implication: Continuously improve the performance of long-term care hospitals, current quality assessment program are needed to update their system such as adopting indicators measuring the service process, or compensating the cost for quality assessment program. It will enable to provide more reasonable and accurate performance assessment scores.

• Journal of Preventive Medicine and Public Health
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• v.36 no.4
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• pp.339-348
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• 2003

Objective : To quantify the economic value of the Sirolimus fluting Stent ($CYPHER^{TM}$) in treating acute coronary heart disease (CMD), and to assist in determining an adequate level of reimbursement for $CYPHER^{TM}$ in Korea. Methods : A decision-analytical model, developed by the Belgium Health Economics Disease Management group, was used to investigate the incremental cost-effectiveness of $CYPHER^{TM}$ versus conventional stenting. The time horizon was five years. The probabilities for clinical events at each node of the decision model were obtained from the results of large, randomized, controlled clinical trials. The initial care and follow-up direct medical costs were analyzed. The initial costs consisted of those for the initial procedure and hospitalization, The follow-vp costs included those for routine follow-up treatments, adverse reactions, revascularization and death. Defending on the perspective of the analysis, the costs were defined as insurance covered or total medical costs (=sum of insurance covered and uncovered medical costs). The cost data were obtained from the administrative data of 449 patients that received conventional stenting from five participating Korean hospitals during June 2002. Sensitivity analyses were peformed for discount rates of 3, 5 and 7%. Since the major clinical advantage of $CYPHER^{TM}$ over conventional stenting was the reduction in the revascularization rates, the economic value of $CYPHER^{TM}$, in relation to the direct medical costs of revascularization, were evaluated. If the incremental cost of $CYPHER^{TM}$ per revascularization avoided, compared to conventional stenting, was no higher than that of a revascularization itself, $CYPHER^{TM}$ would be considered as being cost-effective. Therefore, the maximum acceptable level for the reimbursement price of $CYPHER^{TM}$ making the incremental cost-effectiveness ratio equal to the cost of a revascularization was identified. Results : The average weighted initial insurance covered and total medical costs of conventional stenting were about 6,275,000 and 8,058,000 Won, respectively. The average weighted sum of the initial and 5-year follow-up insurance covered and total medical costs of conventional stenting were about 13,659,000 and 17,353,000 Won, respectively. The estimated maximum level of reimbursement price of $CYPHER^{TM}$ from the perspectives of the insurer and society were $4,126,897{\sim}4,325,161$ and $4,939,939{\sim}5,078,181$ Won, respectively. Conclusion : By evaluating the economic value of $CYPHER^{TM}$, as an alternative to conventional stenting, the results of this study are expected to provide a scientific basis for determining the acceptable level of reimbursement for $CYPHER^{TM}$.

• Journal of Korean Academy of Rural Health Nursing
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• v.3 no.2
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• pp.96-103
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• 2008

Purpose: The Study of vaccination for infants and children business in Primary Health Care Posts from 1980 to 2009. Method: look for national essential vaccination look for the change of vaccination by the times in Primary Health Care Posts and the rate of vaccination for infants and children by a administrative report statistics survey of a vaccine delivery system of Public health care institutions investigation about assistance details of vaccination cost in order to raise the rate of vaccination for infants and children. Results: In 1980s, there are many infants and children management object, but now there are rapidly decreasing infants and children management subject of a Primary Health Care Post because of rural exodus phenomenon of 1990's and a low birthrate of 2000's. Currently, the infants and children that registed, and managed to a Primary Health Care Post is most multi-cultural families. A multi-cultural family assistance program is provided these infants and children to the objects. Conclusions: Infant vaccination execution in Primary Health Care Posts showed to high vaccination rate because the prevention of vaccination delay or omission of the interior child who raised geographical accessibility to object sons nowadays it difficult to management of transportation of vaccine and storage management for a little shroud objects limited and management of inoculation business in quality. A main problem is as follows. There are a little vaccine transportation, trouble of proper temperature maintenance of a storage process, and having a lot of vaccine abolition as a little objects, educational training shortage of health care practitioner regarding to execute an inoculation. Therefore, vaccination business needs measures for management in quality in Primary Health Care Posts.

• KDI Journal of Economic Policy
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• v.30 no.2
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• pp.99-128
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• 2008

Nearly all Koreans are insured through National Health Insurance(NHI). While NHI coverage is nearly universal, it is not complete. Coverage is largely limited to minimal level of hospital and physician expenses, and copayments are required in each case. As a result, Korea's public insurance system covers roughly 50% of overall individual health expenditures, and the remaining 50% consists of copayments for basic services, spending on services that are either not covered or poorly covered by the public system. In response to these gaps in the public system, 64% of the Korean population has supplemental private health insurance. Expansion of private health insurance raises negative externality issue. Like public financing schemes in other countries, the Korean system imposes cost-sharing on patients as a strategy for controlling utilization. Because most insurance policies reimburse patients for their out-of-pocket payments, supplemental insurance is likely to negate the impact of the policy, raising both total and public sector health spending. So far, most empirical analysis of supplemental health insurance to date has focused on the US Medigap programme. It is found that those with supplements apparently consume more health care. Two reasons for higher health care consumption by those with supplements suggest themselves. One is the moral hazard effect: by eliminating copayments and deductibles, supplements reduce the marginal price of care and induce additional consumption. The other explanation is that supplements are purchased by those who anticipate high health expenditures - adverse effect. The main issue addressed has been the separation of the moral hazard effect from the adverse selection one. The general conclusion is that the evidence on adverse selection based on observable variables is mixed. This article investigates the extent to which private supplementary insurance affect use of health care services by public health insurance enrollees, using Korean administrative data and private supplements related data collected through all relevant private insurance companies. I applied a multivariate two-part model to analyze the effects of various types of supplements on the likelihood and level of public health insurance spending and estimated marginal effects of supplements. Separate models were estimated for inpatients and outpatients in public insurance spending. The first part of the model estimated the likelihood of positive spending using probit regression, and the second part estimated the log of spending for those with positive spending. Use of a detailed information of individuals' public health insurance from administration data and of private insurance status from insurance companies made it possible to control for health status, the types of supplemental insurance owned by theses individuals, and other factors that explain spending variations across supplemental insurance categories in isolating the effects of supplemental insurance. Data from 2004 to 2006 were used, and this study found that private insurance increased the probability of a physician visit by less than 1 percent and a hospital admission by about 1 percent. However, supplemental insurance was not found to be associated with a bigger health care service utilization. Two-part models of health care utilization and expenditures showed that those without supplemental insurance had higher inpatient and outpatient expenditures than those with supplements, even after controlling for observable differences.

• Journal of Preventive Medicine and Public Health
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• v.33 no.4
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• pp.436-448
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• 2000

Objectives : To identify the factors affecting users' satisfaction with the Order Communicating System(OCS) and to highlight the factors important for the successful establishment of OCS. Methods : A Users Satisfaction survey was sent to 4,513 people, consisting of 1,503 doctors, 2,379 nurses, 255 pharmacists and 370 administrative workers in 16 hospitals which had introduced OCS. The response rate was 63.9%. Measurement of users' satisfaction was peformed with the instrument which was used in Doll's study. Some aspects of Doll's instrument were adjusted according to the aims of this study. The classifying sections of this survey included age, job and status classification, computer experience, OCS education, duration of daily OCS use, type of order entering, number of personnel in the Hospital Information System's department, cost of OCS, problem frequency, proportion of work managed by hand, OCS type, and Hospital establishment type. Results : There was a positive correlation between satisfaction level and managerial status throughout all job classifications. Irrespective of the importance of OCS education as a factor relating to users' satisfaction, the additional work load caused by OCS lowered users' satisfaction. Different factors affected users' satisfaction according to job and status classification. The composition of factors affecting the pharmacist and administrative worker satisfaction levels was simpler than that of the doctor and nurse levels. There were no statistically significant differences between the actual computer experience duration of daily OCS use and users' satisfaction with OCS. Conclusions : There was an understandable relationship between users' attitude to OCS and factors affecting users' satisfaction. The results of this study could be used as a basis for the successful expansion of the operation of OCS. But more detailed studies on users' satisfaction and further improvements of methodologies are required for the successful establishment of OCS.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.16
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• pp.6903-6908
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• 2015

Background: As smoking is the leading preventable cause of multiple diseases and premature cancer deaths, estimating the burden of cancer attributable to smoking has become the standard in documenting the adverse impact of smoking. In Indonesia, there is a dearth of studies assessing the economic costs of cancers related to smoking. This study aimed to estimate indirect mortality costs of premature cancer deaths and years of potential life lost (YPLL) attributable to smoking among the Indonesian population. Materials and Methods: A prevalence based method was employed. Using national data, we estimated smoking-attributable cancer mortality in 2013. Premature mortality costs and YPLL were estimated by calculating number of cancer deaths, life expectancy, annual income, and workforce participation rate. A human capital approach was used to calculate the present value of lifetime earnings (PVLE). A discount rate of 3% was applied. Results: The study estimated that smoking attributable cancer mortality was 74,440 (30.6% of total cancer deaths), comprised of 95% deaths in men and 5% in women. Cancers attributed to smoking wereresponsible for 1,207,845 YPLL. Cancer mortality costs caused by smoking accounted for USD 1,309 million in 2013. Among all cancers, lung cancer is the leading cause of death and economic burden. Conclusions: Cancers related to smoking pose an enormous economic burden in Indonesia. Therefore, tobacco control efforts need to be prioritized in order to prevent more losses to the nation. The data of this study are important for advocating national tobacco control policy.