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Analyses of the Efficiency in Hospital Management (병원 단위비용 결정요인에 관한 연구)

  • Ro, Kong-Kyun;Lee, Seon
    • Korea Journal of Hospital Management
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    • v.9 no.1
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    • pp.66-94
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    • 2004
  • The objective of this study is to examine how to maximize the efficiency of hospital management by minimizing the unit cost of hospital operation. For this purpose, this paper proposes to develop a model of the profit maximization based on the cost minimization dictum using the statistical tools of arriving at the maximum likelihood values. The preliminary survey data are collected from the annual statistics and their analyses published by Korea Health Industry Development Institute and Korean Hospital Association. The maximum likelihood value statistical analyses are conducted from the information on the cost (function) of each of 36 hospitals selected by the random stratified sampling method according to the size and location (urban or rural) of hospitals. We believe that, although the size of sample is relatively small, because of the sampling method used and the high response rate, the power of estimation of the results of the statistical analyses of the sample hospitals is acceptable. The conceptual framework of analyses is adopted from the various models of the determinants of hospital costs used by the previous studies. According to this framework, the study postulates that the unit cost of hospital operation is determined by the size, scope of service, technology (production function) as measured by capacity utilization, labor capital ratio and labor input-mix variables, and by exogeneous variables. The variables to represent the above cost determinants are selected by using the step-wise regression so that only the statistically significant variables may be utilized in analyzing how these variables impact on the hospital unit cost. The results of the analyses show that the models of hospital cost determinants adopted are well chosen. The various models analyzed have the (goodness of fit) overall determination (R2) which all turned out to be significant, regardless of the variables put in to represent the cost determinants. Specifically, the size and scope of service, no matter how it is measured, i. e., number of admissions per bed, number of ambulatory visits per bed, adjusted inpatient days and adjusted outpatients, have overall effects of reducing the hospital unit costs as measured by the cost per admission, per inpatient day, or office visit implying the existence of the economy of scale in the hospital operation. Thirdly, the technology used in operating a hospital has turned out to have its ramifications on the hospital unit cost similar to those postulated in the static theory of the firm. For example, the capacity utilization as represented by the inpatient days per employee tuned out to have statistically significant negative impacts on the unit cost of hospital operation, while payroll expenses per inpatient cost has a positive effect. The input-mix of hospital operation, as represented by the ratio of the number of doctor, nurse or medical staff per general employee, supports the known thesis that the specialized manpower costs more than the general employees. The labor/capital ratio as represented by the employees per 100 beds is shown to have a positive effect on the cost as expected. As for the exogeneous variable's impacts on the cost, when this variable is represented by the percent of urban 100 population at the location where the hospital is located, the regression analysis shows that the hospitals located in the urban area have a higher cost than those in the rural area. Finally, the case study of the sample hospitals offers a specific information to hospital administrators about how they share in terms of the cost they are incurring in comparison to other hospitals. For example, if his/her hospital is of small size and located in a city, he/she can compare the various costs of his/her hospital operation with those of other similar hospitals. Therefore, he/she may be able to find the reasons why the cost of his/her hospital operation has a higher or lower cost than other similar hospitals in what factors of the hospital cost determinants.

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Detorque values of abutment screws in a multiple implant-supported prosthesis (다수 임플란트 지지 보철물에서 지대주 나사의 풀림 토크값에 대한 연구)

  • Lee, Ju-Ri;Lee, Dong-Hwan;Hwang, Jae-Woong;Choi, Jung-Han
    • The Journal of Korean Academy of Prosthodontics
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    • v.48 no.4
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    • pp.280-286
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    • 2010
  • Purpose: This study evaluated the detorque values of screws in a multiple implant-supported superstructure using stone casts made with 2 different impression techniques. Material and methods: A fully edentulous mandibular master model and a metal framework directly connected to four implants (Br${\aa}$nemark $System^{(R)}$; Nobel Biocare AB) with a passive fit to each other were fabricated. Six experimental stone casts (Group 1) were made with 6 non-splinted impressions on a master cast and another 6 experimental casts (Group 2) were made with 6 acrylic resin splinted impressions. The detorque values of screws ($TorqTite^{(R)}$ GoldAdapt Abutment Screw; Nobel Biocare AB) were measured twice after the metal framework was fastened onto each experimental stone cast with 20 Ncm torque. Detorque values were analyzed using the mixed model with the fixed effect of screw and reading and the random effect of model for the repeated measured data at a .05 level of ignificance. Results: The mean detorque values were 7.9 Ncm (Group 1) and 8.1 Ncm (Group 2), and the mean of minimum detorque values were 6.1 Ncm (Group 1) and 6.5 Ncm (Group 2). No statistically significant differences between 2 groups were found and no statistically significant differences among 4 screws were found for detorque values. No statistically significant differences between 2 groups were also found for minimum detorque values. Conclusion: In a multiple external hexagon implant-supported prosthesis, no significant differences between 2 groups were found for detorque values and for minimum detorque values. There seems to be no significant differences in screw joint stability between 2 stone cast groups made with 2 different impression techniques.

Effects of Self Care Program on Hypertensive Control in Hypertensive Patient (고혈압환자에게 적용한 자가관리프로그램 중재 효과)

  • Kim, Ok-Ran
    • Research in Community and Public Health Nursing
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    • v.14 no.4
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    • pp.568-578
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    • 2003
  • This study was conducted to estimate the effects of self-care program on knowledge and symptoms related hypertension self-care and physiological index in essential hypertensive patients aged between 35-74 year. The subjects for the experiment group and the control group of this study were 70 men and women selected through random sampling from adults at Sangju Red Cross Hospital in Gyeongsanbuk-do, and the experiment was carried out during the period from the 15th of September to the 30th of April in 2002. This study measured systolic and diastolic blood pressure (SBP, DBP, the mean value of the two measures) and total cholesterol (TC) and surveyed the subjects' diet and life style in relation to hypertension using a self-report questionnaire. In order to study the significance of the effects of self-care program, the author carried out t-test, paired t-test, ANCOVA, chi-square analysis and effectiveness index (EI) analysis. Results of the study are as follows: The experiment group got higher mean scores than the control group in the degree of low sodium intake and the degree of high calcium and high potassium intake, and the difference was statistically significant(P<0.05). The effectiveness index of the self-care program in smoking was 0.797 at the 1st posttest and 0.601 at the 2nd posttest, and in physical activities 0.600 at the 1st posttest and 0.849 at the 2nd posttest. The rate of regular antihypertensive drugs intake of the experimental group was higher than that of the control group. and the effectiveness index of the self-care program was 0.715. The mean score of the systolic blood pressure of the experimental group was lower than that of the control group, and the difference was statistically significant(P<0.05). In conclusion, these findings support usefulness of self-care programs in reducing systolic blood pressure and in promoting self-care related to diet and life style for treating and preventing hypertension.

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Development of Respiration Gating RT Technique using Moving Phantom and Ultrasound Sensor: a feasibility study (동 팬텀과 초음파 센서를 이용한 호흡운동 조절 방사선치료 기술 개발)

  • Lee, Suk;Lee, Sang-Hoon;Shin, Dong-Ho;Yang, Dae-Sik;Choi, Myung-Sun;Kim, Chul-Yong
    • Proceedings of the Korean Society of Medical Physics Conference
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    • 2004.11a
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    • pp.122-125
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    • 2004
  • In radiotherapy of tumors in liver, enough planning target volume (PTV) margins are necessary to compensate breathing-related movement of tumor volumes. To overcome the problems, this study aims to obtain patients' body movements by using a moving phantom and an ultrasonic sensor, and to develop respiration gating techniques that can adjust patients' beds by using reversed values of the data obtained. The phantom made to measure patients' body movements is composed of a microprocessor (BS II, 20 MHz, 8K Byte), a sensor (Ultra-Sonic, range 3 cm ${\sim}$3 m), host computer (RS232C) and stepping motor (torque 2.3Kg) etc., and the program to control and operate it was developed. The program allows the phantom to move within the maximum range of 2 cm, its movements and corrections to take place in order, and x, y and z to move successively. After the moving phantom was adjusted by entering random movement data(three dimensional data form with distance of 2cm), and the phantom movements were acquired using the ultra sonic sensor, the two data were compared and analyzed. And then, after the movements by respiration were acquired by using guinea pigs, the real-time respiration gating techniques were drawn by operating the phantom with the reversed values of the data. The result of analyzing the acquisition-correction delay time for the three types of data values and about each value separately shows that the data values coincided with one another within 1% and that the acquisition-correction delay time was obtained real-time (2.34 ${\times}$ 10$^{-4}$sec). This study successfully confirms the clinic application possibility of respiration gating techniques by using a moving phantom and an ultra sonic sensor. With ongoing development of additional analysis system, which can be used in real-time set-up reproducibility analysis, it may be beneficially used in radiotherapy of moving tumors.

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A Meta-analysis of Ambient Air Pollution in Relation to Daily Mortality in Seoul, $1991\sim1995$ (메타분석 방법을 적용한 서울시 대기오염과 조기사망의 상관성 연구 (1991년$\sim$1995년))

  • Dockery, Douglas W.;Kim, Chun-Bae;Jee, Sun-Ha;Chung, Yong;Lee, Jong-Tae
    • Journal of Preventive Medicine and Public Health
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    • v.32 no.2
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    • pp.177-182
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    • 1999
  • Objectives: To reexamine the association between air pollution and daily mortality in Seoul, Korea using a method of meta-analysis with the data filed for 1991 through 1995. Methods: A separate Poisson regression analysis on each district within the metropolitan area of Seoul was conducted to regress daily death counts on levels of each ambient air pollutant, such as total suspended particulates (TSP), sulfur dioxide $(SO_2)$, and ozone $(O_3)$, controlling for variability in the weather condition. We calculated a weighted mean as a meta-analysis summary of the estimates and its standard error. Results: We found that the p value from each pollutant model to test the homogeneity assumption was small (p<0.01) because of the large disparity among district-specific estimates. Therefore, all results reported here were estimated from the random effect model. Using the weighted mean that we calculated, the mortality at a $100{\mu}g/m^3$ increment in a 3-day moving average of TSP levels was 1.034 (95% Cl 1.009-1.059). The mortality was estimated to increase 6% (95% Cl 3-10%) and 3% (95% Cl 0-6%) with each 50 ppb increase for 9-day moving average of SO2 and 1-hr maximum O3, respectively. Conclusions: Like most of air pollution epidemiologic studies, this meta-analysis cannot avoid fleeing from measurement misclassification since no personal measurement was taken. However, we can expect that a measurement bias be reduced in a district-specific estimate since a monitoring station is hefter representative cf air quality of the matched district. The similar results to those from the previous studios indicated existence of health effect of air pollution at current levels in many industrialized countries, including Korea.

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The Relationship Between Social Security Network and Security Life Satisfaction in Community Residents: Scale Development and Application of Social Security Network (사회안전망과 지역사회주민의 안전생활만족의 관계: 사회안전망 척도개발과 적용)

  • Kim, Chan-Sun
    • The Journal of the Korea Contents Association
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    • v.14 no.6
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    • pp.108-118
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    • 2014
  • The purpose of this study is to develop a relationship of measuring method for the social security network and verify its validity and reliability and apply it to investigate the due to security life satisfaction. This study is based by setting general residents of Seoul in 2013 and using the stratified cluster random sampling method to analyze a total amount of 203 examples. The measuring methods for the social security network was developed through document research, conceptual definition and drafting the survey, experts' conference, preliminary inspection and original examination, verification of the validity and reliability of the survey. An experts' conference took pace to verify the validity of the survey, and 6 factors were extracted through exploratory factor analysis crime prevention design, street CCTV facilities, volunteer neighborhood patrol, local government security education, police public peace service, private security service. The conclusion are the following. Collected data was analyzed based on the aim of this study using SPSSWIN 18.0, and practice frequency analysis, F test, factor analysis, reliability analysis, correlation analysis, multiple regression analysis. First, the validity of the social security network measurement is very high. Thus, the factors constituting the social security network were found to be crime prevention design, street CCTV facilities, volunteer neighborhood patrol, local government security education, police public peace services, and private security services, and the crime prevention design factor was found to be most explanatory. Second, the reliability of the social security network measurement is very high. Thus, the correlation between the questions and the sector, the questions and the social security net was very high, and the internal consistency showed a Cronbach's${\alpha}$ value of over 0.865. Third, the establishment of a social security network had the biggest effect on people in their forties. Thus, when the crime prevention design, street CCTV facilities, local government security education, police public peace services are systematically established, the social anxiety of citizens was reduced.

Correlation among Ownership of Home Appliances Using Multivariate Probit Model (다변량 프로빗 모형을 이용한 가전제품 구매의 상관관계 분석)

  • Kim, Chang-Seob;Shin, Jung-Woo;Lee, Mi-Suk;Lee, Jong-Su
    • Journal of Global Scholars of Marketing Science
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    • v.19 no.2
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    • pp.17-26
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    • 2009
  • As the lifestyle of consumers changes and the need for various products increases, new products are being developed in the market. Each household owns various home appliances which are purchased through the choice of a decision maker. These appliances include not only large-sized products such as TV, refrigerator, and washing machine, but also small-sized products such as microwave oven and air cleaner. There exists latent correlation among possession of home appliances, even though they are purchased independently. The purpose of this research is to analyze the effect of demographic factors on the purchase and possession of each home appliances, and to derive some relationships among various appliances. To achieve this purpose, the present status on the possession of each home appliances are investigated through consumer survey data on the electric and energy product. And a multivariate probit(MVP) model is applied for the empirical analysis. From the estimation results, some appliances show a substitutive or complementary pattern as expected, while others which look apparently unrelated have correlation by co-incidence. This research has several advantages compared to previous literatures on home appliances. First, this research focuses on the various products which are purchased by each household, while previous researches such as Matsukawa and Ito(1998) and Yoon(2007) focus just on a particular product. Second, the methodology of this research can consider a choice process of each product and correlation among products simultaneously. Lastly, this research can analyze not only a substitutive or complementary relationship in the same category, but also the correlation among products in the different categories. As the data on the possession of home appliances in each household has a characteristic of multiple choice, not a single choice, a MVP model are used for the empirical analysis. A MVP model is derived from a random utility model, and has an advantage compared to a multinomial logit model in that correlation among error terms can be derive(Manchanda et al., 1999; Edwards and Allenby, 2003). It is assumed that the error term has a normal distribution with zero mean and variance-covariance matrix ${\Omega}$. Hence, the sign and value of correlation coefficients means the relationship between two alternatives(Manchanda et al., 1999). This research uses the data of 'TEMEP Household ICT/Energy Survey (THIES) 2008' which is conducted by Technology Management, Economics and Policy Program in Seoul National University. The empirical analysis of this research is accomplished in two steps. First, a MVP model with demographic variables is estimated to analyze the effect of the characteristics of household on the purchase of each home appliances. In this research, some variables such as education level, region, size of family, average income, type of house are considered. Second, a MVP model excluding demographic variables is estimated to analyze the correlation among each home appliances. According to the estimation results of variance-covariance matrix, each households tend to own some appliances such as washing machine-refrigerator-cleaner-microwave oven, and air conditioner-dish washer-washing machine and so on. On the other hand, several products such as analog braun tube TV-digital braun tube TV and desktop PC-portable PC show a substitutive pattern. Lastly, the correlation map of home appliances are derived using multi-dimensional scaling(MDS) method based on the result of variance-covariance matrix. This research can provide significant implications for the firm's marketing strategies such as bundling, pricing, display and so on. In addition, this research can provide significant information for the development of convergence products and related technologies. A convergence product can decrease its market uncertainty, if two products which consumers tend to purchase together are integrated into it. The results of this research are more meaningful because it is based on the possession status of each household through the survey data.

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A study on the smile of Korean Youth compared with twenty years ago (20년전과 비교한 한국청년의 미소 변화에 관한 연구)

  • Beom, Seung-Gyun;Jung, Ji-Hye;Kim, Tae-Young;Lee, Kyung-Eun;Dong, Jin-Keun
    • The Journal of Korean Academy of Prosthodontics
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    • v.50 no.3
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    • pp.162-168
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    • 2012
  • Purpose: Teeth are generally exposed when people smiling. Moreover, the exposed teeth and soft tissue when smiling becomes an important guideline for esthetically prosthetic restoration. This research is to compare and find out differences of Korean young men's smile living in presence and twenty years ago. Materials and methods: Subjects, 100 young men (50 male and 50 female), were required about several aspects; normally developed physical condition, no psychological or genetic disorders, a fine face with no loss of teeth, no experience in orthodontic or prosthetic treatment, relatively normal occlusion, aged between 20-29. The photos of the subject at rest position and front face when fully smiled were taken three times. 100 photos (50 male and 50 female) were chosen at random from the 240 university students' smile photos taken by Yoon and his colleagues in 1991. By Hulsey's method of measuring smile, several factors; the change of upper lip curvature, the change of the relation between the upper lip and teeth, parallelism between Mx. incisor and lower lip, contact relation between Mx. incisor and lower lip and teeth displayed in a smile, were measured and analyzed. Meanwhile, ten dentists assessed aesthetic evaluation about men and women's smile for twice and recorded and compared smile score. The -test (P<.05) was used to compare the measured value. The difference of smile score was analyzed by t-test (P<.05). Results: The smile score calculated in 2011 (60.22) was higher than that of 1991 (52.80). Among five measurement categories, the noticeable difference was distinguished from two factors; the change of upper lip curvature and contact relation between Mx. incisor and lower lip. Conclusion: The Korean young men's smile has been considerably improved for twenty years. And it is found that the change of upper lip curvature plays an important role, that is, the smile formed with an ascended labial commissure has been increased significantly.

Effects of Dietary Yellow Clay on Sensory Evaluation of Meat in Broiler Chicks (육계의 사료내 황토 첨가가 계육의 관능적 특성에 미치는 영향)

  • Choi, O.J.;Yang, C.J.;Kim, C.B.;Moon, S.T.;Jung, H.S.;Shim, K.H.;Chae, Y.K.
    • Korean Journal of Poultry Science
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    • v.34 no.2
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    • pp.111-117
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    • 2007
  • This experiment was conducted to research the effects of Yellow Clay(YC) on the sensory evaluation of cooked meat in broiler chicks. A total of 216 one day old broiler chicks were divided into 6 groups at random. The six groups are consisted of one control group, to which no YC was added, and 5 groups to which an amount of YC was differently added. Diets contained 0.5, 1.0, 2.0, 4.0 and 8.0% of YC and fed to the 5 group broilers for 6 weeks. The lightness of meat in the broilers treated with YC was significantly higher than that of the control group in after-cooking(P<0.05). Besides, the lightness of meat was higher after-cooking than before-cooking. The properties of hardness, gumminess and chewiness were significantly lowered in the groups treated with Yellow Clay, as the amount of Yellow Clay increased at before-cooking and after-cooking(P<0.05). The turbidity of stock was higher in the groups treated with Yellow Clay as the percentage level of Yellow Clay increased, compared with the control group(P<0.05). The acceptability of color, flavor, and texture of meat and stock was higher in the groups treated with Yellow Clay, when compared with that of the control group(P<0.05). In total, the group treated with the 4 percentage of Yellow Clay was the highest in the overall preference(P<0.05).

Development of Evaluation Method for Jointed Concrete Pavement with FWD and Finite Element Analysis (FWD와 유한요소해석을 이용한 줄눈콘크리트포장 평가법 개발)

  • Yun, Kyong-Ku;Lee, Joo-Hyung;Choi, Seong-Yong
    • International Journal of Highway Engineering
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    • v.1 no.1
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    • pp.107-119
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    • 1999
  • The joints in the jointed concrete pavement provide a control against transverse or longitudinal cracking at slab, which may be caused by temperature or moisture variation during or after hydration. Without control of cracking, random cracks cause more serious distresses and result in structural or functional failure of pavement system. However, joints nay cause distresses due to its inherent weakness in structural integrity. Thus, the evaluation at joint is very important. and the joint-related distresses should be evaluated reasonably for economic rehabilitation. The purpose of this paper was to develop an evaluation system at joints of jointed concrete pavement using finite element analysis program, ILLI-SLAB, and nondestructive testing device. FWD. To develop an evaluation system for JCP, a sensitivity analysis was performed using ILLI-SLAB program with a selected variables which might affect fairly to on the performance of transverse joints. The most significant variables were selected from precise analysis. An evaluation charts were made for jointed concrete pavement by adopting the field FWD data. It was concluded that the variables which most significantly affect to pavement deflections are the modulus of subgrade reaction(K) and the modulus of dowel/concrete interaction(G), and limiting criteria on the performance of joints at JCP are 300pci. 500,000 lb/in. respectively. Using these variables and FWD test, a charts of load transfer ratio versus surface deflection at joints were made in order to evaluate the performance of JCP. Practically, Chungbu highway was evaluated by these evaluation charts and FWD field data for jointed concrete pavement. For Chungbu highway, only one joint showed smaller value than limiting criterion of the modulus of dowel/concrete interaction(G). The rest joints showed larger values than limiting criteria of the modulus of subgrade reaction(K) and the modulus of dowel/concrete interaction(G).

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