• 한국응용약물학회:학술대회논문집
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• 한국응용약물학회 2006년도 Proceedings of The Convention
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• pp.23-39
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• 2006

The application of the knowledge from the Human Genome Project to clinical medicine will be through both industrial drug development and the application of pharmacogenomics (PG) to patient care. The slow uptake of clinical innovations into clinical practice can be frustrating, but understanding the history of acceptance and sustaining medical innovation is critically important to position PG to succeed. This primarily means that PG tests must have legitimacy; they must be thoroughly validated, must be cost-effective, must be widely accepted by medical practitioners, must be supported by public policy, and must have a way of being easily incorporated into current medical practice. They must also lead to actionalble decisions by health care providers for their patients. Innovative PG assays should be tested in the best US laboratories, and reimbursement for testing must be accepted at the federal and state level. The companies providing these PG tests should be capable of supporting the interpretation and use of the test throughout medical practice. Advances such as the addition of PG information to drug labeling and the routine use of validated biomarkers to determine choice of cancer chemotherapy have been made. The PG research community must pay attention to the principles that have been previously described for acceptance and sustaining medical innovations in order for PG to be widely accepted in clinical medical practice.

• 대한영양사협회학술지
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• 제8권1호
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• pp.26-32
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• 2002

In Korea, implementation of nutrition support guidelines has been limited due to strict health insurance reimbursement policies as well as the lack of consensus on the best approach to TPN management. We examined the impact of TPN provision to hospitalized patients where NST (nutrition support team ) consultations were not requested by their primary physicians. The study showed the followings : 1. The median dutation of TPN provision was 8 days, but many patients were on TPN for less than 1 week. 2. The intake of energy and protein were less than the patient's requirements 3. Lipid emulsion was not provided to the most TPN patients. In conclusion, the role of NST should be expanded and studies are needed not only on TPN formulations which are suitable to Koreans but also on the cost-effectiveness of NST activities. TPN policies and protocols should be established based on the needs of each hospital.

• 간호행정학회지
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• 제12권1호
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• pp.14-22
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• 2006

Purpose: The purpose of this study is developing the nursing information system which contains the core elements of nursing practice, the Nursing Minimum Data Set (NMDS) that should be collected and documented all the settings in which nursing care is provided. Method: The program was developed under the hospital information system by TCP/IP protocol and used NANDA, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC) to fill out the elements of NMDS. The Oracle was used as DBMS under the Windows 98 environment and Power Builder 5.0 was used as a program language. Results: This study developed linkage among the NANDA-NOC-NIC to facilitate choosing correct nursing diagnosis, interventions, and outcomes and stimulate nurses' critical thinking. Also the system developed includes nursing care sensitive patient outcomes, so nurses can actively involve in nursing effectiveness research by analyzing the data stored in the database or by making relational databases with other health care related databases. Conclusion: The program developed in this study ultimately can be used for the nursing research, policy development, reimbursement of nursing care, and calculating staffing and nursing skill mix by providing tool to describe and organize nursing practice and measure the nursing care effectiveness.

• 한국항만경제학회지
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• 제20권2호
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• pp.73-87
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• 2004

The purpose of this paper is to setup reasonable criterion for underwriters to reimburse the expenses of suing and labouring incurred by assured, using game theory. As for the upper limit for the reimbursement, MIA and ICC do not mention at all but stipulate that proper and reasonable expenses shall be reimbursed, while ITC-Hulls set the amount insured as the upper limit to compensate the sum of expenses and damage loss. And as for failed measures of averting and minimizing loss, MIA and ICC do not mention either, while ITC-Hulls stipulates underwriters shall compensate the expenses and damage loss within the amount insured. The main results of this paper are as follows: First, it is for the benefit of underwriters to reimburse the expenses incurred to take such reasonable measures to avert or minimizing a loss which would be recoverable under the insurance. Second, the expenses of single measure should not be above the amount insured. Third, even if the measures failed, the expense should be reimbursed if it is less than the expected value of the subject-matter insured that could be recovered by the measures. Last, if the measures are taken several times individually, even if the sum of expenses might be above the amount insured, it should be reimbursed.

• 보건행정학회지
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• 제14권1호
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• pp.44-64
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• 2004

As of 1 July 2000 a big reform was introduced into the Korean health care system: the separation between prescribing and dispensing of drugs (SPD reform). There was, however, a big financial stake associated with pharmaceuticals, particularly before the reform, because physicians as well as pharmacists were allowed to purchase drugs at much lower costs than the insurance reimbursement. In this respect, this study focuses on the change in income and profit of both doctor's clinics and pharmacies after the reform. Data from National Health and Nutritional Survey by the ministry of health and welfare were used to estimate the income or expenditure that are financed by out-of-pocket payment of the patients, while national health insurance data etc. were used for the estimation of the income or expenditure that is financed by insurers. Average annual income per doctor's clinic increased from 299 million won to 338 million won for the three years between 1998 and 2001, whereas average annual income per pharmacy increased enormously from 60 million won to 305 million won for the same period. Average annual 'profit' increase per each doctor's clinic caused by the reform itself was estimated to range from 50 to 83 million won, while that per each pharmacy, from 23 to 87 million won. In sum, while both doctor's clinics and pharmacies are beneficiaries of the SPD reform, its positive impact is particularly prominent on the latter.

• 보건행정학회지
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• 제14권2호
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• pp.58-77
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• 2004

Cost containment has become high political issues since financial crisis of the Korean Health Insurance fund in 2000. Korean Government has developed and implemented several measures to reduce the pharmaceutical expenditures. Pharmaceutical economic evaluation can be a tool in decision to allocate scare resource efficiently. In order to increase the quality of economic evaluation for pharmaceuticals, the Korean Health Insurance Review Agency(HIRA) is considering the development of a guideline for economic evaluation. It mandates that pharmaceutical companies could submit the result of an economic evaluation when demanding reimbursement of new pharmaceutical drugs. The purpose of this study is to provide a critical review of the economic evaluations of health care technologies published in the Korean context whether they have been performed according to current guidelines and therefore whether their results are directly useful for decision making. We found there exist important problems and deviation from, good practice' both in the general features of the studies, like the study design and perspective, and in terms of cost measurement and valuation. There are needs to develop clear guidelines and to educate and train researchers in performing economic evaluations.

• 한국임상약학회지
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• 제16권2호
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• pp.96-100
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• 2006

Korea Food and Drug Administration (KFDA) has been expediting the Biological Equivalence Examination (BEE) project to encourage generic substitution without expense of inappropriate therapeutic outcome. However, little is known about which considerations are most important in making the decision to prescribe a drug among many generic drugs. The purpose of this survey was to identify how strongly the KFDA certification of BEE influenced doctors when they make a choice between brand and generics of glimepiride preparations. Telephone survey was performed towards doctors working at local clinics by using a questionnaire. Most influential factor to doctors' decision was drug cost followed by pharmaceutical representatives, therapeutic efficacy, and review guideline for reimbursement. Advertisement of the drug was the least influential followed by KFDA certification of BEE. The meaning of BEE was best understood by relatively young doctors with specialty in surgical parts. This survey result further indicated that the doctors considered the therapeutic equivalence examination a preferred measure to expedite generic substitution.

• Journal of Preventive Medicine and Public Health
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• 제41권2호
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• pp.74-79
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• 2008

Since the positive listing system for prescription drug reimbursement has been introduced in Korea, the number of pharmacoeconomic evaluation studies has increased. However it is not clear if the quality of pharmacoeconomic evaluation study has improved. Due to the lack of randomized clinical studies in Korean health care setting, Korean economic evaluation studies have typically integrated the local cost data and foreign clinical data. Therefore methodological issues can be raised in regard to data coherence and consistency. But the quality of data was not questiened and the potential bias has not been investigated yet. Even though changes in policy have encouraged the undertaking of pharmacoeconomic evaluations, there is few public-side funding for validation study of cost-effectiveness models and data. Several companies perform economic evaluation studies to be submitted on behalf of their own products, but do not want the study results to be disclosed to the academic community or public. To improve the present conduct of pharmacoeconomic evaluations in Korea, various funding sources need to be developed, and, like other multidisciplinary areas, the experts in different fields of study should collaborate to ensure the validity and credibility of pharmacoeconomic evaluations.

• BMB Reports
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• 제43권10호
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• pp.643-648
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• 2010

Sir William Osler (1849-1919) recognized that "variability is the law of life, and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions we know as disease". Accordingly, the traditional methods of medicine are not always best for all patients. Over the last decade, the study of genomes and their derivatives (RNA, protein and metabolite) has rapidly advanced to the point that genomic research now serves as the basis for many medical decisions and public health initiatives. Genomic tools such as sequence variation, transcription and, more recently, personal genome sequencing enable the precise prediction and treatment of disease. At present, DNA-based risk assessment for common complex diseases, application of molecular signatures for cancer diagnosis and prognosis, genome-guided therapy, and dose selection of therapeutic drugs are the important issues in personalized medicine. In order to make personalized medicine effective, these genomic techniques must be standardized and integrated into health systems and clinical workflow. In addition, full application of personalized or genomic medicine requires dramatic changes in regulatory and reimbursement policies as well as legislative protection related to privacy. This review aims to provide a general overview of these topics in the field of personalized medicine.

• 정보학연구
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• 제3권4호
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• pp.55-72
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• 2000

본 연구는 오늘날 국제금융 또는 국제건설공사거래 외에 매매대금의 지급을 위해 활용되는 보증신용장을 중심으로 하여 보증신용장의 본질과 보증신용장과 관련된 국제규칙을 분석한 다음, 보증신용장에 관한 신통일규칙의 제정배경과 규정된 내용 기존의 UCP와 URDG 등과 비교하여 이 규칙의 효용성과 활용상의 문제점들을 구체적으로 제시하였다.