• 보건행정학회지
• /
• 제27권2호
• /
• pp.149-156
• /
• 2017

Background: This study was conducted to evaluate the performance of the Hierarchical Condition Category (HCC) model, identify potentially high-cost patients, and examine the effects of adding prior utilization to the risk model using Korean claims data. Methods: We incorporated 2 years of data from the National Health Insurance Services-National Sample Cohort. Five risk models were used to predict health expenditures: model 1 (age/sex groups), model 2 (the Center for Medicare and Medicaid Services-HCC with age/sex groups), model 3 (selected 54 HCCs with age/sex groups), model 4 (bed-days of care plus model 3), and model 5 (medication-days plus model 3). We evaluated model performance using $R^2$ at individual level, predictive positive value (PPV) of the top 5% of high-cost patients, and predictive ratio (PR) within subgroups. Results: The suitability of the model, including prior use, bed-days, and medication-days, was better than other models. $R^2$ values were 8%, 39%, 37%, 43%, and 57% with model 1, 2, 3, 4, and 5, respectively. After being removed the extreme values, the corresponding $R^2$ values were slightly improved in all models. PPVs were 16.4%, 25.2%, 25.1%, 33.8%, and 53.8%. Total expenditure was underpredicted for the highest expenditure group and overpredicted for the four other groups. PR had a tendency to decrease from younger group to older group in both female and male. Conclusion: The risk adjustment models are important in plan payment, reimbursement, profiling, and research. Combined prior use and diagnostic data are more powerful to predict health costs and to identify high-cost patients.

• 한국중재학회지:중재연구
• /
• 제27권2호
• /
• pp.3-18
• /
• 2017

International legal reviews on ISD, a procedure for resolving disputes under the Korea-US FTA, are examined from the perspective of law. If the ISD system does not exist, even if the investor suffers damage due to the illegal act of the host country, he or she must file a lawsuit through the court of the host country, which is unreasonable from the investor's point of view and makes it difficult to guarantee fairness and transparency. Some of the Koreans pointed out that there are some problems with the KORUS FTA dispute settlement regulations, and that the United States federal courts are taking a friendly attitude to the decisions made by the US Customs in determining the dispute by the KORUS FTA Agreement and the US Customs Act. In cases where the State does not violate international law but results in harmful consequences, the responsibility of one country is borne by the treaty. Foreign investment always comes with many challenges and risks. Therefore, the ISD system is a fair and universal arbitration system, which is considered to be a necessary system even for protecting the Korean companies investing abroad. In the investment treaty, compensation for the nationalization of foreign property and reimbursement under the laws of the host country were dissatisfied with foreign investors. In particular, some Koreans have pointed out that there are some problems in the KORUS FTA dispute resolution regulations and there is a need for further discussion and research. Based on the experiences and wisdoms gained in the course of Korea-US FTA negotiations, the dispute arbitration mechanism is urgently needed to reduce the possibility of disputes and to make amicable directions.

• 생물정신의학
• /
• 제24권4호
• /
• pp.167-174
• /
• 2017

Based on advances in biotechnology and neuroscience, neuromodulation is poised to gain clinical importance as a treatment modality for psychiatric disorders. In addition to old-established electroconvulsive therapy (ECT), clinicians are expected to understand newer forms of neurostimulation, such as deep brain stimulation (DBS), vagus nerve stimulation (VNS), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS). Given the growing interest in non-invasive neuromodulation technologies, clinicians may seek sufficient information about neuromodulation to inform their clinical practice. A growing literature suggests that applications of non-invasive neuromodulation have evidence particularly for indications where treatments are currently insufficient, such as drug-resistant depression. However, positive neuromodulation studies require replication, and the precise interactions among stimulation, antidepressant medication, and psychotherapy are unknown. Further studies of long-term safety and the impact on the developing brain are needed. Non-invasive neuromodulatory devices could enable more individualized treatment. However, do-it-yourself (DIY) stimulation kits require a better understanding of the effects of more frequent patterns of stimulation and raise concerns about clinical supervision, regulation, and reimbursement. Wide spread enthusiasm for therapeutic potential of neuromodulation in clinical practice settings should be mitigated by the fact that there are still research gaps and challenges associated with non-invasive neuromodulatory devices.

• 수산경영론집
• /
• 제39권1호
• /
• pp.43-61
• /
• 2008

Excessive public loan with low interest and other tax benefits have been provided for fishermen, but much of them turned out to be little performed. There were the moral hazards of Suhyup in the process of executing the public loans. As the government gave the reimbursement on the financial loss of Suhyup resulting from the public loans, Suhyup had no responsibility of the bad debt loss. Therefore, Suhyup gave little efforts to reduce the non-performing. The government perceived this problem and tried to reduce the under-performing loans. Thus, the government decided to take limited responsibilities. Suhyup made the progress to reduce the under-performing public loans. Suhyup dealt with these situation and made the credit evaluation model of the fisherman's public loan. This paper is for the credit evaluation model in the fisherman's public loan, which explains the model development methodology and the model characteristics in detail. This evaluation model is composed of two sub-component model. the one is the quantitative model and the other is the qualitative model. The quantitative sub-model is for the identification of fishermen financial status and is based on the financial transaction information. Its development methodology is the CSS modeling for the consumer market. The qualitative sub-model is for the evaluation the business prospect and is based on the business information such as fisherman's management skills, technology, equipment. Its development methodology is the AHP. It provides the detailed information in the model development methodology, which is the ideal example such as the public loan. In addition it gives the information to the interest parties such as policy makers, suhyup and fishermen.

• 보건교육건강증진학회지
• /
• 제6권1호
• /
• pp.11-21
• /
• 1989

Among disease prevention methods, health education is an excellent and effective method low cost. However, enforcing health education has the following limitations: there is little health education for the supported, health education disregards the characteristics of those educated, education materials are not specified and published satistactorily, and so on. This study suggests systemic health education planning to the Korea Medical Insurance Corporation. The special methods are as follows: 1. Health education for primary prevention a. We educate the insured who are judged to be normal by the results of health screening, dividing them into three groups:completely healthy status, emotionally disturbed status, and early pathologic status. b. We educate the insured characteristically according to occupational disease. c. In an advanced sense, we educate the insured according to their health condition and occupational status. 2. Health education for secondary and tertiary prevention We educate the insured who are judged to be inn a risk group or to be disease group according to the results of health screening. a. Health education for the risk group By health education on elimination of the risk factors, the risk group can be prevented from the disease. b. Health education for the disease group By health education on the therapeutic process and the method of rehabilitation, the disease group can return to the previous state. We conclude that: 1). Reimbursement for preventive activities{health interview, health education) must be realized. 2) A special organization for health education must be established. 3) All of the insured must be educated and managed during their lifetime by a new special organization.

• Journal of Preventive Medicine and Public Health
• /
• 제28권2호
• /
• pp.325-333
• /
• 1995

Laparoscopic cholecystectomy was introduced into Korea in 1990 and has been rapidly replacing open cholecystectomy when the indications were met. In this study a medical utilization and technology was assessed on the selected hospitalized patients with cholelithiasis who underwent open or laparoscopic cholecystectomy from April 1, 1991 to March 31, 1994. The results are as follows. Despite the low reimbursement rate by the health insurance, the number of laparoscopic cases have been steadily increased. The post-operative days before health insurance coverage were significantly shortened from 8.4 days to 4.6 days. The preoperative days before health insurance coverage were significantly shorted from 8.4 days to 4.0 days. The total length-of-stays in the hospital were also significantly shortened from 15.2 days to 10.7 and 9.8 days in laparoscopic cholecystectomy. The laparoscopic cholecystectomy showed low expenses in all aspects expect the average hospital charges per day. For the hospital to have cost containment, it is more effective if length-of-stay is shorter because of high daily inpatient hospital charge. The laparoscopic cholecystectomy also showed shortened anesthesia time and operation time compared with open cholecystectomy that were statistically significant. The mean anesthesia and operation time for open cholecystectomy were 113.2 and 90.2 minutes but those of laparoscopic cholecystectomy were 105.7 and 68.6 minutes. According to this study the laparoscopic cholecystectomy has reduced the medical expenditure and we recommend this procedure over open cholecystectomy. The further discussion on the different morbidity rate between two types of procedure is essential in providing quality medical care, and to educate specialist.

• Clinical and Experimental Pediatrics
• /
• 제51권3호
• /
• pp.243-247
• /
• 2008

대한신생아학회에서 실시한 세 차례의 조사를 통하여 얻은 자료를 분석하여 우리나라 신생아 중환자실의 현황을 알아보았다. 신생아 중환자실의 면적은 다소 향상되었으나 아직 집중치료를 위한 수준의 면적의 60% 정도에 머물러 있으며, 가스송출구 등의 설비도 아직 부족한 실정이다. 신생아 집중치료에 중요한 인공환기기 등의 장비의 보유 숫자는 증가하였으나, 환자를 담당할 인력의 부족 현상은 전혀 개선되지 않고 오히려 악화되고 있다. 신생아 중환자실 담당 전문의는 1.2명, 전공의는 1.7명으로 1999년 보다 감소하였으며, 간호인력의 부족도 오히려 악화되었다. 간호사 1인당 담당 환자수는 평균 7,7명으로 많은 부담이 되어 집중치료의 어려움을 나타내고 있다. 이러한 현상은 신생아 집중치료에 대한 비현실적으로 부족한 건강보험수가 때문에 의료기관들이 시설이나 장비 부족에 대해서는 다소 개선을 하였으나 인력 투입에 매우 어려움을 가지고 있다는 것을 보여 준다. 전국적으로 신생아 중환자실의 병상 규모는 필요병상수의 71.1% 정도를 갖추고 있는 것으로 집계되므로 이를 개선하기 위해서는 정부의 정책적 지원이 절실히 필요하다.

• 한국의료질향상학회지
• /
• 제2권2호
• /
• pp.46-54
• /
• 1996

Background : The medical record is a compilation of pertinent facts of a patient's life and health history, including past and present illness and treatment. It is written by the health professionals contributing to that patient's care. And the medical record is the permanent, legal document which must contain sufficient information to identify the patient, justify the diagnosis and treatment, and record the results. As such, it must be accurate and complete. So we try to analyze the medical record especially a kind of incomplete record, loose laboratory reports. Methods: During the one-year period(from January to December 1988), a medical record practitioner examine and analyze the record of laboratory reports at K Hospital in Seoul. A total of 320 loose laboratory reports for 3,818 admitted laboratory reports. And a medical record practitioner and a physician review and analyze the influencing factors for the various reasons of clinical and laboratory aspects. Result: The loose percentage by department is the highest in obstetrics(40.4%) but the highest loose rate is in pediatrics(25.0%). The most of omission is occurred in operation room(80.3%) than OPD(19.7%). The change of diagnosis is according to duration of laboratory and more changable in cancer patient. Conclusion : Regular analysis of the documentation in the medical record so it fulfills its purposes of communicating patient care information. So it serves as evidence of the patient's course of illness and treatment for various legal, reimbursement, and peer evaluation review. And it is very important aspect of quality assurance in medical activities.

• 한국의료질향상학회지
• /
• 제2권2호
• /
• pp.56-71
• /
• 1996

Background : Review of readmissions in health care facilities is necessary from the viewpoint of both economic concerns and quality considerations. To identify the characteristics, factors, and causes of multiple admissions in comparison with single admissions is essential for both providers and payers in order to assure quality care and efficient use of medical resources. Methods: All discharges from an university hospital in 1993 were analyzed, and the characteristics of multiple admissions were identified and were compared with those of single admissions by using the data bases of the discharge abstract and billing for reimbursement. Medical records of patients readmitted within 6 days after the previous discharge were reviewed to identify the reasons for such prompt readmission. Statistical analysis between groups of patients were performed by using SPSS. Result : The mean age was higher in multiple admissions than those of single admissions, and the average length of stay was longer in multiple admissions than in single admissions. The hospital cost per day is higher in single admissions while the cost per case is higher in multiple admissions. More than half of readmissions occurred within one month after the preceding discharges. Above 15% of the readmission within 6 days after the preceding discharges seemed to have close relationship with quality of care provided during the preceding hospitalization. The death rate of the patients readmitted within 6 days was the highest in comparison with multiple admissions and single admissions. Conclusion : Potential preventable readmissions should be reduced by identifying characteristics of multiple admissions, especially unplanned readmission, and by applying some interventions such as standard predischarge assessment or careful follow-up care after discharge for high risk readmission groups. As the results of these efforts, health care facilities could achieve quality improvement in medical care, and effective use of hospital resources.

• 한국IT서비스학회지
• /
• 제19권3호
• /
• pp.57-73
• /
• 2020

The proportion of digital evidence in criminal cases has increased, while at the same time, the spread of the Internet has made it easy to delete information that is stored in another place and thus, the Internet is being used to delete online criminal evidence. To respond quickly and effectively to cybercrime, 29 countries signed the Convention on Cybercrime in 2001 through the Council of Europe. Article 16 of the Convention relates to the expedited preservation of stored computer data and requires signatories to adopt legislative measures to enable its competent authorities to order expeditious preservation of specified computer data where there are grounds to believe that the data is particularly vulnerable to loss or modification. More than 60 countries have joined the Convention since 2001 and have made efforts to improve their legal system in line with it. The United States legislated 18 U.S.C. § 2703(f) to preserve electronic evidence pending the issuance of a court order. The German Code of Criminal Procedure §§ 94~95 allows prosecution authorities to seize evidence or issue production orders without court control in urgent circumstances. A custodian shall be obliged to surrender evidence upon a request that evidence be preserved, and non-compliance results in punishment. Japan legislated the Criminal Procedure Act § 197(3) and (4) to establish a legal base for requesting that electronic records that are stored by an ISP not be deleted. The Korean Criminal Procedure Act § 184 outlines procedures for the preservation of evidence but does not adequately address the expeditious preservation of digital evidence that may be vulnerable to deletion. This paper analyzes nine considerations, including request subjects, requirements, and cost reimbursement to establish directions to improve the legal system for the expedited preservation of digital evidence. A new method to preserve online digital evidence in urgent cases is necessary.