• 한국병원경영학회지
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• 제20권4호
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• pp.72-77
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• 2015

• 환경영향평가
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• 제17권6호
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• pp.381-391
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• 2008

The instances of the damage to livestock are increasing with frequent environmental disputes on the noise and vibration. This study analyzed 134 open cases dealing with the environmental disputes on livestock damaged by noise and vibration, and being intervened by National Environmental Dispute Resolution Commission. The environmental disputes on the noise and vibration account for 86% of all the disputes, and cases of the consequent damages to livestock have increased. As shown in the 134 cases, pig is the most lethal livestock attacked by the noise and vibration. During last 10 years, 89% of the noise damages hurting the livestock resulted from the noises pertaining to construction and 58% was due to the noise damages from the road constructions. The noise levels in the range of 70~80 dB(A) and the vibration levels of 70~75 dB(V) caused most of the disputes. The average rate of reimbursement for the livestock damages for the last 10 years was higher than the average rate of reimbursement of the total disputes intervened by National Dispute Resolution Commission.

• 한국국방경영분석학회지
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• 제31권2호
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• pp.1-12
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• 2005

Defense firms' excess profitability by shifting common overhead costs from non-defense sector to defense sector in the award of cost reimbursement type of defense contracts is a widespread conclusion in prior researches. In this paper, we reviewed cost-shifting incentives in defense-contracting firms and extended the analysis of McGowan and Vendrzyk(2002) by applying modified model to Korea Defense Contracts. We formulated six hypotheses to test the relation of cost-shifting and excess profitability regarding market openness, auditing system, ranking in defense contracts, and firm types(sole defense contractors, sole non-defense contractors, and defense and non-defense mixed contractors). But, we could not find any evidence that defense firms shifted costs from non-defense sector to defense sector for the period 1997-2002. The results suggest that the excess profitability of Korea defense firms may not be from the cost-shifting but from other reasons.

• 보험의학회지
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• 제24권
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• pp.21-25
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• 2005

• 보건행정학회지
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• 제12권1호
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• pp.21-53
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• 2002

The purpose of this study is to measure the resource use of the elderly in long-term care services and to examine the effects of patient and facility characteristics on their use of resources. The data were collected from 510 old people over sixty years of age, residing in five long-term care hospitals and two skilled nursing homes during the period between December 1, 2000 and February 28, 2001. For a full sample, when the first level of RUG(Resource Use Group)-III categories were employed as the proxy of patient severity, facility characteristics, such as location, size and ownership, have large effects on the resource use measured by service intensity, whereas patient characteristics such as severity have little or no effect. The resource use is significantly high if the facility: (1) is located in rural areas (gun): (2) has mare than 200 beds; (3) is a long-term care hospital; (4) is private; and (5) has a low percentage of medical aid patients. The analysis of the resource use in each RUG-III categories, for which ADL(Ability of Daily Living) were employed as the prosy of patient severity, shows a similar result. The loose relationship between the needs of residents and the resource use seems to be closely associated with the ineffective reimbursement system for providers. The current reimbursement system has no provision for quality improvement and reimburses facilities simply according to their types: fee-for-service for long-term care hospitals, and monthly-flat-rate or full-coverage-national-aid for skilled nursing facilities. It will be necessary to develop a more reasonable reimbursement system that takes patient's severity into account and gives incentives for long-term care providers to offer cost-effective services.

• 간호행정학회지
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• 제14권3호
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• pp.229-240
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• 2008

Purpose: To develop the patient classification system based on the resource utilization for reimbursement of long-term care hospitals in Korea. Method: Health Insurance Review & Assessment Service (HIRA) conducted a survey in July 2006 that included 2,899 patients from 35 long-term care hospitals. To calculate resource utilization, we measured care time of direct care staff (physicians, nursing personnel, physical and occupational therapists, social workers). The survey of patient characteristics included ADL, cognitive and behavioral status, diseases and treatments. Major category criteria was developed by modified delphi method from 9 experts. Each category was divided into 2-3 groups by ADL using tree regression. Relative resource use was expressed as a case mix index (CMI) calculated as a proportion of mean resource use. Result: This patient classification system composed of 6 major categories (ultra high medical care, high medical care, medium medical care, behavioral problem, impaired cognition and reduced physical function) and 11 subgroups by ADL score. The differences of CMI between groups were statistically significant (p<.0001). Homogeneity of groups was examined by total coefficient of variation (CV) of CMI. The range of CV was 29.68-40.77%. Conclusions: This patient classification system is feasible for reimbursement of long-term care hospitals.

• 한국임상약학회지
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• 제26권3호
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• pp.207-212
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• 2016

Objective: Prescription rate of dabigatran and rivaroxaban, which are the direct oral anticoagulants (DOAC), has increased. We have analyzed the prescription trend and medication use of dabigatran and rivaroxaban in patients with non-valvular atrial fibrillation (NVAF). Methods: It was retrospectively studied from September 2012 to April 2014 using the electronic medical records and the progress notes. Patients with NVAF (n=424) were evaluated on the medication use, prescribing preferences, adverse drug reactions (ADRs) and the availability of prescription reimbursement of dabigatran (n=210) and rivaroxaban (n=214). Results: Dabigatran was prescribed higher than rivaroxaban (23.3% versus 7.5%, p<0.001) in the neurology department, but rivaroxaban was prescribed higher compared to dabigatran in the cardiology department (87.4% versus 74.3%, p<0.001). Dabigatran was prescribed more than rivaroxaban in high risk patients with CHADS2 score ${\geq}3$ (44.3% versus 31.3%, p=0.006). Dabigatran patients seemed to have more ADRs than patients with rivaroxaban (25.2% versus 11.2%, p<0.001), but no serious thrombotic events and bleeding were found. Only 35.6% (n=151) were eligible for prescription reimbursement by the National Health Insurance (NHI). Bridging therapy (86, 31.5%) and direct-current cardioversion (57, 20.2%) were main reasons of ineligibility for reimbursement. Conclusion: Prescription preferences were present in choosing either dabigatran or rivaroxaban for patients with NVAF. Inpatient protocols and procedures considering patient-factors in NVAF need to be developed.

• 보건행정학회지
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• 제19권4호
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• pp.98-120
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• 2009

The purpose of this study is to elicit preference for drug listing decision criteria and to estimate the ICER threshold in South Korea using the discrete choice experiment (DCE) method. To collect the data, a DCE survey was administered to a subject sample either educated in the principle concepts of pharmacoeconomics or were decision makers within that field. Subjects chose between alternative drug profiles differing in four attributes: ICER, uncertainty, budget impact and severity of disease. The orthogonal and balanced designs were determined through computer algorithm to take the optimal set of drug profiles. The survey employed 15 hypothetical choice sets. A random effect probit model was used to analyze the relative importance of attributes and the probabilities of a recommendation response. Parameter estimates from the models indicated that three attributes (ICER, Impact, Severity of disease) influenced respondents' choice significantly(p${\pm}$0.001). In addition, each parameter displayed an expected sign. The Lower the ICER, the higher the probability of choosing that alternative. Respondents also preferred low levels of uncertainty and smaller impact on health service budget. They were also more likely to choose drugs for serious diseases rather than mild or moderate ones. Uncertainty however is not statistically significant. The ICER threshold, at which the probability of a recommendation was 0.5, was 29,000,000 KW/QALY in expert group and 46,500,000 KW/QALY in industry group. We also found that those in our sample were willing to accept high ICER to get medication for severe diseases. This study demonstrates that the cost-effectiveness, budget impact and severity of disease are the main reimbursement decision criteria in South Korea, and that DCE can be a useful tool in analyzing the decision making process where a variety of factors are considered and prioritized.

• 한국임상약학회지
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• 제24권1호
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• pp.1-8
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• 2014

Objective: Currently, rivaroxaban is widely used clinically for thromboprophylaxis after surgery. However, there are concerns on effectiveness and safety of rivaroxaban for its proper use. We aimed to evaluate the effectiveness and safety of rivaroxaban in orthopaedic patients after total hip replacement surgery in a large medical centre after the preferred formulary was switched from enoxaparin to rivaroxaban. Methods: The study was conducted on the patients who underwent hip arthroplasty surgery at the department of Orthopaedic Surgery at Seoul St. Mary's Hospital, South Korea. Electronic medical records were retrospectively reviewed to identify patients treated with rivaroxaban following total hip replacement between February 2011 and March 2012. Evaluation criteria included indications for use, dose, initiation and duration of therapy, drug interactions, adverse reactions, and status of health care reimbursement. The patients who were on enoxaparin were also reviewed as a reference. Results: We identified 57 patients who received rivaroxaban and 50 who received enoxaparin. All patients were prescribed the drugs for Korean Food and Drug Administration-approved indications. No thromboembolic or bleeding events were observed in either group. However, only 5.3% of rivaroxaban- treated patients had an appropriate length of prophylaxis and only 3.5% began rivaroxaban treatment at the recommended time. Surprisingly, 47.4% of rivaroxaban-treated patients received rivaroxaban despite being ineligible for reimbursement benefits. Conclusion: Rivaroxaban was generally well tolerated clinically. However, the duration of treatment, the time of initiation and patient eligibility for reimbursement require improvements, emphasising the need for education which indicates the area of pharmacists' involvement.

• 한국중재학회지:중재연구
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• 제22권3호
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• pp.119-139
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• 2012

In the case of Banque Paribas V. Banco Santander in England for the reimbursement request of deferred payment credit by the nominated bank, the L/C-issuing bank refused to pay the proceeds at maturity because of a fraudulent transaction. The reason of refusal was that the nominated bank, Banco Santander, had no right of payment in deferred credit before its maturity if it made payment of proceeds without notice to the issuing bank, that is, payment not based upon a credit transaction but on its own account. However, in the case of ADIB V. Fortis Bank in America, the New York court made the decision that the deferred payment bank could not refuse to reimburse to the nominated bank, Fortis Bank, because of fraud. Its decision was based on the UCP600. We have analyzed and investigated the above two cases-one was an English court's decision and the other an American's. The English court's decision was made under UCP500, but the American court's was made under UCP600, which was revised in 2007. As a result, we can expect that from now on in deferred payment credit transactions, the power of the nominated bank will be greater than before, but the issuing bank will bear the risk of the beneficiary's fraud, so the issuing bank will be hesitant to issue deferred payment credit. Notwithstanding, we thought that the New York court decision would come into effect in the activation of deferred payment credit in practical trade transactions.