• Journal of Gastric Cancer
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• v.24 no.4
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• pp.464-478
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• 2024

Purpose: Endoscopic submucosal dissection (ESD) is the standard treatment for early gastric cancer (EGC) with a low risk of lymph node metastasis. In Korea, ESD was included in the National Health Insurance (NHI) coverage in 2011, which was expanded in 2018. In the present study, we investigated the status and trends of ESD for EGC over the past decade since its incorporation into the NHI system. Materials and Methods: We analyzed the data from the National Health Insurance Service (NHIS) database from 2011 to 2021, focusing on patient characteristics, number of ESD procedures, in-hospital length of stay (LOS), and total medical cost (TMC) per admission. In addition, we conducted an interrupted time series analysis to assess the impact of changes in insurance coverage on these variables. Results: Overall, 95,348 cases of ESD for EGC were identified. A consistent annual increase in ESD procedures was observed, particularly in tertiary care hospitals and among patients aged >60 years. The overall median LOS and TMC were 4 days and 2,123,000 KRW, respectively. The 2018 insurance coverage expansion did not significantly affect the number of ESD procedures or LOS; however, the TMC increased significantly. Conclusions: Our study illustrates decade-long trends in the ESD for EGC in Korea. The policy needs to be revised continuously to optimize ESD use and improve resource allocation within healthcare systems.

• Health Policy and Management
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• v.9 no.1
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• pp.72-109
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• 1999

This study is conducted to investigate the current status on the utilization of health care and plan for solving this problem. The claims data of the fiscal tear 1995 obtained from the regional health insurance society are used for the study. The main findings of the study are summarized as follows. Indexes(The Extremal Quotient(EQ), coefficients of variance(CV's))which represent the regional difference in the admission rate of the tertiary medical diagnosis group report that there is difference in quantity and quality of utilization of health care. The admission rate is lower in the big city areas, Kyoungkido, Kangwondo and Chunlapukdo. Even after age-sex adjustment, the admission rate is still low in Kangwondo, Chunlapukdo and Kyoungsangpukdo. The big city areas tend to have higher rates in the expenses per claim, hospital days per claim, and daily expenses but the rates are still low in some area in Kangwondo, Chunlanamdo and Kyoungsangpukdo. This result remains as same after age-sex adjustment. There is a large regional difference in average utilization rate for the tertiary hospital of the tertiary medical diagnosis group: 57.2%(SD 11.53). The utilization rates for the tertiary hospital in their large catchment area are 96.34%, 83.19% and 73.22% in each Kyoungin, Kyoungnam and Kyoungpuk areas whereas it is lower in a Chungpuk and Chungnam areas. The regional differences of health care utilization of the tertiary medical diagnosis group gave some relationships with their geographical characteristics such as socio-economic characteristics and supply factors of medical services. It is important that many medical policies should be developed in order to minimize and balance out the regional differences of health care utilization. The service allocation policy should include the reconstruction of manpower policy, developing the resource allocating formula, finding the self-sufficient catchment area and reforcing of public health services. Moreover, in order to achieve the balanced development by region, they should investigate and consider each county's microscopic properties under the consistent macrocopic policy. The further studies to find causes of regional difference are needed.

• Journal of Preventive Medicine and Public Health
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• v.38 no.2
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• pp.175-181
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• 2005

Objectives: This study estimated the burden of disease due to high alcohol consumption using DALY, a composite indicator recently developed by the Global Burden of Disease study group. The results were analyzed by age and sex. Methods: Firstly, high alcohol consumption-related diseases, and their relative risk (RR), were selected. Secondly, population attributable fractions (PAFs) were computed using formulae, including the relative risk (RR) and prevalence of exposure (Pe). Thirdly, the DALYs of high alcohol consumption-related diseases were estimated. Lastly, the attributable burdens of diseases due to high alcohol consumption wereconcluded as being the sum of the products that multiplied the DALYs of high alcohol consumption-related diseases by their population attributable fraction (PAF). Results : The burden of high alcohol consumption in Korea was 2992.3 person years (PYs) per 100,000 persons in men, and 1426.6 in women. For men, the high alcohol consumption-induced diseases with the five biggest burdens were liver cirrhosis, hypertensive disease, liver cancer, cerebral infarction and intracerebral hemorrhage. For women, these were cerebral infarction, intracerebral hemorrhage, hypertensive disease, liver cirrhosis and liver cancer. Conclusion: This study highlighted the attributable fraction of diseases due to exposure to high alcohol consumption, by quantifying the results of exposure to risk factors. Therefore, it is now possible to assess interventions for risk factors in quantifiable terms in each population. Finally, measuring the risk factor burdens was expected to contribute to priority setting and effective resource allocation in public health policy.

• The Transactions of the Korea Information Processing Society
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• v.6 no.2
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• pp.385-395
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• 1999

Video-On-demand system provides electronic video rental services from remote video servers on a broadband communication networks. When we assume some situation that serve the same video stream by batching, each time single video stream became available at server-end side, we face the problem that what video stream to be scheduled at what time instant. Hence, in order to manage the resource bandwidth which is different at each stream, the policy of channel allocation became important factor. In this work, we proposed three type of scheduling policies with queueing, as are cumulative Waiting Time(CWT), Mean Waiting Time(MWT) and Predictable Popular Factor(PPF). While CWT policy is good for popular video, MWT policy was good for non-popular video. Also, we know that PPT policy has some fairness for average wait time and reneging rate of user requests.

• Health Policy and Management
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• v.17 no.3
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• pp.1-25
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• 2007

Relative value scales introduced in 2001 remarkably improved health insurance fee schedule, but current relative value scales have many problems. In the beginning the government intended to introduce 'resource based relative value scales(RBRVSs)' like USA, but political adjustment of RBRVS studied in 19.17 weakened the relationship between relative value scale and resource consumption. So unbalance of health insurance fees are existing till now. Also relative value was not divided to physician work and practice expense, and malpractice fee was not divided separately. To correct the unbalance of current relative value scales, the refinement project of health insurance relative value scales started in 2003. The project team divided relative value scales into three components, which are physician work, practice expense, malpractice fee. Physician work was studied by professional organizations like Korean medical association. To develop the practice expense relative value, project team organized clinical practice expert panels(CPEPs) composed of physicians, nurses, and medical technicians. CPEPs constructed direct expense data like labor costs, material costs, equipment costs about each medical procedures. The practice expense relative values of medical procedures were developed by the allocation of the institution level direct & indirect costs according to CPEPs direct costs. Institution level direct & indirect costs were collected in 21 hospitals, 98 medical clinics, 53 dental clinics, 78 oriental clinics, and 46 pharmacies. The malpractice fee relative values were developed through the survey of malpractice related costs of hospitals, clinics, pharmacies. Putting together three components of relative values in one scale, the final relative values were made. The final relative values were calculated under budget neutrality by medical departments, that is, total relative value score of a department was same before and after the revision. but malpractice fee relative value scores were added to total scores of relative values. So total score of a department was increased by the malpractice fee relative value score of that department This project failed in making 'resource based' relative value scales in the true sense of the word, because the total relative value scores of medical departments were fixed. However the project team constructed the objective basis of relative value scale like physician's work, direct practice expense, malpractice fee. So step by step making process of the basis, the fixation of total scores by the departments will be resolved and the resource based relative value scale will be introduced in true sense.

• The Korean Journal of Air & Space Law and Policy
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• v.27 no.1
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• pp.123-156
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• 2012

This study focuses on the satellite licenses and the requirements for satellite spectrum management (i.e. frequency allocation) in Korean satellite industry via comparative analyses against those cases in other developed countries, in order to provide complementary measures to the domestic satellite policies. The satellite industry is one of the main pursuits of a nation's efforts, and it shows distinct characteristics depending on various factors such as national defense and security. In addition, the industry is determined by the nation's market size as well as its international relationship. Consequently, the present study considers examples from various organizations and nations - including U.S.A, Japan, and ITU - and provides a hybrid policy that is well customized for the domestic market. This study looks at similarities between policies of other countries, and finds any supplements for domestic polices by specifying similar cases in others and analyzing their results. The main purpose of this study, therefore, is to find the best agreement for domestic policy with internal interpretation, rather accepting others. While the licensing method for domestic satellites need not be distinct from that of other nations, the case of using non-Korean licensed satellites must be complemented by the conditions in the domestic market. Furthermore, the spectrum management is essential to the nation's satellite industry since the spectrum is a scarce resource. As such, spectrum management that is carefully designed to incorporate the rapidly changing international market demand is crucial to provide a sufficient supply for domestic space industry. In the present study, we find that auction-like market based approaches together with measures to avoid exclusive uses of the scarce resource (e.g. share, leas and reallocation) would provide an excellent method for the domestic satellite industry.

• Journal of Nuclear Fuel Cycle and Waste Technology(JNFCWT)
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• v.12 no.4
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• pp.253-265
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• 2014

Nuclear education & training is an important issue for sustainability of nuclear energy and the safety of the nuclear power plant. The purpose of this paper is to present policy initiatives for establishment of the national nuclear education & training system. It analyzed current status of nuclear manpower and nuclear education & training systems of Korean nuclear organizations and government strategic plans for nuclear manpower education & training. The features of the current nuclear education & training in Korea are institutional diversification and decentralization in Industry-University-Research system. However, linkages and cooperation systematically integrated between institutions are very weak. In addition, duplicated education & training programs and resource allocation, and the resultant inefficiency have been raised as a problem. Therefore, this paper proposed the national nuclear education & training system model as a macro policy initiatives and construction of control tower that manage and adjust overall nuclear education & training.

• KDI Journal of Economic Policy
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• v.13 no.2
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• pp.41-67
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• 1991

Local autonomy of Korea's lower-level local council has been reinstated following elections last March for the first time in thirty years. Last June, we had elections for the upper-level local council. Mayors, governors, and administrative chiefs of cities, provinces and other local government bodies are slated for elections in the first half of next year. The impacts of local autonomy are taking effect in not only the political sphere, but also the administrative and economic spheres. In fact, it seems that some modification of all economic policy making and administration is inevitable. Since the initiation of local autonomy, in order to make the economy work more efficiently, it has become quite important to examine the impact of local autonomy on the national economy. The areas of local autonomy include independent legislative power, administrative power, organizational power, and most important of all, the independent public financial power of the local governments. The purpose of this paper is to examine the effects of local autonomy on the national economy and ways of enhancing the role of local public finance to facilitate settlement and development of the local autonomy system. Local autonomy will contribute to the continuous growth of our economy, allow balanced development, and generate greater efficiency. However, local autonomy can also incur economic costs causing at times short-term price instability, inefficient resource allocation, through tax competition and tax exporting, and insolvency of local government due to abusive fiscal operation. To reduce these side effects, different alternatives must be considered. Local autonomy systems generally provide more efficient resource allocation than centralization. But in the model used in Chapter 3 of this paper, the relative efficiencies of both local autonomy and centralization are determined by comparing the elasticity of substitution between national public goods and local public goods. If the elasticity of substitution is bigger than one, centralization provides a more efficient resource allocation. The development of local autonomy could be attained through democratization of the local public finance system including the following three propositions. I) The independence of public financial power of local governments should be established over central government. Furthermore, a democratically operated scheme of intergovernmental fiscal coordination is especially necessary. 2) In the operation of local finance, direct democracy is needed to induce the voluntary participation of local residents. The residents can take part in planning both the local budget and the development of the community. To attain this goal, all the results of local finance operations should be made public. 3) Among economic ill-effects of the local autonomy system, the most serious one is the possibility of insolvency of local governments. Therefore, measures to limit abusive spending by the local governments should be introduced, such as the fiscal restraints system adopted in the United States.

• Journal of Institute of Control, Robotics and Systems
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• v.13 no.7
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• pp.677-682
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• 2007

Concurrent competition for finite resources by multiple parts in flexible manufacturing systems(FMS's) and inappropriate initial marking or net structure of Petri net with share resources results in deadlock. This is an important issue to be addressed in the operation of the systems. Deadlock is a system state so that some working processes can never be finished. Deadlock situation is due to a wrong resource allocation policy. In fact, behind a deadlock problem there is a circular wait situation for a set of resources. Deadlock can disable an entire system and make automated operation impossible. Particularly, an unmanned system cannot recover from such a status and a set of jobs waits indefinitely for never-to-be-released resources. In this paper, we proposed a deadlock prevention method using siphon and trap of Petri net. It is based on potential deadlock which are siphon that eventually became empty. This method prevents the deadlock by the control of transition fire and initial marking in the Petri net. An given example of FMS is shown to illustrate our results with deadlock-free.

• KSII Transactions on Internet and Information Systems (TIIS)
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• v.8 no.5
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• pp.1532-1553
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• 2014

Radio spectrum is a precious resource and characterized by fixed allocation policy. However, a large portion of the allocated radio spectrum is underutilized. Conversely, the rapid development of ubiquitous wireless technologies increases the demand for radio spectrum. Cognitive Radio (CR) methodologies have been introduced as a promising approach in detecting the white spaces, allowing the unlicensed users to use the licensed spectrum thus realizing Dynamic Spectrum Access (DSA) in an effective manner. This paper proposes a generalized framework for DSA between the licensed (primary) and unlicensed (secondary) users based on Continuous Time Markov Chain (CTMC) model. We present a spectrum access scheme in the presence of sensing errors based on CTMC which aims to attain optimum spectrum access probabilities for the secondary users. The primary user occupancy is identified by spectrum sensing algorithms and the sensing errors are captured in the form of false alarm and mis-detection. Simulation results show the effectiveness of the proposed spectrum access scheme in terms of the throughput attained by the secondary users, throughput optimization using optimum access probabilities, probability of interference with increasing number of secondary users. The efficacy of the algorithm is analyzed for both imperfect spectrum sensing and perfect spectrum sensing.