• Health Policy and Management
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• v.30 no.1
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• pp.72-81
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• 2020

Background: The out-of-pocket maximum is one of the distinctive healthcare systems which sets a ceiling on co-payment in order to reduce the burden of households from the unpredictable medical expenditure. However, this leads to an increase in the demand for healthcare services especially in long-term care hospitals (LTCHs) in Korea. Methods: This study analyzed the influence factor of medical service overuse of 165,592 inpatients in LTCHs which out-of-pocket maximum is applied, by utilizing data from the National Health Insurance Service (2016). Based on Anderson Model, the medical service overuse, as a dependent variable, was defined as long-stay admission more than 180 days at the LTCHs. Independent variable was comprised of predisposing factors (gender, age), enabling factors (income level, types of out-of-pocket maximum) and need factors (illness level, patient use of tertiary hospital). Results: The most powerful factor of medical service overuse in LTCHs was availability of pre-payment for the out-of-maximum (odds ratio [OR], 191.66; p<0.001). This tendency was found in high income level status (p<0.001). Furthermore, mild inpatients (OR, 1.50; p<0.001) which had no experience with the tertiary hospitals (OR, 2.06; p<0.001) were more relevant to the medical service overuse in LTCHs, compared to the severe inpatients. Conclusion: It is suggested that a separate standard of out-of pocket maximum with regards to LTCHs is required to secure the beneficial functions of long-term hospitals and prevent unnecessary financial leakage to achieve sustainable and financially sound National Health Insurance.

• Korea Journal of Hospital Management
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• v.9 no.1
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• pp.46-65
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• 2004

The study was designed to investigate what effect of working time reduction which will be gradually expanded to corporate size from June, 2004 could give to medical industries, and to provide basic information for hospitals and government to prepare the policy. 276 hospitals were surveyed about medical service income and manpower realities during the first half of 2003, using a structured survey tool. Response rate was 8% and 20 hospitals were finally analyzed. The effect of working time reduction in hospital management was different to the size of hospitals and the alternative. Income to existing service income was decreased by $2.2{\sim}4.6%$ in tertiary hospitals, by $3.2{\sim}5.7%$ in general hospitals with more than 300 beds, and by $3.7{\sim}6.0%$ in general hospitals with less than 300 beds. In preparation against such decrease in income, government is required to raise insurance payment, to calculate added service charge for day-off on Saturday forenoon, to retain emergency care payment, to expand emergency care facilities, to secure duty doctors, and to support middle and small sized hospitals. Hospitals are required to give self improving efforts such as fortifying of weekday care, development of weekend care program, strengthening of care capacity and function of emergency care center, and making manpower operation efficient.

• Quality Improvement in Health Care
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• v.25 no.2
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• pp.16-25
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• 2019

Purpose:The healthcare system of South Korea is at the extreme of the dispersed system. Few regulations limit patients from directly visiting higher-level medical institutions for primary care sensitive conditions. As a result, similar to local clinics, general and tertiary teaching hospitals also provide diverse primary care services. Our study aimed to examine the general public's perceptions of their primary care performance. Methods: Face-to-face surveys were conducted with 1000 adults who were living in South Korea with the aid of a questionnaire that included the Korean Primary Care Assessment Tool (KPCAT). The KPCAT consists of five domains, which are the main indicators of primary care performance: first contact, comprehensiveness, coordination, personalized care, and family/community orientation. One-way analysis of variance and post hoc tests were used to compare the KPCAT scores across the three types of medical institutions. Results: Domain-wise analyses revealed two different patterns. With regard to first contact and its subdomains, the highest and lowest scores emerged for local clinics and tertiary teaching hospitals, respectively. However, the other four domain scores were significantly lower for local clinics than for the other two types of medical institutions. Conclusions: Local clinics were perceived to be medical institutions that are responsible for providing primary care. However, the general public perceived only one domain of their primary care to be superior to that of the other two types of medical institutions: first contact. National efforts should be taken to strengthen their other four domains of primary care by training their workforce and providing appropriate incentives.

• Korea Journal of Hospital Management
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• v.4 no.2
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• pp.60-84
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• 1999

Hospitals under competitive environment are getting more interested in PR(public relations) as a means of marketing. A typical form of public relations for the hospital is publicity, and its principal instrument is the press release that provides the mass media with the raw material and background for a news story. The purpose of this paper is to examine and analyze the public relations articles associated with hospitals in the section of health care in major daily newspapers. Three major daily newspapers, Chosun, Joongang and Hankyoreh have been analyzed for a year from January 1, 1998 to December 31, 1998. All articles in the health care section are classified by content, size, press comments, and style. This study has found some perverse aspects of the public relations such as the preponderance of health articles on tertiary medical institutions, inappropriate publicity focused on certain medical treatments, doctors, and hospitals, and the positive press comments on the hospitals that are affiliated with the same corporate group as the newspaper.

• Journal of Preventive Medicine and Public Health
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• v.24 no.4 s.36
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• pp.485-495
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• 1991

This study examined the effects of referral requirements for insurance patients which have been enforced since July 1, 1989 when medical insurance coverage was extended to the whole population except beneficiaries of medical assistance program. The requirements are mainly aimed at discouraging the use of tertiary care hospitals by imposing restrictions on the patient's choice of a medical service facility. The expectation is that such change in the pattern of medical care utilization would produce several desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities. In this study, these effects were assessed by the change in the number of out-patient visits and bed-days per illness episode and the share of each type of facility in the volume of services and the amount of expenditures after the implementation of the new referral system. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for the patients treated during the first six months of 1989, prior to the enforcement of referral requirements, and those of the patients treated during the first six months of 1990, after the enforcement. The 1989 sample included 299,824 claims (3.6% of total) and the 1990 sample included 332,131 (3.7% of total). The data were processed to make the unit of analysis an illness episode instead of an insurance claim. The facilities and types of care utilized for a given illness episode are defined to make up the pathway of medical care utilization. This pathway was conceived of as a Markov Chain process for further analysis. The conclusion emerged from the analysis is that the enforcement of referral requirements resulted in less use of tertiary care hospitals, and thereby decreased the volume of services and the amount of insurance expenses per illness episode. However, there are a few points that have to be taken into account in relation to the conclusion. The new referral system is likely to increase the use of medical services not covered by insurance, so that its impact on national health expenditures would be different from that on insurance expenditures. The extension of insurance coverage must have inereased patient load for all types of medical service organizations, and this increase may be partly responsible for producing the effects attributed to the new referral system. For example, excessive patient load for tertiary care hospitals may lead to the transfer of their patients to other types of facilities. Another point is that the data for this study correspond to very early phase of the new system. But both patients and medical care providers would adapt themselves to the new system to avoid or overcome its disadvantages for them, so as that its effects could change over time. Therefore, it is still necessary to closely monitor the impact of the referral requirements.

• Journal of the Korean Dietetic Association
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• v.20 no.4
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• pp.257-274
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• 2014

The objective of this study was to examine job satisfaction status and its related factors among dietitians working in hospitals. A survey questionnaire was sent to dietitians working in tertiary, general, and convalescent hospitals in Korea. The study sample hospitals included all tertiary hospitals (n=43), and the sample of general hospitals (n=114) and convalescent hospitals (n=240) was randomly selected using a stratified sampling method. A total of 665 dietitians completed the survey questionnaire. The questionnaire included 27 job satisfaction questions on task, stability vision, working conditions, and relationship areas, and the questions on task improvement need. The job satisfaction scores in all four areas ranged from 2.53/5.00 to 3.89/5.00, implying generally low job satisfaction level in hospital dietitians. The job satisfaction levels in the convalescent hospital group were significantly lower compared to those in the tertiary and general hospital groups. Whereas job satisfaction levels of tertiary and convalescent hospital groups did not differ by number of beds, those of the general hospital group increased significantly with the number of beds for all four areas. Multivariate regression analysis results showed that hospital type was a significant predictor of job satisfaction level for all four areas. Job satisfaction of relationship area was also significantly affected by the number of beds, whereas that of working conditions was influenced by annual income and working experience. The study findings provide useful information in planning clinical dietitians' optimal supply outlook for the improvement of clinical nutrition services.

• Journal of Korean Academy of Nursing Administration
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• v.12 no.2
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• pp.225-232
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• 2006

Purpose: The purpose of this study was to analyze the services and cost of CVA patients in hospital-based home health care and compare the differences of home health care cost by hospital types. Methods: The subjects of this study were 5,756 home care patients with cerebrovascular disease. Data were collected by using home health care medical expense claims from 127 hospitals in 2004. Results: The home care service 'indewelling catheterization' was the highest(19.28%), and then 'nasogastric tube insertion and change(16.72%)', 'bladder irrigation(15.98)', 'wound management(simple dressing)(10.42%)' followed. Average home health care cost per visit was 39,943 won, and the highest 46,058 won in general hospitals and the lowest 33,922 won in tertiary hospitals, so there were statistically significant among the types of hospitals(F=1112.47, p<0.0001). Conclusions: The number of home health care patients has been rapidly growing with the increase of aged population and demand for home care services is rising. So, it could be urgent to develop a reasonable cost reimbursement system for home health services and to expend scopes of the roles of home care specialist nurses. Amid the demand of more detail understanding the present status of home care, our study can be contributed to provide fundamental information of home care in Korea.

• YAKHAK HOEJI
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• v.58 no.4
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• pp.268-276
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• 2014

Background: World Health Organization considers opioid analgesic use as an important measure in the treatment of pain relief. However, there are limited data about the pattern of opioid analgesic use in tertiary care hospitals in Korea. The aim of this study was to describe the trends in the prescribed amount of the opioid for 13 years from 2000 to 2012 in a single tertiary care hospital. Methods: The data from the prescribed amount of opioid use in patients aged over 18 years were retrieved from medical charts and longitudinal pharmacy records of Seoul National University Hospital. Yearly prescribed amount of opioids were calculated using defined daily dose adjusted by hospital stay (DDD/1000${\bullet}$HS). Results: Over the 13 years of the study period, overall use of opioid has increased by 64.1%. Although, the opioid use by hospitalized patients comprised 98%~99% of total amount of opioid use, the proportions of opioid use by outpatient and by cancer patient increased from 1.1% to 2.2% and from 60.5% to 69.3%, respectively. The use of non-injectable opioids has increased by 47% and that of injectables has increased by 70%. While the amount of codeine and morphine use has decreased, the use of both transdermal and injection formulation of fentanyl has increased dramatically. Also, the use of oxycodone has increased, especially in outpatient setting. Conclusion: This longitudinal study showed that opioid analgesic use in tertiary hospital, especially in outpatient is continuously increasing. Improvement in pain management in tertiary care hospital can be cautiously inferred based on this results.

• Korea Journal of Hospital Management
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• v.10 no.4
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• pp.51-74
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• 2005

This paper presents an analysis of the current status of domestic hospital industry which went trough the time of new hospitals operated by chaebols from 1994 to 2003 and the dramatic changes of medical service environment such as IMF relief loan in 1997 and the separation of prescription and dispensing (SPD) in 2000. For the sake of righteous policy-making in the future, this paper presents a productivity analysis of the management and administration of 38 tertiary hospitals nationwide in the past 10 years. The analysis is based on the Malmquist index approach using linear programming. d prepare a productivity index that measures not merely efficiency but the technological evolution and adjustment to changing environments.

• Health Policy and Management
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• v.13 no.1
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• pp.98-115
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• 2003

Concerns about growing health insurance expenditures became a national Issue in 2001 when the National Health Insurance went into a deficit. Increases in spending for ambulatory care shared the largest portion of the problem. Methods and systems to control the spending should be developed and a system to measure case mix of providers is one of core components of the control system. The objectives of this article is to examine the feasibility of applying Korean Diagnosis Related Groups (KDRGs) to classify health insurance claims for ambulatory care and to identify problem areas of the classification. A database of 11,586,270 claims for ambulatory care delivered during January 2002 was obtained for the study, and the final number of claims analyzed was 8,319,494 after KDRG numbers were assigned to the data and records with an error KDRG were excluded from the study. The unit of analysis was a claim and resource use was measured by the sum of charges incurred during a month at a department of a hospital of at a clinic. Within group variance was assessed by th coefficient of variation (CV), and the classification accuracy was evaluated by the variance reduction achieved by the KDRG classification. The analyses were performed on both all and non-outlier data, and on a subset of the database to examine the validity of study results. Data were assigned to 787 KDRGs among 1,244 KDRGs defined in the classification system. For non-outlier data, 77.4％ of KDRGs had a CV of charges from tertiary care hospitals less than 100％ and 95.43％ of KDRGs for data from clinics. The variance reduction achieved by the KDRG classification was 40.80％ for non-outlier claims from tertiary care hospitals, 51.98％ for general hospitals, 40.89% for hospitals, and 54.99% for clinics. Similar results were obtained from the analyses performed on a subset of the study database. The study results indicated that KDRGs developed for a classification of inpatient care could be used for ambulatory care, although there were areas where the classification should be refined. Its power to predict tile resource utilization showed a potential for its application to measure case mix of providers for monitoring and managing delivery of ambulatory care. The issue concerning the quality of diagnostic information contained in insurance claims remains to be improved, and significance of future studies for other classification systems based on visits or episodes is guaranteed.