• Title/Summary/Keyword: the-fee-for service system

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The Conflict over the Separation of Prescribing and Dispensing Practice (SPDP) in Korea: A Bargaining Perspective (의약분업을 둘러싼 갈등 : 협상론의 관점에서)

  • Lee, Kyung-Won;Kim, Joung-Hwa;T. K. Ahn
    • Health Policy and Management
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    • v.12 no.4
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    • pp.91-113
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    • 2002
  • We report and analyze the Korean physicians' recent general strike over the implementation of the Separation of Prescribing and Dispensing Practice (SPDP) in which more than 18,000 private clinics and 280 hospitals participated. Utilizing game-theoretic models of bargaining we explain why the Korean physicians were so successful in organizing intense collective action against the government and securing very favorable policy outcomes. In particular, we highlight the role of distributional conflict among social actors in shaping the details of institutional reform. The introduction of the SPDP was a necessary first step in the overall reform of health care system in Korea. However, the SPDP was perceived to be a serious threat to the economic viability of their profession by the vast majority of Korean physicians who had long been relied on the profits from selling medicines to compensate for the loss of income due to the low service fee under the previous health care system. The strong political coalition among heterogeneous physicians enabled them to organize an intense form of collective action, the general strike. Thus, physicians were successful not only in dragging the government to a bargaining table, but also winning in the bargaining and securing an outcome vastly favorable to them. On the other hand, the lack of an overall reform plan in the health care policy area, especially the finance of the National Health Insurance and the need for maintaining an image as a successful reform initiator, motivated the government to reach a quick resolution with the striking physicians.

A Study on the Online Newspaper Archive : Focusing on Domestic and International Case Studies (온라인 신문 아카이브 연구 국내외 구축 사례를 중심으로)

  • Song, Zoo Hyung
    • The Korean Journal of Archival Studies
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    • no.48
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    • pp.93-139
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    • 2016
  • Aside from serving as a body that monitors and criticizes the government through reviews and comments on public issues, newspapers can also form and spread public opinion. Metadata contains certain picture records and, in the case of local newspapers, the former is an important means of obtaining locality. Furthermore, advertising in newspapers and the way of editing in newspapers can be viewed as a representation of the times. For the value of archiving in newspapers when a documentation strategy is established, the newspaper is considered as a top priority that should be collected. A newspaper archive that will handle preservation and management carries huge significance in many ways. Journalists use them to write articles while scholars can use a newspaper archive for academic purposes. Also, the NIE is a type of a practical usage of such an archive. In the digital age, the newspaper archive has an important position because it is located in the core of MAM, which integrates and manages the media asset. With this, there are prospects that an online archive will perform a new role in the production of newspapers and the management of publishing companies. Korea Integrated News Database System (KINDS), an integrated article database, began its service in 1991, whereas Naver operates an online newspaper archive called "News Library." Initially, KINDS received an enthusiastic response, but nowadays, the utilization ratio continues to decrease because of the omission of some major newspapers, such as Chosun Ilbo and JoongAng Ilbo, and the numerous user interface problems it poses. Despite these, however, the system still presents several advantages. For example, it is easy to access freely because there is a set budget for the public, and accessibility to local papers is simple. A national library consistently carries out the digitalization of time-honored newspapers. In addition, individual newspaper companies have also started the service, but it is not enough for such to be labeled an archive. In the United States (US), "Chronicling America"-led by the Library of Congress with funding from the National Endowment for the Humanities-is in the process of digitalizing historic newspapers. The universities of each state and historical association provide funds to their public library for the digitalization of local papers. In the United Kingdom, the British Library is constructing an online newspaper archive called "The British Newspaper Archive," but unlike the one in the US, this service charges a usage fee. The Joint Information Systems Committee has also invested in "The British Newspaper Archive," and its construction is still ongoing. ProQuest Archiver and Gale NewsVault are the representative platforms because of their efficiency and how they have established the standardization of newspapers. Now, it is time to change the way we understand things, and a drastic investment is required to improve the domestic and international online newspaper archive.

A Study on Users' Recognition of Selection Attributes for Connection between Recreational Forest and Rural Tourism Village (자연휴양림과 체험마을 연계를 위한 이용객의 선택속성 인식 연구)

  • Lee, Yong-hak;Cho, Yeong-Eun;Kang, Eun-jee;Kim, Yong-Geun
    • Journal of the Korean Institute of Landscape Architecture
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    • v.44 no.1
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    • pp.16-28
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    • 2016
  • The study was conducted to compare and analyze the importance and performance of leisure destination selection attributes of persons who use recreational forests and rural tourism villages. This researcher investigated the use patterns of users to identify the ground for connection between recreational forest and rural tourism village, analyzed their recognition differences in physical selection attribute, program selection attribute, and service selection attribute in order for leisure destination selection, and conducted importance-performance analysis(IPA analysis) to draw a plan for connection. The main results and suggestions are presented as follows. First, recreational forests were visited by family users in order for rest and emotional cultivation and provided experience programs using simple public interest function of forest, whereas rural tourism villages were visited by family users, friends and co-workers, groups and club members to experience a variety of annual programs and understand regional cultures. It was found that it was necessary to connect natural forest with rural tourism village in order to meet the leisure needs of the people changed in diversified ways. Secondly, it was found that the connection between rural tourism village and recreational forest visited mainly for simple rest led to positive visit intention of users. It was expected that there will be various kinds of uses, including experience program participation, child education, and safe accommodations security. In other words, the connection between recreational forest and rural tourism village is an alternative to trigger actual demands and recreational forest activities with high quality. Thirdly, in the case of users of recreational forests, their performance of all selection attributes was lower than their importance of them. Therefore, overall improvements were needed. In particular, needed were the diversity, benefit, and promotion of programs, improvements in locality(themes), supply of lodges and convenient facilities, booking system, the purchase system of local special products, and professional skills of operators and managers. On contrary, the performance of program selection attribute of rural tourism village was high. Therefore, it was found that program attribute of rural tourism village was the main connection factor to activate recreational forest use. Fourthly, according to IPA analysis, the proper connections between loges, convenient facilities, and nearby touristattractions, which give high expectations and satisfaction to users, needed to remain. And it was required to make common efforts to accomplish the goal (income creation) of rural tourism village and improve booking system for visitors and performance of local special products sales opportunity. In addition, the essential factors to induce users' leisure destination selection were found to be maintenance of the use fee system of recreational forest, diversity of rural tourism village program, and retention of locality.

General Characteristics and Satisfaction of Out-patients of University Hospitals in Seoul, Korea (대학병원 외래환자의 일반적 특성과 만족도 - 서울시내 5개 대학병원을 대상으로 -)

  • Chang, Sung-Goo;Ha, Hun-Young;Shin, Young-Jun;Lee, Jong-Gil
    • Quality Improvement in Health Care
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    • v.2 no.2
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    • pp.130-145
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    • 1996
  • Purpose : the management of University Hospital is being challenged in maintenance of reasonable level of income and high ranked reputation by domestic competition with each other and emergence of enterprised owned hospitals. It is imperative that University Hospitals have to make management for patient satisfaction. Furthermore, increased patient's requirement for qualified hospital services (quality assurance) and low-estimated service fee also repress the hospital management condition as well as medical markets open following with Urguay Connection. Due to these unforable conditions surrounding hospital management, -University Hospitals are being pressed to seek improved management strategies. To develope the strategies, we need to have basic understanding about the problems on hospital management and detail information for various patient's requirement. Methods: For this study, we have analysed out-patients from five different University Hospitals located in Seoul, Korea. To obtain the data, we have carried out personal interviews with patients who patients who visit the Out-Patient Clinics of five different University Hospitals using a previously prepared questionnaire. Result: Around 65.7 percent of the visits to University Hospitals were indwelt in the vicinity of 1 hour and motuvation of visiting University Hospital was expending high wuality medical csre in 49.3 percent. The 79.3 percent of the patients have experienced inconvenience during medical care in University Hospital. The most inconvenient condition was waiting for doctors. The 57.2 percent of total patient have experienced rudness. The most rudness condition was registration and receipt desk in 44.4 percent. Patient expect that doctors working in University Hospitals as professors have high and updated medical knowledge(50.4%) and University Hospitals have a high quality medical care system(79.4%). The patient satisfaction was relatively low in 61.1 percent of total patient and revealed high frequency of again visit University Hospital in satisfaction group. Comparison of interhospital analytical study showed quite difference on various problems. Conclusion: Almost patients who visit to Out-Patient Clinic of University Hospital havevisiting motivation to high quality medical care. University Hospitals have several different unsatisfactorial factors and revealed different degree of patient satisfaction. In a future day, University Hospitals have to make use of another University Hospital's merits for approach of Benchmarking and also should be studied decision factors of patient satisfaction and interhospital difference of them.

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Factor Analysis on Citizen's Motives to Tree Burial and Choice Conditions to Tree Burial Site (수목장의 동기와 수목장지 선호조건에 대한 요인 분석)

  • Woo, Jae-Wook;Byun, Woo-Hyuk;Park, Won-Kyung;Kim, Min-Soo;Yim, Min-Woo
    • Journal of Korean Society of Forest Science
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    • v.100 no.4
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    • pp.639-649
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    • 2011
  • The purpose of this study aimed to analyze factors on motives to tree burial and choice conditions to tree burial site in order to suggest policy direction for the desirable settlement of tree burial. For those purpose, this study performed questionnaire, targeting 522 visitors of funeral hall all around Korea. As the result, the factors of motives to tree burial were extracted as follows: funeral ceremony progressed along with trees, simplicity, memorial site's easy insurance, environmental friendliness and consideration toward descendants. The factors on choice conditions to tree burial sites were extracted as follows: beauty of natural scenery, emotional mood as a memorial site, convenience, stability and economic feasibility. Based on the results of factor analysis, this study suggested policies related to motives to tree burial as follows: develop various types of tree burial sites, develop a funeral ceremony suitable for tree burial, come into wide use of tree burial as a social welfare service, develop tree burial methods capable of many burials, and improve professionalism to manage tree burial system. In addition, this study proposed related choice conditions to tree burial sites as follows: establish natural forest scenery, convert existing graveyards into tree burial sites, select easily accessible places for tree burial sites, form tree burial sites as places for both rest and memory, and reduce using fee of tree burial site.

A study on the trend in the length of hospital stay in Korea (우리나라 병원의 평균재원기간의 추이)

  • Cho, Woo-Hyun;Chun, Ki-Hong;Kang, Im-Ok
    • Journal of Preventive Medicine and Public Health
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    • v.29 no.1 s.52
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    • pp.51-65
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    • 1996
  • The purpose of this study was to examine the trends of length of hospital stay (LOS), which is most likely to be a major attribute to hospital performance. From 1984 to 1994, an average LOS of each hospital was analyzed by factors such as medical departments, bed size, occupancy rate, region and ownership. This study was analyzed changing rate of LOS during 11 years. This rate was calculated by simple regression, which was used only with hospital without missing data during 11 years. This study findings are as follows. 1. The results indicated that the average LOS was steadily increased until 1990 but it was slightly decreased after 1990. 2. This trend could be found in all hospital scale and all group of occupancy rate. Specifically this trends of LOS were found in internal medicine, corporate owned hospitals, and hospitals in major city. But LOS of individual owned hospital was continuously increased until 1994. 3. Means of changing rates of LOS were calculated from 1984 to 1994. If we devided it into two parts, before 1990 and after 1990, most changing rates of LOS before 1990 except individual owned hospital were found positive sign. The changing rates after 1990 were negative sign but small hospital(lesser then 200 bed), individual owned hospital, national & public hospital and hospital in small urban have little change of LOS after 1990. Finally from this results we thought that most hospitals in Korea began to be concerned with LOS. Nevertheless LOS of several hospital such as small hospital or individual owned hospital was increased. And this trend may be caused by a few patients, low occupancy rate, or low profit. This trend of LOS is different from that of other countries. Perhaps this phenomenon is resulted from the reimbursement method. Because of fee for service reimbursement system in Korea the hospitals didn't need to shorten LOS in order to save the cost and increase the profit. Therefore reform of hospital cost reimbursement method will be needed to reduce hospital cost in Korea. We thought that the Korean health authority should consider the reimbursement method by unit of bundle of services, for example DRG and prepayment in the United States. This study presents some limitations such as no insight of severity of disease, case-mix measurement of hospital, and other clinical characteristics that can. possibly affect LOS. However, this study reports an important trend in LOS from 1984 to 1994.

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A study on the change of complication incidence rate according to introduction of quality evaluation by the DRG payment -focussing on patients with lens surgery (질병군 포괄수가 적정성 평가 도입에 따른 합병증 발생률 변화에 대한 연구 -수정체 수술 환자를 대상으로)

  • Kim, Myoung-Ok;Park, Arma;Lee, Chong Hyung;Kim, Kwang-Hwan
    • Journal of the Korea Convergence Society
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    • v.9 no.6
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    • pp.99-106
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    • 2018
  • The purpose of this study is to investigate incidence rates of complications in response to the introduction of quality evaluation of the DRG(diagnosis related group) payments, focusing on an increasing number of patients with lens surgery as the population aging increases.Fourthly, there were three dependent variables ('vitreous prolapse', 'IOP elevations', and 'other complications') in this study, and therefore multivariate logistic regression was performed. The result of the analysis indicates that as the number of hospitalized days increased, vitreous prolapse decreased to 0.27 times(95% CI 0.08~1.00) and IOP elevation decreased by 0.14 times(95% CI 0.03~1.59), compared to other complications, and this was statistically significant. From the above results, this study is meaningful in that it has compared the evaluation results of the appropriateness of DRG payment and the medical quality for lens surgery complications patients, in response to the introduction of quality evaluation by DRG payment.

Corporate Bond Rating Using Various Multiclass Support Vector Machines (다양한 다분류 SVM을 적용한 기업채권평가)

  • Ahn, Hyun-Chul;Kim, Kyoung-Jae
    • Asia pacific journal of information systems
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    • v.19 no.2
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    • pp.157-178
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    • 2009
  • Corporate credit rating is a very important factor in the market for corporate debt. Information concerning corporate operations is often disseminated to market participants through the changes in credit ratings that are published by professional rating agencies, such as Standard and Poor's (S&P) and Moody's Investor Service. Since these agencies generally require a large fee for the service, and the periodically provided ratings sometimes do not reflect the default risk of the company at the time, it may be advantageous for bond-market participants to be able to classify credit ratings before the agencies actually publish them. As a result, it is very important for companies (especially, financial companies) to develop a proper model of credit rating. From a technical perspective, the credit rating constitutes a typical, multiclass, classification problem because rating agencies generally have ten or more categories of ratings. For example, S&P's ratings range from AAA for the highest-quality bonds to D for the lowest-quality bonds. The professional rating agencies emphasize the importance of analysts' subjective judgments in the determination of credit ratings. However, in practice, a mathematical model that uses the financial variables of companies plays an important role in determining credit ratings, since it is convenient to apply and cost efficient. These financial variables include the ratios that represent a company's leverage status, liquidity status, and profitability status. Several statistical and artificial intelligence (AI) techniques have been applied as tools for predicting credit ratings. Among them, artificial neural networks are most prevalent in the area of finance because of their broad applicability to many business problems and their preeminent ability to adapt. However, artificial neural networks also have many defects, including the difficulty in determining the values of the control parameters and the number of processing elements in the layer as well as the risk of over-fitting. Of late, because of their robustness and high accuracy, support vector machines (SVMs) have become popular as a solution for problems with generating accurate prediction. An SVM's solution may be globally optimal because SVMs seek to minimize structural risk. On the other hand, artificial neural network models may tend to find locally optimal solutions because they seek to minimize empirical risk. In addition, no parameters need to be tuned in SVMs, barring the upper bound for non-separable cases in linear SVMs. Since SVMs were originally devised for binary classification, however they are not intrinsically geared for multiclass classifications as in credit ratings. Thus, researchers have tried to extend the original SVM to multiclass classification. Hitherto, a variety of techniques to extend standard SVMs to multiclass SVMs (MSVMs) has been proposed in the literature Only a few types of MSVM are, however, tested using prior studies that apply MSVMs to credit ratings studies. In this study, we examined six different techniques of MSVMs: (1) One-Against-One, (2) One-Against-AIL (3) DAGSVM, (4) ECOC, (5) Method of Weston and Watkins, and (6) Method of Crammer and Singer. In addition, we examined the prediction accuracy of some modified version of conventional MSVM techniques. To find the most appropriate technique of MSVMs for corporate bond rating, we applied all the techniques of MSVMs to a real-world case of credit rating in Korea. The best application is in corporate bond rating, which is the most frequently studied area of credit rating for specific debt issues or other financial obligations. For our study the research data were collected from National Information and Credit Evaluation, Inc., a major bond-rating company in Korea. The data set is comprised of the bond-ratings for the year 2002 and various financial variables for 1,295 companies from the manufacturing industry in Korea. We compared the results of these techniques with one another, and with those of traditional methods for credit ratings, such as multiple discriminant analysis (MDA), multinomial logistic regression (MLOGIT), and artificial neural networks (ANNs). As a result, we found that DAGSVM with an ordered list was the best approach for the prediction of bond rating. In addition, we found that the modified version of ECOC approach can yield higher prediction accuracy for the cases showing clear patterns.

Determination of Cost and Measurement of nursing Care Hours for Hospice Patients Hospitalized in one University Hospital (일 대학병원 호스피스 병동 입원 환자의 간호활동시간 측정과 원가산정)

  • Kim, Kyeong-Uoon
    • Journal of Korean Academy of Nursing Administration
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    • v.6 no.3
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    • pp.389-404
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    • 2000
  • This study was designed to determine the cost and measurement of nursing care hours for hospice patients hostpitalized in one university hospital. 314 inpatients in the hospice unit 11 nursing manpower were enrolled. Study was taken place in C University Hospital from 8th to 28th, Nov, 1999. Researcher and investigator did pilot study for selecting compatible hospice patient classification indicators. After modifying patient classification indicators and nursing care details for general ward, approved of content validity by specialist. Using hospice patient classification indicators and per 5 min continuing observation method, researcher and investigator recorded direct nursing care hours, indirect nursing care hours, and personnel time on hospice nursing care hours, and personnel time on hospice nursing care activities sheet. All of the patients were classified into Class I(mildly ill), Class II (moderately ill), Class III (acutely ill), and Class IV (critically ill) by patient classification system (PCS) which had been carefully developed to be suitable for the Korean hospice ward. And then the elements of the nursing care cost was investigated. Based on the data from an accounting section (Riccolo, 1988), nursing care hours per patient per day in each class and nursing care cost per patient per hour were multiplied. And then the mean of the nursing care cost per patient per day in each class was calculated. Using SAS, The number of patients in class and nursing activities in duty for nursing care hours were calculated the percent, the mean, the standard deviation respectively. According to the ANOVA and the $Scheff{\'{e}$ test, direct nursing care hours per patient per day for the each class were analyzed. The results of this study were summarized as follows : 1. Distribution of patient class : class IN(33.5%) was the largest class the rest were class II(26.1%) class III(22.6%), class I(17.8%). Nursing care requirements of the inpatients in hospice ward were greater than that of the inpatients in general ward. 2. Direct nursing care activities : Measurement ${\cdot}$ observation 41.7%, medication 16.6%, exercise ${\cdot}$ safety 12.5%, education ${\cdot}$ communication 7.2% etc. The mean hours of direct nursing care per patient per day per duty were needed ; 69.3 min for day duty, 64.7 min for evening duty, 88.2 min for night duty, 38.7 min for shift duty. The mean hours of direct nursing care of night duty was longer than that of the other duty. Direct nursing care hours per patient per day in each class were needed ; 3.1 hrs for class I, 3.9 hrs for class II, 4.7 hrs for class III, and 5.2 hrs for class IV. The mean hours of direct nursing care per patient per day without the PCS was 4.1 hours. The mean hours of direct nursing care per patient per day in class was increased significantly according to increasing nursing care requirements of the inpatients(F=49.04, p=.0001). The each class was significantly different(p<0.05). The mean hours of direct nursing care of several direct nursing care activities in each class were increased according to increasing nursing care requirements of the inpatients(p<0.05) ; class III and class IV for medication and education ${\cdot}$ communication, class I, class III and class IV for measurement ${\cdot}$ observation, class I, class II and class IV for elimination ${\cdot}$ irrigation, all of class for exercise ${\cdot}$ safety. 3. Indirect nursing care activities and personnel time : Recognization 24.2%, house keeping activity 22.7%, charting 17.2%, personnel time 11.8% etc. The mean hours of indirect nursing care and personnel time per nursing manpower was 4.7 hrs. The mean hours of indirect nursing care and personnel time per duty were 294.8 min for day duty, 212.3 min for evening duty, 387.9 min for night duty, 143.3 min for shift duty. The mean of indirect nursing care hours and personnel time of night duty was longer than that of the other duty. 4. The mean hours of indirect nursing care and personnel time per patient per day was 2.5 hrs. 5. The mean hours of nursing care per patient per day in each class were class I 5.6 hrs, class II 6.4 hrs, class III 7.2 hrs, class IV 7.7 hrs. 6. The elements of the nursing care cost were composed of 2,212 won for direct nursing care cost, 267 won for direct material cost and 307 won for indirect cost. Sum of the elements of the nursing care cost was 2,786 won. 7. The mean cost of the nursing care per patient per day in each class were 15,601.6 won for class I, 17,830.4 won for class II, 20,259.2 won for class III, 21,452.2 won for class IV. As above, using modified hospice patient classification indicators and nursing care activity details, many critical ill patients were hospitalized in the hospice unit and it reflected that the more nursing care requirements of the patients, the more direct nursing care hours. Emotional ${\cdot}$ spiritual care, pain ${\cdot}$ symptom control, terminal care, education ${\cdot}$ communication, narcotics management and delivery, attending funeral ceremony, the major nursing care activities, were also the independent hospice service. But it is not compensated by the present medical insurance system. Exercise ${\cdot}$ safety, elimination ${\cdot}$ irrigation needed more nursing care hours as equal to that of intensive care units. The present nursing management fee in the medical insurance system compensated only a part of nursing car service in hospice unit, which rewarded lower cost that that of nursing care.

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Improvement Plan to Facilitate a Landscape Architectural Promotion Facility and Complex System (조경진흥시설과 조경진흥단지 제도 활성화 방안 연구)

  • Kim, Yong-Gook;Kim, Shin-Sung
    • Journal of the Korean Institute of Landscape Architecture
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    • v.46 no.1
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    • pp.9-16
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    • 2018
  • Landscape architecture is an indispensable professional service in building sustainable land and urban environments. The landscape architecture industry is closely related to the promotion of the health and welfare of the people, urban revitalization and residential environment improvement as well as job creation. Despite various public interest values of landscape architecture, the growth engine of the landscape architecture industry, which is supposed to improve the quality of landscape services, has stagnated. In 2015, the Landscape Architecture Promotion Act was enacted to provide a landscape architectural promotion facility and complex system to support revitalization through the integration of the landscape architecture industry. The purpose of this study is to suggest an improvement plan to enhance the effectiveness of the landscape architectural promotion facility and complex system. The results of the analysis are as follows: First, workers and experts in landscape architecture recognized the need for policies and projects to promote the landscape architecture industry. Second, the industrial types suitable for the landscape architectural promotion facility were landscape design, landscape maintenance and management, and landscape construction industry. Meanwhile the industrial types suitable for a landscape architectural promotion complex were landscape trees and landscape facilities production and distribution. Third, the expected effect of the designation of the landscape architectural facility was 'the increase of the business opportunity through the expansion of the network'. On the other hand, that of the landscape architectural promotion complex was 'the activation of various information sharing'. Fourth, 'the size of the local government landscape architecture industry and the capacity to cultivate' was the most important among the designation criteria of the landscape architectural promotion facility. As for that of the landscape architectural promotion complex, the 'feasibility of promotion plan' was the most crucial. Fifth, 'tax benefit and deductible exemption' was considered as a necessary support method for the activation of the landscape architectural promotion facility, and 'maintenance and management fee support' was recognized in the case of the landscape architectural promotion complex.