• 보건행정학회지
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• 제25권2호
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• pp.80-89
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• 2015

Background: This study aims to identify the monthly average medical expenses of public pension recipients, and analyze the determinants of total health and medical expenses and Western and Oriental medicine expenses, medical service expenses, and medical supplies expenses. Methods: This study used the fifth year data of 2013 out of the raw data of the Korean Retirement and Income Study collected by the National Pension Research Institute. This study conducted t-test, analysis of variance, and linear regression to verify publicly the relevance between pension recipients' general characteristics and health and medical expenses status using IBM SPSS ver. 21.0 for data analysis. Results: It was analyzed that there is a difference in the spending of expenditure and health care costs according to public pension recipients. Medical expenses of the national pensioners was higher compared to the special corporate pensioners. The national pensioner is related expenditure size, education level, family members living together, residential areas, status of spouse, number of chronic illness, and status of limitation in daily life with psychological health status. Conclusion: Therefore, fairness does not occur fire to the medical use between the special corporate pensioners and national pensioners, aggressive of government such as health policy and financial support for the retiree pension policy that reflects the reality intervention would be required.

• 디지털융복합연구
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• 제10권11호
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• pp.493-502
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• 2012

본 연구는 진료비 삭감율에 영향을 미치는 의료기관의 운영요인과 환경요인이 무엇인지 알아보기 위한 연구로 삭감율을 최초 삭감율과 최종 삭감율로 구분하고, 진료비는 입원과 외래로 구분하여 조사 연구 하였다. 연구의 자료는 전국 병원급 이상 독립된 보험심사부서의 부서장을 대상으로 직접 설문조사를 통해 얻어진 205부의 설문지를 최종 분석 자료로 이용하였다. 본 연구의 결과는 다음과 같다. 진료비 최초 삭감율과 최종 삭감율에 대한 집단 간의 차이를 분석한 결과 입원의 의료기관 운영요인은 보유 병상, 총 진료과, 보험심사 인력, 총 직원수에 유의한 결과를 보였으며, 외래는 의무기록 운영형태, 보유병상, 총 진료과, 보험심사인력, 총 직원수에 유의한 결과를 보였다. 진료비 삭감율에 영향을 미치는 의료기관의 운영요인은 최초 삭감과 최종 삭감이 동일하게 입원은 병상수가 높을수록, 외래는 전자의무기록을 시행할수록 유의한 결과를 보였다. 진료비 삭감율에 영향을 미치는 의료기관의 환경요인은 최초 삭감과 최종 삭감이 동일하게 입원은 업무협조가 잘 될수록, 지표관리를 시행할수록, 시간외 수당이 지급될수록 유의한 결과를 보였다. 외래의 경우 진료비 최초 삭감은 지표관리를 시행할수록, 진료비 관련 위원회를 구성하여 운영할수록 유의한 결과를 보였으며, 최종 삭감은 업무협조가 잘 될수록, 지표관리를 시행할수록, 시간외수당이 지급될수록 유의한 결과를 보였다.

• 한국병원경영학회지
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• 제19권3호
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• pp.1-10
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• 2014

The purpose of this study was to present base data for an efficient management of medical expenses at the hospital management by doing grasp of status of medical expenses from seamen's insurance by voluntary agreements. A Object of study is analyzing the data of medical expenses occurred from the total number of 2,699(inpatients 507, outpatients 2,192)cases who were covered by seamen's insurance at a general hospital which is located in Pusan Metropolitan City during 48 months from January 1, 2009 to Dec 31, 2012. The main results of this study are as follows: accrual medical expenses are the ship management companies member of P&I insurance is the most highest but share of receivables are the Korean ocean-going companies member of P&I insurance is the most highest, therefore, Korean ocean-going companies focus strictly than the payments from accounts receivable management should be considered to reduce the occurrence and concerning the turn around period of medical receivables are 4 months to 6 months during a research period. Therefore, it will be needed for managers of hospitals to prepare differentiated management based on the characteristics of each in insurer and to have recovery strategies of uncollected medical expenses.

• 보건행정학회지
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• 제28권4호
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• pp.352-359
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• 2018

Background: The purpose of this study is to propose an analysis of trends and characteristics of high-cost patients who take over 40% of total national health insurance medical expenses. Methods: It has been analyzed the tendency of high-cost patients by open data based on the medical history information of 1 million people among national health insurance subscriber from 2002 to 2015. To conduct detailed study of characteristics of high-cost patients, multiple regression has been performed by sex, age, residence, main provider, and admission status based on the top 5% group. Results: The amount of medical expenses and the number of high-cost patients have gradually increased in decades. The number of high-cost patients for Korean won (KRW) 5,000,000 category has increased by 7.6 times, KRW 10,000,000 category has increased by 14.1 times in comparing of year 2002 and 2015. Top 5% medical expenses have increased by 4.6 times. In consideration of the characteristics of patients, the incidence of high medical expenses has been higher in female patients than male ones, the older patients than in the younger. Patients residence in Gyeonsang or Jeonla province have had a high incidence of medical expenses than other area. The disease including dementia, cerebral infarction, and cerebrovascular disease for high-cost patients has been also increased. Conclusion: The major increase factor for high medical expenses is the aging of population. The elderly population receiving inpatient care residing in the province that increases high medical costs have to management. There is an urgent need to develop a mechanism for predicting and managing the cost of high-cost medical expenses for patients who have a heavy financial burden.

• 동의신경정신과학회지
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• 제32권4호
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• pp.337-343
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• 2021

Objectives: To investigate effectiveness and satisfaction of applying critical pathway (CP) to Hwa-byung outpatients. Methods: Subjects were 32 outpatients who were diagnosed with Hwa-byung between January 1 and 2021 to October 31, 2021. Among these patients, 18 patients were applied with CP and 14 patients received treatment without applying CP. Their medical records and administration records were retrospectively analyzed. Data were analyzed by mean, standard deviation, and t-test using SPSS 26.0 program. Results: Mean total treatment period significantly decreased in the CP group compared with the non-CP group. Medical expenses were classified by treatment period, per visit, and patient charges per type of visit. When analyzed specifically by detailed items, there was a decreasing tendency in total medical expenses, uncovered medical expenses, and patient charges but an increasing tendency in covered medical expenses, although some of these changes were not statistically significant. Satisfaction score increased in the CP group compared with the non-CP group in general, although not all increases were statistically significant. Conclusions: Applying CP may contribute to the reduction of medical expenses and improvement of medical service quality. Further research on the development of CP for various diseases and the application of CP under various circumstances is needed.

• 대한한의학회지
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• 제34권1호
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• pp.35-51
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• 2013

Objectives: The purpose on this study was to analyze medical health insurance to provide useful data to reestablish oriental medical insurance fees for long-term care hospitals. Methods: First, comparative analysis on medical health insurance was performed, calculating insurance fees of patients admitted to Mungyung Long-term Care Hospital. The oriental medical insurance fee of the patients was calculated as if the patients have been admitted to oriental long-term care hospitals, and the ratio of oriental medical insurance fee to western was calculated. Results: 1. The ratios of total medical expenses were 90% within 3 months and 82% over 3 months. 2. The ratios of co-pays were 86% within 3 months and 82% over 3 months. Conclusions: Oriental medical insurance fees need to be reevaluated.

• 한국의료질향상학회지
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• 제5권1호
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• pp.58-75
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• 1998

Background : In Korea, the rational use of antibiotics are rarely controlled, and their patterns of utilization are not understood. In order to reduce the excessive use and to improve the appropriate use of antibiotics, it is necessary to accurately determine present uses of antibiotics in hospitals. Methods : Analysis of the use of prescription drugs was performed on NFMI(National Federation of Medical Insurance) 1994 medical expense claim data. A stratified sampling by types of hospitals, departments, and diseases was obtained from 1994 August data. Patients with secondary diseases were excluded. In this study, 2,697 adults with URI, 6,397 children with URI, 704 adults with bronchitis, and 1,838 children with bronchitis were included. Results : Most patients were prescribed medication (95.2-99.6%). Of the patients prescribed medication, more than 85% of URI patients and more than 91% of bronchitis patients were prescribed antibiotics. Antibiotics expenses accounted for 14% of total medical expenses in adults and 9% of total medical expenses in children. In adults with URI, antibiotics expenses accounted for 52% of drug expenses. Of the patients prescribed antibiotics, average number of antibiotics used was 1.6-1.7. For patients who are prescribed antibiotics, drug expenses were 62-97% greater than patients not prescribed antibiotics. When children were prescribed antibiotics, the highest price of drugs prescribed were 3.4-fold greater. In addition, the number of drugs prescribed also increased by more than one. Elderly patients, more than 60 years, were prescribed antibiotics less frequently. Children less than 10 years and elderly patients greater than 60 years old were prescribed fewer antibiotics than other patients. And they were prescribed medications for longer days than other patients. Conclusion : This study demonstrated that the average rate of prescribing antibiotics was higher in Korea than other countries. Measures to reduce overuse of antibiotics and to improve the appropriate prescription of antibiotics must be considered for cost effective treatment and overall health of people.

• 보건행정학회지
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• 제20권3호
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• pp.123-137
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• 2010

The main purpose of this article is for deriving functions related to the prediction of the closure of the hospitals, and finding out how the discriminant functions affect the closure of the hospitals. Empirical data were collected from 3 years financial statements of 41 private hospitals closed down from 2000 till 2006 and 62 private hospitals in business till now. As a result, the functions related to the prediction of the closure of the private hospital are 4 indices: Return on Assets, Operating Margin, Normal Profit Total Assets, Interest expenses to Total borrowings and bonds payable. From these discriminant functions predicting the closure, I found that the profitability indices - Return on Assets, Operating Margin, Normal Profit Total Assets - are the significant affecting factors. The discriminant functions predicting the closure of the group of the hospitals, 3 years before the closure were Normal Profit to Gross Revenues, Total borrowings and bonds payable to total assets, Total Assets Turnover, Total borrowings and bonds payable to Revenues, Interest expenses to Total borrowings and bonds payable and among them Normal Profit to Gross Revenues, Total borrowings and bonds payable to total assets, Total Assets Turnover, Total borrowings and bonds payable to Revenues are the significant affecting factors. However 2 years before the closure, the discriminant functions predicting the closure of the hospital were Interest expenses to Total borrowings and bonds payable and it was the significant affecting factor. And, one year before the closure, the discriminant functions predicting the closure were Total Assets Turnover, Fixed Assets Turnover, Growth Rate of Total Assets, Growth Rate of Revenues, Interest expenses to Revenues, Interest expenses to Total borrowings and bonds payable. Among them, Total Assets Turnover, Growth Rate of Revenues, Interest expenses to Revenues were the significant affecting factors.

• 재활치료과학
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• 제12권1호
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• pp.51-63
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• 2023

목적 : 본 연구에서는 빅데이터를 통해 정신과 질환을 가진 노인의 생활 습관 행태와 의료비 지출 크기 간의 연관성을 분석하여 생활 습관의 긍정적 영향 및 중요성을 제시하고 이에 관련한 중재의 근거를 제언하고자 하였다. 연구방법 : 건강보험공단에서 제공하는 노인 코호트 데이터베이스(Database; DB)의 2014, 2015년 자료를 활용하여 이차데이터 분석을 시행하였다. 연구 목적에 따라 전체 변수 중 생활 습관 행태와 연간 의료비 지출 크기를 추출하였다. 각각의 생활 습관 행태와 연간 의료비 지출 크기 사이의 연관성은 일반선형모형(Generalized linear model)을 사용하여 분석하였다. 결과 : 선정기준에 따라 추출된 총 32,853명의 데이터가 분석에 사용되었다. 12,617명(38.40%)의 남성과 20,236명(61.60%)의 여성으로 구성되어 있었다. 생활 습관과 의료비의 연관성을 분석한 결과, 비흡연자의 경우 흡연자보다 의료비 지출이 유의하게 낮았으며(estimate = -218,255원, p = .037), 일주일 중 30분 이상 걷는 일수가 증가할수록 의료비 지출이 유의하게 감소하였다(estimate = -58,843원, p < .0001). 반면, 일주일 중 술을 마시는 일수가 감소할수록 의료비 지출이 증가하는 양상이 나타나는 결과가 도출되었다(estimate = 692,289원, p < .0001). 결론 : 본 연구는 정신과 질환을 가지고 있는 노인에게 있어 생활 습관의 행태에 따른 의료비의 변화를 분석하였다. 흡연과 운동은 의료비 지출과 음의 연관성을 나타냈으며 걷기 운동을 많이 할수록, 흡연을 하지 않을수록 의료비 지출이 감소함을 알 수 있었다. 이러한 결과는 정신과 질환을 가지고 있는 노인에게 있어 건강한 생활 습관의 중요성을 시사한다. 본 연구가 정신과 질환을 가진 노인의 신체적, 정신적 건강 증진을 위한 생활 습관 관리 프로그램의 임상적 근거로써 활용될 수 있기를 기대한다.

• 보건행정학회지
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• 제22권1호
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• pp.29-48
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• 2012

The purpose of this study is to analyze medical expenses by decedents in their last year of life and compare them with those by survivors during the year 2008. This study is conducted firstly in Korea, except some studies focusing on medical cost of decedents from specific diseases. To study this, national health insurance(NHI) claims data was used with medicaid claims data. The study group(decedents) was selected from the insurance entitlement file who were dropped out from January to December of 2008. The control group(survivors) was selected from the entitlement file by stratified sampling with keeping age-sex composition of the study group. The medical expenses of decedents during one year before death were measured and compared with those of survivors by sex and age. And the medical expenses were analyzed by causes of death, and also the expenses were examined by each item of medical services. On average, the medical expense amounted to 11 million Korean Won per decedent during their last year of life in 2008. The medical expense per decedent was 9.3 higher than that of survivor. The death-related expense of under the age 35 was about 16 million Won, compared with 4 million Won in the case of over the age 95, in average. The death-related expense is higher in younger ages. This means that more medical resources are put in to save life in younger ages. Total death-related expenditure took 8.3 percent in total NHI expenditures. Of the death-related medical expenses, the largest one was injection-related cost which shares twenty five percent, and the second largest one was hospitalization charges, and then the third one was surgery cost. The results of this study suggested that we should pay attention to the medical expenses in the last of year of life when we study health care expenditure in Korea. In addition, we have to deliberate health care policy to cope with medical expenditures before death in more efficient way.