• Title, Summary, Keyword: 일당진료비

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A study of the impacts of medical institution information on daily medical expenses and medical expense reduction rate in convergence age (융복합시대에 의료기관 정보가 일당진료비와 삭감율에 미치는 영향에 관한 연구)

  • Yang, Yu-Jeong;Lee, Hye-Seung
    • Journal of Digital Convergence
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    • v.13 no.7
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    • pp.259-268
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    • 2015
  • This research grasped the difference of between the daily medical expenses and the medical expenses reduction rate also the cause of change. In the centre, it was conducted in order to offer the necessary basic data to a recuperation pay management solution's establishment. This research surveyed across the country's urban region 50-general hospital's the infective enteritis disease for a year. Then it was conducted the average daily medical expenses and the average medical expenses reduction rate as a distinguishable survey that is a hospitalization and an outpatient the result is followed. The inpatient daily medical expenses correlated with the total number of medical institution personnel, and the outpatient daily medical expenses correlated with the number of beds.. Inpatient medical expense reduction rate was correlated with number of beds and the total number of medical institution personnel. The interaction between medical institution information and daily medical expenses was found to have a positive (+) effect on the total number of medical institution personnel, as well as the numbers of inpatients vs. outpatient. This research about the medical expense reduction rate and daily medical expense help medical institution's efficient, rational decision making and it will be an important basis of a priority recuperation pay's policy.

A Study on the Analysis of Factors for the Increase of Oriental Medicine Expenditure in the Automobile Insurance (자동차보험 한방진료비 증가요인 분석)

  • Lee, ChangSoo;Lee, Hyeon Ju;Chae, JungMi
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.20 no.1
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    • pp.121-130
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    • 2019
  • Automobile insurance medical expenses increased by 12% in year 2015 compared to year 2014. But the oriental medical service expenses in automobile insurance increased by 36% during the same period. In this paper the reason for the rapid increase of expenses for oriental medical service was analyzed using the method of decomposing medical expenses. As a result of analyzing 34,351,120 cases that were examined and completed during the period of 2014~2015, the number of oriental medicine patients increased by 27% and the medical expense per patient increased by 7%. The result of analysis showed that there was no significant change in service period per patient but medical expense per day increased by 7%. The increase in the number of patients receiving only oriental medical services was 32%. Increase in the number of patients receiving medical treatment and oriental medical services was 24% and the number of patients receiving medical treatment only decreased by 4%. There was significant increase in non standardized cost of oriental physical therapy which was one reason of the increase of the expenses. However, the most influential factor of the increase in the expenses of oriental medical services was the increase of the number of patients.

Medical Expenses during the last 6 Months of Life in Cancer Patients (암 환자의 사망 전 6개월의 의료비용)

  • Park, No-Rai;Yun, Young-Ho;Shin, Soon-Ae;Jeong, Eun-Kyeong
    • The Korean Journal of Hospice and Palliative Care
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    • v.2 no.2
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    • pp.109-113
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    • 1999
  • Purpose : Because we don't have inappropriate health care system for the terminal cancer patients, there were abnormal behavior patterns of health care utilization. So, There were needs to develop the comprehensive care for terminal cancer patients. Increased attention is being paid to the futility of life-sustaining treatment and high cost of management of terminal cancer patients Materials and Methods : This study was performed on cancer patients, registered in 1996 Central Cancer Registry, who were as insured person of Korea Medical Insurance and died from January 1997 to June 1998. We studied the day of medical care and medical expenses of 151 cancer patients evaluable. Results : The mean day of inpatient care was 39 days, and the mean days of outpatient care was 14 days in study subjects. Mean expenses per day of medical care, day of inpatient, and day of outpatients care were 85,392 won, 105,908 won, and 40,173 won. 95% of medical expenses is paid to the general hospital, and 85% of medical expenses was paid for inpatient care. About half of all medical expenses in th last 6 months were incurred in the last 60 days of life, and about 30 percent were incurred in the last 30 days. Expenses of outpatients care increased between 6 month and 3 months, after which they decreased. Expenses of inpatients care increased during all last 6months Conclusion : The distribution or medical expenses during the last 6 months in our study is similar to the distribution of American Medicare costs. We need to study medical expenses during the last year of life with large scale and details in order to develop the plan about the management of terminal cancer patient.

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Differences of Cancer Patient's Health Care Utilizations between Medical Aid Program and National Health Insurance in the Elderly (노인 암환자의 건강보험과 의료급여 이용차이 분석)

  • Lee, Yong-Jae
    • The Journal of the Korea Contents Association
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    • v.11 no.5
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    • pp.270-279
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    • 2011
  • This study to analyze differences of cancer patient's health utilizations in medical aid program and national health insurance by analysing health insurance claims data, and identify effects of health care systems. The majors results of the research were as follows. First, cancer patients in medical aid program more used total medical expenditures than in national health insurance mostly by many outpatient visits and long term hospitalization. Second, results of multiple regression, cancer patients in medical aid program more used total expenditures and inpatient expenditures. But, outpatient expenditures weren't different, cancer patients in medical aid program more visited medical institutions and hospitalized long term periods than in national health insurance. Therefore, it is too early to conclude that moral hazard is in health utilizations of medical aid program, because cancer patients in medical aid program many use in benefits for many nonbenefit burdens.

Medical Care Utilization Pattern of Medical Aid Program Beneficiaries (의료보호대상자(醫療保護對象者)의 의료이용(醫療利用) 양상(樣相))

  • Kim, Ju-Ho
    • Journal of Preventive Medicine and Public Health
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    • v.17 no.1
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    • pp.37-45
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    • 1984
  • This study was conducted to identify the problems in the medical aid program by reviewing the medical care utilization pattern of the beneficiaries. The data were abstracted from the monthly bills and vouchers for medical care of the whole benefi챠aries(17,527) in Gyeongsan Gun submitted by the physicians to county government for the period of 1 calendar year from October 1981 to September 1982. The number of medical aid beneficiary accounted for 12.7% of the total county population, a higher proportion than the national average-9.5%. Monthly primary care utilization rate per 100 beneficiaries was 9.3 persons with 14.0 visits and 42.9 medication days. for the 2nd and 3rd care, there were 1.7 admissions and 9.3 OPD visits per 100 beneficiaries per year. The beneficiaries of the first class medical aid program had a higher utilization rate of both the primary and secondary/tertiary care facilities. Females utilized more the primary care facilities than males while males utilized more the secondary/tertiary care facilities than females. A significantly lower utilization rate was observed in January than in the other months and this was seemed due to the renewal process of the medical aid certificate. Among 1,931 patients utilized the 2nd/3rd care facilities 84.4% was out-patients and the lowest ratios were in the minor specialties including ENT, ophthalmology, dermatology and urology. The average hospital days per in-patient were 21.2 days and OPD days per out patient were 4.7 days. The average hospital days for a psychiatry in-patient was 74.4 days which was the longest average hospital days among all the specialties. Average medical care cost per beneficiary in a year was W9,821:W24,240 for the 1st class and W7,464 for the 2nd class. The medical care cost for the primary care per patient was W3.901 and W840 per day compared with W49,875 per patient and W5,822 per day for the secondary/tertiary care. From the findings of this study following recommendations were made to improve the medical care program: 1) The renewal process of the medical care certificate should be expedited. 2) Minor specialty clinics should be designated as the primary medical care facility for the medical aid program to reduce the expenses by absorbing more patients referred to the secondary/tertiary care facilities directly. 3) The medical care cost for the primary care facility should be escalated to reduce the differential between the primary and secondary/tertiary care facilities.

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A Study on Characteristics of Medical Expenses and the Hospitalization Period of Hospitalized Patients Using Diem Payment System at Convalescent Hospitals (요양병원 일당정액제 입원환자의 입원일수 및 진료비 특성에 관한 연구)

  • Roh, Ock-Hee;Lee, Chong Hyung;Park, Arma;Kim, Kwang-Hwan
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.17 no.8
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    • pp.407-414
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    • 2016
  • This study was conducted to provide basic data to evaluate the appropriateness of convalescent hospitalization treatment by investigating the number of hospitalization days and the total treatment expenses of a total of 44,037 monthly billing statements requested from the Health Insurance Review and Assessment Service. Evaluated data consisted of medical care expenses of patients of the diem payment system hospitalized at convalescent hospitals in Daejeon, Chungnam, Chungbuk and Sejong from January through December of 2014. According to the analysis result of the general characteristics of the study objects and the canonical correlation analysis of the top 15 main diagnosis names, 7 canonical functions have been deducted. Among them, six canonical functions were shown to be statistically significant (p<0.001), and canonical function 1 had a chi-squared value of 5955.49 and 98 degrees of freedom at p<0.001 level. Overall, the results indicated that if health and welfare service in the regional society is magnified, social hospitalization can be reduced.

Analysis of Medical Expenses Structure for Patients on Percutaneous Coronary Intervention by Medical Security Type (의료보장형태에 따른 관상동맥중재술 환자의 진료비 구조분석)

  • Son, Mi-Kyung;Lee, Sok-Goo
    • Journal of agricultural medicine and community health
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    • v.44 no.4
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    • pp.195-208
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    • 2019
  • Objectives: The purpose of this study was to analyze whether there are differences in medical expenses according to medical security type in the use of medical services with high disease burden such as coronary intervention. Methods: Chi-square test and covariance analysis(ANCOVA) were conducted to identify the differences in the characteristics and costs according to medical security type of 1,904 patients who underwent coronary intervention in a university hospital from 2011 to 2012. Hierarchical regression analysis was conducted to determine whether the cost affects medical expenses. Results: In the medical aid group, the proportion of women, those without a job, those without a spouse, and those who received hemodialysis was high, length of stay was high, patients using the emergency room and those who died was high. The medical aid patients were significantly higher in the non-benefit medical expenses, optional medical expenses, physician and admission, meals, medications and injections. National health insurance patients were significantly higher in procedure. The medical security type was found to be significant as a variable affecting the medical expenses. Conclusions: Provision of medical expenses should be managed in advance by providing prevention and education services for the vulnerable, and care services in the region should be provided to suppress the occurrence of medical expenses due to the increase in the number of days spent. In addition, it is necessary to support medical expenses to prevent unsatisfactory medical services from occurring for non-benefit and optional care.

Structural Characteristics and Feasibility of Per Diem Payment System for Elderly Dementia Inpatients (치매노인환자 입원진료비의 구조적 특성과 일당수가제화의 타당성)

  • Kim, Jae-Sun
    • Korea Journal of Hospital Management
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    • v.4 no.1
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    • pp.66-95
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    • 1999
  • This study was conducted to analyze the medical charges of the elderly dementia inpatients, to identity their characteristics, and there by to evaluate feasibility of the per diem payment system for the patients. Data on medical charges of the patients were collected from the National Federation of Medical Insurance and sample hospitals from October through December 1997. The data were analysed in order to find the characteristics and test hypotheses postulated. The results are summarized as follows; Firstly, there was no difference statistically in between disease groups and between the dementia inpatients belonging to each disease group. Secondly, the amount of the non-insurance medical charges of the elderly dementia inpatients is considerably high compared to the insurance medical charges paid by the patient, which implies that some measures are to be prepared by the Government. Finally, medical charges per inpatient day of the dementia patients are not different statiscally by sex, by age group, and by disease group. This result supports the feasibility of the per diem payment system for the elderly dementia inpatients.

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Critical Pathway for Operable Gastric Cancer (위암수술 환자에서의 Critical Pathway의 개발과 적용)

  • Song, Kyo-Young;Kim, Seung-Nam;Park, Cho-Hyun
    • Journal of Gastric Cancer
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    • v.5 no.2
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    • pp.95-100
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    • 2005
  • Purpose: Critical pathways (CP), also known as clinical pathways, are management plans that display goals for patients and have led to improved outcomes for many disease entities. This study was aimed at developing a critical pathway for the surgical treatment of gastric cancer patients and evaluating its usefulness. Materials and Methods: A CP was developed and implemented by a team of surgeons, nurses, nutritionists, and administrative officials. Among the 117 patients who received curative gastrectomies for gastric cancer at Kangnam St. Mary's Hospital, The Catholic University of Korea, between October 2003 and August 2004, 26 patients were treated according to the CP. We evaluated its usefulness by comparing the clinical characterisctics, postoperative progress, hospital stays, and costs between the CP and the non-CP groups. Patient satisfaction was also surveyed with questionnaires. Results: Of the initial 26 patients in the CP group, two were excluded from the final evaluation; one patient had a duodenal stump leakage, and the other had a gastric stasis postoperatively. In 8 patients, protocol violation occurred; six patients refused to be discharged on the $7^{th}$ postoperative day, one patient who had an gastric staisis postoperatively stayed for 2 additional days, and one patient who needed ICU care stayed for 4 additional days. The drop-out rate was $7.7\%$ (2/26), and the variance rate was $30.8\%$ (8/26). The mean hospital stay was 11.3 days ($10\~15$ days) for the CP group compared with 17.5 days ($9\∼68$ days) for the non-CP group, resulting in a difference of about 6 days (P<0.05). The mean hospital stays after surgery were 10.3 days ($7\∼68$ days) and 8.3 days ($7\∼12$ days) for the non-CP and the CP groups, respectively, but the difference was statistically not significant (P>0.05). The mean charge during the hospital stay was higher in the non-CP group ( $\\$ 6,292,200) than in the CP group ( $\\$ 4,863,685). The charge per hospital day was higher in the CP group ( $\\$ 430,414) than in the non-CP group ( $\\$ 359,554). Patient satisfaction was higher in the CP group than in the non-CP group. Conclusion: By developing and applying a critical pathway in the surgical treatment of stomach cancer patients, we could reduce the length of hospital stay as well as the cost. A multi-centered prospective study to establish a standard treatment pathway and to demonstrate its effectiveness is needed in the future.

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Variation Analysis of Medical Service Utilization in Oriental Medicine Frequent Disease of Rural Area (농어촌지역 한방 외래 다빈도 상병의 의료이용 변이분석)

  • Jang, Yong-Myung
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.14 no.2
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    • pp.713-720
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    • 2013
  • The objectives of this study are to identify whether the small area variation also exists in the oriental medicine and, if it exists, what causes, to expand our boundary of research interests on the small area variation observed at the western medicine toward the oriental medicine as one of the fundamental research foundations and to provide any fundamental findings from this study results to the healthcare politicians to promote consumer's rational behaviors for the use of healthcare. This study analyzed the health insurance claim data (2010, 2011) which were the patients of western medicine and the outpatients of the oriental medicine with the top 10 most frequent diseases and looked into the variation of healthcare utilization among the areas after grouping resident area into an 86-area category. The study result shows that the small area variation was also observed at the part of the oriental medicine in which the characteristics of patients critically affect the healthcare expenditure per visit day rather than those of providers and the characteristics of both patients and providers equally affect the healthcare expenditure per patient. Therefore, this study suggests that government set up healthcare policies on the standardization of oriental medicine to prevent its over-utilization and unmet need, enforcing the roles of oriental medicine in the markets, enhancing the appropriate health care utilization, and expanding provision and sharing the health care information to reduce unnecessary health care utilization.