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Analysis of Medical Use and Costs of Liver Transplant Patients Using National Patients Sample Data (환자표본자료를 이용한 간이식 환자의 의료이용 특성 및 의료비용 분석)

  • Kim, Hye-Lin
    • Korean Journal of Clinical Pharmacy
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    • v.28 no.1
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    • pp.57-64
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    • 2018
  • Background: Patients experience significant differences in aspects of mortality, quality of life, and costs between during the year of receiving liver transplant (LT) and the subsequent years (post-LT). This study aimed to estimate the medical utilization and cost of LT for patients compared to post-LT patients by using a recent National Patient Sample (NPS) data provided by the Korean Health Insurance Review and Assessment Service (HIRA). Methods: This study used a subset of the 2015 HIRA-NPS. Patient claims data that included Z944 (Korean Standard Classification of Diseases code for LT status) were selected. Within the selected data, LT patients were identified based on whether the national health insurance number code of Q80 (procedure code for LT surgery) was included, and they were compared to post-LT patients. Results: In the analysis, 330 patients were included. The average cost per patient was $90,066{\pm}36,959$ thousand KRW and $10,557{\pm}9,668$ thousand KRW for LT and post-LT patients, respectively. Especially, LT patients' costs for injection/procedure, surgery/treatment, and examination were higher than other costs, being $35,983{\pm}18,115$ thousand KRW, $28,246{\pm}9,408$ thousand KRW, and $12,131{\pm}6,604$ thousand KRW, respectively. For inpatients, the average number of hospitalized days was $63.5{\pm}66.0$ days for LT patients and $22.3{\pm}35.1$ days for post-LT patients. Conclusion: Compared to post-LT patients, LT patients had higher costs, especially for injection/procedure, surgery/treatment, and examination. Additionally, the LT group had longer hospitalization duration and higher costs for their hospital admission, whereas they did not show a significant difference in number of visits and medical costs for outpatient-care.

The development of the critical pathway for hysterectomy patients and its effect (자궁절제술 환자의 표준진료지침(Critical pathway) 개발과 적용효과)

  • Kim, Kyung-Hee;Seo, Young-Seung;Tae, Young-Sook;Lee, Hwa-Ja;Jeon, Sung-Sook
    • Journal of Korean Academy of Nursing Administration
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    • v.6 no.1
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    • pp.123-134
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    • 2000
  • This study intended to analyze the effectiveness to obtain by developing the critical pathway presented as the method to improve the quality-betterment and cost effectiveness the through the continuous and consistent patient management for the hysterectomy patient and applying it to the real practice. This study was designed to develop and effect the critical pathway for hysterectomy patients in the way to be possible the intergrated in patient management. It was adopted the process of seven phase to develop a critical pathway. To analyze the application effect of the developed critical pathway, this author offered health care service applying the critical pathway to the hysterectomy patient from July. 20 to Oct. 19. 1999. The study method had been done by investigating the experimental group and control group through the questionnaire on 40 patients who had been inpatient hysterectomy. Dependent variables were measured by modified from satisfaction, and cost and length of hospital stay. The data anlyzed by frequency, x2-test, t-test. The results of this study was as follows; 1. It was decided that the vertical line of the critical pathway was made up of eight items such as monitoring/assessment, treatment, activity, medication, consult. Lab test, diet, patient teaching and horizontal line was 7days from admission to discharge. 2. After the verifying the validity of the expert group about the critical pathway, the horizontal line was amended from hospitalization to five postoperative days and taking their consensus, some contents of the horizontal line was amended and deleted. 3. There was no significant differences in the experimental group and control group in the satisfaction, and significant differences in the cost, the length of hospital stay.

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A Strategic Quality Initiative and Its Opportunities to Improve Healthcare Environment (진료환경개선을 위한 우선적 전략과제 설정 및 그 적용)

  • Tark, Kwan-Chul;Park, Hyun-Ju;Park, Chang-Il;Kang, Jin-Kyung
    • Quality Improvement in Health Care
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    • v.5 no.2
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    • pp.324-334
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    • 1998
  • Background : Strategic planning is an organizationwide or systemwide, ongoing look into the future usually of 2~3 years, based on objective analysis of the current environment and trends, but it can incorporate both short-term and long-term goals. The strategic planning process includes external analysis, internal analysis, issue analysis, development of mission, vision and values, and lastly development of organizational goals and objectives. As a part of the strategic quality planning process, certain service lines, important organizationwide functions, or key processes supporting these functions can be prioritized to expedite and roll out certain strategic goals. This is called strategic quality initiatives. Methods : We organized a quality improvement team, a subgroup of 21st century vision planning corps of our medical center, and pursued QI activities for improvement of healthcare environment, particularly in the admission setting. We developed a strategic quality initiative based on the results of patient satisfaction surveys, and carried out functions of self-directed work team. Results : The strategic goal was to be the benchmark for peer group hospitals in Korea for providing cost-effective best-practice. The QI team included 3 medical doctors, 1 nurse, 1 social worker, and 1 QI consultant as well as many operational members to support services and quality initiatives met every Tuesday for 18 weeks. Outcome objectives were to improve patient satisfaction score. The issues included in the objectives were comfort, temperature, noise, cleanliness of the admission wards, quality and education of patient meals, matters regarding the admission process, and an appurtenant facility such as restaurant or convenience store. Every issue was discussed and recommendations, conclusions and opportunities were implemented. Conclusions : By developing a strategic quality initiative as a part of the strategic quality planning process, and pursuing a self-directed work team, certain sen/ice lines, important organizationwide functions, or key processes supporting these functions can be improved effectively within a short period. Strategic quality initiatives serve to support, or roll out, certain strategic goals that are relevant to performance improvement and development of specific measurable outcome objectives, and associated performance measure for each initiative. Each strategic quality initiative should include a statement of intent outcome objectives, and performance measures. We will come back with follow up of the strategic quality initiative, for improvement of healthcare environment, and results of patient satisfaction re-survey.

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The Relationship between Admission to University of Education and Private Education through Perceptions of Pre-service Teachers and High School Teachers (예비교사와 고등학교 교사의 인식을 통한 교육대학 입학과 사교육의 관련성)

  • Lee, Jong-Hak;Kim, Yoo-Young;Yoon, Ma-Byong
    • The Journal of the Korea Contents Association
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    • v.19 no.11
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    • pp.132-143
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    • 2019
  • The purposes of this study are to identify how university's entrance examination system is related to private education, and to explore how to improve the university of education entrance system in order to reduce private education costs. For these purposes, 116 teachers of senior students in high school in Daegu and Gyeongbuk and 107 pre-service teachers who had experienced the entrance of the university were surveyed in order to find out the perception of the relationship between admissions elements and private education. As a result, it is possible to concentrate more on school education by strengthening high school grades in the entrance examination. However, there was other opinion that the strengthening high school grades in the university entrance could lead to the further increase in the cost of private education. As there are big differences in the perception of the screening factors between rural areas (Gyeongsangbuk-do) and large cities (Daegu), it is necessary to introduce the entrance examination system considering the characteristics of each region. Third-year teachers in high schools argued that university admissions should reduce the rate of the College Scholastic Ability Test (CSAT) and increase the rate of interviews. The results of this study suggest that the improvement of the university entrance examination system to reduce the cost of private tutoring requires securing fairness of document evaluation, strengthening interviews, and opening interview questions.

Analyses of the Efficiency in Hospital Management (병원 단위비용 결정요인에 관한 연구)

  • Ro, Kong-Kyun;Lee, Seon
    • Korea Journal of Hospital Management
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    • v.9 no.1
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    • pp.66-94
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    • 2004
  • The objective of this study is to examine how to maximize the efficiency of hospital management by minimizing the unit cost of hospital operation. For this purpose, this paper proposes to develop a model of the profit maximization based on the cost minimization dictum using the statistical tools of arriving at the maximum likelihood values. The preliminary survey data are collected from the annual statistics and their analyses published by Korea Health Industry Development Institute and Korean Hospital Association. The maximum likelihood value statistical analyses are conducted from the information on the cost (function) of each of 36 hospitals selected by the random stratified sampling method according to the size and location (urban or rural) of hospitals. We believe that, although the size of sample is relatively small, because of the sampling method used and the high response rate, the power of estimation of the results of the statistical analyses of the sample hospitals is acceptable. The conceptual framework of analyses is adopted from the various models of the determinants of hospital costs used by the previous studies. According to this framework, the study postulates that the unit cost of hospital operation is determined by the size, scope of service, technology (production function) as measured by capacity utilization, labor capital ratio and labor input-mix variables, and by exogeneous variables. The variables to represent the above cost determinants are selected by using the step-wise regression so that only the statistically significant variables may be utilized in analyzing how these variables impact on the hospital unit cost. The results of the analyses show that the models of hospital cost determinants adopted are well chosen. The various models analyzed have the (goodness of fit) overall determination (R2) which all turned out to be significant, regardless of the variables put in to represent the cost determinants. Specifically, the size and scope of service, no matter how it is measured, i. e., number of admissions per bed, number of ambulatory visits per bed, adjusted inpatient days and adjusted outpatients, have overall effects of reducing the hospital unit costs as measured by the cost per admission, per inpatient day, or office visit implying the existence of the economy of scale in the hospital operation. Thirdly, the technology used in operating a hospital has turned out to have its ramifications on the hospital unit cost similar to those postulated in the static theory of the firm. For example, the capacity utilization as represented by the inpatient days per employee tuned out to have statistically significant negative impacts on the unit cost of hospital operation, while payroll expenses per inpatient cost has a positive effect. The input-mix of hospital operation, as represented by the ratio of the number of doctor, nurse or medical staff per general employee, supports the known thesis that the specialized manpower costs more than the general employees. The labor/capital ratio as represented by the employees per 100 beds is shown to have a positive effect on the cost as expected. As for the exogeneous variable's impacts on the cost, when this variable is represented by the percent of urban 100 population at the location where the hospital is located, the regression analysis shows that the hospitals located in the urban area have a higher cost than those in the rural area. Finally, the case study of the sample hospitals offers a specific information to hospital administrators about how they share in terms of the cost they are incurring in comparison to other hospitals. For example, if his/her hospital is of small size and located in a city, he/she can compare the various costs of his/her hospital operation with those of other similar hospitals. Therefore, he/she may be able to find the reasons why the cost of his/her hospital operation has a higher or lower cost than other similar hospitals in what factors of the hospital cost determinants.

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A Study on The Practical Risk Mitigation Methodology for Systematical Risk Management of Information System (정보시스템의 체계적인 위험관리를 위한 실용적인 위험감소 방법론에 관한 연구)

  • Eom, Jung-Ho;Woo, Byeong-Koo;Kim, In-Jung;Chung, Tai-M.
    • The KIPS Transactions:PartC
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    • v.10C no.2
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    • pp.125-132
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    • 2003
  • In the paper, we can select the best safeguard as proposed the definite and systematical method and procedure on risk mitigation of risk management for information system. The practical risk mitigation methodology has a good fulfillment procedure and a definition to fulfill procedure on each phase. So, it is easy to fulfill and can apply to any risk management methodology. The practical risk mitigation is composed of 6 phases, which are the existing safeguard assessment, safeguard means selection, safeguard technique selection, risk admission assessment, cost-effective analysis and safeguard embodiment. The practical risk mitigation's advantages are as follow. Efficient selection of safeguards to apply to risk's features with safeguard's means and techniques before embodying safeguards. Prevention of redundant works and security budgets waste as re-using the existing excellent safeguards through the existing safeguard assessment. Reflection of organization's CEO opinions to require special safeguards for the most important information system.

Determining Factors for the Use of Oriental Healthcare Services for Survey Subjects with Chronic Illnesses : 2005 National Health and Nutrition Examination Survey (만성질환자의 한방의료서비스 이용 결정요인 : 2005년도 국민건강영양조사)

  • Lee, Hyun-Joo;Yoo, Weon-Seob;Chung, Su-Kyoung
    • Journal of Society of Preventive Korean Medicine
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    • v.15 no.3
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    • pp.115-125
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    • 2011
  • Objectives : The aim of this study is to investigate the relevant factors which determine the use of oriental healthcare services among subjects with chronic illnesses. Method : This study utilized the data from the Korean National Health and Nutrition Examination Survey in 2005. Out of all the participants of the survey, 11,665 individuals who are older than 19 years old and have one or more chronic diseases were included in this study. Results : The factors that affect utilization of oriental healthcare services were significantly associated with gender, educational level, job, personal income, the number of chronic illnesses, experiences of nontreatment or delayed treatment and admission experiences for the last one year(p<.001). Although some of these factors need further studies, the determining factors for the use of oriental healthcare services are the presence of chronic illness and the number of chronic disease. That is, the chronically ill are more likely to seek oriental healthcare services. And the more chronic diseases the clients have the higher probability of seeking oriental healthcare services was found. Conclusions : The results suggest that the national integrated care services should be established for diverse development of policy regarding the quality of care of chronic illness and cost-effectiveness.

Possible Effects of Senior Hospital Selection Factors and Satisfaction on Revisit Intention (노인병원 선택요인과 만족도가 재이용의사에 미치는 영향 - 환자보호자 관점에서 -)

  • Choi, Young-Sun;Rue, Hwang-Gun;Bae, Sung-Kwon
    • The Korean Journal of Health Service Management
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    • v.3 no.1
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    • pp.33-46
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    • 2009
  • In order to analyze possible effects of senior hospital selection factors and service satisfaction on senior hospital patients' revisit of senior hospital, this study surveyed guardians of total 204 patients hospitalized in major 4 senior hospitals in Busan. As a result, this study came to the following conclusions: First, it was found that guardians considered appropriateness of medical treatment cost as the biggest factor of choice, which was followed by kindness of doctor and hospital employees, locational accessibility (traffic convenience), and doctor's medical capacity. Second, the factor analysis about patients' satisfaction showed that the influential factors consisted of satisfaction at medical staffs, satisfaction at nursing and care, and satisfaction at facilities. Third, there was not significant difference in the overall impression of hospital and the intention of revisit depending upon sociological variables. Fourth, satisfaction at nursing and care and satisfaction at facilities had significant effects on better satisfaction at overall impression of hospital, and it was noted that the shorter admission period and the less complaint led to the higher intention of revisit. Therefore, it is necessary to improve satisfaction at medical staffs, nursing and care, and facilities rather than patients' own sociological characteristics.

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The determinants of the Profitability of University Hospitals in Korea (대학병원 수익성에 영향을 미치는 요인 분석)

  • Yang, Jong-Hyun;Chang, Dong-Min;Suh, Chang-Jin
    • Korea Journal of Hospital Management
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    • v.15 no.4
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    • pp.43-62
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    • 2010
  • This study provides an evidence on the determinants of the profitability of university hospital by analyzing university hospital-level data set of hospital performance during the year 2007 (32 university hospitals in total). For the study, a multiple regression model is employed in which profitability index obtained from the DEA computations, operating margin to total asset and gross revenue are used as the dependent variables, and a number of hospital operating characteristics are chosen as the independent variables such as ownership type, location, bed size, period of establishment, bed occupancy rate, admission ratio of outpatients, patients per medical specialist, personnel cost per patient, liabilities to total assets, current ratio, fixed ratio, total asset turnover, medical assistance rate and public indicator. First, the results indicate that the bed occupancy rate and liabilities to total assets are positively and significantly associated with operating margin to total asset. Second, number of beds, the bed occupancy rate and number of patients per medical specialist are positively and significantly associated with operating margin to gross revenue. Third, the bed occupancy rate, number of patients per medical specialist, liabilities to total assets, total asset turnover are positively and significantly associated with profitability index revealed from DEA.

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Characteristics of Supplementary Private Health Insurance Insured and Medical Utilization Behavior (실손형 민간의료보험 가입 특성 및 의료이용행태)

  • Oh, Hyang-Suk;Kim, Chang-Yoon
    • The Korean Journal of Health Service Management
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    • v.8 no.2
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    • pp.115-125
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    • 2014
  • This study tries to investigate inequity in supplementary private health insurance insured in terms of the analysis of insurance insured general characteristics and to analyze the influence of supplementary private health insurance on their admission and their outpatient medical utilization behavior. As a result of the analysis of the general characteristics of supplementary private health insurances insured, it has turned out that men, persons at low ages, people with a spouse and chronic diseases, and persons with a high income have applied such insurances more. We can also tell that low-income classes have difficulty in applying private health insurances as people in the fifth income quintile have applied such insurances about 9 times as much as those in the first income quintile. The analysis of supplementary private health insurance insured health care utilization behavior has revealed that both male and female insured aged less than 55 and without chronic diseases have increases the number of their use of health care, their patient charge, and their medical cost per visit.