Health Policy and Management (보건행정학회지)

Korean Academy of Health Policy and Management (한국보건행정학회)
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The Effects of Hospital Resources on the Service Uses: Hospital Service Area Approach

병원서비스지역 내 병원자원과 의료서비스 이용 간의 관련성 분석

  • Kwak, Jin-Mi (Department of Health Administration, Yonsei University Graduate School) ;
  • Kim, Da-Yang (Department of Health Administration, Yonsei University Graduate School) ;
  • Seo, Eun-Won (Department of Health Administration, Yonsei University Graduate School) ;
  • Lee, Kwang-Soo (Department of Health Administration, Yonsei University College of Health Sciences)
  • 곽진미 (연세대학교 대학원 보건행정학과) ;
  • 김다양 (연세대학교 대학원 보건행정학과) ;
  • 서은원 (연세대학교 대학원 보건행정학과) ;
  • 이광수 (연세대학교 보건과학대학 보건행정학과)
  • Received : 2015.08.31
  • Accepted : 2015.09.22
  • Published : 2015.09.30
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Abstract

Background: This study explored the relationship between hospital resources and services uses in outpatient/inpatient-based hospital service area (HSA) in Korea. Methods: Study hospitals included all acute care hospitals except tertiary hospitals. Inpatient and outpatient hospital claims from the Korean National Health Insurance (NHI) program in 2010 were used to identify the service uses. Hospital resources and the degree of insurance premium in study areas were identified with the NHI corporation data. Study variables were computed by summing the service uses or hospital resources of study hospitals in each HSA. Service uses were represented by the total medical charges and number of visits/inpatient days. Hospital resources were measured by number of beds, number of doctors, and number of computed tomography (CT). The economic status of NHI enrollees in each HSA was controlled by the average monthly premium of NHI program per household in each HSA. The degree of using local hospitals was controlled with the localization index. Results: Analysis results showed that hospital resources such as beds, CT were statistically related to the service uses. And also localization index was found to have positive significant relationships with service uses. Conclusion: Hospital resources such as beds, CT had not only positive impacts on inpatient service uses, but also influences on the outpatient setting. Health policy makers will require monitoring and assessing the hospital resources in Korea.

Keywords

References

  1. Organization for Economic Cooperation and Development. International comparisons. In: Organization for Economic Cooperation and Development, editor. OECD insurance statistics 2014 [Internet]. Paris: OECD Publishing; 2015 [cited 2015 Jul 14]. Available from: http://dx.doi.org/10.1787/ins_stats-2014-6-en.
  2. Korea Institute for Health and Social Affairs. Increase in health service uses for elderly. Health Welf Issue Focus 2012;167:1-8.
  3. Organization for Economic Cooperation and Development. OECD health data: health care resources: OECD health statistics [database]. Paris: OECD Publishing; 2014.
  4. Joines JD, Hertz-Picciotto I, Carey TS, Gesler W, Suchindran C. A spatial analysis of county-level variation in hospitalization rates for low back problems in North Carolina. Soc Sci Med 2003;56(12):2541-2553. DOI: http://dx.doi.org/10.1016/s0277-9536(02)00295-2.
  5. Klauss G, Staub L, Widmer M, Busato A. Hospital service areas: a new tool for health care planning in Switzerland. BMC Health Serv Res 2005;5:33. https://doi.org/10.1186/1472-6963-5-33
  6. Cooper RA, Cooper MA, McGinley EL, Fan X, Rosenthal JT. Poverty, wealth, and health care utilization: a geographic assessment. J Urban Health 2012;89(5):828-847. DOI: http://dx.doi.org/10.1007/s11524-012-9689-3.
  7. Lee KS, Hwang SW, Lee KH. The geographical characteristics of hospital utilization among National Health Insurance patients in Korea: focusing on hospital service area and hospital referral region. Korean J Health Econ Policy 2013;19(1):1-22.
  8. Kwon S; International Labour Office, Social Security Policy and Development Branch. Achieving health insurance for all: lessons from the Republic of Korea. Geneva: International Labor Office; 2002.
  9. Fisher ES, Wennberg JE, Stukel TA, Skinner JS, Sharp SM, Freeman JL, et al. Associations among hospital capacity, utilization, and mortality of US Medicare beneficiaries, controlling for sociodemographic factors. Health Serv Res 2000;34(6):1351-1362.
  10. Krakauer H, Jacoby I, Millman M, Lukomnik JE. Physician impact on hospital admission and on mortality rates in the Medicare population. Health Serv Res 1996;31(2):191-211.
  11. Kronick R, Gilmer TP. Medicare and Medicaid spending variations are strongly linked within hospital regions but not at overall state level. Health Aff (Millwood) 2012;31(5):948-955. DOI: http://dx.doi.org/10.1377/hlthaff.2009.1065.
  12. Yasaitis LC, Bynum JP, Skinner JS. Association between physician supply, local practice norms, and outpatient visit rates. Med Care 2013;51(6):524-531. DOI: http://dx.doi.org/10.1097/MLR.0b013e3182928f67.
  13. Kim YG. A study on the disparity with health resources and medical service utilization in Korea. Popul Korea 1994;17(2):61-76.
  14. Kang AG. An analysis of the equity in health service utilization with the regional distribution of health care resources. Korean Soc Sec Stud 2007; 23(2):189-219.
  15. An analysis of the actual state of regional medical utilization using National Health Insurance data: focused on patient with cancer, National Health Insurance Service Research report 2010-12. Seooul: National Health Insurance Service; 2010.
  16. Kwon YC, Kim KH, Chang DM. A study on small area variations of hospital services utilization in some acute disease: focused on gastric diseases and acute appenditis. J Digit Policy Manag 2012;10(7):193-200.
  17. Seo YS, Lee KS, Park JH, Kang SH. A study on regional medical utilization variation of hospital inpatients in Korea. Korea Acad-Ind Coop Soc 2010;11(4):1511-1519.
  18. Dartmouth Medical School Center for the Evaluative Clinical Sciences. The Dartmouth atlas of the health care. Chicago (IL): American Hospital Publication; 1996.
  19. Kwak JM, Lee KS, Kwon HJ. A study on the relationship between the concentration status of inpatient services and medical charges per case between 2009 and 2011. Knowl Manag Res 2015;16(1):209-224. https://doi.org/10.15813/kmr.2015.16.1.010
  20. Alexander JA, Lee SY, Griffith JR, Mick SS, Lin X, Banaszak-Holl J. Do market-level hospital and physician resources affect small area variation in hospital use? Med Care Res Rev 1999;56(1):94-117. DOI: http://dx.doi.org/10.1177/107755879905600106.
  21. Onega T, Tosteson TD, Wang Q, Hillner BE, Song Y, Siegel BA, et al. Geographic and sociodemographic disparities in PET use by Medicare beneficiaries with cancer. J Am Coll Radiol 2012;9(9):635-642. DOI: http://dx.doi.org/10.1016/j.jacr.2012.05.005.
  22. Wennberg JE. Dealing with medical practice variations: a proposal for action. Health Aff (Millwood) 1984;3(2):6-32. DOI: http://dx.doi.org/10.1377/hlthaff.3.2.6.
  23. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med 2003;138(4):288-298. DOI: http://dx.doi.org/10.7326/0003-4819-138-4-200302180-00007.
  24. Organization for Economic Cooperation and Development. Computed tomography (CT) scanners (indicator) [Internet]. Paris: OECD Publishing; 2015 [cited 2015 Jul 14]. Available from: http://dx.doi.org/10.1787/bedece12-en.
  25. Starfield B, Shi L, Grover A, Macinko J. The effects of specialist supply on populations' health: assessing the evidence. Health Aff (Millwood) 2005;Suppl Web Exclusives:W5-97-W5-107. DOI: http://dx.doi.org/10.1377/hlthaff.w5.97.
  26. Ministry of Health and Welfare. 2011 Health and welfare statistics. Sejong: Ministry of Health and Welfare; 2011.
  27. Kilaru AS, Wiebe DJ, Karp DN, Love J, Kallan MJ, Carr BG. Do hospital service areas and hospital referral regions define discrete health care populations? Med Care 2015;53(6):510-516. DOI: http://dx.doi.org/10.1097/MLR.0000000000000356.
  28. Kang HJ. Policy direction for decreasing the concentration of patients to extra-large hospitals. Health Welf Policy Forum 2014;210:65-76.