During the COVID-19 pandemic, most of the western countries with advanced medical technology failed to contain coronavirus. This fact triggered our research question of what factors influence the clinical outcomes like infection rates and case mortality rates. This study aims to identify the determinants of COVID-19 related infection rates and case mortality rates. We considered three sets of independent variables: 1) socio-demographic characteristics; 2) cultural characteristics; 3) healthcare system characteristics. For the analysis, we created an international dataset from diverse sources like World Bank, Worldometers, Hofstede Insight, GHS index etc. The COVID-19 related statistics were retrieved from Aug. 1. Total cases are from 95 countries. We used hierarchical regression method to examine the linear relationship among variables. We found that obesity, uncertainty avoidance, hospital beds per 1,000 made a significant influence on the standardized COVID-19 infection rates. The countries with higher BMI score or higher uncertainty avoidance showed higher infection rates. The standardized COVID-19 infection rates were inversely related to hospital beds per 1,000. In the analysis on the standardized COVID-19 case mortality rates, we found that two cultural characteristics(e.g., individualism, uncertainty avoidance) showed statistically significant influence on the case mortality rates. The healthcare system characteristics did not show any statistically significant relationship with the case mortality rates. The cultural characteristics turn out to be significant factors influencing the clinical outcomes during COVID-19 pandemic. The results imply that the persuasive communication is important to trigger the public commitment to follow preventive measures. The strategy to keep the hospital surge capacity needs to be developed.

Purposes: The purpose of this study is to analyze the institutional and personal factors that affect the medical utilization of patients transferred to tertiary medical institutions. Methodology: We retrospectively analyzed the 2 weeks electronic medical records of 1,556 patients, who were referred to the tertiary hospital, from June 15 to 26, 2015. The patient's personal characteristics, referral hospital, referral path, medical experiences and expenses were analyzed for 6 months after the patient's first visit. Findings: The largest proportion (848; 54.5%) of referrals was referred from primary clinic but the referrals of the same tertiary hospital level were one in seven (228; 14.7%) of the patients. Most patients (1,401; 90%) were referred from the clinics and hospitals directly and only one in ten (155; 10%) of the patients utilized the medical referral center. Patients who had been referred from tertiary care institutions had significantly higher medical costs than those referred to primary care (7,560,000 vs 2,333,000 won). The institutional factors including the numbers of visits to outpatient clinic, previous history of hospitalization and operation, consultation to other medical departments and hospitalization fee significantly influenced on medical utility pattern. Personal factors including patient's medical diagnosis and department of disease have a highly correlation with patient's referrals. Practical implications: The medical utilization of medical expenses and experiences is influenced by institutional and individual factors, and it is important to establish a referral system considering the institutional factors of the type of referral hospital.

Purposes: This study purposed to identify influence of postpartum care services on health-related quality of life in women after birth. Methodology: Korea Health Panel Survey 2009-2015 provided by the Korea Institute for Health and Social Affairs and National Health Insurance Service was used for the analysis. The health-related quality of life evaluate as a EuroQoL-5D(EQ-5D-3L, used the weight of the CDC) was used as dependent variables. Postpartum care services was used as independent variable. Demographic factors(education, economic activity, region, house income), health related variable(presence of chronic disease, self-rated health), birth related variable(birth-related problem, childbirth, pregnancy of advanced maternal age) used as covariates. Regression analysis was used. Findings: The rate of use of postpartum care services is increasing year by year. Postpartum care services and self-rated health positively influence on the health-related quality of life in women after birth and chronic disease and birth-related problem negatively influence on. Practical Implications: Therefore, it is necessary that the government's policy of the postpartum care service be expanded and systematized to increase accessibility on. There are rare studies on the health-related quality of life of women after childbirth, adjusted for birth-related variables. So this study has significance.

Purposes: The problem in the recent immigration policy and social policy changes for foreigners is that the preliminary analysis or research on the actual impact of the influx of foreigners has not been done enough in Korea yet.. This study is to examine the impact of the Korean health insurance finances on the influx of foreigners. Approach: This study analyzed the health insurance statistics for foreigners and overseas Koreans of the Health Insurance Corporation from 2013 to 2017. The data is the "Status of Health Insurance Premiums for Nationals, Foreigners, and Overseas Koreans from 2013 to 2017" submitted by the National Health Insurance Service to the Health and Welfare Committee during the 2018 National Audit Period. Findings: To summarize the analysis, first, the proportion of foreigners was only 1% of all subscribers (1.7% at work, 1.9% in regions) until 2017. Second, employees at work have a lower pay-to-pay ratio, and local subscribers have a higher pay-to-pay rate, regardless of nationality. Third, as immigrants are mostly concentrated in younger ages, they are healthy and use of hospitals is relatively low. Fourth, in terms of gender distribution, there are many women of childbearing age due to marriage immigration among foreign local subscribers, and more men use hospitals than workers who have a high proportion of males due to childbirth. In conclusion, the impact of immigration on health insurance finances is not large, and has a positive effect on finances. Practical Implications: If we simply consider the financial aspect, encouraging foreigners to subscribe to health insurance has a positive effect on finances. In particular, the more foreign workers are enrolled, the greater the financial gain. In particular, increasing the employment of foreign women through language education, vocational training, and employment support will help finance health insurance. One of the reasons foreign subscribers have a positive impact on health insurance finance is the low medical utilization rate. It can be said that young and healthy foreigners use fewer hospitals and clinics, but another aspect means that foreigners have difficulty using health insurance for various reasons. Therefore, various supports must be accompanied so that foreign subscribers can use medical services when necessary.

Purposes: The purposes of this study is analysis of business performance in national university hospitals in Korea. Methodology: Data from 2010 to 2019 were collected from balance sheet, income statement, and annual reports in 11 national university hospitals. The dependant variables are business performance which are operating margin to total assets, operating margin to gross revenue, and net income to gross revenue. The independent variables are the number of bed, hospital location, opening, liquidity, stability, and activity. Findings: In recent years, activity has been shown to have a lot of influence on management performance. National university hospitals increase profitability by using resources as efficiently as possible. The short-term debt and fixed assets have been increased rapidly in recent years. It was found that management performance has been increased through active investment using financial leverage. Practical Implications: Based on these results, this study will be the basic data for efficient management of national university hospitals.

Purpose: This study aims to develop a cost model for NRP (Nursing Residency Program) operation and ultimately provide evidence for financial factors for NRP operation in the future by simulating a cost model. Methodology: This study developed a model for the NRP education cost calculation model based on the review of Hansen's model, which has systematically reported on the development and operation of NRP, and discussions with nursing education experts at a university-affiliated hospital. With the simulation, it was intended to predict nurses' supply and demand in the long term and to calculate changes in long-term education costs. Findings: Firstly, turnover model, term model, cost model necessary for calculating a model for the NRP education cost calculation model was set up. Secondly, the simulation showed the following results; 1) the proportion of newly graduated nurses less than 5 years of working decreases gradually over time, which will make the composition of nurses more balanced. 2) In the first year of the partial introduction of NRP, the cost of training new nurses was about 2.1 times higher than before. After the introduction, the training cost in the 13th year began to be lesser than before the introduction, and in the 25th year, it decreased by 28.1% compared to before the introduction. Practical Implications: Firstly, NRP would be an effective way to solve the higher turnover and frequent departure of new nurses and the imbalance of nurses' composition. Secondly, although the costs of NRP are incurred in the early stages, in the end, NRP training costs are reduced compared to before the introduction of NRP. It is necessary to systematically understand the contribution effect of NRP by analyzing the economic value of NRP considering financial and non-monetary returns in the future and providing a basis for decision-making related to NRP implementation.

Purpose: In this study, the general characteristics of subjects who spent more than a certain amount of cost for general medical examination at the general hospital health promotion center, and the characteristics of disease, family history, and lifestyle (smoking, alcohol, physical activity, oral care) significantly differed in cost expenditure. We intend to provide basic data for establishing an appropriate marketing strategy for comprehensive examination. Method: It was conducted for users who received comprehensive checkups at a health promotion center at a general hospital in Seoul. The research data collection period is for 979 people who performed comprehensive examinations from January 2019 to December 2020. In order to carry out a comprehensive examination, a questionnaire before the examination was distributed to the subjects who visited the hospital to prepare, and the investigation was conducted in a way that the subjects of the investigation directly filled in. Results: There was a significant influence on the difference in expenditure for comprehensive examination according to the gender, age, and type of health insurance of the subject. In addition, there were significant differences in expenditure according to the presence or absence of disease and the type of family history. Weight loss, smoking history, smoking period, smoking frequency, drinking history, and drinking frequency all had significant effects on cost expenditure. Also, strength training and oral treatment management showed a significant effect on the cost of comprehensive examination. The number of flossing and interdental brushing was also found to have a significant effect. According to the results of multiple regression analysis, disease history (t=2.683, p<.01) and mean smoking frequency (t=4.315, p<.001) appeared to have the most significant effect on expenditure statistically. In other words, when the subject has a history of disease and when the average number of smoking is large, it means that the comprehensive examination cost is remarkably large. Conclusion: By using these contents, hospitals can further refine the marketing of the examination center. In addition, a more convenient and specialized process should be used by patients by linking the general medical department and the examination center well. In terms of management of operating medical institutions, this can be expected to create patients and increase profits.

Purposes: The purpose of this study was to analyze the trends of hospitalization and emergency room visits of asthma patients over the three years in 25 districts of Seoul. And analyzed the relationship between preventable hospital service uses and number of clinics for asthma patients. Methods: Data was collected from a customized database of the NHI(National Health Insurance) for 2016 to 2018. The number of clinics means Internal Medicine, Pediatrics, Ear-Nose-Throat, and Family Medicine clinics. The hospital service means the number of adults admission for asthma and the number of total asthma emergency visits. This study used kappa analysis to assess the agreements of indicators between years, and structural equation modeling analysis was applied to analyze the relationship. Findings: The kappa value of the number of adults admission for asthma was compared between 2016 and 2017(kappa score=0.68), and was lowered when compared between 2016 and 2018(kappa score=0.26). And the value of kappa in the number of total asthma emergency visits due to asthma between 2016 and 2017(kappa score=0.51) was lower than that of between 2016 and 2018(kappa score=0.60). And the results showed that the number of clinics significantly negatively related to the uses of hospital services in asthmatic patients(β=-0.5, p=0.005). Practical Implication: This research could provide policy implications for strengthening primary care services that can contribute to the reduction of preventable hospital services.

Objectives: The study recognizes the seriousness of depression in youth with atopic dermatitis, and tries to identify factors that affect depression. Methods: Data were obtained from the 2014 Korean Youth Health Behavior Risk Behavior On-line Survey. In this study, 17,232 people who were Atopic dermatitis without missing variables were included in the final analysis. It conducted frequency, chi-square and logistic regression analysis by SPSS 20.0. Results: An analysis of factors affecting depression showed that subjective health level, subjective happiness satisfaction, subjective sleep satisfaction, subjective stress level, smoking, and drinking had an effect. Conclusions: The factors affecting youth depression with atopic dermatitis revealed health status, life behavior. These results are thought to require attention and research on youth with atopic dermatitis, along with the development of practical treatment programs and systematic management by applying them to teenagers in an appropriate time and method.