• Journal of Venture Innovation
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• v.1 no.1
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• pp.1-14
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• 2018

The 4th Industrial Revolution is making a big change for our company like the tsunami. The CPS system, which is represented by the digital age, is based on the data accumulated in the physical domain and is making business that was not imagined in the past through digital technology. As a result, the business model of the 4th Industrial Revolution era is different from the previous one. In this study, we analyze the trends and the issues of business innovation theory research. Then, the business innovation model of the digital age was compared with the previous period. Based on this, we have searched for a business model suitable for the 4th Industrial Revolution era. The existing business models have many difficulties to explain the model of the digital era. Even though more empirical research should be supported, Michael Porter's diamond model is most suitable for four cases of business models by applying them. Type A sharing outcome with customer is a model that pay differently according to the basis of customer performance. Type B Value Chain Digitalization model provides products and services to customers with faster and lower cost by digitalizing products, services and SCM. Type C Digital Platform is the model that brings the biggest ripple effect. It is a model that can secure profitability by creating new market by creating the sharing economy based on digital platform. Finally, Type D Sharing Resources is a model for building a competitive advantage model by collaborating with partners in related industries. This is the most effective way to complement each other's core competencies and their core competencies. Even though numerous Unicorn companies have differentiated digital competitiveness with many digital technologies in their respective industries in the 4th Industrial Revolution era, there is a limit to the number of pieces to be listed. In future research, it is necessary to identify the business model of the digital age through more specific empirical analysis. In addition, since digital business models may be different in each industry, it is also necessary to conduct comparative analysis between industries

• Korean Security Journal
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• no.36
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• pp.349-386
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• 2013

This research analyzes and evaluates The Korean Security Industry Law(TKSIL) putting the regulation of the present government about the private security industry. It nowadays becomes the important axis of the police services offered in the aspect of 'the national life safety' in connection with 'the materialization of society which is safe from the crime'. TKSIL is one of the national administration strategies which Park Gun-hye government aims on supervision policy. After seeking out the core values of the private security industrial policy which sets up in order to approach the national life safety which Park Gun-hye government aims, we make some assessments of this revised security industry law systematically. Particularly all keynote of policy about the private security of the police tried to be confirmed and the desirable direction of policy tries to be presented as to the security industry law application and real operation. In the site of organized civil complaint, the revised security industry law was revised as the direction which intensifies the administrative regulation as to the partial regulation such as it established the reason of the introduction of the arrangement license system. And grounds for disqualification of security instructor and guard, and rules of punishment is intensified order to intercept previously illegal and violent act of the security company etc. However it has the feature that it accomplishes 'the law principle(principle of statute)' the substantial portion through the effort of them changing a lot the content for the form of the law when being the clauses of the fundamental human rights limit, although it has been prescribed in "the security industry law enforcement ordinance" or "the security industry law enforced regulation". The security industry law revised this time brought from the change of the sharp policy through the revision of 17 clauses or new establishment. It can divide into 4 categorizes. (1) strictness of punishment in the site of organized civil complaint (2) Intensification of throwing out for the violation person in the private security business market time-limitedly (3) Intensification of the legal guide supervision power of police (4) upstream of the capital, name tag attachment under compulsion and the limit about other equipment use etc. Essentially "the security industry law" cannot help regulating the national interference of the private security and regulation with this content. However as to this interference and regulation, the limit has to be possible within reasonable range. As the history proved, excessive regulation by the country is not only due to bring the distortion of the security system of nation but also provoke national social cost. It can't be disregards ever that it premises the harmony which appropriate as well as reasonable in the socio-economic dimension for drawing the best combination that all things which get the compulsory education, it limits the person providing the private security service to the corporation, or it limits to the certificate of qualification holder are the ultimate for 'the safety of the national life'.

• Proceedings of the Korea Water Resources Association Conference
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• 2006.05a
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• pp.1241-1245
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• 2006

절 성토사면에 구조물을 설치할 경우 가장 중요하게 고려되어야 하는 점은 사면의 안정성 여부이다. 특히, 절 성토사면에 설치된 구조물이 붕괴되는 가장 큰 원인은 뒷채움재 내에 존재하는 수압의 영향이라는 것을 우리는 이미 많은 연구와 경험을 통해 알고 있다. 만일 지하수위가 존재하는 상태에서 단시간에 발생되는 집중호우로 인해 수위가 갑자기 상승하였을 경우, 구조물을 통해 전혀 배수되지 않는다면 절 성토사면의 안정성은 급격히 저하될 것이다. 이러한 사면의 배수압을 소산시킬 수 있는 공법은 여러 가지가 있으나, 본 연구에서는 특히 제주도의 지역적 특성을 고려하여 화산석을 채움재로 사용한 Mattress/Filter를 절 성토사면에 설치함으로써 배수압을 소산시킬 수 있는 방법을 연구하였다. Mattress/Filter는 제방 또는 절 성토사면의 파괴와 침식을 방지하기 위해 사면에 설치하는 육각형의 철망구조로서 유연성, 다공성, 배수성 및 식생성과 같은 특징이 있으며, 콘크리트 구조물과 달리 별도의 배수시설을 필요로 하지 않는 장점이 있다. 또한 본 연구에 사용된 Mattress/Filter의 채움재인 화산석은 현재 제주도 지역에 방대하게 분포되어 있다. 특히 현무암은 제주도 암석 전체의 90%이상을 차지하고 있으며, 투수성이 매우 큰 암석이다. 현무암의 공극률은 그 종류에 따라 $0.02{\sim}0.36$의 범위로 나타난다. 특히, 표선리현무암의 경우 평균 공극률이 0.23으로 나타나 모래의 공극률인 $0.3{\sim}0.8$에 비교하여 볼 때, 연구에 사용된 재료는 아주 우수한 투수성을 가진 것으로 판명된다. 또한 현무암의 경우 암석의 겉 표면이 미세한 다공질 조직으로 이루어져 있다. 따라서 암석자체에 물이 정체될 수 있어 구조물을 통해 배수될 때 암석이 머금고 있는 물로 인해 추가적으로 발생하는 중력은 다른 재료가 가지지 못한 화산석의 또 다른 장점이라 할 수 있다.서는 자료변환 및 가공이 필요하다. 즉, 각 상습침수지구에 필요한 지형도는 국립지리원에서 제작된 1:5,000 수치지형도가 있으나 이는 자료가 방대하고 상습침수지구에 필요하지 않은 자료들을 많이 포함하고 있으므로 상습침수지구의 데이터를 인터넷을 통해 서비스하기 위해서는 많은 불필요한 레이어의 삭제, 서비스 속도를 고려한 데이터의 일반화작업, 지도의 축소.확대 등 자료제공 방식에 따른 작업 그리고 가시성을 고려한 심볼 및 색채 디자인 등의 작업이 수반되어야 하며, 이들을 고려한 인터넷용 GIS기본도를 신규 제작한다. 상습침수지구와 관련된 각종 GIS데이타와 각 기관이 보유하고 있는 공공정보 가운데 공간정보와 연계되어야 하는 자료를 인터넷 GIS를 이용하여 효율적으로 관리하기 위해서는 단계별 구축전략이 필요하다. 따라서 본 논문에서는 인터넷 GIS를 이용하여 상습침수구역관련 정보를 검색, 처리 및 분석할 수 있는 상습침수 구역 종합정보화 시스템을 구축토록 하였다.N, 항목에서 보 상류가 높게 나타났으나, 철거되지 않은 검전보나 안양대교보에 비해 그 차이가 크지 않은 것으로 나타났다.의 기상변화가 자발성 기흉 발생에 영향을 미친다고 추론할 수 있었다. 향후 본 연구에서 추론된 기상변화와 기흉 발생과의 인과관계를 확인하고 좀 더 구체화하기 위한 연구가 필요할 것이다.게 이루어질 수 있을 것으로 기대된다.는 초과수익률이 상승하지만, 이후로는 감소하므로, 반전거래전략을 활용하는 경우 주식투자기간은 24개월이하의 중단기가 적합함을 발견하였다. 이상의 행태적 측면과 투자성과측면의 실증결과를 통하여 한국주식시장에 있어서 시장수익률을 평균적으로 초과할 수 있는 거래전략은 존재하므로 이러한 전략을 개발 및 활용할 수 있으며, 특히, 한국주식시장에 적합한 거래전략은 반전거래전략이고, 이 전략의 유용성은 투자자가 설정한 투자기간보다 더욱 긴 분석기간의 주식가격정보에 의하여 최대한 발휘될 수 있음을 확인하였다.(M1), 무역적자의 폭, 산업

• Journal of Korea Game Society
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• v.4 no.4
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• pp.11-18
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• 2004

The on-line games in the past were played by only two persons exchanging data based on one-to-one connections, whereas recent ones (e.g. MMORPG: Massively Multi-player Online Role-playings Game) enable tens of thousands of people to be connected simultaneously. Specifically, Korea has established an excellent network infrastructure that can't be found anywhere in the world. Almost every household has a high-speed Internet access. What made this possible was, in part, high density of population that has accelerated the formation of good Internet infrastructure. However, this rapid increase in the use of on-line games may lead to surging traffics exceeding the limited Internet communication capacity so that the connection to the games is unstable or the server fails. expanding the servers though this measure is very costly could solve this problem. To deal with this problem, the present study proposes the load distribution technology that connects in the form of local clustering the game servers divided by their contents used in each on-line game reduces the loads of specific servers using the load balancer, and enhances performance of sewer for their efficient operation. In this paper, a cluster system is proposed where each Game server in the system has different contents service and loads are distributed efficiently using the game server resource information such as CPU utilization. Game sewers having different contents are mutually connected and managed with a network file system to maintain information consistency required to support resource information updates, deletions, and additions. Simulation studies show that our method performs better than other traditional methods. In terms of response time, our method shows shorter latency than RR (Round Robin) and LC (Least Connection) by about 12%, 10% respectively.

• Journal of Intelligence and Information Systems
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• v.24 no.3
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• pp.135-155
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• 2018

The purpose of this study is to analyze the difference of interpretation level and intention to use message framing when autonomous vehicle, which is emerging as the product of 4th industrial revolution, is used as taxi, Interpretation level refers to the interpretation of a product or service, assuming that it will happen in the near future or in the distant future. Message framing refers to the formation of positive or negative expressions or messages at the extremes of benefits and losses. In other words, previous studies interpret the value of a product or service differently according to these two concepts. The purpose of this study is to investigate whether there are differences in intention to use when two concepts are applied when an autonomous vehicle is launched as a taxi. The results are summarized as follows: First, the message format explaining the gain and why should be used when using the autonomous taxi in the message framing configuration, and the loss and how when the autonomous taxi is not used. Messages were constructed and compared. The two message framing differed (t = 3.063), and the message type describing the benefits and reasons showed a higher intention to use. In addition, the results according to interpretation level are summarized as follows. There was a difference in intentions to use when assuming that it would occur in the near future and in the near future with respect to the gain and loss, Respectively. In summary, in order to increase the intention of using autonomous taxis, it is concluded that messages should be given to people assuming positive messages (Gain) and what can happen in the distant future. In addition, this study will be able to utilize the research method in studying intention to use new technology. However, this study has the following limitations. First, it assumes message framing and time without user experience of autonomous taxi. This will be different from the actual experience of using an autonomous taxi in the future. Second, self-driving cars should technical progress is continuing, but laws and institutions must be established in order to commercialize it and build the infrastructure to operate the autonomous car. Considering this fact, the results of this study can not reflect a more realistic aspect. However, there is a practical limit to search for users with sufficient experience in new technologies such as autonomous vehicles. In fact, although the autonomous car to take advantage of the public transportation by taxi is now ready for the road infrastructure, and technical and legal public may not be willing to choose to not have enough knowledge to use the Autonomous cab. Therefore, the main purpose of this study is that by assuming that autonomous cars will be commercialized by taxi you can do to take advantage of the autonomous car, it is necessary to frame the message, why can most effectively be used to find how to deliver. In addition, the research methodology should be improved and future research should be done as follows. First, most students responded in this study. It is also true that it is difficult to generalize the hypotheses to be tested in this study. Therefore, in future studies, it would be reasonable to investigate the population of various distribution considering the age, area, occupation, education level, etc. Where autonomous taxi can be used rather than those who can drive. Second, it is desirable to construct various message framing of the questionnaire, but it is necessary to learn various message framing in advance and to prevent errors in response to the next message framing. Therefore, it is desirable to measure the message framing with a certain amount of time when the questionnaire is designed.

• The Korean Journal of Air & Space Law and Policy
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• v.8
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• pp.231-248
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• 1996

이 논문(論文)은 한국(韓國)의 우주(宇宙) 산업(産業) 발달(發達)과 그 과정(過程)을 고찰(考察)하고 현재 진행 중인 통신위성(通信衛星)의 개발(開發)과 그 사업(事業)을 뒷받침해 주는 국가(國家)의 정책(政策)을 살펴보고 있다. KOREASAT라고 명명(命名)된 통신위성(通信衛星) 개발(開發)에 현재 여러 기관이 관계(關係)하고 있으나 그 중 KARI(한국항공우주연구소(韓國航空宇宙硏究所)), ETRI(전자통신연구소(電子通信硏究所)), SERI(시스템공학연구소(硏究所)), KAIST(한국과학기술연구소(韓國科學技術硏究所)) 등이 중추적인 연구(硏究)를 하고 있다. 특히 이 논문(論文)에서는 아래와 같은 문제(問題)를 다루고 있다 첫째, 최근(最近) 한국우주개발(韓國宇宙開發) 상황(狀況) 둘째, 장기(長期) 우주개발(宇宙開發) 계획(計劃) 셋째, 현재(現在) 우주개발(宇宙開發) 상황(狀況)과 미래(未來) 우주개발(宇宙開發)에 관련한 정책(政策)적 문제(問題) 넷째, 한국(韓國) 우주개발(宇宙開發)과 정책(政策) 방향(方向)에 대한 의견(意見) 최근의 한국우주개발(韓國宇宙開發) 상황(狀況)은 크게 한국(韓國)의 통신위성(通信衛星) 사업(事業)인 Koreasat program과 다목적 위성사업(衛星事業)인 KOMSAT로 나타나는데 한국(韓國)의 최초 상업용(商業用) 위성(衛星)인 Koreasat는 1호가 1995년도에 발사(發射)되었으나 정상궤도(正常軌道) 진입(進入)에 문제(問題)가 발생하여 발사업체(發射業體)로부터 보상문제(補償問題)가 제기(提起)되기도 하였으나 2호는 성공리에 발사(發射)되었다. 미국항공우주회사(美國航空宇宙會社)와 공동(共同)으로 개발(開發)중인 새로운 과학위성(科學衛星)인 KOMSAT는 한국우주과학기술(韓國宇宙科學技術)을 한단계 더 발전(發展)시킬 수 있을 것이고 1999년도에 발사(發射) 계획(計劃)이다. 한국항공우주연구소(韓國航空宇宙硏究所) 중심(中心)의 장기(長期) 우주개발(宇宙開發) 계획(計劃)에서 제시(提示)하는 4가지 우주개발(宇宙開發)의 기본목표(基本目標)는 첫째, 우주산업응용산업(宇宙産業應用産業)의 상호협조개발(相互協助開發)에 의한 우주산업(宇宙産業) 육성(育成) 둘째, 한국(韓國)의 현재 우주산업상황(宇宙産業狀況)에 알맞은 특정분야(特定分野)를 선정(選定)하고 이 분야(分野)에서 최단기에 세계(世界) 최고의 기술수준을 성취(成就)하도록 집중(集中) 셋째, 외국과 긴밀한 협조(協助)로 선진기술(先進技術)의 습득(習得) 넷째, 체계적이고 통합(統合)된 장기우주산업발전(長期宇宙産業發展) 계획(計劃) 성립(成立) 등이다. 이러한 계획(計劃)에 주요 사안(事案)으로는 2015년까지 19기의 인공위성(人工衛星) 보유(保有)를 위한 제작계획(製作計劃)과 2010년까지 발사체(發射體) 개발(開發)을 마련하는 것이다 현재 우주활동(宇宙活動)에 관련된 문제(問題)는 주로 Koreasat의 서비스와 사용계획(使用計劃)에 대한 것으로 위성개발사업(衛星開發事業)에 있어서 관련 정부부서간(政府部署間)에 의견(意見)을 달리하고 있는 형태이다. 한국통신(韓國通信)과 정보통신부(情報通信部)는 위성(衛星)의 DBS 트랜스폰더에 대해 디지털 방식(方式)을 적용(適用)할 것을 제안(提案)했지만 공보처(共報處)는 반대(反對)의 입장(立場)을 표명(表明)한 것과 방송국(放送局)의 관리(管理)와 통제(統制)는 공보처(共報處)에 있고 무선통신표준(無線通信標準)에 대한 면허(免許)는 정보통신부(情報通信部)에 있기 때문에 방송국(放送局)에 대한 면허(免許)는 각기 다른 두 단계(段階)로 구성(構成)되는 문제(問題)가 발생(發生)한다. 또한 DBS 서비스에서 사기업(私企業)의 참여(參與)와 관련하여 재벌(財閥)의 참여(參與)를 허용(許容)하느냐의 여부(與否)의 논쟁(論爭)이다. 다음으로 미래(未來) 우주산업개발(宇宙産業開發)에 관한 정책문제(政策問題)를 살펴보면 국가적(國家的) 차원(次元)에서 조직적(組織的)인 육성책(育成策)에 대한 문제(問題)로 현재 주관 부처가 과학기술처(科學技術處)와 통상산업부(通商産業部)로 나뉘어 추진(推進)되고 있다는 점이다. 그리고 차세대(次世代) 통신위성개발(通信衛星開發) 계획(計劃)에 대한 문제(問題)로 최소 2${\sim}$4개의 궤도확보(軌道確保)와 이미 정상궤도(正常軌道) 진입(進入) 실패(失敗)에 따른 Koreasat 1호의 생명단축(生命短縮)으로 새로운 통신위성(通信衛星)을 4년이내에 발사(發射)해야 한다는 문제(問題)이다. 결론적으로 장기(長期) 우주개발계획정책(宇宙開發計劃政策)에 있어서 첫째, 국제적 우주개발사업(宇宙開發事業)에 대한 적극적(積極的) 참여(參與), 둘째, 우주(宇宙)에서 독립적(獨立的)인 활동(活動)을 할 수 있는 국가안보체제(國家安保體制)의 개발(開發), 셋째, 국가(國家) 위상(位相)의 발전(發展)과 우주개발(宇宙開發)을 위한 인력활용(人力活用)의 개발(開發), 넷째, 무한한 우주(宇宙)에 도전(挑戰)할 수 있는 우수(優秀)한 인재(人才)의 교육(敎育), 다섯째, 21세기를 대비(對備)하여 한국(韓國)의 우주개발정책(宇宙開發政策)의 결정(決定) 등이 고려(考慮)되어야 할 5가지 요소(要所)들이다. 그리고 막대(莫大)한 비용(費用)이 드는 우주개발사업(宇宙開發事業)을 효율적으로 추진(推進)하기 위해서는 국가(國家) 최고(最高) 지도자(指導者)의 직접지휘(直接指揮)를 받는 정부기구(政府機構)가 수립(樹立)되어 정부차원(政府次元)에서 추진(推進)하되 산학연(産學硏)이 협조(協助)하여 우주개발계획(宇宙開發計劃)을 추진(推進)하여야 할 것으로 본다.

• Journal of Intelligence and Information Systems
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• v.17 no.2
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• pp.77-96
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• 2011

An exhibition is defined as market events for specific duration to present exhibitors' main products to business or private visitors, and it plays a key role as effective marketing channels. As the importance of exhibition is getting more and more, domestic exhibition industry has achieved such a great quantitative growth. But, In contrast to the quantitative growth of domestic exhibition industry, the qualitative growth of Exhibition has not achieved competent growth. In order to improve the quality of exhibition, we need to understand the preference or behavior characteristics of visitors and to increase the level of visitors' attention and satisfaction through the understanding of visitors. So, in this paper, we used the observation survey method which is a kind of field research to understand visitors and collect the real data for the analysis of behavior pattern. And this research proposed the following methodology framework consisting of three steps. First step is to select a suitable exhibition to apply for our method. Second step is to implement the observation survey method. And we collect the real data for further analysis. In this paper, we conducted the observation survey method to obtain the real data of the KIDS & EDU EXPO for Children in SETEC. Our methodology was conducted on 160 visitors and 78 booths from November 4th to 6th in 2010. And, the last step is to analyze the record data through observation. In this step, we analyze the feature of exhibition using Demographic Characteristics collected by observation survey method at first. And then we analyze the individual booth features by the records of visited booth. Through the analysis of individual booth features, we can figure out what kind of events attract the attention of visitors and what kind of marketing activities affect the behavior pattern of visitors. But, since previous research considered only individual features influenced by exhibition, the research about the correlation among features is not performed much. So, in this research, additional analysis is carried out to supplement the existing research with data mining techniques. And we analyze the relation among booths using data mining techniques to know behavior patterns of visitors. Among data mining techniques, we make use of two data mining techniques, such as clustering analysis and ARM(Association Rule Mining) analysis. In clustering analysis, we use K-means algorithm to figure out the correlation among booths. Through data mining techniques, we figure out that there are two important features to affect visitors' behavior patterns in exhibition. One is the geographical features of booths. The other is the exhibit contents of booths. Those features are considered when the organizer of exhibition plans next exhibition. Therefore, the results of our analysis are expected to provide guideline to understanding visitors and some valuable insights for the exhibition from the earlier phases of exhibition planning. Also, this research would be a good way to increase the quality of visitor satisfaction. Visitors' movement paths, booth location, and distances between each booth are considered to plan next exhibition in advance. This research was conducted at the KIDS & EDU EXPO for Children in SETEC(Seoul Trade Exhibition & Convention), but it has some constraints to be applied directly to other exhibitions. Also, the results were derived from a limited number of data samples. In order to obtain more accurate and reliable results, it is necessary to conduct more experiments based on larger data samples and exhibitions on a variety of genres.

• Journal of Intelligence and Information Systems
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• v.23 no.4
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• pp.1-31
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• 2017

Modern businesses are adopting new technologies to serve their markets better as well as to improve efficiency and productivity. The advertising industry has continuously experienced disruptions from the traditional channels (radio, television and print media) to new complex ones including internet, social media and mobile-based advertising. This case study focuses on proposing intelligent advertising business model in Seoul's metro network. Seoul has one of the world's busiest metro network and transports a huge number of travelers on a daily basis. The high number of travelers coupled with a well-planned metro network creates a platform where marketers can initiate engagement and interact with both customers and potential customers. In the current advertising model, advertising is on illuminated and framed posters in the stations and in-car, non-illuminated posters, and digital screens that show scheduled arrivals and departures of metros. Some stations have digital screens that show adverts but they do not have location capability. Most of the current advertising media have one key limitation: space. For posters whether illuminated or not, one space can host only one advert at a time. Empirical literatures show that there is room for improving this advertising model and eliminate the space limitation by replacing the poster adverts with digital advertising platform. This new model will not only be digital, but will also provide intelligent advertising platform that is driven by data. The digital platform will incorporate location sensing, e-commerce, and mobile platform to create new value to all stakeholders. Travel cards used in the metro will be registered and the card scanners will have a capability to capture traveler's data when travelers tap their cards. This data once analyzed will make it possible to identify different customer groups. Advertisers and marketers will then be able to target specific customer groups, customize adverts based on the targeted consumer group, and offer a wide variety of advertising formats. Format includes video, cinemagraphs, moving pictures, and animation. Different advert formats create different emotions in the customer's mind and the goal should be to use format or combination of formats that arouse the expected emotion and lead to an engagement. Combination of different formats will be more effective and this can only work in a digital platform. Adverts will be location based, ensuring that adverts will show more frequently when the metro is near the premises of an advertiser. The advertising platform will automatically detect the next station and screens inside the metro will prioritize adverts in the station where the metro will be stopping. In the mobile platform, customers who opt to receive notifications will receive them when they approach the business premises of advertiser. The mobile platform will have indoor navigation for the underground shopping malls that will allow customers to search for facilities within the mall, products they may want to buy as well as deals going on in the underground mall. To create an end-to-end solution, the mobile solution will have a capability to allow customers purchase products through their phones, get coupons for deals, and review products and shops where they have bought a product. The indoor navigation will host intelligent mobile-based advertisement and a recommendation system. The indoor navigation will have adverts such that when a customer is searching for information, the recommendation system shows adverts that are near the place traveler is searching or in the direction that the traveler is moving. These adverts will be linked to the e-commerce platform such that if a customer clicks on an advert, it leads them to the product description page. The whole system will have multi-language as well as text-to-speech capability such that both locals and tourists have no language barrier. The implications of implementing this model are varied including support for small and medium businesses operating in the underground malls, improved customer experience, new job opportunities, additional revenue to business model operator, and flexibility in advertising. The new value created will benefit all the stakeholders.

• The Korean Society of Law and Medicine
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• v.15 no.1
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• pp.335-373
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• 2014

According to one Medicare report, in the US, total federal spending on health care expends almost 18 percent of the nation's GDP, about double what most industrialized nations spend on health care. And in 2011, Medicare spending reached close to $554 billion, which amounted to 21 percent of the total spent on U.S. health care in that year. Of that $554 billion, Medicare spent 28 percent, or about $170 billion, on patients' last six months of life. So what are the reasons of this high cost in EOL care and its possible solutions? Much spendings of Medicare on End-of-Life care for the terminally ill/chronically ill in the US has led health economics experts to assess the characteristics of the care. Decades of study shows that EOL care is usually supply-sensitive and poor in cost-effectiveness. The volume of care is sensitively depending on the supply of resources, rather than the severity of illness or preferences of patients. This means at the End-of-Life care, the medical resources are being overused. On the other hand, opposed to the common assumption, "The more care the better utility", the study shows that the outcome is very poor. Actually the patient preference and concerns are quite the opposite from what intense EOL care would bring about. This study analyzes the reasons for the supply-sensitiveness of EOL care. It can be resulted from the common misconception about the intense care and the outcome, physicians' mission for patients, lack of End-of-Life Care Decision which helps the patients choose their own preferred treatment intensity. It also could be resulted from physicians' fear of legal liabilities, and the management strategy since the hospitals are also seeking for financial benefits. This study suggests the possible solutions for over-treatment at the End-of-Life resulting from supply-sensitiveness. Solutions can be sought in two aspects, legal implementation and management strategy. In order to implement advance directive properly, active ethics education for physicians to change their attitude toward EOL care and more conversations about end-of-life care between physicians and patients is crucial, and incentive system for the physicians who actively have the conversations with patients will also help. Also, the general education towards the public is also important in the long run, and easy and official advance directive registry system-such as online registry-has to be built and utilized more widely. Alternative strategies in management are also needed. For example, the new strategic cost management and management education, such as cutting unnecessary costs and resetting values as medical providers have to be considered. In order to effectively resolve the problem in EOL care for the terminally ill/chronically ill and provide better experience to the patients, first of all, the misconception and the wrong conventional wisdom among doctors, patients, and the government have to be overcome. And then there should be improvements in systems and cultures of the EOL care.

• Journal of Hospice and Palliative Care
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• v.7 no.2
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• pp.200-213
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• 2004

Purpose: The purpose of this study was to create an electronic nursing record form to build a hospice nursing process database to be used in the u-hospital EMR system. Specific aims of the study were: 1. To generate a complete, accurate, and simple electronic nursing record form. 2. To verify its appropriateness following documentation with the standardized hospice protocol. 3. To verify its validity and finalize the hospice nursing process database through discussion among hospice professionals. Methods: Nursing records from three independent hospice organizations were collected and analyzed by five expert hospice nurses with more than 10 years of experience, and a nursing record database was developed. This database was applied to 81 hospice patients at three hospice organizations to verify its completeness. Results: 1. An electronic nursing record form with completeness, accuracy, and simplicity was developed. 2. The completeness of the standardized home hospice service protocol was 95.86 percent. 3. The hospice nursing process database contains 18 items on health problems, 79 items on related causes and major symptoms, and 229 items on nursing interventions. Conclusion: The new nursing record form and database will reduce documentation time and articulate and streamline the working process among team members. They can also improve the quality of hospice services, and ultimately enable us to estimate hospice service costs.