• International Journal of Knowledge Content Development & Technology
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• 제11권1호
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• pp.65-84
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• 2021

Our understanding of how barriers to access systematically varies with the compositional and contextual characteristics of users is incomplete. Using a public university library in Ghana, this study assessed the heterogeneous barriers or constraints students encounter in accessing electronic resources based on their demographic and contextual attributes. A descriptive survey design was adopted and structured questionnaires were administered randomly to 558 students in the four constituent colleges of the University of Cape Coast, Ghana. Data were collected and analysed using SPSS and descriptive statistics were generated. The results revealed that students faced six key challenges in accessing electronic information resources in the library namely delays in download of information, poor internet connectivity, and limited accessibility of university portal, inadequate computers in the library, poor lighting and limited ancillary services (on the spot printing facilities), with differences based on gender, academic level, and college affiliation. Only 24% males and 26% females had no challenges or problems with delays in download of electronic information. About three-fourth of all users had poor internet connectivity and complained about inadequate computers associated with accessing electronic resources. 40% percent of undergraduate students in the Colleges of Education Studies, Agriculture and Natural Sciences, and Humanities and Legal Studies each encountered four to six simultaneous challenges. Irrespective of gender, first year undergraduate students in all the four colleges were the least likely to report multiple challenges. This suggests the need for targeted and context-specific interventions to address the identified challenges.

• Journal of Preventive Medicine and Public Health
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• 제11권1호
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• pp.123-127
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• 1978

The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are estab-lished for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The 'AUT-OGRP System' was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The 'Departmental Method' was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying patterns of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among the study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables (i. e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death. rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The wei틴fed mean total case cost (TOTC) of the study hospitals for Medicare patients during the study years was $11,27.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($743.45). The weighted mean per diem total cost (DTOC) of the study hospitals for Medicare patients during the sutdy years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the hospital with the lowest average DTOC ($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variance to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of interhospital cost variation: 59.1 percent for TOTC and 44.3 percent for DTOC. Thsee results demonstrate that the casemix index is the most importand determinant of interhospital cost variation Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.

• Journal of Preventive Medicine and Public Health
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• 제27권2호
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• pp.366-376
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• 1994

환자 만족도의 증진은 의료 제공의 궁극적인 목적의 하나이며, 의료의 질적 수준 향상을 위해서는 환자의 만족도 평가가 매우 중요하다. 따라서 판자의 만족도를 타당도와 신뢰도가 높은 도구를 이용하여 측정하고, 환자의 만족도에 영향을 미치는 요인을 규명할 필요가 있다. 이 연구는 우리 나라 실정에 적합한 표준화된 설문서의 개발에 필요한 기초자료를 제공하기 위하여 환자의 만족도를 평가하는 설문지를 개발하고 한 3차 병원 외래를 방문한 827명의 환자를 대상으로 이의 신뢰도와 타당도를 평가하였으며, 환자의 만족도에 영향을 미치는 요인을 파악하였다. 외래 방문 환자가 질을 평가하는 차원은 인자 분석을 통하여 병원 환경 및 편의 시설에 관련된 요인, 원무관리 및 보조 서비스에 관련된 요인과 의사진료에 관련된 요인으로 분류되었으며, 이 3개의 병원내 과정에 대한 척도들은 비교적 높은 신뢰도와 타당도를 나타내고 있었다. 전반적인 진료 결과를 나타내는 3개 문항은 신뢰도가 낮아, 서로 다른 별도 차원의 개념임을 의미하고 있었다. 로지스틱 회귀분석 결과 전반적인 만족도에 영향을 미치는 요인은 최근의 건강 상태, 진료비에 대한 인식과 진료에 따른 건강상태의 변화였고, 타인에게 병원을 추천할 의향에 영향을 미치는 요인은 환자의 성, 초 재진 여부, 진료에 따른 건강상태의 호전에 대한 기대, 진료비에 대한 인식과 진료에 따른 건강상태의 변화였다. 앞으로의 환자 만족도에 대한 연구에서는 이 연구 결과를 참고로 하여 조사 대상의 확대, 포괄적인 설문 문항의 개발, 조사 방법의 보완 등이 필요할 것이다. 이 연구에 사용된 설문지의 입수를 원하시는 분은 저자에게 개인적으로 연락하여 주시면, 설문지를 보내드리겠습니다.

• 보건행정학회지
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• 제25권3호
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• pp.185-196
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• 2015

Background: Issues concerning with the classification accuracy of Korean Outpatient Groups (KOPGs) have been raised by providers and researchers. The KOPG is an outpatient classification system used to measure casemix of outpatient visits and to adjust provider risk in charges by the Health Insurance Review & Assessment Service in managing insurance payments. The objective of this study were to refine KOPGs to improve the classification accuracy and to evaluate the refinement. Methods: We refined the rules used to classify visits with multiple procedures, newly defined chemotherapy drug groups, and modified the medical visit indicators through reviews of other classification systems, data analyses, and consultations with experts. We assessed the improvement by measuring % of variation in case charges reduced by KOPGs and the refined system, Enhanced KOPGs (EKOPGs). We used claims data submitted by providers to the HIRA during the year 2012 in both refinement and evaluation. Results: EKOPGs explicitly allowed additional payments for multiple procedures with exceptions of packaging of routine ancillary services and consolidation of related significant procedures, and discounts ranging from 30% to 70% were defined in additional payments. Thirteen chemotherapy drug KOPGs were added and medical visit indicators were streamlined to include codes for consultation fees for outpatient visits. The % of variance reduction achieved by EKOPGs was 48% for all patients whereas the figure was 40% for KOPGs, and the improvement was larger in data from tertiary and general hospitals than in data from clinics. Conclusion: A significant improvement in the performance of the KOPG was achieved by refining payments for visits with multiple procedures, defining groups for visits with chemotherapy, and revising medical visit indicators.

• 한국항만경제학회지
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• 제36권3호
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• pp.1-20
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• 2020

연안 여객항로는 육지와 섬지역의 연결, 섬주민의 수송수단, 섬지역 관광과 같은 역할을 수행하기 때문에 매우 중요하다. 특히 최근 국민소득의 증대, 일과 휴식이 균형 잡힌 워라벨(Work-life balance) 문화의 확산, 주 5일제 도입 등 삶의 질이 향상됨에 따라 여가문화생활인 여행에 대한 관심이 높아졌으며, 이에 섬지역에 대한 우리 국민의 관광 수요 증가하고 있다. 이러한 연안관광 환경 변화에 의해서 연안 여객터미널 이용객수가 증가함에 따라 연안 여객터미널 시설 및 서비스에 대한 중요성과 필요성이 점점 증대되고 있다. 이러한 상황에서 여객터미널 관리 조직들이 예산을 합리적으로 집행하여 여객터미널 이용객의 이용편익을 제고할 수 있도록 연안 여객터미널을 효율적으로 관리 운영할 필요가 있다 본 연구에서는 연안 여객터미널 관리·운영기관(업체)이 수익성 중심의 경영과 공공성 중심의 경영을 효율적으로 하고 있는지에 대한 평가 및 분석을 실시하였다. 연안여객 터미널의 경여 효율성 평가를 위하여 터미널의 건물 연면적, 투입인력, 예산지출 대비 이용객수와 운영수입의 관계를 분석하고, 이들 투입 및 산출변수들을 투입한 DEA분석을 통해 경영효율성을 비교 평가하였다. 분석결과, 분석결과 15개 터미널 중 인천항 제1국제, 사동항, 포항항, 목포항 제2 연안, 부산항 연안 여객터미널의 경영효율성이 떨어지는 것으로 나타났다. 전체 연안 여객터미널과 비교하여 수익성이 낮은 것으로 평가되는 8개 터미널은 섬관광 활성화와 러시아 및 일본지역 항로 개발(동해항 국제)을 통해 이용객수 증가에 따른 터미널 이용료 수입을 증대시키고, 터미널 사무실 임대 수입 및 부대사업 수입을 증대시켜 수익성을 개선하여야 할 것이다. 공익성의 경영효율성이 낮은 8개 터미널은 섬관광 홍보 및 마케팅 강화, 일본 및 중국 연안지역 관관상품 개발, 항로 개발, 초대형 쾌속선 도입 등을 통해 이용객수를 증대시켜나가야 할 것이다. 이 연구는 연안 여객터미널의 건물 연면적, 투입인력, 예산지출의 투입지표와 운영수입 및 이용객수의 산출지표를 할용하여 경영 효율성을 최초로 평가하고, 터미널의 특성을 반영하여 수익성 및 공익성의 경영효율성 개선방안을 제시하였다는 점에서 연구의 의의가 크다고 할 수 있다.