• Journal of Preventive Medicine and Public Health
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• v.36 no.1
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• pp.33-38
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• 2003

Objectives : To assess the difference in the volume of psychiatric treatments provided to health insurance inpatients, compared with those on medical assistance(the medical aid program) Korean psychiatric hospitals, and to determine factors which affect the volume of the services. Methods : 21 psychiatrists, from 3 Korean psychiatric hospitals recorded the frequencies psychiatric treatments provided to inpatients in one week (February 18-24, 2002). The records of 329 patients were analyzed through t-tests, and random effectmixed model analyses to define the difference between the two groups, and to find other factors affecting the volume of service. Results : A significant difference in the volume of psychiatric treatments provided was observed between the health insurance and medical assistance groups. The variation in the volume of service between hospitals was prominent, and other factors (gender, agegroup, length of stay and mental disorder)were also found to be significant. The patients on medical assistance received only 70% of the psychiatric treatments of those on health insurance. Conclusions : More effort is required to improve the methods of payment to increase the level of fee scheduling for medical assistance. Further studies on the mechanisms causing these differences in the volume of service are required.

• Journal of Korean Physical Therapy Science
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• v.3 no.2
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• pp.1065-1077
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• 1996

Fees for medical insurance services in Korea has not being been set based on service costing. Recently in the USA, fees for physican services are determined by developing and applying Resoure Based Relative Value Scales (RBRVS). This study attempts to develop relative value scales for personal factors of rehabilitative and physical therapeutic services. The personal factors were classified into four categories as having been done in the USA;service time, treatment technology and physical efforts, mental efforts and judgement, and stress. Input factors were measured using Magnitude Estimation Method (MEM), and relative value units were calculated for each of twenty eight rehabilitative and physical therapeutic services. Results show that service time surveyed differs from that provided in the public fee schedules in 24 services; the three personal factors but the service time are highly correlated; the physical therapists hold treatment technology and physical efforts to be the most important factor in setting the for services; and that relative values developed for noninsurance services such as Silver Spike Electrode (SSP) and Proprioceptive Neuromuscular Facilitation (PNF) are higher than those of similar insurance services. The policy implications and measures for improvement for the above findings were suggested respectively.

• Health Policy and Management
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• v.9 no.1
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• pp.156-177
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• 1999

The current method of rate adjustment for inflation is based on the evaluation of the financial performance of hospitals. The method has the disadvantage such as too complicated, expensive process as well as low reliability. This study, therefore, develops the 'Korean Medical Insurance Economic Index(MIEI)' as a new model for the rate adjustment with the use of the macro economic indices. In addition, we calculate the 1992∼1998 rate adjustment with the MIEI, and examines the validity of the MIEI by comparing with the conventional method. Medical costs are classified into nine categories : physician salaries, nurse·pharmacist·medical technician salaries, assistants & others salaries, material cost(by imports), material cost(by domestics), depreciation & rent paid(by imports), depreciation & rent paid(by domestics), power utilities, other administrative costs. Then the category weight which is the ratio of category in the total cost is calculated. Macro economic indices are selected for each cost category in order to reflect the concept of the each cost category and inflation during the year of 1992∼1998. Finally MIEI which integrate all category according to the category weight and selected macro indices is calculated. The mean of hospital MIEI which weighting by amount paid by insurers was cacluated. The result from the application of empirical data to the MIEI model is very similar to that of the current method. Furthermore, this method is very simple and also easy to get social consensus. This MIEI model can be replaced the current method based on the analysis of the financial performance for the adjustment of medical fees.

• Health Policy and Management
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• v.7 no.1
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• pp.100-124
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• 1997

In order to suggest the strategies for participation in the PPS(Prospective Payment System), analyses were performed based on variations in utilization pattern and changes in revenues of hospitals in 10 selected KDRGs. The data was collected from the claims data of a tertiary hospital in Kyunggido from September 1, 1995 to August 31, 1996. The studies consisted of 1, 718 inpatients diagnosed for lens procedures, tonsilectomy &/or adenoidectomy, appendectomy with complicated principal diagnosis, Cesarean section, or vaginal delivery without any complications. The resources used in each KDRG were measured including average length of stay, total charges, number of orders, intensity of medical services, frequencies of medical services, the rate of non-reimbursable charges, and the rate of non-reimbursable orders. Then, the changes in hopital revenues due to the composition of medical fee schedules under the PPS were estimated as follows: 1) The variations in average lenght of stay, total charges, number of orders, the intensity of medical services, the frequency of medical services, the rate of non-reimbursable charges, and the rate of non-reimbursable orders among the 10 KDRGs were comparatively small. 2) The average lenght of stay was the longest(6.0 days) for appendectomy with complicated principal diagnosis, while it was the shortest(2.1 days) for two vaginal deliveries. Statistically differences existed in the average length of stay among physicians and among the dates of admission in several KDRGs. 3) The total charges were the highest for lens procedures(1, 716, 000 won), while the lowest charges were for two vaginal deliveries(558, 000 won). Statistically differences in the total charges were found among physicians in several KDRGs: however, there were no differences with the dates of admission. 4) The number of orders was the greatest(155) for appendectomy with complicated principal diagnosis, while it was the smallest(75) for the two vaginal deliveries. Statistical differences in the number of orders did not exist among physicians in the KDRGs. 5) Significant differences were found in the intensity of medical services, and in the frequency of medical services among physicians in the KDRGs. 6) The rate of non-reimbursable charges for each KDRG was not related to the rate of non-reimbursable orders. The rate of non-reimbursable orders was the highest(36.0%) for lens procedures, while the lowest rate(11.6%) was for appendectomy with complicated principal diagnosis. The rate of non-reimbursable charges was the highest(39.4-39.7%) for vaginal deliveries, while the lowest rate(13.1%) was for tonsillectomy &/or adenoidectomy(<17 ages). 7) If the physician's practicing style were not change under the PPS, the hospital revenuses could be increased by 10%, and the portion of patient payment could be decreased by 1.4-22.4%. However, the non-reimbursable charges for showed little change between two reimbursement systems. Based upon the above findings, this hospital could be eligible for participation in the PPS(Prospective Payment Systm). However, the process of diagnosis and treatment should be standardized, inentifying methods to reduce cost and to assure quality of medical care. Furthermore, consideration should be given to finding ways to increase patient volume.

• Management & Information Systems Review
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• v.28 no.3
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• pp.99-115
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• 2009

This research analyzed determining factors of expenditure for processing fee by targeting trade show participants under a microeconomic approach in order to analyze determining factors of the participations of trade shows. As a result, with regard to the participation fees, income and the level of education seemed to be the socioeconomic factors that positively affected visitors in paying admission fees: and age and gender were negative elements. With regard to the participating businesses, the sales and the corporate history of the businesses were the positive elements to their willingness to pay the participation fees: however, the ratio of male and female personnel turned out to be a negative element in incurring the participation fees. The purchase of ticket was a positive mode-of participation factor to the visitors: however, distance tended to be a negative element for the visitors. For the participating businesses, the number of participation tended to be a positive element: however, distance was a negative one. The positive satisfaction factors that affected visitors' willingness to pay the participation fees included exhibited items, location, and schedules for events of the convention: for the participating businesses, the actual sales at the convention, the effects of advertisement and the level of satisfaction for location tended to play positive parts.

• The Journal of Fisheries Business Administration
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• v.18 no.1
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• pp.37-57
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• 1987

This article discussed the characteristics of several Pareto-optimal incentive contracts between owner and labor, more specifically, four situations: reporting output jointly observable by labor ana owner; reporting both output and effort; incorporating other endogenous elements (like capital) that affect the production process and Pareto-optimal fee schedules; and ascertaining the effects of private pre-decision information private- decision information, and per-contact informational asymmetries. Also presented were several extensions of the basic contractual model, and the different components of agency costs associated with labor-owner contractual relations. In a single-period model, the agency problem exists because the uncertainty prevents the owner from using the cash flow to determine unambiguously the labor's action. Holmstrom(1979) suggests that "when the same situation repeats itself over time, the effects of uncertainty tend to be reduced and dystunctional behavior is more accurately revealed, thus alleviating the problem of moral hazard. " Under these conditions, if the labor selects the first-best level of effect in each period, the cash flow will be independent and identically distributed over time. As the number of periods increases, the variance of the labows average output, if he selects the first-best level of effort in each period, gets smaller. Note that for this diversification effect to occur, it is necessary that the owner evaluate the labor's effort over the entire history of his employment, rather than evaluate each period's performance separately. Radner(1980) and Rubinstein and Yaari(1980) consider the extreme case in which there are an infinite number of observations. They show that the owner can eventually detect and systematic shirking on the part of the labor by comparing the labor's average output with what would be expected if the labor had been selecting the first-best level of effort in each period. In a dynamic model with incentive problems we have demonstrated that the labor's second-period compensation will depend on his first-period performance. This allows the owner to diversify away some of the uncertainty surrounding the labor's actions. In addition, this allows the owner to smooth the labor's income over time by spreading the risk of the first-period outcome over both periods. At least some unexplored avenves in this area invite future accounting research: situations where owner has different incompatible objectives and negotiates a contract with labor; circumstances in which owner deals with multiple objectives and negotiates contracts with several labors simultaneously; the value of costly accounting information systems and communication in establishing, Pareto-optimal incentive contracts, and the value and effects of inside information, Thorough theoretical or empirical research on each of these topics not only would increase our knowledge about the role and significance of accounting information but could also provide explanations of the inherent differences among various organizations and in their economic behavior. behavior.

• Journal of radiological science and technology
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• v.11 no.2
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• pp.27-64
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• 1988

Most hospital administrators in our country have doubted whether or not the size of their hospital personnel staffs, and the personnel management styles implemented are efficient or not. Actually, increased personnel expenditures due to sophisticated specialization of medical practices has become the biggest hospital expense. Therefore, it is said that hospitals can be run move efficiently by implementing reasonable management strategies for hospital personnel management. In this paper, the departments of diagnostic radiography in 16 general hospitals in Seoul, which were classified into 4 groups by the scale of hospital beds, were used as sample cases. Then, the data for the number of X-ray examination by diagnostic item was collected from sample hospitals. The unit hour spent on X-ray examinations in each diagnostic service was quoted from "A Study on setting-up of the relative value units of medical services and on the structure of current fee schedules" written by Mr. Ik Je Seong. The data analysis results are as follows; First, the number of hours per day spent on X-ray examinations in 13 hospitals out of 16 hospitals, was shorter than the general daily working hours (8 hours). Second, in the morning there was not enough time to work for X-ray examinations required, with the available manpower. In the afternoon, however, the situation was diametrically opposed to that in the morning. Third, in light of above results, though most hospitals employ sufficient personnel for the quantity of the actural work, they were always short-handed where their works were performed Fourth, this study tells us that there is a maldistribution of the work in the schedule : too much work for the available personnel in the morning. The following recommendations are resulted from the data analysis described above. First, it is recommended that all out-patients coming again, except specific patients(G. B. or I.V.P. etc) who have to have their X-ray examinations on an empty stomach in the morning among out-patients, be required to visit the hospital in the afternoon. Second, it is recommended that all new out-patients be required to make a reservation in order to equalize the number of patients throughout the day. Third, it is recommended that all in-patients, except specified patients, be arranged to have their X-ray examinations in the afternoon. Fourth, it is recommended that part time workers be employed during peak hours. This recommendation, if applied in a wider scale, would allow hospitals to overcome the problem of the maldistribution of work and personnel, and then more efficient hospital management through the appropirate personnel management procedures could be expected.

• Journal of Korean Academy of Nursing
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• v.8 no.1
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• pp.131-138
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• 1978

The change of society has brought about various health problems which have become to demand comprehensive health services not only for individuals but also for families and communities as the unit. To meet the societal needs W Hospital in a rural Korea established a Department of Community Health Nursing Services and provided nursing services to patients under a early discharge program. This study is to evaluate the community health nursing services carried out the department in general, and has following specific objectives : 1. To learn attitude of the consumers and the "referees" toward early discharge program. 2. To find out attitude toward home care and cure services. 3. To find out the consumers and the "Referees" attitude toward the 15 selected home cue and cure activities by public health nurse. 4. To investigate possibility of charging fee for the 15 selected home care and cure activities by public health nurse. Three different study population were chosen: namely the consumer, the "referee" I and II. Excluding families moved out and not able to be contacted, the total families (77) referred to the department during the study period of September 1974 - December 1975 are defined as the consumer. Thirty seven nurses among 81 nurses who have been working in W Hospital since the inception of the Community Health Nursing Service Program were randomly selected. Thirty two nurses were defined as the "referee"I, because 5 questionnaires were not able to be collected. Twenty four doctors out of 37 who have been working since the Community Health Nursing Service Program started, and who were able to contact were called as the "referee" II. Data collection method employed for the consumers was direct interviewing with preposed interview schedules, and for the "referees"questionnaire method was utilized. x$^2$test and 100-percentage were employed in analyzing the data. The study findings are follows: 1. Attitude toward early discharge: Above 85% of the consumers and the "referees" approved the early discharge: Above 85% of the consumers and the "referees" approved the early discharge program. 2. Attitude toward the home care and cure services: Above 75% of the consumers and the "referees" showed positive attitude toward the home care and cure services by public health nurses. 3. Attitude toward 15 selected home care and curative activities by public health nurses: On the average more than 50% of the consumers and the "referees" expressed an affirmative attitude to perform 15 selected home care and cure services by public health nurses. 4. Attitude toward charging fee for 15 selected home care and curative activities by public health nurses: Above 85% of the consumers thought that they would pay for the services. Only 12.8% of the consumers and 5% of the "referees" what to have the services for nothing. Based upon the findings of this study; That is, the home care and cure services to be given by public health nurse were positively responded by the consumers and the pro-fissionable, one can conclude that the services provided by the Department of Community Health Nursing Service of W Hospital have been well accepted, and that early discharge program of hospital is believed to be a means to lessen the expenses of patients from hospitalization and to promote recovery from illness. It is recommended that hospital centered cure services should be reconsidered and scrutinized to meet community health needs. NOTE : "referees" are nurses and doctors who refer the early discharged Patient to the Department of Community Health Nursing Service.