• 보건행정학회지
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• 제29권1호
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• pp.40-48
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• 2019

Background: As of July 2015, per diem payment was changed from fee for service Therefore, this study aims to analyse changes in medical charges and medical services before and after enforcement of the palliative care, targeting palliative care wards in a general hospital, and provide basic data needed for development of per diem payment. Methods: The subjects of the study were a total of 610 cases consisting of 351 patients of service fee who left hospital (died) from July 2014 to June 2016 and 259 ones of per diem payment at Chosun University Hospital in Gwangju Metropolitan City. Results: The results are summarized as follows. First, after the palliative care system was applied, benefit medical service charges and insurance increased significantly (p<0.001). As benefit medical service charges increased, benefit private insurance payment increased significantly (p<0.001). Second, after the per diem payment was applied, total private insurance payment to medical institutes decreased significantly (p=0.050) and non-benefit also decreased significantly (p=0.001). Conclusion: It is suggested that additional rewards in the obligatory palliative care items should be continuously remedied and monitored to provide good quality hospice palliative care.

• 보건의료산업학회지
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• 제9권1호
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• pp.1-16
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• 2015

This study intended to measures for high performance and for identifying competitive advantages by examining the relation between the competence and performance of the first special hospitals for which the law has now been in effect for 3 years. Furthermore, the members of special hospitals were also surveyed on measures to improve the special hospital system in order to activate it. A total of 80 special hospitals participated in this study, and 171 people responded to a survey on the special hospital system. According to the results of the multiple regression analysis the relation between the competence and performance after establishing a hypothesis that special hospital competence would have an effect on organizational performance, member competence and hospital business management competence significantly had a positive (+) effect on internal performance, and marketing management competence significantly had a positive (+) effect on external performance, which partially supported this research hypothesis. Moreover, according to the results of survey on the special hospital system, the policy thought to be the most important by special hospitals was reasonable fee system reform, followed by granting incentives.

• 한국병원경영학회지
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• 제10권1호
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• pp.48-70
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• 2005

The purpose of this study was to make an analysis of the impact of the DRG payment system on medical care pattern and cost of cataract surgery in a general hospital. The subjects were 173 patients whose DRG severity grade was zero, selected from among the hospitalized who underwent cataract surgery before and after the joining to the demonstrational operation of the third year DRG payment system. Their medical records and the details of their medical bills were examined to find out the length of hospital stay, medical care pattern provided to them, the cost of medical care, and the quality of medical care. The length of stay and the amount of medical care supplied during being in hospital dropped significantly for both single-eye and double-eyes cataract surgery groups. The amount of antibiotic use went down during the hospitalization and upon discharge from the hospital, but decreased after discharge. The total medical bills and the rate of basic examination implementation increased in the OPD before hospitalization but after discharge dropped. For double-eyes cataract patients, the rate of double-eyes cataract surgery went down. The total medical bills of DRG payment system converted into the fee-for-service system was greater by 113.3% for the single-eye cataract surgery group and by 102.9% for the doble-eyes cataract surgery group, compared to that by the fee-for-service. The contribution shared by the insurance corporation increased for both single-eye and double-eyes cataract surgery groups, but the copayment by the insured went down. Regarding the treatment outcome, no difference was found in complication rate, resurgery rate and mortality rate before and after the joining to the DRG payment system was implemented. The use of special lens lessened significantly. The amount of medical care supplied during hospitalization decreased but the complication rate didn't increase. But the increased use of low-price artificial cataract and the avoidance of double-eyes cataract surgery was observed. The phenomenon decreased number of OPD visit and the decreased total medical bills of OPD care after discharge in this hospital required further evaluation.

• 대한예방한의학회지
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• 제7권1호
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• pp.17-28
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• 2003

We met results like the followings through the literatures and questionnaires about the tasks and solutions about the insurance fee of packed medical herbs. 1) It's turned out that 74.8% of herb doctors agrees to the insurance fee of packed medical herbs. However, in comparison with the same survey of the herb doctor association the percentage of general approval went somewhat lower, and especially the percentage of 'positive approval' became notably lower$(43.7%{\rightarrow}26.5%)$ and the percentage of 'active objection' raised about 2 times$(6.8%{\rightarrow}12.9%)$. Inquiring into the approval reasons on the insurance fee application of packed medical herbs some heads such as 'development toward treatment medical science' and 'decrease of publics burden' were higher than the one of 'management income and expenditure.' 2) As a result of the research, 36.0% of the patients and 42.8% of the residents recognized that the pay range of Chinese herb health insurance is narrow. They recognized that less people have the experiences of Chinese medical hospital use and internal application of the packed medical herbs as they are older, men rather than women. 85.4% of the patients and 74.9% of the residents agreed on the insurance pay of packed medical herbs. It's shown that they agree on the Chinese medical hospital use more as the economic standard is lower, on the insurance pay as they have ever taken the packed medical herbs. In the aspect of increase of insurance fee, 66.7% of the patients and 44.3% of the residents agreed on the insurance pay of packed medical herbs, and 18.1% and 36.1% disagreed on the insurance pay of packed medical herbs. The main objective reason why they disagree on the insurance pay of packed medical herbs was 'because the insurance fee goes up higher,' which answered 95.2% of the patients and 78.8% of the residents. 7.22% of the patients and 1.80% of the residents answered that they can pay more insurance fee in case of the insurance pay of packed medical herbs. However, in the priority order of the insurance pay, it hold the 5th position between 2 target research groups which was less than medical examination, charges for hospital accommodation and taking MRI. 3) According to the result of analysis about the cost of packed medical herbs, current practice price is 115,000 won and the average prime cost of a packed medical herb is 73,000 to 106,000 won. It's examined that the herb doctors regard that 95,000 won will be reasonable when the packed medical herb is payed in insurance. However, it was found out that the public generally thinks that the price would be appropriate on the level of 30,000 to 40,000 won and the percentage of the answers of 20,000 won to 30,000 was fairly high. 4) the central system of a prescription should be change into the central system of demonstration and the sick and wounded. 5) To solve this problem, the government should regulate it to pass by the circulation gradation of [importer, $peasantry{\rightarrow}manufacturer{\rightarrow}wholesaler{\rightarrow}distributor$(Chinese medical hospital, pharmacy dispensary of Chinese medicine)]And it should intervene into the quality and the circulation steps of Chinese medicine through 'the office or organization which is in charge of certification of Chinese medicine' and 'the office or organization which is in charge of the circulation of Chinese medicine.' And some actions such as simple severance, lavation, drying should be included into the conception of manufacture and the boundary between food and medical supplies should be made at a manufactory. And the regulation of standardized goods at one's own house should be improved so that, the peasantry can sell the materials of Chinese medicine only to the manufacturer. 6) In company with the insurance pay of packed medical herbs, the study about the separation of dispensary from medical practice in the Chinese medicine should be accomplished.

• 여성건강간호학회지
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• 제17권4호
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• pp.328-336
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• 2011

Purpose: The purpose of this study is to develop the optimal nursing fee for nurse-midwifery center (MC) in the national health insurance system. Methods: The three methodologies used to calculate the conversion factors for the MCs in the national health insurance include cost accounting method, sustainable growth rate (SGR) model, and index model. In this study, the macro-economic indicators and the national statistics were used to estimate the conversion factors for the MCs. Results: The optimal nursing fee for the MCs in 2011 was estimated to be an increase of 57.7% by cost accounting analysis, a decrease of 17.1% by SGR model, and a decrease of 16.1% by index model. The results from SGR model and index model could had been biased due to the upswing of medical spendings in the short-term period (2008~2009). A sensitivity analysis of pre-delivery subsidy program for OB & GYN hospitals and clinics showed that the program has substantially diminished the demand for the MC services. Conclusion: More reliable methodologies to estimate nursing fees precisely are required to prove the value of nurses' services and a government subsidy program for the MC services should be followed from a social perspective.

• 한국산학기술학회논문지
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• 제15권6호
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• pp.3534-3547
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• 2014

행위별 지불보상제도는 의료적 관점의 장점에도 불구하고 건강보험 진료비가 급증하는 문제점이 지적되고 있어 이에 대한 합리적인 통제의 필요성이 강하게 제기되고 있다. 본 연구에서는 자료수집이 가능한 27개 상급종합병원을 대상으로 SGR 모형과 DEA모형을 결합해 진료비목표예산 수립과 배분제도를 제안하였다. SGR모형은 거시적 측면에서 누적진료비 목표예산과 당해연도 진료비 목표예산에 따라 차년도의 진료비목표를 제시하는데 사용하였고 DEA모형은 개별병원에 원가의식과 관리 효율성 목표를 제시함으로써 전체적인 예산관리를 가능하게 한다. 즉 예산제도를 성과평가도구의 하나인 DEA모형과 결합함으로써 효율성 그룹에 따른 개별병원 예산을 설계할 수 있었다. 이를 통해 거시적 수준에서 국민소득 수준을 고려한 SGR 모형에서 구해진 예산총액을 배분하고 관리할 수 있는 기전을 확보해 건강보험제도에서 실무적으로도 적용가능한 모형을 설계할 수 있었다.

• 한국산학기술학회논문지
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• 제10권6호
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• pp.1304-1316
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• 2009

본 연구는 효율성에 기초한 환산지수의 도입 가능성을 알아보기 위한 기초 연구로 시도되었다. DEA 효율성지표와 환산지수가 전공의 수련교육을 실시하고 있는 60 개 병원을 그룹화하는데 얼마나 유용하게 사용될 수 있는가를 고찰하였다. 이러한 목적을 달성하기 위해 자료수집이 가능한 표본병원의 환산지수와 AHP 개념을 도입해 DEA 모형의 투입변수와 산출변수를 선정하였다. 그 결과 병상규모가 클수록 규모적 비효율성이 큰 것으로 나타났으며 기술적으로 또는 규모적으로 비효율적인 병원일수록 환산지수가 더 큰 것으로 나타났다. 환산지수와 효율성지표는 수련병원을 병원의 종별에 따라 종합전문병원과 종합병원으로 구분하는데 유용하게 사용될 수 있었다. 또한 DEA 효율성을 구하는 과정에서 독립변수로 사용된 투입 산출변수를 판별함수에 도입하였음에도 불구하고 환산지수와 효율성지표는 판별함수를 구성하는 주요 변수로 작용함을 확인하였다. 따라서 만약 모집단을 대표할 수 있는 많은 표본을 기초로 보다 명확한 결과를 얻을 수 있다면 건강보험의 수가계약제 하에서 효율성 개념을 바탕으로 한 환산지수계약의 도입을 신중하게 고려해 볼 수 있다.

• 한국병원경영학회지
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• 제2권1호
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• pp.1-21
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• 1997

In order to analyze the shifts in the volume and profits of Computed Tomography(CT) and Magnetic Resonance Imaging(MRI) utilization for a year before and after the implementation of insurance coverage for CT, this study has been undertaken examining CT and MRI cost data from 'Y' University Hospital situated in Seoul, Korea. Following are the results of this study: 1. The medical insurance payment for CT, implemented on January 1, 1996, increased CT utilization from January 1996 to April 1996 due to low insurance premiums: however, from May 1996 the number of CT cases significantly decreased as a result of strengthened medical cost reviews and the new 'Detailed standards for approval of CT' announced near the end of April 1996 by the insurer. 2. Since the implementation of insurance coverage for CT, CT fee reduction rates for reimbursements by the insurer to the hospital were 50% and 40% for January and February, respectively, and 31% and 15% for March and April. A significant point in the lowering of the reduction rate was reached in May at 11%; furthermore, since June the reduction rate fell below the average reduction rate for reimbursements for all procedures. If the 'Detailed standards for approval of CT' had been announced before the implementation of insurance coverage for CT, CT utilization would not have been so high due to the need to meet those 'standards'. In addition, loss of hospital profits resulting from the reduction for reimbursements would not have occurred. 3. The shifts in MRI utilization showed that there was no particular change with the beginning of insurance coverage for CT, and the introduction of the 'Detailed standards for approval of CT' made MRI utilization increase because MRI is free of restrictions imposed by the insurer. 4. The relationship between CT utilization and MRI utilization showed that they were supplementary to each other before insurance coverage for CT, but that CT was substituted for MRI because of strengthened medical cost reviews after t~e beginning of insurance coverage for CT. 5. The shifts in volume by patient characteristics showed that the number of inappropriate case patients, according to the insurer's "Standards for approval", decreased more than the number of appropriate case patients after the introduction of insurance coverage for CT. Therefore, the health insurance fee schemes for CT have influenced patient care. 6. The shifts in profits from CT utilization showed a net profit decrease of 31.6%. In order to match the pre-coverage profit level, 5,471 more cases would need to be seen and productivity would need to be increased by 32.7%. This profit decrease resulted from a decrease of CT utilization and low reimbursements. With insurance coverage, net profits from CT were 24.4%, and a margin of safety ratio was 39.6%. Because of the net profits and margin of safety ratio, CT utilization fees for insured appropriate cases could not be considered inappropriate. 7. The shifts in profits from MRI utilization before and after the introduction of CT coverage showed that in order to match pre-CT coverage profit levels, 2,011 more cases would need to be seen and productivity would need to be increased by 9.2%. The reasons for needing to increase the number of cases and productivity result from cost burdens created by adding new MRI units. But with CT coverage already begun, MRI utilization increased. Combined with a minor increase in the MRI fee schedule, MRI utilization showed a net profit increase of 18.5%. Net profits of 62.8% and a 'margin of safety ratio' of 43.1% for MRI utilization showed that the hospital relied on this non-covered procedure for profits. 8. The shifts in profits from CT and MRI utilization showed the net profits from CT decreased by 2.33billion Won while the net profits from MRI increased by 815.7million Won. Overall, these two together showed a net profit decrease of 1.51billion Won. The shifts in utilization showed a functional substitutionary relationship, but the shifts in profits did not show a substitutionary relationship. From these results, We can conclude that if insurance is to be expanded to include previously uncovered procedures using expensive medical equipment, detailed standards should be prepared in advance. The decrease in profits from the shifts in coverage and changes in fees is a difficult burden that should be shared, not carried by the hospital alone. Also, a new or improved fee schedule system should include revised standards between items listed and the appropriateness of the fee schedule should constantly be ensured. This study focused on one university hospital in Seoul and is therefore limited in general applicability. But it is valuable for considering current issues and problems, such as the influence of CT coverage on hospital management. Future studies will hopefully expand the scope of the issues considered here.

• 한국병원경영학회지
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• 제1권1호
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• pp.154-169
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• 1996

Some of the large sized companies have taken parts in a hospital business with a view or justification to improve medical care regadless of the disadvantageous fee-for-service medical insurance reimbursement system controlled by authorities related. This gradually brought about the financial difficulties to university hospitals as well as general hospitals that were less competitive. In this circumstance the hospital administrators are called for preparing and implementing proper financial strategies by analyzing external circumstances and internal abilities of their hospitals. In this aspect, an effective cost-analysis system in the hospital has been needed for years. K-University hospital developed the practical cost-analysis system and applied it to the hospital management. The effects of cost analysis system are as belows: first, the trend of the monthly revenue per medical specialist from March to July in 1996 showed increasing pattern which is different from that in past years. second, it turned out that the department of functional laboratory in relation to medical treatment enlarged the medical revenue very sharply. third, the intensive care units were being operated at the state of deficit, while other general wards were lucrative.

• 한국병원경영학회지
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• 제14권4호
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• pp.149-162
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• 2009

The purpose of this study is to design strategic hospital service based on each hospital's features. For this study, an assessment was conducted by 398 in-patents of one university hospital located in Seoul. The self-questionnaires, which were investigated from Oct. 15th to 29th in 2008, compared central reception desk with ward reception desk in satisfaction and re-use rate of patients. The major results of this study are as follow. First, according to each reception desk user, they have different satisfaction of it. As for the staff kindness, admission procedure, discharge procedure and manner of staff, those made patients be gratified as well. Second, when it comes to the intention of re-use, there were no significant features between them. Only convenience in admission and discharge procedure, however, was an attractive factor for the recommendation. Third, this study found out the reasons for higher re-use rate of central reception desk users. Regarding service, they were contented with the time for test and treatment. As for the hospital service, they would like to re-use this hospital because of convenient steps of paying interim fee and getting certificates. Forth, this study found out the reasons for higher re-use rate of ward reception desk users. As a point of hospital service view, they responded that respected privacy, hospital facility and general service were good for staying. As for the manner of staff, they mentioned nurses and staff in charge and whole staff members were kind. When it comes to the procedures of patient management, steps of discharge and paying interim fee were convenience. In conclusion, the results of this study suggest that providing a ward reception desk service can boost the satisfaction and re-use rate of in-patients. Furthermore, this strategic management method would be good for not only cutting the moving line but also efficient in-patient care system. These results can be used for the strategic hospital marketing field, as well. Even though this study has a limitation of the targeted populations which were only in a ward reception desk running hospital, it can say that having competitiveness in satisfaction of hospital service is good for promoting and differencing each hospital. Consequently, whole general management system would be adjusted first for differencing each hospital; however, this sort of additional factor should be concerned as well. I expect that this study would give meaningful data for designing strategic and differencing marketing method to lots of hospitals.