• Health Policy and Management
• /
• v.2 no.2
• /
• pp.194-220
• /
• 1992

In recent years there has been a rapid influx of high cost MRI equipment into Korea. This diffusion has raised concerns about the changes it will bring for the health care utilization. Therefore, the purpose of this study is to identify socio-economic characteristics of MRI uses in Korea. A structured questionnaire was designed for this purpose, and 1, 091 users were surveyed at the 35 MRI units of 33 hospitals during a week, sometimes March 1992. The study reveals that high cost technology such as MRI, CT scanner is so prevalent in Korea. This is particularly the case in metropolitan areas. Among others, Seoul has the highest percentage of MRI equipment, 51.05%, Pusan 12.10% and Kwangju 11.9%. Unfortunately, most high cost technology equipments are foreign products. Thus, hospitals with such a high cost technology have difficulties in maintenance of the equipment. The average performance of MRI equipment has declined from 10.2 cases per day in 1988 to 7.16 cases in March 1992. Due to the rapid increase, the performance of MRI equipment seems to be deterioration. Male usere are dominant in the case of MRI use. The utilization rate has positively increased with the rise of educational level of users. The same is true for the level of income; the MRI utilization rate by income level shows that it is negatively proportional to income, which indicates that the poor have difficulties in the use of high cost technology. Particularly, the cost of MRI is so high that ordinary patients are unable to pay for it. For example, 86.3% of respondents have answered that the cost is too high even though they are insured by health insurance. This is the first empirical study on the use status of MRI. The information obtained in this study is sufficient to maintain that the Korean health insurance programme is urgently in need of improving the insurance benefit schemes. The easiest way to do this is to include provision of high cost technology service into the benefit package.

• Progress in Superconductivity and Cryogenics
• /
• v.25 no.4
• /
• pp.75-80
• /
• 2023

Rare earth barium copper oxide (REBCO) materials have shown the possibility of high-temperature superconductor (HTS) magnetic resonance imaging (MRI) magnets due to their elevated transition temperature. While numerous MRI magnet designs have emerged, there is a growing emphasis on estimating the cost before manufacturing. In this paper, we propose two designs of REBCO whole-body MRI magnets: (1) 1.5 T and (2) 3.0 T, the standard center field choices for hospital use, and compare their costs based on conductor usage. The basis topology of the design method is based on discretized solenoids to enhance field homogeneity. Magnetic stress calculation is done to further prove the mechanical feasibility of their construction. Multi-width winding technique and outer notch structure are used to improve critical current characteristic. We apply consistent constraints for current margins, sizes, and field homogeneities to ensure an equal cost comparison. A graph is plotted to show the cost increase with magnetic flux growth. Additionally, we compare our designs to two additional MRI magnet designs from other publications with respect to the cost and magnetic flux, and present the linear relationship between them.

• Korean Management Science Review
• /
• v.21 no.2
• /
• pp.93-109
• /
• 2004

The imports of used medical equipment such as CT. MRI have been rapidly increased every year. How to manage those medical equipment has been one of critical issues in the government sector. In this study, we demonstrate how benefit/cost analysis using the Analytic Hierarchy Process (AHP) can be applied to the comparison of used CT/MRI and new CT/MRI. The final results show that the new CT/MRI is more attractive than the used CT/MRI.

• Investigative Magnetic Resonance Imaging
• /
• v.23 no.3
• /
• pp.179-201
• /
• 2019

Portable low-cost magnetic resonance imaging (MRI) systems have the potential to enable "point-of-care" and timely MRI diagnosis, and to make this imaging modality available to routine scans and to people in underdeveloped countries and areas. With simplicity, no maintenance, no power consumption, and low cost, permanent magnets/magnet arrays/magnet assemblies are attractive to be used as a source of static magnetic field to realize the portability and to lower the cost for an MRI scanner. However, when taking the canonical Fourier imaging approach and using linear gradient fields, homogeneous fields are required in a scanner, resulting in the facts that either a bulky magnet/magnet array is needed, or the imaging volume is too small to image an organ if the magnet/magnet array is scaled down to a portable size. Recently, with the progress on image reconstruction based on non-linear gradient field, static field patterns without spatial linearity can be used as spatial encoding magnetic fields (SEMs) to encode MRI signals for imaging. As a result, the requirements for the homogeneity of the static field can be relaxed, which allows permanent magnets/magnet arrays with reduced sizes, reduced weight to image a bigger volume covering organs such as a head. It offers opportunities of constructing a truly portable low-cost MRI scanner. For this exciting potential application, permanent magnets/magnet arrays have attracted increased attention recently. A magnet/magnet array is strongly associated with the imaging volume of an MRI scanner, image reconstruction methods, and RF excitation and RF coils, etc. through field patterns and field homogeneity. This paper offers a review of permanent magnets and magnet arrays of different kinds, especially those that can be used for spatial encoding towards the development of a portable and low-cost MRI system. It is aimed to familiarize the readers with relevant knowledge, literature, and the latest updates of the development on permanent magnets and magnet arrays for MRI. Perspectives on and challenges of using a permanent magnet/magnet array to supply a patterned static magnetic field, which does not have spatial linearity nor high field homogeneity, for image reconstruction in a portable setup are discussed.

• Proceedings of the Korean Information Science Society Conference
• /
• 2011.06c
• /
• pp.393-396
• /
• 2011

In this paper, we propose a constrained alternating least squares nonnegative matrix factorization algorithm (cALSNMF) to detect active brain regions from single subject's task-related fMRI data. In cALSNMF, we define a new cost function which considers the uncorrelation and noisy problems of fMRI data by adding decorrelation and smoothing constraints in original Euclidean distance cost function. We also generate a novel training procedure by modifying the update rules and combining with optimal brain surgeon (OBS) algorithm. The experimental results on visuomotor task fMRI data show that our cALSNMF fits fMRI data better than original ALSNMF in detecting task-related brain activation from single subject's fMRI data.

• The Korean Journal of Health Service Management
• /
• v.4 no.1
• /
• pp.145-156
• /
• 2010

The purpose of this study is one of high price medical equipment wished to grasp propriety factor about the MRI introduction, analyzing payability through cost accounting into compensation. It was investigated from January 1 to December 31, 2007 about the MRI of a General Hospital. Expectation availability was 23.2 cases, but actual availability did achievement more than 196.1% with 45.5 items. It is estimated that there are a lot of occurrence cases because great reasons that actual availability increases more than expectation availability is excellent resolving power than a CT, and is device that prefer to reason back that radiation damage is less in person body. The followings show the main results of this study. 1. The MRI was construed in order of cost accounting, wave and personnel expenses 45.4%, administrative expenses 53.0%, and material costs 1.6%. 2. According to CVP (Cost-volume-profit) analysis, BEP (Break Even Point) profit is 173,931,428 won for 11 months, and break even usage number of items are 37.5 cases, and separation usage number of items were confirmed by 1.4 cases. Therefore, was construed that can achieve BEP within 11 months though usage number of items keeps 1.4 items day to create the MRI's hospital operation profit. 3. Estimated limit profitability appears high by 96.7%, exceed fixed charges even if when is non-benefit and when it is benefit consider variable, is judged that the MRI's addition induction helps in hospital management enhancing earning rates.

• Health Policy and Management
• /
• v.8 no.1
• /
• pp.155-182
• /
• 1998

There exists a remarkable differences in use of MRI scanning among income classes. The poor can hardly utilize it. This is because, among high cost technnologies, MRI is the only equipment not covered under health insurance benefits in Korea. This study was designed 1) to reveal the status of nation-wide MRI installation, customary charges and per unit annual scanning performance, and 2) to analyse factors influencing the above variables. The data for this study came from "MRI Prevalence Survey" conducted by the National Federation of Medcial Insurance(NFMI) in 1997, and were analyzed through SAS packages for T-test, analysis of variance and stepwise multiple regression. Data were collected from 188 hospitals equipped with MRI scanners. Major findings are summarized as follows : The number of MRI scanners has increased from 69 in 994 to 158 in 1996(2.3 times) while per unit annual scanning performance has risen by 11.2% from 2,173 cases in 1994 to 2,417 cases in 1996. Such a rapid increase was made possible mainly due to the inclusion of CT scanning under the health insurance benefit package. The customary charges for MRI scanning with or without contrast media, on average, amounted to 484,000 Won and 402,000 Won, respectively, with the percentile increase of 17.8% and 8.1% each during the same time. Korea ranks the third worldwidely in terms of number of MRI installations, 4.8 scanners per one million persons, only next to Japan and United States. Geographical variation of MRI, however, was rather high, 7.91 unit, in Cheju area compared to 1.82 in Kyongnam area. Variations of customary charges of MRI scanning can be explained as much as by 44.8% by both the total amount of claims to NFMI and geographical variable. The charges were more likely to be higher in metropolitan areas like Seoul and in hospitals with a bigger amount of claims. While those of per unit annual scanning performance can be explained as much as by 30.7% by both MRI installation cost and level of MRI-installed organizations. Per capital scannig performance was higher in tertiary hospitals and hospitals equipped with more expensive scanners than hospitals with less expensive scanners. Two measures are called for the remedying the existing excessive abundance in MRI units in korea : One is to set a ceiling of MRI units in an area like a province or a metropolitan district. The other is to establish a committee on introduction of high cost technologies for reviewing its effective use.ctive use.

• Korea Journal of Hospital Management
• /
• v.2 no.1
• /
• pp.1-21
• /
• 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.

• Investigative Magnetic Resonance Imaging
• /
• v.16 no.1
• /
• pp.1-5
• /
• 2012

Breast MRI is the most accurate adjunctive to the mammography for the screening of breast cancer. Despite lack of randomized controlled trials on the effectiveness of MRI screening, it is now recommended for the women at high risk for breast cancer by the American Cancer Society and the National Comprehensive Cancer Network based on several prospective observational studies. In Korea, a retrospective study reported that preoperative MRI screening of the contralateral breast in women with unilateral breast cancer was associated with reduced metachronous cancer incidence. To introduce breast MRI as a supplemental modality to screening mammography in Korea, standardization and education of interpretation, establishment of MR-guided biopsy and adequate indication, and evaluation of cost-effectiveness and should be preceded.

• Progress in Superconductivity and Cryogenics
• /
• v.5 no.1
• /
• pp.1-12
• /
• 2003

In this paper we present a brief description and summary results of each of our recent activities in three areas, all devoted to NMR and MRI superconducting magnet technologies: 1) development of a high-field LTS / HTS NMR magnet; 2) development of a novel digital flux injector for slightly resistive NMR magnets; and 3) a proposal fer a low-cost MRI magnet system based on $MgB_2$ composite and an innovative cryogenic design / operation concept.