• Health Policy and Management
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• v.23 no.1
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• pp.3-18
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• 2013

This paper investigates the possibility of expanding pay-for-performance (P4P) program as a provider payment system, in terms of financial, economical, and political sustainability. In order to expand the sustainable P4P, P4P should have usefulness in terms of economic value as well as efficiency in the financial aspects of health care. More importantly, the P4P would be politically sustainable only when both providers and consumers can accept. Korea's healthcare system seems to have logical ground for the P4P program financially and economically. However, how well the P4P can work remains to be proven in its implementation. After 43 tertiary hospitals applied the P4P program for acute myocardial infarction (AMI) and C-section in 2007, the number of hospitals adopting the P4P program for AMI and C-section has increased to 316 in 2011, and an incentive for hospitals applying the P4P has risen to 2% from 1% of health insurance benefits. This shows that the P4P program introduced by Health Insurance Review and Assessment Service is quite successful. In addition, people are aware of the need for improved P4P program and policy alternatives have been already made. Therefore, it is very important to come up with politically supportable strategies that can make providers and consumers accept the P4P program while maintaining the governance of the existing health insurance policy. To this end, there are some tasks to be considered. First, the expansion of the P4P program should be placed on the agenda of the Health Insurance Policy Review Committee, the highest decision-making body, and a separate agency for P4P planning should be established. Second, for more efficient P4P program, the processes of review and assessment, currently carried out separately, should be integrated into a single process. Third, infrastructure to measure the quality of medical services should be sharply expanded. Fourth, the current paradigm for the assessment should be changed. Lastly, a P4P program for consumers should be considered. Given that the consumers in Korea can use medical services freely, the National Health Insurance Corporation could initiate the P4P program for consumers as a means of controlling excessive use of medical services and adjusting consumer's moral hazard.

• The Journal of the Korea Contents Association
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• v.20 no.10
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• pp.510-521
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• 2020

Recently, transparency in accounting for medical institutions has been emphasized. However, due to the current system problems and structural limitations, there is a lack of diagnosis on the financial status of domestic hospitals. This study is based on the financial statements per 100 beds of 374 including domestic hospital level to tertiary hospital, and analyzed the Free Cash Flow(FCF) by hospital size from the perspective of Free Cash Flow Hypothesis. After deriving Operating Cash Flow(OCF) through the profit or loss statement of medical institutions, FCFs were analyzed through the prior and current financial statements and OCFs, and the correlation between financial variables was confirmed. According to the analysis, first, hospitals with 160 to 299 beds and 300 beds or more have relatively high FCFs. Second, certified tertiary hospitals, hospitals with less than 160 beds, and general hospitals have negative(-) FCFs. Thus, there's a need to narrow the FCF gap based on the size of the hospital, maintaining an appropriate level of FCF. This study is meaningful in that it was the first FCF analysis based on hospital size. This study is also expected to offer an informative resources in setting differentiated strategies according to the size of medical institutions when establishing new accounting policies in the future.

• Progress in Medical Physics
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• v.26 no.3
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• pp.185-191
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• 2015

As radiation therapy is one of three major cancer treatment methods, many cancer patients get radiation therapy. Because of the invisible and scattering characteristics of radiation, it is impossible to identify the quality and the amount of radiation and secondary cancer could be induced by scattered radiation. Because of advanced technique of radiation therapy and the reasons mentioned above, quality assurance of radiotherapy machine should be performed completely. International organizations such as International Atomic Energy Agency (IAEA), American Association of Physicists in Medicine (AAPM) suggest report of quality assurance to recommend united method of radiotherapy machine quality assurance. Domestic society of medical physics, however, is too small to make such a report, domestic hospitals selectively choose some of contents in global suggestions. As there are no suggestions for domestic hospitals and global suggestions are being updated, we did a survey about quality assurance for radiotherapy machine. The questionnaire is composed of possession of radiotherapy machine, items performed for quality assurance and manpower, etc. 37 of 72 hospitals answered to survey. These results could be used for making domestic standard quality assurance procedure.

• Journal of Preventive Medicine and Public Health
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• v.37 no.3
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• pp.260-266
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• 2004

Objectives : To assess the impacts of implementing case payment system (CPS) to Medical Aid (MA) hemodialysis patients on the frequencies and expenditure of dialysis. Methods : Fifty-eight clinics and 35 tertiary care hospitals were identified as having a minimum of 10 hemodialysis patients for each of the MA and Medical Insurance (MI) programs, who received hemodialysis from the same dialysis facilities for both periods of July 2001 and July 2002. From these facilities, a total of 2,167 MA and 2,928 MI patients were identified as the study subjects. Using electronic claims data, the changes in the total number of monthly treatments and charges for outpatient hemodialysis treatments for each patient after the introduction of the CPS were compared between the MA and MI patients. Multiple regression analyses were performed to examine the independent impact of the CPS on the utilization and expenditure of dialysis treatments among the MA patients. Results : There was a significant decrease in the total charges for the hemodialysis treatments of the MA patients, 3.4% (p<0.05), whereas a significant increase was observed for the MI patients, 2.5% (p<0.05). For both the MA and MI patients, the frequency of the monthly hemodialysis treatments were significantly increased, 5.5 (from 12.1 to 12.7) and 7.8% (from 11.6 to 12.5), for the MA and MI patients, respectively. However, a multivariate regression analysis showed no significant difference in the changes in the total number of monthly hemodialysis treatments between the MA and MI patients after implementation of the CPS. Another regression model, regressing on the changes in the monthly claims of dialysis treatments, showed a significant negative coefficient for the MA ((=-70725, p<0.05). Conclusion : The significant decrease in the total charges for hemodialysis treatments among MA as compared to MI patients suggests that there was a cost reduction in the MA program following the introduction of the CPS.

• Korea Journal of Hospital Management
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• v.19 no.1
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• pp.1-20
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• 2014

In this study, we investigated the relationship between friendship level within a hospital organization and job satisfaction, organizational commitment and job stress. Focusing on the hierarchy and occupation of a hospital, different from previous introductory studies. As a study tool, structured questionnaire were devised and used. The subjects were nurses, administrators and medical technicians who worked at 17 tertiary hospitals in Seoul and Kyongin area. To analyze the data, we conducted frequency analysis, t-test, one-way ANOVA, two-way ANOVA and multiple regression analysis.The main results of our study can be summarized as followings:Firstly, seen from the viewpoint of social demographic characteristics, on the whole friendship level with fellows is the highest, and then that with subordinates and that with bosses the lowest. Secondly, the friendship level with bosses, subordinates and fellows had a significant relationship with job satisfaction, organizational commitment and job stress, though there were some differences among them. In case of junior managers, the friendship level with fellows had a significant relationship with job satisfaction and organizational commitment; in case of middle managers, the friendship level with fellows had significant relationship with job satisfaction. We found that the friendship level with the bosses had a deeper relationship with job satisfaction, organizational commitment and job stress as we went down the hierarchy. Thirdly, analyzing the differences between occupation, administrators and medical technicians had relatively higher significant relationship with the friendship level with bosses than nurses in job satisfaction, organizational commitment and job stress. High friendship level with the bosses influenced job satisfaction significantly for the nurse; yet, in case of administrators and medical technicians, the friendship level with bosses influenced all of job satisfaction, organizational commitment and job stress. Based on our study, we recommend facilitating friendly relationship between the bosses and the subordinates in order to enhance job satisfaction, organizational commitment and job related stress reduction.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.2
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• pp.1216-1226
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• 2015

This study aimed to suggest education direction for diving safety through investigating actual condition to diving safety before and during scuba diving. The study subjects were 227 scuba divers. Data were collected from September 21, 2012 to August 16, 2013. The collected data were analyzed using SPSS 21.0. The results were as follows. Many higher level divers didn't obey regulations: 'alcohol drinking', 'warming-up exercise', 'to dive even when he/she suffers from respiratory disease' before scuba diving. Many lower level divers didn't obey regulations: 'to stop diving under abnormal physical condition', 'to do safety stop during ascending time', 'to check during ascending time', 'to know ascending and descending speed per minute', 'to use an alpha flag or buoy' during scuba diving. In conclusion, it is necessary to implement a discriminative safety education and to check actual condition to diving safety periodically in consideration of duration and level of diving.

• Journal of the Korean Society of Radiology
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• v.15 no.7
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• pp.1041-1047
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• 2021

In this study, the effective dose for frequently general radiography among the diagnostic reference level (DRL) for examinations provided by the government in Korea was evaluated using the Monte Carlo N-Particle eXtended (MCNPX) simulation tool. We were selected to evaluate for a total of 5 examination sites which included head anterior-posterior, chest (posterior-anterior, lateral), abdomen anterior-posterior and pelvis anterior-posterior. Physical conditions such as tube voltage and tube current used in MCNPX simulation were used in domestic conditions of the Korea Disease Control and Prevention Agency (KDCA). To evaluate domestic medical radiation exposure, we used the HDRK-Man computerized human phantom manufactured based on the international standard ICRP 103 that was applied to the MCNPX simulation. The phantom could represent the standard body shape of Koreans. As a results, the effective dose corresponding to the DRL based on adult males of head anterior-posterior position was 0.086 mSv, chest posterior-anterior position was 0.05 mSv, chest lateral was 0.354 mSv, abdomen anterior-posterior position was 0.548 mSv, and pelvis anterior-posterior position was 0.451 mSv.

• Safety and Health at Work
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• v.12 no.4
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• pp.530-535
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• 2021

Background: Despite the lack of official COVID-19 statistics, various workplaces and occupations have been at the center of COVID-19 outbreaks. We aimed to compare legal measures and governance established for managing COVID-19 infection risks at workplaces in nine Asia and Pacific countries and to recommend key administrative measures. Methods: We collected information on legal measures and governance from both general citizens and workers regarding infection risks such as COVID-19 from industrial hygiene professionals in nine countries (Indonesia, India, Japan, Malaysia, New Zealand, Republic of the Philippines, Republic of Korea, Taiwan, and Thailand) using a structured questionnaire. Results: A governmental body overseeing public health and welfare was in charge of containing the spread and occurrence of infectious diseases under an infectious disease control and prevention act or another special act, although the name of the pertinent organizations and legislation vary among countries. Unlike in the case of other traditional hazards, there have been no specific articles or clauses describing the means of mitigating virus risk in the workplace that are legally required of employers, making it difficult to define the responsibilities of the employer. Each country maintains own legal systems regarding access to the duration, administration, and financing of paid sick leave. Many workers may not have access to paid sick leave even if it is legally guaranteed.

• Quality Improvement in Health Care
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• v.27 no.2
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• pp.73-82
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• 2021

Purpose: This study aims to examine the quality of tuberculosis (TB) care after the 1st to 3rd national quality assessment (QA) program for TB healthcare service in Korea was conducted. Methods: We analyzed Health Insurance Review & Assessment Service (HIRA) claims data of new TB patients during the period of January to June from 2018-2020. The new TB patients were defined as TB patients reported to Korea Centers for Disease Control and Prevention Agency (KCDA). The unit of analysis was the patient. Chi-square tests were used to analyze the differences in indicator value according to the types of medical facilities. The QA indicators of TB care were divided into 3 areas consisting of the following 7 quality indicators: 4 indicators of diagnosis test (the rate of acid-fast bacilli smear, the rate of acid-fast bacilli culture, the rate of Mycobacterium tuberculosis-polymerase chain reaction, drug susceptibility test), 1 compliance of treatment guideline, and 2 indicators of care management of TB patients (encounter rate, day of therapy). Results: The QA program for TB care was conducted among 8,246 patients from 534 facilities in 2020. The value of the 7 quality indicators was shown to increase as a result of the QA program. The indicators of the diagnostic test were all higher than 95%, with the exception of the drug susceptibility test which was 84.8%. Both indicators for care management of TB patients were 88.5%. Conclusion: The quality of TB care has been improving with the implementation of the QA program. In order to continue to improve the quality of TB care, it will be necessary to disclose the results of the QA program in medical facilities in the future.

• Journal of Popular Narrative
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• v.27 no.1
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• pp.133-185
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• 2021

This study is an attempt to connect television drama M, which deals with abortion issues, with theoretical focus such as materiality, relativity, and agency, to understand diffractively as an cartography of agential reality. According to Karen Barard's Agential Realism, Television drama M is a sociocultural phenomenon produced by the agential intra-actions of material-discursive apparatuses such as medical technology, ghost stories and legends, and male-affect. The 1990s repeatedly revealed "hate" through apparatuses such as technology, discourse, and affect, which are directed at women's gendered bodies. The material -discursive practice of plastic surgery and abortion proves that the agential reality surrounding the body is closely intertwined with medical technology, as well as with the genderized hate. Another related material-discursive phenomenon is rediscovery of the legend and fad of the ghost story, which is also produced from the hate of the denaturalized body, which is once again expanded and reproduced. Appearing in this environment of affect, M enacts diffraction, which is based on backlash, lacking posthuman implications for the materialization of the techno-body. M puts humanistic assumptions about "Man" as a universal definition, historically framed and defined in context. But it is not universal and it is gendered. The current time when the political turmoil surrounding medical technology, discourse, and bodily matters is violently intra-acted is the time to carefully account and respond to the alternative definitions of human beings that M has rejected.