• Korea Journal of Hospital Management
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• v.10 no.1
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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.

• The Korean Society of Law and Medicine
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• v.15 no.1
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• pp.83-122
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• 2014

Compared with medical cases and health care law from other countries there has been a lot of progress on medical law, especially on medical precedents in Korea. However, in recent years, medical precedents tend to reflect a realistic position of health care providers, rather than normative position of the victim. The burden of proof to prove strict liability is given to patients in civil law suits by courts, patients generally has the burden of proof. The rate of claims to prove the negligence of medical malpractice is falling significantly. Even if the error is acknowledged, it is not enough to get right to be relief for patients by increasing limitations of liability or ratio of patient's own negligence. Compensation fee is included in medical fees and risk of medical malpractice actions contributes ultimately to a health care consumer. In conclusion, author represents a major the new upgrade of above mentioned problem. By advising that court should assess actively for the perspective of victim for medical negligence we will be able to exercise remedies of patients' rights and to prevent recurring medical accidents and also contribute to medical advances.

• Journal of agricultural medicine and community health
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• v.30 no.1
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• pp.1-14
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• 2005

Objectives: This study attempts to analyze the length of hospital stay and expenses of frequent disease admitted in a Vaterans Hospital. Methods: Data was collected from January 1, 2001 to December 31, 2003 from the Claim records of 9,640 patients in a Vaterans Hospital. Results: The results were as follows: 1. In age & sex distribution, there was male 70.9%, female 29.1%, and 35.8% of them is 70 age group. Frequency by insurance program was Health insurance 78.1%, Medical aid 14.2%, no insurance 4.1%, others 3.6%. Distribution of each department was internal medicine 28.3%, orthopedic surgery 21.3%, surgery 16.6%, neurosurgey 7.1%, pediatrics 5.9%. Also, in the veterans group, male to female patient ratio was 99.3% male to 0.7% female, them over 70 years old was 51.6%, and them which live in daejeon was 43.5%. 2. In frequency of disease, there was gastroenteritis 4.8%, pneumonia 3.8%, cartaract 3.7%, cerebral infarct 3.2%, hyperplasia of prostate 3.0%. In frequency of korean standard classification of diseases, there was injury and poisoning and certain other consequences of external causes 17.1%, diseases of digestive system 16.1%, diseases of musculoskeletal system and connective tissue 13.9%, diseases of respiratory system 9.4%, diseases of genitourinary system 8.6%. Also, in veterans group, frequency of them was diseases of musculoskeletal system and connective tissue 19.4%, diseases of digestive system 16.8%, injury and poisoning and certain other consequences of external causes 15.7%, diseases of genitourinary system 9.7%, diseases of circuatory system 8.2%. 3. Average length of hospital stay was 29.0 days for total patients, 51.8 days for the veterans group, 15.7 days for the non-veterans one. Average total expenses was 3,669,579 won, the veterans group 7,263,877 won, the non-veterans one 1,560,333 won. The ratio of insurer to insuree was 55.2 : 44.8, the ratio of amount paid by patient in the veterans group 61.7%, in the non-veterans one 33.0%. 4. In items of medical expenses, fee for hospital accommodation was 34.7%, fee for medication 13.2%(injection 7.8%, drug 5.4%), fee for service 48.6%(physical therapy 26.3%, operation 9.7%, laboratory examination 5.2%, radiological examination 3.1%, etc), others 3.4%. In them for the veterans group, fee for physical therapy was 35.3%, fee for hospital accommodation 35.2%, fee for injection 6.2%, fee for operation 5.9%, for the non-veterans one, fee for hospital accommodation 35.7%, fee for operation 16.4%, fee for injection 11.4%, fee for laboratory examination 8.3%. 5. In the comparison of the frequency by Korean standard classification of diseases and distance between the hospital and home, the region under 21.5Km was more frequent in symptoms, signs an abnormal clinical and laboratory findings 56.0%, injury and poisoning and certain other consequences of external causes 55.6%, diseases of the eye and adnexa 52.9%, the one over 21.5Km was more frequent in neoplasms 57.4%, diseases of musculoskeletal system and connective tissue 55.9%, diseases of genitourinary system 53.5%.

• Korea Journal of Hospital Management
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• v.2 no.1
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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.

• The Journal of the Korea Contents Association
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• v.18 no.11
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• pp.581-593
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• 2018

The purpose of this study is to examine the effect of the medical service quality of the nursing hospital on the inpatients' satisfaction, reuse intention and to verify the mediating effect of the inpatients' satisfaction. The subjects of this study were 255 male and female inpatients in Hiroshima in Japan. The collected data were used as a model of path coefficients obtained through analysis of covariance structure and hypothesis test. As a result of verification, level of medical team and medical service, reception, facility and fee of the medical service quality of the nursing hospital perceived by the inpatients showed a statistically significant positive correlation with the inpatients' satisfaction. The inpatients' satisfaction showed a statistically significant positive correlation with their reuse intention. The level of medical team and medical service, reception, facility and fee of the medical service quality of the nursing hospital perceived by the inpatients shows a statistically no significant positive correlation with the reuse intention. But, they show a statistically significant positive correlation with the reuse intention with the mediating effect of the inpatients' satisfaction. Finally, the result of this study is to confirm the effect of the medical service quality on the inpatients' satisfaction, reuse intention of the nursing hospital. In this process, it is meaningful to verify the role and function of medical service quality of the nursing hospital.

• Health Policy and Management
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• v.9 no.1
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• pp.1-29
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• 1999

The Government has recently planned to improve the medical insurance drug price systems by removing the drug margin occurring from the difference between the official and purchasing prices, and instead by setting prices through adding drug administration casts calculated to the purchasing costs. In the circumstances, the major policy and implementing issues are how to define the drug administrance cost and how to calculate them. This study attempts to provide for the conceptional and operational definitions and thereby develop a costing model for the cost. The relationship between the current systems of medical services costs and prices were reviewed to define the concept of the costs. The study defined the costs from the narrow and wide prospective of meaning, and three operational definitions were provided. The costing model was developed applying the departmental costing principles. Finally, several prerequisites that have to be considered for the implementation of the definition and the model from the practical viewpoint.

• The Journal of Korean Medicine
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• v.29 no.3
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• pp.100-112
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• 2008

Objectives: The purpose of this survey is to monitor the changes that have occurred in the business environment surrounding Oriental medicine clinics, with the focus on their facilities, staff, patients, and service fee revenue. Method adopted: A questionnaire was sent in December 2006 to 1,000 Oriental medicine clinics nationwide, of which 122 (or 12 percent of them) replied. Previous questionnaires similar to this one in nature were checked for comparison. Results: As a result of analyzing the aforesaid replies, the average Oriental medicine clinic appears to have a floor size of 156 square meters (= 47.2 pyeong) and is equipped with 6.6 beds. The number of helpers and nurse's aids at each Oriental medicine clinics comes to 3.2 and 1.58, respectively. The number of patients coming to see a practitioner of Oriental medicine stands at 36.3 persons per day, of whom 32.06 come for acupuncture treatment. 50.2 percent of the Oriental medicine clinics' service fee revenue is paid from the health insurance. Each clinic spends on average 2.42 million won per month on the purchase of medicinal substances and so forth. The foregoing indicates a 27 percent increase from 1999 in terms of floor size, a 30 percent increase in the number of beds, a 47 percent increase in the number of helpers, a 45 percent increase in the number of nurse's aides, and an 11 percent increase in the number of patients who visit a practitioner of oriental medicine. As for the latter figure, there was an increase of 3.64 over a seven-year period. The number of patients coming for acupuncture treatment increased by 7.06 in the same period, whereas the number of those coming for medication treatment decreased by 4.28 percent. Health insurance payments as a proportion of Oriental medicine clinics' service fee revenues increased by 23.9 percentage points from 26.29 percent in 1997 to 50.2 percent in 2006. The amount that a clinic spends on the purchase of medicinal substances, etc, decreased by 250,000 won or by 9.3 percent from 1999. The estimated value of the domestic Oriental medical service market for 2006 stood at 2,422.2 billion won in total. Conclusion: Oriental medicine clinics in Korea appear to be getting larger, with an increase in the number of beds and helpers. Health insurance payments now account for a greater proportion of Oriental medicine clinics' service fee revenues, and management conditions at the clinics are deteriorating.

• Korean Journal of Clinical Laboratory Science
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• v.55 no.3
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• pp.159-166
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• 2023

This study investigates the current situation of medical technologists for blood collection, which is considered the most important step for diagnosis. The survey enrolled 650 medical technologists working in hospitals and medical check centers in Busan, Ulsan, and Gyeongnam. We found that each medical technologist performed blood collection for about 100 patients. There was more than one blood collection failure per day, with more than one case of pain and filing of civil complaints per year. Hence, there was a high work burden on the medical technologists. Cases where a medical technologist was stabbed with a used needle occurred more than once a year, and about 15% of them received infection control and treatment because of stab wounds. Additionally, more than half of the participants suffered from musculoskeletal disorders and mental stress due to blood collection work. Unlike administering intravenous and intramuscular injections using the same needle, no fee is charged for blood collection. Based on the results of this study, it will be possible to improve the safety and rights of medical technologists by calculating the actual fee for blood collection work and assigning a relative value score.

• The Journal of Internal Korean Medicine
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• v.27 no.4
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• pp.827-835
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• 2006

Objectives : This study investigated the actual condition of an oriental medical office in a public health center. Methods : We classified patients who visited an oriental medical office in the public health center of Gyeyang-gu over a 1-year period, according to age, sex, disease, etc. The number of patients was 6529. Results : Analyzing these 6529 persons, 65.8% were female, and 79.6% were seniors aged over 65. By disease category motor systemic disease or circulatory disease affected 84% of the patients. By medication or treatment category. O-Juk-San (五積散) at 38.3% was the greatest proportion, and Pal-Mul-Tang (八物湯) the second greatest. As to medical fee, 80.2% of the patients were not charged for treatment. Conclusions : The extract of herbal medication should be more expanded in the medical insurance, and should be improved in quality. The oriental medical office in a public health center should focus more on health promotion and disease prevention than patient care. For accomplishing this goal, the institutional position and rights of oriental medical doctors as civil officials should be equal to those of western medical doctors.

• Health Policy and Management
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• v.5 no.1
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• pp.1-30
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• 1995

This study was conducted to investigate the distribution of private medical practitioners' income from the medical insurance and its determinants. Total amount of the medical service fee paid by the medical insurance to 1,268 private clinics(767 in Taegu and 510 in Kyungpook that had been in practice at least for one year) in 1993 was compared by the characteristics of practitioner, clinic, patient and population. The practitioners in 40-49 years of age and 6-10 years inpractice had the highest income. Total income of a clinic was increased with the number of physicians, employees and equipments. The largest income differentials were observed among obstetrics and gynecology clinics and the least differentials were among pediatrics clinics. The characteristics of practitioner, clinic and population accounted for 41.7% of the total variance of income. The important determinants of income were specialty of the clinic, age of the practitioner and number of the employee and equipments. The large income differentials among clinics imply a skewed distribution of patients and thus long waiting time, inefficient utilization of manpower and inadequate quality of care. Effective measures to reduce the income differentials need to be developed.