• Journal of Preventive Medicine and Public Health
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• v.34 no.4
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• pp.347-353
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• 2001

Objectives : To determine the impacts of Diagnosis-Related Groups/Prospective Payment System (DRG/PPS) on the quality of care in cases of Cesarean section and to describe the policy implications for the early stabilization of DRG/PPS in Korea. Methods : Data was collected from the medical records of 380 patients who had undergone Cesarean sections in 40 hospitals participating in the DRG/PPS Demonstration Program since 1999. Cesarean sections were peformed in 122 patients of the FFS(Fee-For-Service) group and 258 patients of the DRG/PPS group. Measurements of quality used included essential tests of pre- and post-operation, and the PPI(Physician Performance Index) score. The PPI was developed by two obstetricians. Results : Univariate analysis demonstrated significant differences in PPI scores according to the payment systems. With respect to the mean of PPI scores, a higher score was found in the DRG/PPS group than in the FFS group. However, the adjusted effect did not show significant differences between the FFS group and the DRG/PPS group. Conclusion : This study suggested that the problem of poor quality may not be related to the implementation of DRG/PPS in Cesarean section. However, this study did not consider the validity and reliability of the process measurement, and it did not exclude the possibility of data emission in medical records.

• Korea Journal of Hospital Management
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• v.26 no.3
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• pp.68-83
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• 2021

Background: It is widely acknowledged that single bedrooms have many potential advantages compared to multiple bedrooms. However, Korea has a reimbursement system that patients have to pay the additional fee if they will use single bedroom or pay-bed (1-3 bedroom). There is little research on patients' bed selection and relationship between patient satisfaction and bed type in the Korean setting. Methods: Using the 2017 Korea Health Panel (KHP) Survey data, we modified bed type by two dichotomous variables: single bedroom vs. multiple bedroom (2+ bedrooms) and pay-bed (1-3 bedroom) vs. reimbursed bed (4+ bedroom). Multivariate logistic regression is performed to determine the factors affecting the patient's choice of room types. Multivariate regression analysis was conducted to examine how hospital room types are affecting patient satisfaction. Results: Single room and pay-bed (1-3 bedroom) use was influenced by patient age (19- years old), male, a person at work, hospitalizing in a clinic, and birth. After controlling variables of the behavioral model of medical utilization, the association between patient satisfaction and use of single bedroom & pay-bed (1-3 bedroom). Cause of hospitalization, major treatment, and recognition of unnecessary care are statistically significant variables on patient satisfaction. Conclusion: Although the single room is about the standard for newly built hospitals in western countries, it remains unclear that single room or pay-bed (1-3 bedroom) has positive effects on patient's outcomes and satisfaction. In this empirical study, the difference in patient satisfaction by bedroom type was not noticeable. In terms of bed management by hospital staff, securing patient credibility in hospital care is an important task. Patients' perception of whether medical staffs have encouraged unnecessary treatment or tests has a significant impact on patient's satisfaction.

• Korea Journal of Hospital Management
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• v.24 no.2
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• pp.67-83
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• 2019

The aim of this study is to analyze the differences in the publicness indices depending on the environmental factors of regional public hospitals to derive the policy implications for improving management for regional public hospitals. The data of the 34 regional public hospitals from 2016 was used for the analysis. Major results of this study are as follows. First, the analysis of the differences in the scores of the medical safety net function showed significantly higher scores for regional public hospitals with a larger location, a larger number of hospitals in a unit area, a larger number of nurses per 100 beds, and the lower management fee ratio. Second, the analysis of the differences in the scores of the unmet healthcare needs showed significantly higher scores for regional public hospitals with a larger number of hospitals in a unit area, and a larger number of beds. Third, the analysis of the differences in the scores of the hospital-specialized services showed significantly higher scores for regional public hospitals with a larger location, a higher financial independence of the local government, a larger number of hospitals in a unit area, a larger number of beds, and a larger number of nurses per 100 beds. Major conclusions of this study are as follows. Consideration should be given to the appropriate number of nurses for each regional public hospital to maximize publicness by providing the appropriate amount of medical services, but not to incur unnecessary labor costs. In addition, efforts should be made to enhance profitability, which can be a means of strengthening publicness, by identifying the minimum administrative expenses required for efficient operation and reducing unnecessary administrative expenses. Finally, it is necessary to identify the appropriate number of beds to meet the needs of the customers and to create maximum profits.

• Journal of Physiology & Pathology in Korean Medicine
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• v.33 no.3
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• pp.181-190
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• 2019

In South Korea, traffic accident patients can be treated under automobile insurance coverage. This study investigated the status of Korean medicine (KM) Automobile insurance system and usage status of main pharmacopuncture in KM clinic which reported that the largest number of automobile insurance fee claims among medical institutions. We surveyed 258 traffic accident patients who were treated at Namsangcheon KM clinic from 2014 to 2018 according to medical chart. The majority of the patients were male and thirties. In traffic accident situation, the highest distribution was car to car crash with 85.66% and 66.67% of the patients visited in the most acute phase. The most frequent treatment period was within 4 weeks and the number of treatments was 10 or less with 72.87%. In total results of treatment, the distribution was exellent with 10.08%, good with 46.90%, fair with 27.13% and poor with 15.89%, and the effective rate was 84.11%. The most frequent treatment period was within 4 weeks with 64.73% and the number of treatments was 10 or less with 72.87%. Of the 242 patients who received pharmacopunture, 91.5% were treated with HO, which was named after Honghwaja and TA, which was named after traffic accidents, and there were significant differences in the number of treatments and symptom improvement between the two groups. In this study, we confirmed the status of automobile insurance treatment and usage of main pharmacopuncture of single KM clinic with symptom improvement. This study can be regarded as one of the basis of KM treatment for the rapidly growing automobile insurance market.

• Journal of Society of Preventive Korean Medicine
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• v.26 no.1
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• pp.25-41
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• 2022

Background & Objectives : As the government of South Korea implemented policies to strengthen health insurance coverage, the health insurance benefit for raw herbal medicines has been promoted. This study investigated the current status of the herbal medicines coverage in the Japanese national health insurance to secure reference data for the design of herbal medicines coverage in South Korea. Methods : Literature review was conducted to collect and analyze the history and current situation on herbal medicines coverage in the Japanese health insurance system. To supplement the contents not presented in the documents, on-site interviews were conducted at the medical institutions and pharmacies that prescribed or prepared herbal medicines in Tokyo, Japan. The contents of the survey included the background and progress of the herbal medicines coverage, the status of herbal medicines use, the payment system, and the safety management of herbal medicines. Results : Since the introduction of health insurance in the 1960s, Japanese insurance system has covered herbal medicines, and so far, it has been maintained without any additional restrictions. When the raw herbal medicines are prescribed to outpatients, the preparation fee is set higher than that of other medicines, but overall payment regulations and systems for herbal medicine are generally the same as other medicines. Conclusions : The case of Japan can be a useful references and implications for national health insurance policy on herbal medicines in south Korea.

• Journal of the Korean Society of Radiology
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• v.81 no.5
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• pp.1024-1037
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• 2020

The resource-based relative value scale (RBRVS) compares the value of a medical practice to the consumption of resources, which consist of the work of the physician, practice expenses, and professional liability insurance. At the time of the 2nd revision of RBRVS, the fee for radiological examinations had been reduced due to the high preservation rate. In RBRVS, practice expenses account for most of the compensation of radiological examinations, and physicians' work is relatively undervalued. A new healthcare policy (Moon Jae-In care) consists of the expansion of the National Health Insurance (NHI) coverage, reduction of patient charges for the vulnerable class, and support for catastrophic medical expenses. However, Moon Jae-In care is expected to negatively affect the NHI in Korea financially. The expansion of the insurance coverage for ultrasonography and MRI examinations is a significant part of the Moon Jae-In care, and radiological societies should establish fair compensations for physicians' work within the field of radiology while implementing the Moon Jae-In care.

• Health Policy and Management
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• v.19 no.3
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• pp.92-108
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• 2009

This study suggests a model for continuing and comprehensive management of hypertension or Type 2 diabetes mellitus (T2DM) in Korea. Moreover, this paper computed the contribution cost of hypertension or T2DM management using the healthcare medical cost, which could have occurred from stroke, myocardial infarction (MI), and end-stage renal disease (ESRD) that were successfully prevented from the effective hypertension or T2DM management. Additionally, these costs were compared with the cost of implementing the hypertension or T2DM management model suggested in this study. This study used the medical fee summary of the health insurance claims submitted to National Health Insurance Corporation by medical facilities for services provided during the period from January 1st 1999 to December 31st 2006. The prevalence rate with treatment referred to cases in which patients submitted their medical claims at least once during the period, along with an accordant diagnosis. The incidence rate with treatment referred to cases in which patients who never submitted claims for the accordant disease during the five years from 1999 to 2003 submitted claims for the accordant disease in 2004 and 2005. The relative risk of the occurrence of stroke, MI and ESRD was 11.0, 13.6, and 30.3, respectively. The attributable risk of hypertension or T2DM for stroke was 0.730, and that for MI and ESRD were 0.773 and 0.888, respectively. Based on these, the contribution cost of hypertension or T2DM is estimated to be 986.3 billion Korean Won(KRW) for stroke patients, 330.5 billion KRW for MI patients, and 561.7 billion KRW for ESRD patients as in 2005. Hence, the total contribution cost of hypertension or T2DM to stroke, MI, and ESRD is 1.878 trillion KRW. The estimate for operational costs included an annual expenditure of 50,000 KRW per each recipient and an annual subsidy of 0.22 million KRW per person for the 1.6 million low.income individuals with hypertension or T2DM to cover their out.of.pocket medical expenses. Under this assumption, it took approximately 0.6 trillion KRW to manage 5 million high.risk patients in the low. and mid.income range, coverings up to 50% of costs. In conclusion, considering the potential benefits of preventing stroke, MI, and ESRD, the costs seems to be reasonable.

• Journal of Technologic Dentistry
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• v.31 no.2
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• pp.15-22
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• 2009

This study examined and analyzed the demographical characteristics of the study target and their expectancy level on the factors in selecting dental medical institutes (basic elements of dental clinics, traffic convenience, physical environment of dental clinic and explicit qualification of dentist) with the questionnaire survey method with 222 questionnaires answered and returned (return rate 88.8%) out of 250 copies distributed to the 1st, 2nd and 3rdyear college students attending technical colleges located in Cheongwon-Gun, Chungbuk, Korea from March 26 to April 7, 2009. The results of this study are as follows: 1. The demographical characteristics of the study target group consisting of 225 college students include 92.3% of age 20s (205 students); 123 males (55.4%) and 99 females (44.6%); the number of those who had at least one experience to visit dental clinic was 199 (89.6%) and 23 (10.4%) of those with no-visiting experience. 2. The descriptive statistics for the selection factor showed that basic elements, traffic convenience, physical environment and explicit qualification of dentist were regarded important as in order. In particular, the factors considered in selecting dental clinic was ordered from most to least in their importance beginning with cleanness of dental clinic as the most important factor, dentist's trustworthiness, kindness of medical staffs, low medical fee, dentist's knowledge level, modernized medical equipments and convenience in using medical facilities as the least. On the contrary, brand name of dental clinic, age, college, sex and appearance of dentist were rated low in order in terms of their importance in selecting dental clinic. 3. As for the difference in the selection factors across demographical characteristics, while male students placed importance on traffic convenience and physical environment of dental clinic, female students placed more importance on dentist's qualification and basic elements of dental clinic. With respect to the difference in the selection factors across the visiting experiences, while those with visiting experience regard traffic convenience more importantly, those without visiting experience regarded physical environment of dental clinic, dentist's qualification and basic elements of dental clinic. 4. In terms of pearson correlation coefficient, the result showed that all aspects in selecting dental clinic were positively correlated. Particularly, the correlation between physical environment of dental clinic and dentist's explicit qualification were correlated highest. Significant positive correlations were found high in traffic convenience, physical environment of dental clinic, dentist's explicit qualification and basic elements of dental clinic in order.

• Journal of Digital Convergence
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• v.12 no.6
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• pp.385-396
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• 2014

The purpose of this study was to examine the recognition of citizens in Busan on the doctor-designation system, the awareness of medical consumers with experience of using this system and their satisfaction in an effort to seek ways of improving this system. The subjects in this study were the selected citizens in Busan who were at the age of 20 and up. As a result, it's found that the largest group of the respondents was female, in their 20s, received college or higher education, students and in the service industry, and that the most common monthly mean income was between two and 2.99 million won. 27.7 percent were aware of the doctor-designation system, and 23.7 percent became cognizant of the system through others who had used it. The rate of knowing the rules of the doctor-designation system (the right answer) stood at 66.3 percent. They got to know about the system through mass media(31.9%), and used it since it offered highly specialized treatment(57.5%). The respondents who had used it intended to reuse it(76.3%), and the reason was that they were provided with high-class medical services (35.2%). The respondents who had used this system got a mean of 2.96 in satisfaction level, which was not high in general. They mentioned more publicity efforts(91.2%), offering information in a conspicuous place (96.7%) and cutting doctor-designation treatment fee as a means of improving this system. As for how to ensure the operating efficiency of the system, sustained publicity seem to be necessary to raise awareness of the system among patients, and it's required to take measures to relieve patients of financial burden caused by medical bills.

• Journal of Acupuncture Research
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• v.33 no.3
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• pp.67-73
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• 2016

Objectives : The objective of this study is to discuss problems and potential improvements of national health insurance fees associated with miniscalpel acupuncture according to Korean medical doctors' workload, material cost and degree of risk. Methods : We researched the change of relative value points, national health insurance fees, the acupuncture process, and Korean medicine doctors' workload related to Miniscalpel acupuncture, as compared to general meridian point acupuncture. We also examined material cost by surveying pharmacies, internet shopping malls and medical appliance shops. Results : Relative value point for Miniscalpel acupuncture decreased from 2010 to 2012, and remained the same from 2012 to 2016. National health insurance fees for Miniscalpel acupuncture increased by a small margin annually for rise of equivalent index. There was no reporting on workload related to Miniscalpel acupuncture. Material cost of Miniscalpel acupuncture was 18.2~20.7 times higher than actual cost of procedure. There were few studies examining medical accidents related to Miniscalpel acupuncture, and thus we could not evaluate degree of risk. Conclusion : We suggest revaluating Korean medical doctors' workload related to including Miniscalpel acupuncture, to consider the material costs of Miniscalpel acupuncture, and investigate its degree of risk by researching medical accidents.