Analyses of the Efficiency in Hospital Management (병원 단위비용 결정요인에 관한 연구)
-
- Korea Journal of Hospital Management
- /
- v.9 no.1
- /
- pp.66-94
- /
- 2004
The objective of this study is to examine how to maximize the efficiency of hospital management by minimizing the unit cost of hospital operation. For this purpose, this paper proposes to develop a model of the profit maximization based on the cost minimization dictum using the statistical tools of arriving at the maximum likelihood values. The preliminary survey data are collected from the annual statistics and their analyses published by Korea Health Industry Development Institute and Korean Hospital Association. The maximum likelihood value statistical analyses are conducted from the information on the cost (function) of each of 36 hospitals selected by the random stratified sampling method according to the size and location (urban or rural) of hospitals. We believe that, although the size of sample is relatively small, because of the sampling method used and the high response rate, the power of estimation of the results of the statistical analyses of the sample hospitals is acceptable. The conceptual framework of analyses is adopted from the various models of the determinants of hospital costs used by the previous studies. According to this framework, the study postulates that the unit cost of hospital operation is determined by the size, scope of service, technology (production function) as measured by capacity utilization, labor capital ratio and labor input-mix variables, and by exogeneous variables. The variables to represent the above cost determinants are selected by using the step-wise regression so that only the statistically significant variables may be utilized in analyzing how these variables impact on the hospital unit cost. The results of the analyses show that the models of hospital cost determinants adopted are well chosen. The various models analyzed have the (goodness of fit) overall determination (R2) which all turned out to be significant, regardless of the variables put in to represent the cost determinants. Specifically, the size and scope of service, no matter how it is measured, i. e., number of admissions per bed, number of ambulatory visits per bed, adjusted inpatient days and adjusted outpatients, have overall effects of reducing the hospital unit costs as measured by the cost per admission, per inpatient day, or office visit implying the existence of the economy of scale in the hospital operation. Thirdly, the technology used in operating a hospital has turned out to have its ramifications on the hospital unit cost similar to those postulated in the static theory of the firm. For example, the capacity utilization as represented by the inpatient days per employee tuned out to have statistically significant negative impacts on the unit cost of hospital operation, while payroll expenses per inpatient cost has a positive effect. The input-mix of hospital operation, as represented by the ratio of the number of doctor, nurse or medical staff per general employee, supports the known thesis that the specialized manpower costs more than the general employees. The labor/capital ratio as represented by the employees per 100 beds is shown to have a positive effect on the cost as expected. As for the exogeneous variable's impacts on the cost, when this variable is represented by the percent of urban 100 population at the location where the hospital is located, the regression analysis shows that the hospitals located in the urban area have a higher cost than those in the rural area. Finally, the case study of the sample hospitals offers a specific information to hospital administrators about how they share in terms of the cost they are incurring in comparison to other hospitals. For example, if his/her hospital is of small size and located in a city, he/she can compare the various costs of his/her hospital operation with those of other similar hospitals. Therefore, he/she may be able to find the reasons why the cost of his/her hospital operation has a higher or lower cost than other similar hospitals in what factors of the hospital cost determinants.
Big data is creating in a wide variety of fields such as medical care, manufacturing, logistics, sales site, SNS, and the dataset characteristics are also diverse. In order to secure the competitiveness of companies, it is necessary to improve decision-making capacity using a classification algorithm. However, most of them do not have sufficient knowledge on what kind of classification algorithm is appropriate for a specific problem area. In other words, determining which classification algorithm is appropriate depending on the characteristics of the dataset was has been a task that required expertise and effort. This is because the relationship between the characteristics of datasets (called meta-features) and the performance of classification algorithms has not been fully understood. Moreover, there has been little research on meta-features reflecting the characteristics of multi-class. Therefore, the purpose of this study is to empirically analyze whether meta-features of multi-class datasets have a significant effect on the performance of classification algorithms. In this study, meta-features of multi-class datasets were identified into two factors, (the data structure and the data complexity,) and seven representative meta-features were selected. Among those, we included the Herfindahl-Hirschman Index (HHI), originally a market concentration measurement index, in the meta-features to replace IR(Imbalanced Ratio). Also, we developed a new index called Reverse ReLU Silhouette Score into the meta-feature set. Among the UCI Machine Learning Repository data, six representative datasets (Balance Scale, PageBlocks, Car Evaluation, User Knowledge-Modeling, Wine Quality(red), Contraceptive Method Choice) were selected. The class of each dataset was classified by using the classification algorithms (KNN, Logistic Regression, Nave Bayes, Random Forest, and SVM) selected in the study. For each dataset, we applied 10-fold cross validation method. 10% to 100% oversampling method is applied for each fold and meta-features of the dataset is measured. The meta-features selected are HHI, Number of Classes, Number of Features, Entropy, Reverse ReLU Silhouette Score, Nonlinearity of Linear Classifier, Hub Score. F1-score was selected as the dependent variable. As a result, the results of this study showed that the six meta-features including Reverse ReLU Silhouette Score and HHI proposed in this study have a significant effect on the classification performance. (1) The meta-features HHI proposed in this study was significant in the classification performance. (2) The number of variables has a significant effect on the classification performance, unlike the number of classes, but it has a positive effect. (3) The number of classes has a negative effect on the performance of classification. (4) Entropy has a significant effect on the performance of classification. (5) The Reverse ReLU Silhouette Score also significantly affects the classification performance at a significant level of 0.01. (6) The nonlinearity of linear classifiers has a significant negative effect on classification performance. In addition, the results of the analysis by the classification algorithms were also consistent. In the regression analysis by classification algorithm, Naïve Bayes algorithm does not have a significant effect on the number of variables unlike other classification algorithms. This study has two theoretical contributions: (1) two new meta-features (HHI, Reverse ReLU Silhouette score) was proved to be significant. (2) The effects of data characteristics on the performance of classification were investigated using meta-features. The practical contribution points (1) can be utilized in the development of classification algorithm recommendation system according to the characteristics of datasets. (2) Many data scientists are often testing by adjusting the parameters of the algorithm to find the optimal algorithm for the situation because the characteristics of the data are different. In this process, excessive waste of resources occurs due to hardware, cost, time, and manpower. This study is expected to be useful for machine learning, data mining researchers, practitioners, and machine learning-based system developers. The composition of this study consists of introduction, related research, research model, experiment, conclusion and discussion.
Bioterrorism is becoming more attractive to terrorist groups owing to the dramatic increase in the utility and lethality of biological weapons in line with today's cutting-edge biological science and technology. The Republic of Korea is facing both internal and external terrorist threats, as well as the possible biological warfare by North Korea. Therefore, it is essential to establish an effective bioterrorism response system in the ROK. In order to come up with the adequate response system for the ROK, an in-depth study has been conducted on the current bioterrorism response system of the U.S. whose preparedness is considered relatively adamant. As a result, the following facts have been found: (1)the legislation with regard to bioterrorism has been established or amended according to the current situation in the U.S., (2)the counter terrorism activities have been integrated with the Department of the Homeland Security as the central agency in order to maximize the national CT capacity, (3)Specific procedures and instructions to cope with bioterrorism have been made into manuals so as to enhance the working-level response capabilities. Next, the analysis on the ROK's bioterrorism response system has been performed in various categories, including the legislation system, task role distribution, cooperative relations, and resource application. It turned out that the ROK's legislation basis is relatively weak and it lacks the apparatus to integrate the bioterrorism response activities on the national level. The shortage of the adequate response facilities and resources, as well as the poor management of manpower have also emerged as problems that hinder the effective CT implementations. Through an analytical and comparative study of the U.S. and the ROK systems, this paper presents several ways to ameliorate improve the current system in the ROK as follows: (1)establish the anti-terrorism law, which would be the basic legal basis for the bioterrorism-related matters; and make revisions to the disaster-related legislation, relevant to bioterrorism response activities, (2)establish an integrated body that has a powerful authority to coordinate the relevant CT agencies; and converge the decentralized functions to maximize the overall response capacity, (3)install the laboratories with a high biosafety level and secure enough of the strategic medical stock-pile, (4)enhance the ability of the inexperienced response personnel by providing with a manual that has detailed instructions.
The purpose of this study is to analyze degree of geographic maldistribution of physicians and changes in the distributional pattern in Korea over the years 1980-1985. In assessing the degree of disparity in physician distribution and in identifying changes in the distributional pattern, the Gini index of concentration was used. The geographical units selected for computation of the Gini index in this analysis are districts (Gu), cities (Si), and counties (Gun). Locational data for 1980 and 1985 were obtained from the population census data in the Economic Planning Board and regular reports of physicians in the Korean Medical Association. The rates of physicians located counties to whole physicaians were 10.4% in 1980 and 9.6% in 1985. In term of the ratio of physicians per 100,000 population, rural area had 9.18 physicians in 1980 and 12.95 in 1985, 7.13 general practitioner in 1980 and 7.29 in 1955, and 2.05 specialists in 1980 and 5.66 in 1985. Only specialists of genral surgery and preventive medicine were distributed over 10% in county and distribution of every specialists except chest surgery in county increased in 1955, comparing with that rates of 1980. The Gini index computed to measure inequality of physician distribution in 1985 indicate as follows; physicians 0.3466, general practitioners 0.5479, and specialists 0.5092. But the Gini index for physicians and specialists fell -15.40% and -10.42% from 1980 to 1985, indication more even distribution. The changes in the Gini index over the period for specialists from 0.3639 to 0.4542 for districts, from 0.2510 to 0.1949 for cities, and 0.5303 to 0.5868 for counties indicate distributional change of 24.81%, -22.35%, and 10.65% respectively. The Gini indices for specialists of neuro-surgery, chest surgery, plastic surgery, ophthalmology, tuberculosis, preventive medicine, and anatomical pathology in 1985 were higher than Gini indices in 1980.
The objective of this study is to supply the good quality of experts the radiation industries in Korea and develop the major subject matter needed in the radiation industries and the curriculum in order to execute it for the variation of fields of employment at the department of radiation in the junior college and the development of the percentage of employment. In addition, this study is to improve the level of radiation experts engaged in the industries in quality, and it is to improve the social recognition of radiation rather negative now because of the development of radiation industry. As for the core results of this research, it was to suggest the detailed choice method curriculum proper to the service fields of radiation industries, but it may be subject to change due to each college's property and the educational objectives. From the result of this research above, it may be summed up as follows. First, as for the detailed curriculum by the service field, this study was to organize two subject matters: 1. the subject matter proper to the field of using the radiation, and 2. the subject matters proper to the safety control field of radiation. Second, as for the detailed curriculum by the pattern of industries, this study was to organize the four subject matters: 1. the subject matter needed in the manufactures, 2. the subject matter needed in the nondestructive testing industries, 3. the subject matter needed in the sales agencies, and 4. the subject matter needed in the laboratories. This study was to suggest the operational model about the curriculum in order to execute these subject matters. It could be executed as two methods below. First, one method is to execute the major systems by the medical field and industrial field in the third course at the department of radiation in the junior college now. Second, the other method is to make them specialize the industrial radiation in the Advanced Course(one year course) after the graduation of junior college. To operate these curricula successively it needs to assume the deeper research and the development of materials about the subject matters related to the nuclear radiation industries hereafter. In addition, it needs to solve the security of finance like the manpower of professor, space for practice, and the educational appliances, etc. needed in the operation of subject matters. Finally, the effect and result from the development or revision of college curriculum did not come out in a short time. It will require considerable time until the undergraduates at the department in the junior college finish a set of curriculum newly developed, and graduate the university, and can get the results while they engage in their works in the industrial sites. Accordingly, all the interested parties have to anticipate the results of this research with the patience in long-standing point of view. Also, this researcher considers it as it is willing to give them the continuous interest and support.
This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However,