• 한국경제지리학회지
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• 제1권2호
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• pp.71-84
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• 1998

의료서비스에 대한 수요와 공급은 지역의 자연환경과 함께 경제.사회 정치적 상황과 의료제도에 따라 차이가 있으므로 의료서비스시설의 입지문제는 그 수요와 공급의 공간작인 특성에 대한 연구가 선행되어야 한다. 본 연구에서는 기존 의료서비스시설의 공간적 분포패턴을 토대로 의료서비스 시설 입지의 지역적 차이를 분석하고, 우리나라 의료서비스시설의 입지적 특성과 의료서비스의 공간배열의 원리를 밝히는데 역점을 두었다. 특히 다른 서비스 시설의 입지문제와는 차별화 되는 입지결정 및 운영의 이원성과, 기능과 규모에 따라 입지원리가 다르게 작용하는 계층구조에 대한 분석을 시도하였다 이러한 연구는 의료서비스에 대한 지역 주민의 요구를 충족시킬 수 있는 의료기관의 적절한 공간적 배분계획모형 수립을 위한 기초 작업으로 지역 주민의 삶의 질 향상을 위한 의료서비스시설의 바람직한 의료서비스 시설 입지계획에 방향을 제시하는 기초가 될 수 있을 것이다.

• 대한지역사회영양학회지
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• 제7권6호
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• pp.852-862
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• 2002

The purposes of this study were 1) to review the Medical Nutrition Therapy (MNT) Act of the United States, 2) to introduce the efforts of the American Dietetic Association (ADA) to expand the Medicare coverage for MNT and 3) to provide information about the reimbursement under Medicare Part B for the cost of MNT. The MNT Act defined MNT services as “the nutritional diagnostic, therapeutic, and counseling services provided by a Registered Dietitian or nutritional professional for the purpose of managing diabetes or renal diseases”. Also, the MNT Act defined “conditions for coverage of MNT”, “limitations on coverage of MNT”, and “qualifications of MNT service provider”. To expand the coverage of Medicare to include MNT, the ADA realized the need for development of a protocol for MNT, as well as studies to evaluate the effectiveness and cost-effectiveness of the MNT protocol developed. Therefore, the ADA supported the studies to develop a strong database of scientific investigations of nutritional services. Furthermore, the ADA needed credible data that could be used by Policy makers, so the ADA contracted with the Lewin Group to if out the study to gather the additional data needed to strengthen the ADA's position. In the report of the Lewin Group, which was entitled, “The Cost of Covering Medical Nutrition Therapy under Medicare : 1998 through 2004”, it was concluded, that if coverage for MNT in the Part B portion of Medicare had begun in 1998, by 2004, approximately $ 2.3 billion would have been saved through reduced hospital spending under Part A of Medicare ($ 1.2 billion) and reduced physician visits under Part B ($ 1.1 billion) Effective January 1 2002, the US Congress extended Medicare coverage to include MNT to beneficiaries with diabetes or renal diseases. The Centers for Medicare and Medicaid Services (CMS) established the duration and frequency for the MNT based on published reports or generally accepted protocols (for example, protocols suggested by the ADA). The number of hours covered by Medicare is 3 hours for the initial MNT and 2 hours for a follow-up MM. In 2002, a Medicare coverage policy was made to define the Physician's Current Procedural Terminology (CPT) codes 97802, 97803, and 97804 for MNT.

• 한국산학기술학회논문지
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• 제3권3호
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• pp.221-226
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• 2002

Medicare에서는 급증하는 진료비 증가를 통제하고 양질의 의료서비스를 제공하기 위하여 일종의 예산통제시스템인 SGR을 도입하여 시행하고 있다. SGR에 대한 비판이 있긴 하나 진료비 급증을 통제하는데 나름대로 기여한 것으로 평가받고 있다. 본 연구에서는 노인인구증가, 급여율 증가 등으로 의료비가 급증하고 있는 우리나라의 현 상황에서 Medicare의 SGR의 의미, 문제점을 살펴보고 수가계약제가 시행되고 있는 우리의 경우 성공적으로 SGR을 적용하기 위한 전제 조건 등을 살펴본다.

• 농촌의학ㆍ지역보건
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• 제4권1호
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• pp.20-30
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• 1979

To investigate the status of morbidity and medicare utilization during last 8 months from 1 st Oct. 1977 to 31th May, 1978 in the area under Sam-Wha Medicare Insurance Union, a study was carried out through analyzing the medicare records of patients who are enrolled. For the study, 3 doctors and one nurse were mobilized and the results are as follows: 1) The total number of the Medicare insurance Union members in the study area were 5,735 composed of 3,000 males(52.3%) and 2,735 females(47.7%). 2) The total number of patients were 1,405 composed of 783 males (55. 0%) and 622 females(45. 0%) and the incidence rate per 1,000 population was 245.0 of total(261.0 in males and 227.4 in females). 3) Five major diseases with 52, 7% of total patients were acute upper respiratory infection(20.7%), peptic ulcer(12.2%), bronchitis(5.5%), injuries(5.2%) and dental problems(5.1%). 4) The order of the incidence rate of age group per 1,000 population was the year group on 0-4(342.6), 25-44(312.7), 45-64(307.0), 65 and over(240.3), 15-24(178.8) and 5-14(164.8). 5) Of the 1,405 total patients, the out-patients were 1,661(96.9%) and the in-patients were 44(3.1%) and the ratio wae 30.9 : 1.0. 6) Among the out-patients 96.7% of them were cared in primary medicare facilities, 1.0,% in secondary care, and 2.3% in tertiary care. And among the in-patients 50. 5% of them were cared in primary medicare facilities, 4. 5% in secondary care, 45. 5% in tertiary care. 7) Duration of medicare was concentrated within a week in 84. 3% of total patients.

• 사회복지연구
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• 제37호
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• pp.5-33
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• 2008

본 연구는 국민건강영양조사 3기 자료를 이용하여 저소득층의 의료이용에 대해 살펴 보았으며, 분석의 초점은 충족되지 않은 의료욕구와 의료급여제도의 효과에 두어졌다. 분석 결과 전반적으로 저소득층은 건강상태가 좋지 않은 반면 가구총소득이나 직업 등 가능요인 측면에서는 매우 불리한 조건에 놓여 있어, 의료욕구는 높으나 이를 충족시킬 자원이 부족한 상황인 것으로 나타났다. 그럼에도 불구하고 실제 저소득층의 의료기관 이용여부는 입원, 외래, 약국 등 모든 측면에서 일반인들보다 높게 나타났으며, 이는 다른 요인들을 통제했을 경우에도 유의미하였다. 분산분석(ANOVA) 결과 이용횟수에 있어서도 의료급여수급자들이 많았다. 반면, 비용 측면에서는 분산분석에서 통계적인 유의도가 검증되지 않았으나, 질병관련 요인을 비롯한 다른 요인들을 통제했을 경우 의료급여제도는 분명히 의료비용을 낮추는 효과가 있다. 의료이용에 대한 분석에서 의료급여제도는 저소득층의 좋지 않은 건강상태와 빈약한 경제적 조건을 효과적으로 보완하여 긍정적으로 기능하고 있는 것으로 분석되었다. 그러나, 의료급여제도는 저소득층의 의료욕구를 충분히 충족시켜주는데는 여전히 부족한 것으로 나타났다. 저소득층의 충족되지 않은 의료욕구는 여전히 일반인들보다 크며, 그 이유 중 가장 큰 것은 경제적인 이유였다. 이에 대한 계량분석결과 의료급여 1종과 2종, 차상위계층 등 모든 빈곤계층은 의료이용 포기가 일반 건강보험 가입자에 비해 높은 것으로 제시되고 있다. 의료급여 대상자들의 높은 의료이용량에도 불구하고 여전히 저소득층의 충족되지 않은 의료욕구가 크다는 것은 의료급여가 대상자들의 자원부족을 보완하여 어느정도 의료접근성을 높여주고 있지만 대상자들이 가진 의료욕구를 완전히 해소하기에는 불충분하다는 것을 의미하는 것이다.

• Journal of Preventive Medicine and Public Health
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• 제11권1호
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• pp.123-127
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• 1978

The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are estab-lished for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The 'AUT-OGRP System' was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The 'Departmental Method' was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying patterns of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among the study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables (i. e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death. rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The wei틴fed mean total case cost (TOTC) of the study hospitals for Medicare patients during the study years was $11,27.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($743.45). The weighted mean per diem total cost (DTOC) of the study hospitals for Medicare patients during the sutdy years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the hospital with the lowest average DTOC ($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variance to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of interhospital cost variation: 59.1 percent for TOTC and 44.3 percent for DTOC. Thsee results demonstrate that the casemix index is the most importand determinant of interhospital cost variation Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.

• 척추신경추나의학회지
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• 제6권1호
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• pp.141-148
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• 2011

Objectives : To introduce the medicare listing system for the clinicians that korean society of Chuna manual medicine for spine and nerves applies presently and wants to promote. Methods : Compare and analyse the differences, merits and demerits between Palmer-Gonstead listing system and medicare listing system using the publications and literatures of Chuna manual medicine and chiropractic. Results : It is easy to explain the movements and subluxations of spine when using medicare listing system. Also it has simple terminological system that can be applied when diagnosing the lesion of spinal joints with various palpations, Conclusion : Listing system used by Korean society of Chuna manual medicine for spine and nerves presently has very appropriate forms to indicate the movements and subluxations, However, it needs to spread to clinicians who still are using former listing system by continuous education.

• Journal of Gastric Cancer
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• 제15권2호
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• pp.87-104
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• 2015

Purpose: To assess real-world treatment patterns, health care utilization, costs, and survival among Medicare enrollees with locally advanced/unresectable or metastatic gastric cancer receiving standard first-line chemotherapy. Materials and Methods: This was a retrospective analysis of the Surveillance, Epidemiology, and End Results-Medicare linked database (2000~2009). The inclusion criteria were as follows: (1) first diagnosed with locally advanced/unresectable or metastatic gastric cancer between July 1, 2000 and December 31, 2007 (first diagnosis defined the index date); (2) ${\geq}65$ years of age at index; (3) continuously enrolled in Medicare Part A and B from 6 months before index through the end of follow-up, defined by death or the database end date (December 31, 2009), whichever occurred first; and (4) received first-line treatment with fluoropyrimidine and/or a platinum chemotherapy agent. Results: In total, 2,583 patients met the inclusion criteria. The mean age at index was $74.8{\pm}6.0years$. Over 90% of patients died during follow-up, with a median survival of 361 days for the overall post-index period and 167 days for the period after the completion of first-line chemotherapy. The mean total gastric cancer-related cost per patient over the entire post-index follow-up period was United States dollar (USD) $70,808{\pm}56,620$. Following the completion of first-line chemotherapy, patients receiving further cancer-directed treatment had USD 25,216 additional disease-related costs versus patients receiving supportive care only (P<0.001). Conclusions: The economic burden of advanced gastric cancer is substantial. Extrapolating based on published incidence estimates and staging distributions, the estimated total disease-related lifetime cost to Medicare for the roughly 22,200 patients expected to be diagnosed with this disease in 2014 approaches USD 300 millions.

• Journal of Preventive Medicine and Public Health
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• 제27권1호
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• pp.107-116
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• 1994

The United States adopted DRG based prospective payment system (PPS) in order to control the inflation of health care costs. No study used statistical test while many studies reported the cost containing effect of the PPS. To study impacts of the PPS on the Medicare expenditure, this study set the following three hypotheses (1) The PPS decelerated the increase in the hospital expenditure (Part A), (2) the PPS accelerated the increase in the expenditure of outpatients and physicians (Part B), (3) the increase in total expenditure was decelerated inspite of the spill over (substitution) effect because saving in the Part A expenditure were greater than losses in the Part B expenditure. The dependent variables are per capita hospital expenditure, per capita Part B expenditure, and per capita total expenditure for the Medicare beneficiaries. An intervention analysis, which added intervention effect to the time series variation on the Box-Jenkins model, was used. The observations included 120 months from 1978 to 1987. The results are as follows : (1) The annual increase in the per capita Part A expenditure was $5.11 after the implementation of DRG where as that before the PPS had been $11.1. The effect of the reduction ($5.99) was statistically significient (t=-3.9). (2) The spill over (substitution) effect existed because the annual increase in the per capita Part B expenditure was accelerated by $1.73 (t=1.91) after the implementation of the PPS. (3) The increase in the total Medicare expenditure per capita was reduced by $4.26 (t=-2.19) because the spill over effect was less than cost savings in the Part A expenditure.

• 한국멀티미디어학회:학술대회논문집
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• 한국멀티미디어학회 2012년도 춘계학술발표대회논문집
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• pp.345-348
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• 2012

본 논문은 만성질환 환자를 위한 인체 삽입형 시스템을 구현하기 위해서 의료용 통신 기술을 사용한 생체신호의 송수신 및 제어가 가능하며, 무선전력전송 기술을 통해 반영구적 사용을 가능하게 하는 IT융합형 인체 삽압형 시스템 플랫폼 원천기술을 개발하고 생리기능(혈당, 혈압, 심장박동 등) 감시가 가능한 이식형 융복합 시스템 기술에 관하여 분석하였다. 인체삽입형 생리기능 자동감시 시스템은 사후진단 및 치료에서 능동적인 조기진단과 예방으로 진화하고 있으며 신기술 및 융합 기술이 의료기기의 응용 범위를 더욱 확대하는 방향으로 가고 있다. 미국/유럽 등 선진국이 대부분의 시장을 차지하고 있으므로 국내개발 성공시 수입대체 효과뿐만 아니라 기술적 격차 극복을 통한 세계 시장 진출도 가능하다. 이 분야는 세계적 경쟁력을 가진 국내 IT 산업과의 강한 시너지를 통하여 복합 기술형 첨단 의료기기의 기술경쟁력을 제고하고, 진입장벽이 높은 미래 첨단산업 시장 진출에 의한 국가전략산업 육성에 기여할 수 있을 것으로 기대된다.