• 한국병원경영학회지
• /
• 제22권2호
• /
• pp.58-69
• /
• 2017

Recently, with the increase in the number of private health insurance subscribers, interest in overuse of the medical service is increasing. This study analyzed the impacts of private health insurance (PHI) on medical institution selection in outpatient service utilization among persons with arthritis. In order to control patients' health status, we extracted outpatient episodes with the same disease (KCD6, M13) from Korea Health Panel. The unit of analysis was an outpatient visit with arthritis in 2014 (n=23,363). In the light of insurance coverage, we redefined three type of private health insurance (ex, indemnity, fixed benefit, and non-insured) as a test variable and two type of medical institution (ex, hospital and physician visit) as a dependent variable. We conducted a probit regression analysis to identify the impacts of PHI on medical institution selection controlling for heteroscedasticity. The results of this study showed that the insured with indemnity were more likely to choose hospital departments than clinics (marginal effect=0.0475, p=0.000). The impact of participation of fixed benefit PHI was not as clear as that of indemnity type (marginal effect=0.0162, p=0.047). In conclusion, this study confirmed that PHI, particularly indemnity type has a significant impact on the selection of medical institutions. Healthcare policy makers should consider that PHI not only affects the overall quantitative increase in healthcare utilization, but also influences the selection of medical institutions.

• 한국병원경영학회지
• /
• 제11권1호
• /
• pp.54-90
• /
• 2006

Medical clinics are core institutes that cover the primary medical care in Korea. Financial viability of the clinics is essential for them to conduct their roles and functions, and can be improved by increasing their operating profitability. On this ground, this study aimed at finding important factors that affect the operating profitability, and thereby at suggesting strategic alternatives that can contribute to the improvement of the profitability. Operating margin was set as a dependent variable, and such factors as general management conditions, number of visits, medical revenue, marketing activities, input resources, medical cost as independent variables. Nineteen hypotheses related to the variables were established and tested using data collected from 138 sample clinics for the year 2003. The results of the study are as follows : Firstly, such variables as percent ratio of the depreciation plus rent costs to total administration costs, type of clinical department manifested whether medical, surgical, or quasi-surgical, percent ratio of the interior facility investment to total fixed assets, and total number of outpatient visit are important factors that affect, positively or negatively, the medical profitability of the clinics. Secondly, following measures are needed to be established and implemented to improve the medical profitability. (1) Administration costs share 53.2% of the total medical costs, and depreciation plus rent costs 16.3% of the total administration costs. This implies that such measures as reinforcement of marketing activities, establishment of the cooperative utilizing system of the facility and equipment, or group practice are needed to increase cost-effectiveness. (2) Occupancy rate of the clinics with inpatient bed is as low as 45.5%, causing high fixed costs and low medical profitability. For its improvement, the resource input structure should be reorganized. Thirdly, in the future, a study that can increase sample representativeness of the study and explanation power of the variables should be performed for each type of clinical department to find more specific determinant factors and to contribute to the improvement of the medical profitability of the clinics.

• 한국병원경영학회지
• /
• 제28권3호
• /
• pp.47-57
• /
• 2023

Purpose: Health expenditure and utilization of Korean medicine are increasing every year. Since Chuna Manual Therapy was covered by National Health Insurance in 2019, it is predicted that the usage of Chuna Manual Therapy would be also increasing. However, there are few studies about Chuna Manual Therapy using Korean National Health Insurance claims database. Therefore, we will investigate the utilization trend of outpatient's Chuna Manual Therapy using Korean National Health Insurance database and suggest political implications. Methodology: The Korean National Health Insurance claims database was used to identify outpatient's Chuna Manual Therapy usage spanning 4 years from 2019-2023 and the number of Chuna Manual Therapy claims were approximately 18.61 million. Findings: The number of Chuna Manual Therapy claims and patients, health expenditure of Chuna Manual Therapy have been increasing spanning 4 years among over 65 aged. In the case of female patients, the number of Chuna Manual Therapy claims was more than male patients and health spending related to Chuna Manual Therapy was also higher than male patients. Most patients visited Korean medicine clinics due to musculoskeletal diseases, and most claims were from rural regions. Practical Implication: Since Chuna Manual Therapy was covered by National Health Insurance in 2019, Utilization of Chuna Manual Therapy has been increased overall. In particular, Chuna Manual Therapy is mostly implemented in the elderly, Korean medicine clinics, and local areas, thus policy managers will need to consider this.

• Clinics in Shoulder and Elbow
• /
• 제21권4호
• /
• pp.252-255
• /
• 2018

A 51-year-old male who is right-handed visited the outpatient for right fingers-drop. The patient's fingers, including thumb, were not extended on metacarpophalangeal joint. The active motion of the right wrist was available. The electromyography and nerve conduction velocity study were consistent with the posterior interosseous neuropathy. Further evaluation was done with the magnetic resonance imaging for finding the space-occupying lesion or any possible soft tissue lesion around the radial nerve pathway. On magnetic resonance imaging, the ganglion cyst, which was about 1.8 cm in diameter, was observed on the proximal part of the superficial layer of the supinator muscle (Arcade of Frohse). The surgical excision was done on the base of ganglion cyst at the base of stalk of cyst which looked to be connected with proximal radioulnar joint capsule. The palsy had completely resolved when the patient was observed on the outpatient department a month after the operation.

• 한국의료질향상학회지
• /
• 제8권1호
• /
• pp.56-72
• /
• 2001

Background : To shorten processing time for variety of medical affairs of the patient at the outpatient clinic of a big hospital is very important to qualify medical care of the patient. Therefore, patient's waiting time for medical examination is often utilized as a strong tool to evaluate patient satisfaction with a medical care provided. We performed this study to investigate factors delaying related with waiting time for medical examination. Methods : The data were collected from June 26 to July 30, 1999. A total 275 case of medical treatment and 5,634 patients who visited outpatient clinics of a tertiary hospital were subjected to evaluate the waiting time. The data were analyzed using frequency, t-test, ANOVA, $X^2$-test by SPSS Windows 7.5 program. Results : The mean patient's waiting time objectively evaluated ($30.9{\pm}33.9$ min) was longer than that subjectively by patient evaluated ($25.1{\pm}26.2$ min). Patient waiting time objectively evaluated was influenced by the starting time of medical examination, consultation hours, patients arriving time etc, as expected. The time discrepancy between two evaluations was influenced by several causative factors. Regarding the degree of patients accepted waiting time with the medical examination is 20 min. Conclusion : The results show that, besides the starting time of medical examination, consultation hours and patients arriving time, influence the patient's subjective evaluation of waiting time for medical examination and his satisfaction related with the service in the big hospital. In order to improve patient satisfaction related with waiting time for medical examination, it will be effective examination rather than to shorten the real processing time within the consultation room.

• 간호행정학회지
• /
• 제16권3호
• /
• pp.219-228
• /
• 2010

Purpose: The purpose of this study was to explore the degree of delay in waiting time, and the relationships of waiting time, patient satisfaction, and revisiting intention of outpatient in general hospitals. Methods: The data were collected from June 22 to July 4, 2009. A total of 536 outpatients who visited 21 clinics of a general hospital were subjected to evaluate the waiting time. The survey tools used were the Korea Health Industry Development Institutes (2008) tool for patient satisfaction and Reichheld & Sasser (1990) for revisiting intention. The data were analyzed by SAS version 9.1, descriptive statistics, t-test, ANOVA, and Pearson correlation coefficient. Results: The mean patient's waiting time was $28.3{\pm}30.7\;min$, the revealed mean score of patient's satisfaction was 2.92, and the revisiting intention showed was 4.56. The waiting time was negatively correlated with patient's satisfaction (r=-.10, p<.019). Patient's satisfaction was positively correlated with revisiting intention (r=-.51, p<.001). Conclusion: Waiting time management is an important factor of increasing patient's satisfaction and revisiting intention in general hospitals. It is mandatory that reservation management systems take into account the patient's characteristics of visiting outpatient department in order to shorten the real waiting time.

• 한국병원경영학회지
• /
• 제28권4호
• /
• pp.73-89
• /
• 2023

Purposes: The purpose of this study was to empirically analyze the effect of the attitude of medical staff providing medical services on the treatment satisfaction of the patients who experienced outpatient care at the hospitals and clinics. In particular, it was verified whether the courtesy of the medical staff to the outpatients has moderated the effect of the medical staff's explanation on the treatment satisfaction. Methodology: After controlling the socio-demographic factors of the outpatients with their treatment and waiting time, multiple regression analyses were conducted to figure out the effect of the attitude of the medical staff on the treatment satisfaction. And the covariance analyses were adopted to verify the moderating effect of the variables of the medical staff. Findings: At both hospitals and clinics, all attitudes of medical staff such as the way they explain to and communicate with the patients, and their courtesy showed positive effects on treatment satisfaction. Among them, the courtesy of the medical staff was the most influential variable on the satisfaction of the treatment, and it only had the control power over the effect of the way they explain on the treatment satisfaction. Practical Implication: Among the medical staff's attitudes toward patients at hospital or clinic level, the courtesy of doctors and nurses is an important factor in improving treatment satisfaction. In particular, if the level of their courtesy is low among the medical services rendered at the clinics, the satisfaction level will decrease even if the level of explanation of the medical staff is high. Therefore, in terms of hospital management, treatment satisfaction can be improved when doctors and nurses provide medical services to visitors with polite, humble and friendly manner in explaining to and communicating with the patients.

• The Korean Journal of Pain
• /
• 제14권2호
• /
• pp.207-210
• /
• 2001

Backgroud: Caudal blocks have been used for pain management in outpatient clinics. It is important to estimate the proper depth and angle in order to increase the success rate of the procedure. Methods: Data was collected from 60 patients who visited our pain clinic. We measured the depth of the needle's penetration and the angle of the needle at the insertion point when a caudal approach was confirmed by air flow method. We recorded age, sex, body weight and height, and calculated the ponderal index. Results: The depth from the skin to the caudal epidural space was a mean 2-4 cm ($3{\pm}0.4\;cm$). The angle at the needle insertion point was a mean 15-50 degree ($34.9{\pm}6.8$ degree). Conclusions: If we use the mean depth and angle as a guide, complications during the caudal epidural procedure can be avoided.

• 한국병원경영학회지
• /
• 제7권1호
• /
• pp.88-104
• /
• 2002

According to the change of mandatory referral system in July 1, 2000, the effect to the medical utilization of outpatient clinic and medical income in ophthalmology of tertiary care medical institute, S Hospital in Seoul was evaluated for 6 months before(1999. 12$\sim$2000. 5) and after(2000. 12$\sim$2001. 5). The results were as follows: 1. The number of outpatients was reduced by 16.6%. The number of patient with blindness low vision, retina, glaucoma increased and that of patient with accommodation refractive error, cataract decreased. 2. The number of cataract patients was reduced by 36.6%. The major location of patient's address was changed to nearer to the hospital. The number of cataract surgery reduced in 4.1%, the waiting time reduced in 42.2%, however surgery time increased in 20.2% and number of postoperative complications increased in 11.4%. 3. The income of outpatient clinic and cataract surgery reduced. Among items of outpatient clinic income, the most increased was ocular examination and the most reduced was injection and drugs. Among items of cataract surgery income, the most increased was operation fee and the most decreased was doctor's fee. In conclusion, for the patient, due to the lowered density of outpatient population more space was provided to the patients with more severe disease entity such as blindness' low vision, retina and glaucoma. For the hospital, the need for the expansion of ophthalmology was not found, however that for creation of the special clinics dealing with more severe disease entity was found. Due to reduced income and increased need of financial investment for the equipment and manpower for the more severe disease entity, the ophthalmology of tertiary care medical institute is faced with financial disaster. It is strongly suggested that the cost of medical practice of more severe disease entity be raised to achieve the success after change of mandatory referral system in ophthalmology.

• 대한영상의학회지
• /
• 제81권3호
• /
• pp.530-548
• /
• 2020

갑상선 영상의학 진료란 갑상선 질환 환자를 영상의학적 방법을 활용하여 질병 진단과 중재적 치료를 하는 의료 행위로 정의될 수 있으며 주요 진료 대상은 갑상선 결절 질환 환자들이다. 갑상선 결절의 진단은 일차적으로 초음파 영상진단과 생검에 의해서 이루어지고 결절의 치료는 비수술적 중재적 치료와 갑상선절제술이다. 갑상선 낭종 혹은 낭성우세 양성 결절에서는 에탄올절제술이 일차적 치료법이고 고주파절제술은 고형 혹은 고형우세 양성 결절과 갑상선 재발암 치료에 적용되고 있다. 갑상선 영상의학 진료는 갑상선 결절 질환 환자의 진단 및 비수술적 치료의 대부분을 담당하는 중요한 임상적 역할을 가지고 있으며, 적절한 환자 진료를 위해서는 표준적 진료 지침에 근거하여 진료가 수행되어야 한다. 환자에게 최적의 갑상선 영상의학 진료를 제공하기 위해서는 영상의학과 외래에서 환자를 진료하는 것이 바람직하며 외래 중심의 갑상선 영상의학 진료를 확대하도록 함께 노력해야 할 시점이다.