• 감성과학
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• 제21권4호
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• pp.3-10
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• 2018

The present study explores two relationships: first, between number of payment and payment option preference, and second, total sum and payment option preference, with pain of payment as a mediator variable. The analyses revealed that consumers who feel higher pain of payment preferred the pennies-a-day pricing to the aggregate pricing when the per-payment price is low. Consumers who experience higher pain of payment prefer to pay in small frequent installments because they feel the small per-payment price can be comparable to daily expense. Consumers who experienced higher pain of payment preferred aggregate pricing to pennies-a-day pricing when the per-payment price was high. When the per-payment price is high, it is no longer comparable to daily expense, thus leading to greater pain of payment among consumers. The study discusses the implications for mechanism of pain of payment on payment option preference.

• Journal of Preventive Medicine and Public Health
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• 제55권4호
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• pp.389-397
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• 2022

Objectives: This study examined the effect of out-of-pocket (OOP) payment reduction on the potential utilization of low-value magnetic resonance imaging (MRI) across income groups. Methods: We conducted an experimental vignette survey using a proportional quota-based sample of individuals in Korea (n=1229). In two hypothetical vignettes, participants were asked whether they would be willing to use MRI if they had uncomplicated headache and non-specific low back pain, each before and after OOP payment reduction. To account for the possible role of physician inducement, half of the participants were initially presented with vignettes that included a physician recommendation for low-value care. The predicted probability, slope index of inequality (SII), and relative index of inequality (RII) were calculated using logistic regression. Results: Before OOP payment reduction, the lowest income quintile was least likely to use low-value MRI regardless of physician inducement (36.7-49.6% for low back pain; 30.5-39.3% for headache). After OOP payment reduction, almost all individuals in each income quintile were willing to use low-value MRI (89.8-98.0% for low back pain; 78.1-90.3% for headache). Absolute and relative inequalities concerning potential low-value MRI utilization decreased after OOP payments were reduced, even without physician inducement (SII: from 8.15 to 5.37%, RII: from 1.20 to 1.06 for low back pain; SII: from 6.99 to 0.83%, RII: from 1.20 to 1.01 for headache). Conclusions: OOP payment reduction for MRI has the potential to increase low-value care utilization among all income groups while decreasing inequality in low-value care utilization.

• 한국직업건강간호학회지
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• 제13권1호
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• pp.48-58
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• 2004

Purpose: To identify the factors which are related to compensated low back pain disability. These include individual. workplace. economic and injury factors. Method: Data collection was performed at 13 office of Korea Labor Welfare Corporation and 29 hospitals from 23th June to 4th August 2003. This study used 212 workers with compensated low back pain. Result: From the bivariate analysis, industry kind, type of employment, rest schedule, Job control, compensation, payment of company, diagnosis, cause of occupational injury, duration of compensated low back pain, pattern of pain, operation, other injury is related to low back pain disability. From the multiple regression analysis, rest schedule, compensation, diagnosis, pattern of pain, other injury have statistically significant effect on the low back pain disability. Conclusion: In order to reduce low back pain disability, occupational rehabilitation nursing intervention is necessary to workers with compensated low back pain.

• The Korean Journal of Pain
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• 제31권1호
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• pp.27-38
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• 2018

Background: Related to escalating health care costs and the questionable effectiveness of multiple interventions including lumbar facet joint interventions, cost effectiveness or cost utility analysis has become the cornerstone of evidence-based medicine influencing coverage decisions. Methods: Cost utility of therapeutic lumbar facet joint nerve blocks in managing chronic low back pain was performed utilizing data from a randomized, double-blind, controlled trial with a 2-year follow-up, with direct payment data from 2016. Based on the data from surgical interventions, utilizing the lowest proportion of direct procedural costs of 60%, total cost utility per quality adjusted life year (QALY) was determined by multiplying the derived direct cost at 1.67. Results: Patients in this trial on average received $5.6{\pm}2.6$ procedures over a period of 2 years, with average relief over a period of 2 years of $82.8{\pm}29.6$ weeks with $19{\pm}18.77$ weeks of improvement per procedure. Procedural cost for one-year improvement in quality of life showed USD $2,654.08. Estimated total costs, including indirect costs and drugs with multiplication of direct costs at 1.67, showed a cost of USD $4,432 per QALY. Conclusions: The analysis of therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain shows clinical effectiveness and cost utility at USD $2,654.08 for the direct costs of the procedures, and USD $4,432 for the estimated overall cost per one year of QALY, in chronic persistent low back pain non-responsive to conservative management.

• Journal of Oral Medicine and Pain
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• 제30권2호
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• pp.257-268
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• 2005

우리나라 건강보험제도는 보수지불방식에서 전체적으로 보면 행위별수가제(fee for service)를 유지하고 있다. 이 제도에서는 진료수가의 설계에서 각 의료서비스의 단위를 설정하기 위해서는 현재 임상에서 이루어지고 있는 모든 의료행위에 대한 목록이 필요하게 된다. 따라서 본 연구에서는 측두하악장애 의료의 수가구조와 수가항목에 대해 재분류를 통한 체계화과정을 통해서 향후 투입자원에 기초한 상대가치를 산정하여 수가수준을 결정할 수 있는 준거를 제시하고자 하였다. 현행 행위별 수가제도의 범위내에서 측두하악장애 진료행위에 대한 델파이법을 이용하여 의료행위에 대한 재분류하여 항목화 작업을 거치면서 자원기준 상대가치 산출모델의 선행연구를 시행하였다. 이를 통해 의료행위분류에서는 총 151개의 의료 행위를 규명하였다. 이를 건강보험 수가항목이 되도록 하기 위해서는 지속적인 정련화 과정이 필요하게 되므로 용어의 정리 및 통일, 명확한 진료범위의 설명, 체계적인 분류구조 등이 고려되어야 한다. 이상의 연구결과는 향후 치과의료의 구조적 문제점과 현안과제를 해결하는 기초자료로 활용하고, 앞으로 치과의료의 수가 수준을 결정하는 후속연구의 방향설정과 참고자료로 활용하며, 의료수가체계의 표준화를 유도하여 의료이용의 편의성을 도모하고 의료정책에 대한 국민적 신뢰를 회복하여 측두하악관절장애 진료의 건강보험 확대적용 및 향후 민간 사보험 도입시 기초자료로 활용될 것으로 사료된다.

• 대한한의학회지
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• 제28권1호통권69호
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• pp.72-86
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• 2007

Objectives : The purpose of this study was to evaluate and compare the cost-effectiveness of Eastern, Western, and collaborative treatments and suggest a cost-effective approach for patients with frozen shoulder pain. Methods : Using the data of fifty-two patients, treatment effectiveness was measured by CSA, SPABI, and ROM scales and changes from the baseline score were evaluated. Data source for cost estimation was based on the national health insurance (NHI) payment system. Because the price in NHI was differentiated by health care institutions, five collaborative types were considered in assessing costs. Cost-effective ratios were computed for economic evaluation. Results : Compared with Eastern treatment, collaborative and Western treatments showed better effects on CSA scale after 4 weeks' treatment. The collaborative approach was also the most effective treatment on SPADI and ROM scales. The direct cost per patient receiving Eastern treatment was less than other treatments. In general, collaborative treatment dominated Eastern and Western treatments in cost-effectiveness an analysis. However, the cost-effectiveness ratio of Eastern treatment resulted in \9,000 compared to \29,000 of collaborative treatment on SPADI. Four different indicators of ROM scales resulted in different approaches as the cost-effective treatment. Conclusions : Considering cost-effectiveness ratios, collaborative treatment was the best treatment on CSh and SPADI scales after 4 weeks' treatment. As for ROM scales, the recommended alternatives were Eastern treatment for patients with abduction and adduction disabilities, Western treatment for those with flexion disability, and collaborative approach fir those with extension disabiliry.

• 종양간호연구
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• 제7권1호
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• pp.14-25
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• 2007

Purpose: The purpose of this study was to identify the relationship of fatigue and depression in patients with hemato-malignancy receiving chemotherapy. Methods: The data were collected from December 2005 to November 2006. Study objects were recruited from 4 university hospital in B and U city. Fatigue and depression were measured using the Cancer Fatigue Scale and the Revised Zung's Self-rating Depression Scale, respectively. Results: 1) The mean score of fatigue was $64.64{\pm}21.58$. The mean score of depression was $41.28{\pm}7.62$. 2) The fatigue score was significantly different with age, employment status, and present pain. 3) The depression score was signigicant different by the payment, diet, and present pain. 4) There was a moderate positive correlation between depression and fatigue. Conclusions: Patients with hemato-malignancy receiving chemotherapy experience in fatigue. Decrease in fatigue are associated with decreases in depression. Therefore, nurses must provide planned nursing intervention to reduce fatigue and depression in patients with hemato-malignancy.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.178-187
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• 2012

Purpose: In Korea, the nation's medical expenses were 12 billion won in 2010. The medical costs for individuals can also be overwhelming. If a patient has sustained severe trauma, his/her insurance company responsible may pay only part of the medical bills. In Korean, there are diverse types of medical insurance, such as health insurance, automobile insurance, and industrial accident compensation insurance. And each insurance system has a different type of payment system. Our study will be essential for establishing the optimal medical expense payment system. Methods: From January to December 2011, we retrospectively reviewed the medical charts of 161 patients who were admitted to our hospital's emergency room after having undergone severe trauma. Of those 161 patients, 125 were retrospectively reviewed. Written permission was obtained from all of the patients. We analysed the demographic characteristics, clinical outcomes, data of the trauma, type of the patient's insurance, and the entire bill when the patient was discharged. Results: Seventy-one patients had health insurance, 48 automobile insurance, and six industrial accident compensation insurance. High-deductible insurance included health insurance and industrial accident compensation insurance, with the deductibles up to 20.6% and 19.1%, respectively. We attempted to analyze the cause of the high deductible rate. In patients with health insurance, medicines, primarily sedatives, pain killers, antibiotics, and fluids. comprised a large proportion. On the other hand, industrial accident compensation insurance deducted for a high-grade hospital room charge. Conclusion: We found that medical expenses were diverse according to the type of insurance. In particular, health insurance forced patients to pay too much of the medical expenses. Therefore, in Korea we should try to identify the insurance problems and improve the wage system.

• Journal of Acupuncture Research
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• 제29권6호
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• pp.85-89
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• 2012

Objectives : This study is to evaluate the current situation of Japanese tourists for medical tour of Daejeon University hospital and to draw up a plan for better policies. Methods : 59 Japanese tourists visiting oriental medicines hospital of Daejeon University from January 2012 to September 2012, were analysed in the statistics. And 8 of them answer a questionnaire about reasons for selection of Daejeon University hospital, satisfaction for thread embedding therapy and side effects of thread embedding therapy. Results : A total of 59 foreigners visited oriental medicines hospital of Daejeon University for medical service, consisting of 54 females(92 %), the thirties to fifties 71 % by age. The 87.5 % of patients answered that the reason for choosing this hospital was the subsidization of the medical expenses, and 50 % for appropriate payment, 37.5 % for safety, 12.5 % for recommendation of the people who had good experience at this hospital. The 71% of patients selected thread-embedding therapy for treating wrinkles. The degree of satisfaction was evaluated as quite satisfaction of 87.5 %, full satisfaction of 12.5 % showing that a whole number of the patients treated with thread-embedding therapy showed relative satisfaction. This evaluation is, however, a short term survey which should lead to a further term study. For the evaluation of side effects of thread-embedding therapy, 75 % of patients answered as pain occurred during the therapy, 62.5 % as edema, 50 % as hypodermal bleeding. Conclusion : First of all, there should be more constructive promotion and support for medical tour of oriental medicines, ultimately leading to promoting better clusters of oriental medicines. Secondly, support in terms of a medical law should be established for medical disputes, and the best follow-up service should be considered.

• 한국건축시공학회지
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• 제18권4호
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• pp.355-361
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• 2018

한국의 주요 주거시설인 아파트에서 많은 하자가 발생하고 있다. 이는 공사관리소홀이나 시공기술부족등에 기인하고 있다. 아파트가 수분양자에게 공급될수록 준공이후 하자는 급격하게 증가하고 있다. 주택법령에서는 지방정부가 건설회사에 하자보수를 지시할 수 있도록 변경되었다. 그러나 하자가가 발생된 이후 하자가가 해결된다면 수분양자는 하자로 인해 고통을 받기 때문에 근본적인 해결책이라고 보기 어렵다. 그래서 수분양자의 권익을 보호하기 위해 아파트 하자를 감소시킬 필요가 있다. 이에 본 연구에서는 아파트분양시 수분양자에 대한 정보의 비대칭성해소, 최종 준공도서의 계약문서화, 감리자의 설계도서 검토기간 확보, 계약변경시 적정 감리대가의 확보, 감리대가 지급절차의 개선, 주택감리용역표준계약서상 감리업무의 조정 등을 제시하였다.