• 한국의료질향상학회지
• /
• 제11권1호
• /
• pp.16-30
• /
• 2004

Background: Although the number of cancer patients increase, the resources for cancer management are not increased. If the outpatient chemotherapy administration room is operated, the shift of patients from inpatient 10 outpatient is occurred. So the capacities for chemotherapy increased and the shifted rooms were occupied with new non-chemotherapy patients. The income of the hospital increased. The purpose of this study was to assess usefulness and cost-effectiveness of the outpatient-chemotherapy adminstration model. Method: There are six beds, two chairs and two nurses and one personnel in the outpatient chemotherapy room. The satisfaction study by patients/family and doctors and the cost analysis over 12 months, by comparing costs of chemotherapy administration at outpatient chemotherapy room with inpatient at ward and inpatient-nonchemotherapy at ward were done. Results: The 97.1 percent of patients/family and the 94.4 percent of doctor who involved chemotherapy were satisfied with outpatient chemotherapy administration. The 91.7% of doctors said there were no differences in treatment outcome between outpatient and inpatient chemotherapy administration. The average number of patients in outpatient chemotherapy room increased from 10.7 to 15.4 but in inpatient from 19.4 to 18.3. The average number of inpatient chemotherapy were not changed related to increase of the average number of outpatient chemotherapy. The profit between outpatient chemotherapy and inpatient chemotherapy administration was 45,344,710 won and the profit between outpatient chemotherapy and non chemotherapy treatment was -185,294,614 won. Conclusion: The outpatient chemotherapy administration model is good for patients/family, doctors and hospital partially. But the hypothesis described above was not correct. The process of cancer patients treatment were from diagnosis and treatment to first administration of chemotherapy. So the shift from inpatient to outpatient was not occurred. In economic aspect, the profit between outpatient chemotherapy and non chemotherapy treatment was in the red. As the level of health care fees was so low, the hospitals hesitate operating the room of outpatient chemotherapy. It is necessary to raise the level of health case fees for outpatient chemotherapy administration.

• Journal of Preventive Medicine and Public Health
• /
• 제31권3호
• /
• pp.490-502
• /
• 1998

본 연구는 우리 나라 병원도산 예측모형을 도출하기 위한 연구로 1992년에서 1997년 사이 5년간의 전국 병원 경영통계 자료를 이용하여 1995년부터 1997년 사이에 도산한 병원중도산전 3년까지의 연속된 자료가 있는 31개 병원을, 비교군 병원은 도산병원과 유사한 병상규모를 가지고 당기순이익이 발생한 31개 우량병원을 선정하여 단계적 판별분석에 의한 실증연구를 시행하였다. 본 연구의 구체적 연구결과는 다음과 같다. 첫째, 도산전 각 연도별로 도산병원과 우량병원간에 연구변수의 단순 평균치분석 결과, 자본구조 지표인 자기자본비율과 수익성지표인 총자본의료이익을, 의료수익의료이익을, 총자본경상이익을, 의료수익경상이익율, 총자본순이익을 등은 도산 1, 2, 3년전 모두에서 도산병원과 우량병원간에 유의한 차이를 보였다. 자본고정성지표는 도산 1년전에 고정비율이 유의한 차이를 보였고, 유동성지표는 도산 1년전에는 유동비율과 당좌비율이 유의한 차이를 보였고 도산 2년전에는 당좌비율만이 유의한 차이를 보였다. 활동성지표로는 도산 1년전에 총자본회전율과 재고자산회전율이 유의한 차이를 보였고 도산 2년전에는 총자본회전율과 의료미수금회전율이, 도산 3년전에는 의료미수금회전율만이 유의한 차이를 보였다. 생산성지표로는 도산 2년전에 총자본투자효율이, 도산 3년전에는 조정환자1인당 부가가치가 유의한 차이를 보였다. 진료실적지표로는 도산 3년전 일평균재원환자수가 유의한 차이를 보였다. 둘째, 도산 1, 2, 3년전 판별함수는 각각 도산 1년전 Z=($0.0166\times$당좌비율)-($0.1356\times$총자본경상이익을)-($1.545\times$총자본회전을), 도산 2년전 Z=($0.0119\times$당좌비율)-($0.1433\times$총자본의료이익율)-($0.0227\times$총자본투자효율), 도산 3년전 Z=($0.3533\times$총자본순이익율)-($0.1336\times$의료미수금회전율)-($0.04301\times$조정환자1인당부가가치)+($0.000119\times$일평균재원환자수)이었다. 셋째, 도출된 도산 1, 2, 3년전 각 판별함수의 예측력은 77.42%, 79.03%, 82.25% 이었다.

• 보건행정학회지
• /
• 제14권2호
• /
• pp.1-16
• /
• 2004

The study purpose was to find which factors affect selection of hospital network types. This study used the 1998 American Hospital Association Annual Survey Database from Health Forum. Among these U.S. hospitals, the researcher selected hospitals located in Metropolitan Statistical Areas. Therefore the final observation cases for analysis are 1,971 Metropolitan Statistical Area hospitals in the United States. To identify significant variables influencing hospital network types, the study used proportional odds logistics regression model on population size, Health Maintenance Organization penetration rate, and market competition rate of area including a hospital, types of hospital ownership, hospital bed size, proportion of Medicare patients and Medicaid patients in total hospital patients, and occupancy rate. Contrary to conventional wisdom, selection of hospital network types was influenced by population size of area which a hospital located, types of ownership, hospital bed size, and proportion of medicare patients rather than Health Maintenance Organization penetration. Population size 1,000,000-2,499,999 had the highest probability of selecting type IV (clinical-vertical integration) from an independent hospital, and a religious group owned hospitals and for-profit owned hospitals had the highest probability of selecting Type IV (clinical-vertical integration) from an independent hospital. A bed size had positive relation on selecting Type IV (clinical-vertical integration) from an independent hospital. Unlikely general belief that the selecting types of hospital network was determined by the change of health insurance policy such as Health Maintenance Organizations and Preferred Provider Organizations, the types of hospital network were influenced by community characteristics such as population size, and hospital characteristics.

• 한국병원경영학회지
• /
• 제17권4호
• /
• pp.87-115
• /
• 2012

This research classified hospital specialization strategy types through cluster analysis, analyzed fitness of hospital specialization strategy types for external environment or organizational structure, and examined relation between hospital specialization strategy types and organizational performance. This research surveyed 1,437 hospitals which have more than 30 patient's bed and practice national health service in Korea. Specifically, this research divided into two part : external fit - analysis of relation between external environment and specialization strategy, internal fit-analysis of relation between organizational structure factors and specialization strategy. also, as the organizational performance for achieving specialization strategic purpose, not only the productivity, efficiency, profit but also the medical quality was considered. In case of external fit, many hospitals chose integration type if there are a lot of competitive hospitals and regional population. Particularly, if there are many competitive hospitals, concentration type is chosen. In contrast, if there are many doctors in the region, differentiation type is chosen. In case of internal fit, according to organization type and patient's bed number, hospitals chose different types. If it is a general hospital and has a few bed number, generalization or concentration type is chosen. Tertiary hospital or the hospital with many patient's bed chose differentiation type. According to the number of specialists, if there are a few specialists, generalization or concentration type is chosen. If there are many specialists, differentiation type has high fitness for the hospital. In relation to strategy types and organizational performance, differentiation type has best result. Differentiation type has a good result in 7 items out of 11.

• Journal of Preventive Medicine and Public Health
• /
• 제29권1호
• /
• pp.51-65
• /
• 1996

The purpose of this study was to examine the trends of length of hospital stay (LOS), which is most likely to be a major attribute to hospital performance. From 1984 to 1994, an average LOS of each hospital was analyzed by factors such as medical departments, bed size, occupancy rate, region and ownership. This study was analyzed changing rate of LOS during 11 years. This rate was calculated by simple regression, which was used only with hospital without missing data during 11 years. This study findings are as follows. 1. The results indicated that the average LOS was steadily increased until 1990 but it was slightly decreased after 1990. 2. This trend could be found in all hospital scale and all group of occupancy rate. Specifically this trends of LOS were found in internal medicine, corporate owned hospitals, and hospitals in major city. But LOS of individual owned hospital was continuously increased until 1994. 3. Means of changing rates of LOS were calculated from 1984 to 1994. If we devided it into two parts, before 1990 and after 1990, most changing rates of LOS before 1990 except individual owned hospital were found positive sign. The changing rates after 1990 were negative sign but small hospital(lesser then 200 bed), individual owned hospital, national & public hospital and hospital in small urban have little change of LOS after 1990. Finally from this results we thought that most hospitals in Korea began to be concerned with LOS. Nevertheless LOS of several hospital such as small hospital or individual owned hospital was increased. And this trend may be caused by a few patients, low occupancy rate, or low profit. This trend of LOS is different from that of other countries. Perhaps this phenomenon is resulted from the reimbursement method. Because of fee for service reimbursement system in Korea the hospitals didn't need to shorten LOS in order to save the cost and increase the profit. Therefore reform of hospital cost reimbursement method will be needed to reduce hospital cost in Korea. We thought that the Korean health authority should consider the reimbursement method by unit of bundle of services, for example DRG and prepayment in the United States. This study presents some limitations such as no insight of severity of disease, case-mix measurement of hospital, and other clinical characteristics that can. possibly affect LOS. However, this study reports an important trend in LOS from 1984 to 1994.

• 보건행정학회지
• /
• 제9권2호
• /
• pp.21-39
• /
• 1999

An increasing number of hospitals are seeking for new or mixed compensation strategies to improve the productivity of their medical staff in the struggle to provide high quality medical services at low costs amid the economic hardship. To motivate physicians toward the right direction, it is necessary to effectively evaluate their performance that provides a basis for compensation. However, productivity has been historically difficult to measure, particularly for physicians in academic medical centers who are expected to engage in research, education, and patient care simultaneously. The objectives of this study were to define performance measures of physicians and clinical departments in academic medical centers. to examine correlations between the measures. and to investigate factors affecting the measures. The performance data of 212 faculty physicians in 17 clinical departments in two university teaching hospitals affiliated to one medical school during the fiscal year 1994 was used for analyses. Patient care revenue, net profit. and adjusted number of patients were defined to measure the performance in patient care. and number of articles published in academic journals and research grant were defined for research activities. Both individual physicians' performance measures and per physician measures of clinical departments were analyzed. All measures defined to evaluate individual physicians' performance were positively related to each other. Clinical department and rank of faculty position were statistically significant predictors of revenue. and hospital. clinical department. and rank were significant predictors of net profit. journal publication. and research grant. Patient care measures defined to evaluate clinical departments were related to each other. so were research measures. and no significant correlations were found between patient care measures and research measures. Also found were large differences in department. ranks when clinical departments were evaluated by absolute per physician performance measures and evaluated by annual rate of changes in performance measures. These findings suggest that departmental performance measures opposed to individual performance measures are relatively free from problems of factors affecting the performance measures that are not in control of clinical departments or individual physicians. Results from the correlation analysis of departmental performance measures indicates that measures of research performance should be included in the evaluation to promote research activities in academic medical centers.

• 한국콘텐츠학회논문지
• /
• 제9권4호
• /
• pp.299-312
• /
• 2009

병원은 이윤추구를 목적으로 하는 기업과 달리 공익성을 위하여 서비스를 제공하는 측면이 강하다. 하지만, 변화하는 의료환경 속에서 지속적인 성장을 위해서는 경영혁신이 필요하다. 병원의 경영혁신에서 핵심적인 내용은 효율성을 제고하는 것이다. 이를 위해 우선 병원 내부적으로 비효율성이 어떻게 나타나고 있으며 이에 영향을 미치는 요인이 무엇인지 파악하는 것이 필요하다. 그러나 병원의 효율성 평가는 민간부문에서 활용되고 있는 평가방식을 적용하기가 어렵다. 따라서 이 연구에서는 DEA 기법을 이용하여 종합병원의 효율성을 평가하였다. 국내 500병상이상 수련병원 74개를 대상으로 2006년 자료를 이용하여 분석하였다. 분석에 사용된 투입변수는 병상수, 의사수, 간호사수, 의료기사수, 인건비, 관리비, 재료비를 산출변수는 연외래환자수, 연입원환자수, 수술건수, 입원 및 외래 수익을 사용하였다. 또한 병원의 설립형태, 소재지, 설립년, 병원유형에 관해서 효율성에 어떤 영향이 미치는가에 대해서도 검토하였다.

• 산학경영연구
• /
• 제20권2호
• /
• pp.119-133
• /
• 2007

본 연구는 경영혁신의 한 기법으로 BSC를 비영리기업인 대학병원에 도입할 경우 영리기업에서와 같이 그 효과가 있는지를 검증하고자 한다. 대학병원 사례에 의한 BSC 성과측정지표간의 인과관계를 알아보기 위하여 구조방정식 모델을 이용하여 분석하였다. BSC 성과측정지표간의 인과관계를 분석한 결과 모두 통계적으로 유의한 것으로 나타나 연구가설이 모두 채택되었다. 향후에는 실제 재무자료를 학습 및 성장 관점, 내부프로세스 관점, 고객 관점과 연계하여 BSC 성과측정지표간의 인과관계를 연구할 필요가 있다.

• 한국병원경영학회지
• /
• 제23권3호
• /
• pp.1-15
• /
• 2018

Purpose: This study is conducted to identify the impacts of tax exemption on community benefit, policy, human resource management, and public benefit. Based on the results of analysis, we explore several avenues to raise public benefit that is central to the value of existence of non-for-profit hospitals in Korea. Methodology: Survey was formulated referring to the US IRS tax exemption criteria, Form990/Schedule H, and Korean public hospital criteria. A total of 182 survey responses were collected and used to verify measurement validity and perform reliability analysis, confirmatory factor analysis, and path analysis. Findings: The result of this study showed positive relationships among; i) tax development and planning, ii) planning and human resource management, iii) human resource management and policy, iv) policy and community benefit, v) community benefit and public benefit. Practical Conclusion: Tax exemption affects community benefit and public benefit directly as well as indirectly. This implies that expanding tax exemption is likely to improve public benefit mediating community benefit.

• 보건의료산업학회지
• /
• 제12권1호
• /
• pp.1-11
• /
• 2018

Objectives : The purpose of this study was to identify the relationship between decision-making types, public entrepreneurship, and performance management of local public hospital directors. Methods : A questionnaire survey was carried out to assess the dependent variables of directors' decision-making types and public entrepreneurship. The analysis of management performance was carried out through a comparison between 2016 results of, data of variation rate on medical revenue and change rate on medical profit and results in 2015. Results : Results indicated that local public hospital directors who used rational decision-making showed better performance management. The analysis showed that enterprise had a greater positive effect (+) on variation rate of medical revenue than that of innovation. However, innovation had a higher positive effect (+) on change rate of medical profit than that of enterprise. These results suggest that innovation and enterprise have a major influence on performance management. Conclusions : The survey used for this study suggests that an education and training program is needed to improve public hospital directors' ability for rational decision-making, public entrepreneurship and performance management. Additionally, the policy change guaranteeing autonomy within the proper range is demanded that Local Public Hospital Director having spirit of innovation and enterprise achieves peak capacity and have responsibility for management.