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Variation of Hospital Costs and Product Heterogeneity

  • Shin, Young-Soo
    • Journal of Preventive Medicine and Public Health
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    • v.11 no.1
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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.

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A STUDY OF THE NORMAL & ABNORMAL OCCULSAL PATERNS IN ADULTS USING THE SUPERIMPOSED RUBBER PATTERN METHOD (Superimposed Rubber Pattern법에 의한 성인 정상 및 비정상 교합자의 교합 양상에 관한 연구)

  • Choi, Dae-Gyun;Lee, Sung-Bok;Kwon, Young-Hyuk;Choi, Boo-Byung
    • The Journal of Korean Academy of Prosthodontics
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    • v.33 no.3
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    • pp.467-491
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    • 1995
  • In order to analyze the occlusin of intercuspation with maximun bite force, fifteen healthy adult subjects with the ages 23 to 27 were studied(Group1 ; 5-normal occlusion with Angle's Class1, Group2 ; 5-Angle's Class2 malocclusion, Group3 ; 5-Angle’s Class3 malocclusion). Head Position was fixed with occlusal plane paralleling to horizontal line and occlusal registration r cord was made with polyether rubber impression material(Ramitec, ESPECo. West Germany). After all subject were trained for maximum intercuspation at least 5 times, occlusal registration procedure was repeated for this study. Lower posterior rubber occlusal registration records were sliced with 1mm thickness using precision metal sliding channel(Hitachi Ind. Co., Japan). Gross sectional drawings were traced from occluding view of upper and lower posterior teeth on the rubber slices using digitizer, and superimposed for the determination of each drawing distance(Superimposed Rubber Pattern Method). Based on superimposed rubber pattern drawings, total area of occlusal view, sum of each area of the 5 divided occlusal contact provinces and its ratio, total area and number of occlusal contact area were determined to elucidate occlusal stability in the normal and abnormal occlusion groups. The data were analysed by t-test(p=0.05) to determine statistical significance. The obtained results were as follows : 1. Group1 showed the largest standard area with occlusal view of the lower posterior teeth and Group3 showed the smallest area. There was a significant difference between Group2 and Group3(p=0.025), and Gropu1 was not statistically different for both Group2 and Group3. 2. Means and ratio of the under 2.0mm area(D) and ratio showed $197.49mm^2$, 59.76% in Group1, $188,69mm^2$, 56.10% in Group2, and $174.23mm^2$, 55.76% in Group3. The results that Group1 has the most area/ratio and Group3 has the least area/ratio can be considered Group1 is the most advantageous for masticatory effective area, and Group3 is the least adnantageous. 3. Means and ratio of the under 1.0mm area(C) were $198.96mm^2$, 42.65% in Group1, 123.06$mm^2$, 46.58% in Group2, and $92.24mm^2$, 29.52% in Group3. These data means that Group1 is the most advantageous in terms of masticatory effective area and Group3 is the least. 4. Means and ratio of the under 0.5mm area(B) were $86.68mm^2$, 26.68% in Group1, $62.98mm^2$, 18.71% in Group2, and $36.44mm^2$, 11.66% in Group3. These can also be considered Group1 is the most advantageous for masticatory effective area and occlusal stability. 5. Means and ratio of the under 0.05mm area(A) were $30.92mm^2$, 9.21% in Group1, $14.31mm^2$, 4.25% in Group2, and $7.59mm^2$, 2.43% in Group3. The area ratio of the each subject group was(4.1) : (1.9) : (1)and the data of the under 0.05mm area has the intimate relationship with inter-group and intra-group data/ratio. 6. First molar showed the most occlusal contact points in all subject group and Group1 showed somewhat uniformly distributed occlusal contact point except first premolar. In Group2, all contact point in posterior teeth showed significantly reduced distribution except first molar. Group3 showed evenly distributed contace points in first and second molars.

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Establishment of a Hepatocellular Carcinoma Cell Line Expressing Dual Reporter Genes: Sodium Iodide Symporter (NIS) and Enhanced Green Fluorescence Protein (EGFP) (나트륨 옥소 공동수송체 유전자와 녹색 형광 유전자의 이중 리포터 유전자를 발현하는 간암세포주 확립)

  • Kwak, Won-Jung;Koo, Bon-Chul;Kwon, Mo-Sun;Lee, Yong-Jin;Lee, Hwa-Young;Yoo, Jeong-Soo;Kim, Te-Oan;Chun, Kwon-Soo;Cheon, Gi-Jeong;Lee, Sang-Woo;Ahn, Byeong-Cheol;Lee, Jae-Tae
    • Nuclear Medicine and Molecular Imaging
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    • v.41 no.3
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    • pp.226-233
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    • 2007
  • Purpose: Dual reporter gene imaging has several advantages for more sophisticated molecular imaging studies such as gene therapy monitoring. Herein, we have constructed hepatoma cell line expressing dual reporter genes of sodium iodide symporter (NIS) and enhanced green fluorescence protein (EGFP), and the functionalities of the genes were evaluated in vivo by nuclear and optical imaging. Materials and Methods: A pRetro-PN vector was constructed after separating NIS gene from pcDNA-NIS. RSV-EGFP-WPRE fragment separated from pLNRGW was cloned into pRetro-PN vector. The final vector expressing dual reporter genes was named pRetro-PNRGW. A human hepatoma (HepG2) cells were transfected by the retrovirus containing NIS and EGFP gene (HepG2-NE). Expression of NIS gene was confirmed by RT-PCR, radioiodine uptake and efflux studies. Expression of EGFP was confirmed by RT-PCR and fluorescence microscope. The HepG2 and HepG2-NE cells were implanted in shoulder and hindlimb of nude mice, then fluorescence image, gamma camera image and I-124 microPET image were undertaken. Results: The HepG2-NE cell was successfully constructed. RT-PCR showed NIS and EGFP mRNA expression. About 50% of cells showed fluorescence. The iodine uptake of NIS-expressed cells was about 9 times higher than control. In efflux study, $T_{1/2}$ of HepG2-NE cells was 9 min. HepG2-NE xenograft showed high signal-to-background fluorescent spots and higher iodine-uptake compared to those of HepG2 xenograft. Conclusion: A hepatoma cell line expressing NIS and EGFP dual reporter genes was successfully constructed and could be used as a potential either by therapeutic gene or imaging reporter gene.

Functional Properties of Soy Protein Isolates Prepared from Defatted Soybean Meal (탈지대두박(脫脂大豆粕)에서 추출(抽出)한 분리대두단백(分離大豆蛋白)의 식품학적(食品學的) 성질(性質))

  • Byun, Si-Myung;Kim, Chul-Jin
    • Korean Journal of Food Science and Technology
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    • v.9 no.2
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    • pp.123-130
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    • 1977
  • A laboratory study was made to develop a simple and economic model method for the systematic determination of functional properties of 'Soy Protein Isolates (SPI)' prepared from defatted soybean meal. These are required to evaluate and to predict how SPI may behave in specific systems and such proteins can be used to simulate or replace conventional proteins. Data concerning the effects of pH, salt concentration, temperature, and protein concentration on the functional properties which include solubility, heat denaturation, gel forming capacity, emulsifying capacity, and foaming capacity are presented. The results are as follows: 1) The yield of SPI from defatted soybean meal increased to 83.9 % as the soybean meal was extracted with 0.02 N NaOH. 2) The suitable viscocity of a dope solution for spinning fiber was found to be 60 Poises by using syringe needle (0.3 mm) with 15 % SPI in 0.6 % NaOH. 3) Heat caused thickening and gelation in concentration of 8 % with a temperature threshold of $70^{\circ}C$. At $8{\sim}12\;%$ protein concentration, gel was formed within $10{\sim}30\;min$ at $70{\sim}100\;^{\circ}C$. It was, however, disrupted rapidly at $125\;^{\circ}C$ of overheat treatment. The gel was firm, resilient and self-supporting at protein concentration of 14 % and less susceptible to disruption of overheating. 4) The emulsifying capacity (EC) of SPI was correlated positively to the solubility of protein at ${\mu}=0$. At pH of the isoelectric point of SPI (pH 4.6), EC increased as concentration of sodium chloride increased. Using model system$(mixing\;speed:\;12,000\;r.p.m.,\;oil\;addition\;rate:\;0.9\;ml/sec,\;and\;temperature\;:\;20{\pm}1\;^{\circ}C)$, the maximum EC of SPI was found to be 47.2 ml of oil/100 mg protein, at the condition of pH 8.7 and ${\mu}=0.6$. The milk casein had greater EC than SPI at lower ionic strength while the EC of SPI was the same as milk casein at higher ionic strength. 5) The shaking test was used in determining the foam-ability of proteins. Progressively increasing SPI concentration up to 5 % indicated that the maximum protein concentration for foaming capacity was 2 %. Sucrose reduced foam expansion slightly but enhanced foam stability. The results of comparing milk casein and egg albumin were that foaming properties of SPI were the same as egg albumin, and better than milk casein, particularly in foam stability.

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Nutrient Load Balance in Large-Scale Paddy Fields during Rice Cultivation (경지 정리된 광역 논에서 영양물질 수지와 배출 특성)

  • Kim, Min-Kyeong;Roh, Kee-An;Lee, Nam-Jong;Seo, Myung-Chul;Koh, Mun-Hwan
    • Korean Journal of Soil Science and Fertilizer
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    • v.38 no.3
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    • pp.164-171
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    • 2005
  • The aim of this study was to evaluate the load of nutrient from paddy fields. Water management practices that can reduce eutrophication and meet water quality requirements will also be addressed. Continuous monitoring from May to September in 2002 and 2003 was conducted for water quantification and qualification at the intensive paddy fields in Icheon, Gyunggi province of Korea. Water balance and concentration variation of nitrogen and phosphorus in the water were independently compared for water quality assessment at each rice cultivation period. Rice land preparation and transplanting periods usually marked the highest water demand when compared to other periods of cultivation. Overall, a greater net irrigation ratio was observed during the transplanting period in 2002 (92.3%) and 2003 (87.2%). The measured total N loads of precipitation, irrigation, drainage, and percolation during the rice cultivation period were 9.9, 41.6, 22.1, and $5.5kg\;ha^{-1}$ for 2002 and 15.8, 55.4, 17.3, and $7.5kg\;ha^{-1}$ for 2003, respectively. The measured total P loads of precipitation, irrigation, drainage, and percolation during the rice cultivation period were 2.1, 13.0, 3.6, and $1.8kg\;ha^{-1}$ for 2002 and 1.6, 15.0, 5.0, and $1.2kg\;ha^{-1}$ for 2003, respectively. Daily nutrient load followed the pattern of surface drainage water, but this pattern was changed by rainfall events. The nutrient load in drainage water depends on rainfall and surface drainage water amount from the paddy fields. Interestingly, the load of total N and total P output was smaller than the input load due to the natural infiltration that Occurred during the rice cultivation period. It is concluded that the paddy fields have a beneficial effect on the ecosystem and can reduce eutrophication in the water.

Rapid Detection Method for Human Rotavirus from Vegetables by a Combination of Filtration and Integrated Cell Culture/Real-Time Reverse Transcription PCR (Filtration과 Integrated Cell Culture/Real-Time Reverse Transcription PCR 기법을 이용한 채소류에서 Human Rotavirus 신속 검출)

  • Hyeon, Ji-Yeon;Chon, Jung-Whan;Song, Kwang-Young;Hwang, In-Gyun;Kwak, Hyo-Sun;Lee, Jung-Soo;Kim, Moo-Sang;Lee, Jung-Bok;Seo, Kun-Ho
    • Korean Journal of Microbiology
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    • v.47 no.2
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    • pp.117-123
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    • 2011
  • The purpose of this study was to evaluate and compare different elution and concentration methods for optimization of human rotavirus (HRV) detection method using real-time RT-PCR and cell culture techniques. The leafy vegetable samples (lettuce, Chinese cabbage) were artificially inoculated with HRV. Viruses were extracted from the vegetables by two different elution buffers, buffer A (100 mM Tris-HCl, 50 mM glycine, 3% beef extract, pH 9.5) and buffer B (250 mM Threonine, 300 mM NaCl, pH 9.5), and the extracted viruses were concentrated by filtration and PEG precipitation sequentially. To determine infectivity of the viruses, the viruses recovered from the samples were infected to the MA-104 cells, and integrated cell culture real-time RT-PCR was performed at 1, 48, 72, 96, 120, 144, 168 h post-infection (p.i.). The elution buffer A was more efficient in extracting the virus from the produce samples tested than the buffer B, 29.54% and 18.32% of recoveries, respectively. The sensitivity of real-time RT-PCR method was markedly improved when the virus was concentrated by the filtration method. When the viruses were eluted and concentrated by buffer A and filtration, respectively, the average recovery rate was approximately 51.89%. When the viruses recovered from samples were infected to MA-104 cell, infectious HRV was detected within 48 h p.i. by ICC/real-time RT-PCR, whereas cytopathic effects were not observed until 72 h p.i. The optimized detection method evaluated in this study could be useful for rapid and reliable detection of HRV in fresh produce products and applied for detection of other food-borne viruses.

On­farm Survey on Deer Farming Situation and Environment in Korea (우리나라 양록업 현황 및 환경 실태 조사)

  • 성시흥;문상호;전병태;이승기
    • Journal of Animal Environmental Science
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    • v.9 no.2
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    • pp.123-130
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    • 2003
  • In this study, current status of domestic deer farms and its feeding were surveyed. The information of supply and demand of feed f3r deers including its industry were also examined and then analyzed to make fundamental data for deer farms and government policy. The results are as follows. 1. Over 40 years old farmers were about 63% of total deer farms while 20­30 years olds were less than 1% indicating that young people still evade agriculture. Moreover, considering education, over 52% of the farmers have bachelor degree showing much higher rates compared to the other agricultural fields. The reason can be assumed that the labor burden is not serious in deer farming while it is not dirty job compared to the other livestock management. Those high­educated people can be easily trained as experts of deer farming to improve its international competition. 2. Most of investigated farms raise Korean spotted deers and Elk showing that the percentage of Elk has greatly increased(However, many farmers have complained about purchasing methods and they insisted that the sales organization should be controlled by government). 3. 57% of total cost of production is for feed while most of feeds are imported from abroad. It indicated that it is urgent to make counterplan for saving feed cost. 4. It is necessary to develop feeds for deers in the near future while most of the examined farmers currently use normal assorted feed. Typical roughage sources feeds are rice straw, alfalfa hay, browses feed, and so on. Most of them are currently imported except the rice straw indicating urgently needed to develop domestic bulky feed. 5. The present questions are development of processed goods of velvet antler, establishment of reasonable management system, difficulty of velvet antler selling, feed supply, and so on. It is necessary for government and academic world to develop reasonable policy and scientific research program.

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Yield Reductions in the $F_2$ and $F_3$ Generations of Highly Promising Varietal Crosses of Corn (유망시되는 옥수수 품종간교잡의 $F_2$$F_3$에 있어서의 수량감소)

  • Chea-Yu Cho;R.M. Lantican
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.14
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    • pp.123-131
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    • 1973
  • 1. In order to evaluate the performance of the $F_2$ and $F_3$ generations of $F_1$ varietal crosses which in past trials yielded better than or as high as the recommended double-cross hybrids, eleven yellow and five white-endosperm $F_1$ varietal crosses, their $F_2$ and $F_3$ generations, and the parental open-pollinated varieties together with the standard double-cross hybrids were tested in performance trials in the 1963 wet and 1963-64 dry seasons. The former trials, however, failed due to a strong typhoon that damaged the crop. 2. Net hybrid vigor was highly manifested in grain yield in the $F_1$ varietal crosses, which on the average was 39.9 per cent of the mid-parent yields. Reduction in heterosis was 27.2 per cent in the $F_2$and 30.3 per cent in the $F_3$ generation, respectively. 3. A fairly high degree of reduction in yield occurred in the $F_2$ and $F_3$ generation. On the average, the $F_2$ generation decreased by 17.6 per cent and the $F_3$ by 20.7 per cent. The losses in two generations were exhibited in two levels; four crosses decreased by 10.9 per cent and twelve combinations by 22.0 per cent. The advanced generations of one yellow cross, Cuban Yellow Flint ${\times}$ Hawaiian Flinty Dent, and three white flint crosses, Bicol White Flint ${\times}$ Eto Blanco, College White Flint ${\times}$ Eto Blanco and Bicol White Flint ${\times}$ Nariono 330b, yielded as high as Philippine Hybrid No.1 and Philippine Hybrid No.4, respectively. 4. No significant differences in yield were obtained between the $F_2$ and $F_3$ populations, showing that genetic equilibrium was reached in $F_2$, as may be expected in view of the Hardy-Weinberg law on panmixis. 5. As in past trials, Hawaiian Flinty Dent, a variety, yielded as high as Philippine Hybrid No. 1.

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Present Status and Future Prospect of Satellite Image Uses in Water Resources Area (수자원분야의 위성영상 활용 현황과 전망)

  • Kim, Seongjoon;Lee, Yonggwan
    • Korean Journal of Ecology and Environment
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    • v.51 no.1
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    • pp.105-123
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    • 2018
  • Currently, satellite images act as essential and important data in water resources, environment, and ecology as well as information of geographic information system. In this paper, we will investigate basic characteristics of satellite images, especially application examples in water resources. In recent years, researches on spatial and temporal characteristics of large-scale regions utilizing the advantages of satellite imagery have been actively conducted for fundamental hydrological components such as evapotranspiration, soil moisture and natural disasters such as drought, flood, and heavy snow. Furthermore, it is possible to analyze temporal and spatial characteristics such as vegetation characteristics, plant production, net primary production, turbidity of water bodies, chlorophyll concentration, and water quality by using various image information utilizing various sensor information of satellites. Korea is planning to launch a satellite for water resources and environment in the near future, so various researches are expected to be activated on this field.

The Analysis and Strengthening Method of Export Competitive Power of Medical Device Industry - With Respect to Medical Device Industry in Gangwon Area (의료기기산업의 수출경쟁력 분석 및 강화방안 -강원지역 의료기기산업을 중심으로-)

  • Lee, Kang-Bin
    • THE INTERNATIONAL COMMERCE & LAW REVIEW
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    • v.45
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    • pp.191-238
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    • 2010
  • The purpose of this paper is to make research on the trend of the worldwide medical device market, the trend of the medical device market in the major foreign countries, the present status of the medical device industry in Korea and Gangwon area, the present status of export competitive power and the SWOT analysis of competitive power of the medical device industry in Gangwon area, and the strengthening methods of export competitive power of the medical device industry in Gangwon area. As the research method, the questionaire for the strengthening of export competitive power of the medical device industry in Gangwon area was carried out from August 13 to Otober 22, 2009. The worldwide medical device market in 2008 is estimated at USD 210.2 billion, with the United States being the largest market, followed closely by Japan and Western Europe. In 2006, the worldwide export amount of medical devices recorded USD 121.1 billion and the worldwide import amount of medical devices recorded USD 126.3 billion. As of the end of 2008, the number of Korea's medical device manufacturers expanded to 1,726. The production amount of Korea's medical device industry in 2008 recorded 2,525 billion won, and the domestic market volume of medical devices in 2008 recorded 3,618 billion won. Korea's export amount of medical devices in 2008 recorded USD 1,132 million and recorded a 9.67% growth compared to the previous year, and the import amount of medical devices recorded USD 2,123 million and recorded a 1.43% reduction compared to the previous year. As of the end of 2008, the number of Gangwon area's medical device manufacturers expanded to 81. The production amount of Gangwon area's medical industry in 2008 recorded 380 billion won, and Gangwon area's export amount of medical devices recorded USD 269 million and recorded a 0.25% reduction compared to the previous year, and the import amount of medical devices recorded USD 3 million and recorded a 39.63% reduction compared to the previous year. According to the result analysis of the questionaire for the strengthening of export competitive power of medical device industry in Gangwon area(August 13~October 22, 2009), the competing country of the export medical device is the United States being the highest ranking. Comparing to the collective competitive power level 100 of the competing country, the collective competitive level of the export medical device is 60 below and 70-80 below being the highest ranking. Comparing to the quality level 100 of the United States, EU and Japan, the quality level of the export medical device is 80-90 below being the highest ranking. Comparing to the design level 100 of the United States, EU and Japan, the design level of the export medical device is 90-100 below being the highest ranking. Comparing to the technology level 100 of the United States, EU and Japan, the technology level of the export medical device is 80-90 below being the highest ranking. According to the SWOT analysis of competitive power of medical device industry in Gangwon area, the strength is the abundant expert manpower of the medical device in Wonju area. The weakness is the fragility of the brand recognition of the medical device industry. The opportunity is the demand increase of the new medical device owing to the advanced age of population. The threat is the difficulty of entry into overseas market owing to the request of the new specification certification of the medical device. In order to strengthen the export competitive power of the medical device industry in Gangwon area, the following measures should be taken by the government, local self-government body, related organization and medical device industry : the development of new technology and design, the enhancement of brand recognition. the acquisition of the foreign specification certification, the building of overseas distribution channel and after sales service channel, the positive participation in overseas medical device exhibition and opening of medical device exhibition, the training of expert manpower, the strengthening of overseas marketing, and the application of FTA and the establishment of counter measures against FTA. In conclusion, the medical device industry in Gangwon area has the difficulty in the entry into the overseas market owing to the shortage of overseas marketing capability. Therefore, the government and local self-government body should make the intensive and systematical support for overseas marketing of the medical device industry. For the support of overseas marketing, the government and local self-government body should provide positively the support of expenses for the acquisition of foreign specification certification, the support of participation in the overseas medical device exhibition, the despatch of market development mission, the increase of the support amount for R&D investment fund, and the training of expert manpower of medical devices.

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