• 보건행정학회지
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• 제21권4호
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• pp.527-540
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• 2011

Some patients tend to visit tertiary hospitals instead of non-tertiary hospitals for minor illnesses, which is a chronic problem within the Korean health care delivery system. In order to reduce the number of patients with minor severity diseases unnecessarily utilizing the tertiary medical services in Korea, the Ministry of Health and Welfare raised the outpatient co-insurance rate for the tertiary hospitals in July, 2009. Another increase in the prescription drug co-insurance rate by the general and tertiary hospitals is scheduled to take place in the second half of 2011. An increase in copayments may discourage the utilization rate of medical services among the underprivileged or patients who require complicated procedures. This study aims to analyze the diabetic patients' utilization rates of tertiary hospitals according to the Comorbidity score. Diabetic patients' data was gathered from the Health Insurance Claims Records in the Health Insurance Review & Assessment Service between 2007-2009. Comorbidity scores are measured by the Charlson Comorbidity Index and the Elixhauser Index. Chi-square and logistic regressions were performed to compare the utilization rates of both insulin-dependents (n=94,026) and non-insulin-dependents (n=1,424,736) in tertiary hospitals. The higher Comorbidity outcomes in the insulin-dependent diabetic patients who didn't visit tertiary hospitals compared to those who did, was expected. However, after adjusting the gender, age, location, first visits and complications, the groups that scored >=1 on the comorbidity scale utilized the tertiary hospitals more than the O score group. Non-insulin-diabetic patients with higher Comorbidity scores visited tertiary hospitals more than patients who received lower grades. This study found that patients suffering from severe diabetes tend to frequently visit the tertiary hospitals in Korea. This result implied that it is important for Korea to improve the quality of its primary health care as well as to consider a co-insurance rate increase.

• 한국병원경영학회지
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• 제7권1호
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• pp.19-40
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• 2002

The purpose of this study is to find out if there has been any change in the outpatient visit to tertiary care hospitals after the introduction of the new healthcare program that divides the roles of doctors and pharmacists and the reason for the change if there is any. Two tertiary care hospitals with the largest capacity of 1200 beds and two tertiary care hospitals with the lowest capacity of 600-700 beds were randomly selected. Data of the outpatient visits from March-May 2(xx), before the new healthcare system was adopted, were compared with the data from March-May 2001, after the new policy was adopted. Outpatient visits have decreased 5.8% after the new system. There has been a dramatic decrease, especially, in the department of OB-GYN and Pediatrics of tertiary hospitals. Decrease in re-visits is much higher than the first visits. Female patients decreased more than the male patients. Outpatient visits by economically active patients group aged 25-44 declined much. Tertiary hospitals in Seoul and Kyonggi Province, as well. Outpatient income of tertiary hospitals has dropped up to 14.7% due to the decline in outpatient visits and pharmaceutical income, and resell price system which in turn has caused the hospital financial deficits. While the new program has succeeded in lowering the use of antibiotics and injections, it has the pitfall of prescribing long days and expensive drugs. A full-fledged review of the system should be conducted for the establishment of the new system and I believe this study may be a useful references. Furthermore, more profound and overall studies on the chance in the patients use of hospitals are needed.

• 보건의료산업학회지
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• 제8권3호
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• pp.13-25
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• 2014

This research was performed to investigate the characteristics and determination factors on tertiary hospital inpatients. The used data was the four waves of Korea Health Panel(2008, 2009, 2010, 2011), and the number of subjects was 4,430 cases of tertiary and general hospital admission. The statistical methodology used in the study is the logistic regression model. The significant affecting factors in utilizing tertiary hospital admission were gender, marital status, education, household income, residence region and ICD-10 classification. Man, graduating college/university, married, high-income were socio-economic affecting factors in tertiary hospital admission. Medical need factor of ICD-10 classification and residence region of inpatients was also significant affecting factors in tertiary hospital admission. The 81.4% of inpatients at tertiary hospital had chronic disease and the 12.9% of inpatients readmitted, the 68.2% had a selecting doctor and the only 26.7% of inpatients reinforced by private medical insurance. This study recommended the Korean government to provide proper rule for tertiary hospital admission in order to improve the equity and efficiency of health care system.

• 한국병원경영학회지
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• 제26권1호
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• pp.55-70
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• 2021

Purpose: The purpose of this study was to examine the influencing factors of the patient leaning phenomenon in tertiary hospitals. Based on the results of this study, we intended to find implications for improving the problems of the delivery system imbalance in tertiary hospitals caused by patient leaning phenomenon. Methodology/Approach: Qualitative studies were conducted, using focus group interviews and in-depth interviews. The focus group interviews were conducted for 12 users of tertiary hospitals by 2 groups. And in-depth interviews were conducted for 6 tertiary hospital managers. This was considered to be the most effective approach to gather diverse and in-depth information about the influencing factor of patient leaning phenomenon in tertiary hospitals. Findings: In focus group interviews, the reason for choosing tertiary hospitals was the reliability of the hospital(physician, reputation, etc.). And the effect of the policy to strengthen coverage of National Health Insurance and private medical insurance was relatively small. In other words, we found that the individual's desire to receive medical services suitable for one's health status and disease condition was the biggest factor, rather than the cost and policy factors. Practical Implications: We suggested that the appropriate medical care provision should be strengthened according to the role and function of medical institutions. In addition, the education system needs to be reorganized to activate the referral program, expand community medical capabilities, and foster quality primary medical care.

• Journal of Preventive Medicine and Public Health
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• 제28권1호
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• pp.207-223
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• 1995

A new medical delivery system which regulated outpatient department(OPD) use from tertiary care hospitals was adopted in 1989. Under the new system, patients using tertiary care hospital OPD without referral slip from clinics or hospitals could not get any insurance benefit for the services received from the tertiary care hospital. This study was conducted to evaluate the Patient Referral System(PRS) with respect to health care expenditures and utilization. Two data sets were used in this study. One was monthly data set(from January 1986 to December 1992) from the Annual Report of Korea Medical Insurance Corporation(KMIC). The other was monthly joint data set composed of personal data of which 10% were selected randomly with their utilization data of KMIC from January 1988 to December 1992. The data were analyzed by time-series intervention model of SAS-ETS. The results of this study were as follows: 1. There was no statistically significant changes in per capita expenditures following PRS. 2. Utilization episodes per capita was increased statistically significantly after implementation of PRS. The use of clinics and hospitals increased significantly, whereas in tertiary care hospitals the use decreased significantly immediately after implementation of PRS and increased afterwards. 3. Follow-up visits per episode were decreased statistically significantly after implementation of PRS. The decrease of follow-up visits per episode were remarkable in clinics and hospitals, whereas in tertiary care hospitals it was increased significantly after implementation of PRS. 4. There was no statistically significant changes in prescribing days per episode following PRS. Futhermore, clinics and hospitals showed a statistically significant decrease in prescribing days per episode, whereas in tertiary care hospital it showed statistically significant increase after implementation of PRS. 5. Except high income class, the use of tertiary care hospitals showed statistically significant decrease after implementation of PRS. The degree of decrease in the use of tertiary care hospitals was inversely proportional to income. These results suggest that the PRS policy was not efficient because per capita expenditures did not decrease, and was not effective because utilization episodes per capita, follow-up visits per episode. and prescribing days per episode were not predictable and failed to show proper utilization. It was somewhat positive that utilization episodes per capita were decreased temporarily in tertiary care hospitals. And PRS policy was not appropriate because utilization episodes per capita was different among income groups. In conclusion, the PRS should be revised for initial goal attainment of cost containment and proper health care utilization.

• 동력기계공학회지
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• 제6권1호
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• pp.55-60
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• 2002

There has been no report on the life prediction for gas turbine materials at high temperatures based on the creep properties and their relationship with the AE(acoustic emission) properties as a means of real-time non-destructive testing. One of the important issues is thus to develop a reliable method of evaluating creep properties by the AE technique. In this paper, the real-time evaluation of high temperature creep time and AE cumulative counts for nickel-based superalloy Udimet 720 was performed on round-bar type specimens under pure load at the temperatures of 811, 922 and 977K. The total AE cumulative counts until the starting point of secondary creep($N_1$) and that of tertiary creep($N_2$) have quantitative relationship with the tertiary creep time and the rupture time. It is thus possible to construct the life prediction system based on creep and the prevention system of tertiary creep by using AE technique.

• 보건행정학회지
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• 제5권1호
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• pp.31-58
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• 1995

The Korean government achieved the universal coverage of health insurance in July 1989, and concomitantly introduced a new measure of regulated health care delivery system in using medical care. There are three reasons why the government took the new health care delivery system. Firstly, there was ample room for improving the allocative efficiency in the use of medical facilities. And the second one was to constrain the dramatic increase of medical demand under health insurance. Thirdly, and the most important reason was to alleviate the patient crowdedness in big general hospitals, particularly tertiary hospitals. There are essentially two different ways to control the use of health care : one is to cut the demand for health care, and the other to regulate behaviors of providers through the use of incentives/disincentives, demand-side approach or supply-side approach. The objective of this study is to examine whether or not medical care utilization behaviors under health insurance scheme have been changed among medical facilities such as clinic, hospital, general hospital and tertiary hospital in comparison with those before and after the introduction, particularly whether the patient crowdedness in tertiary hospitals has been alleviated or not. In order to conduct this study, the insurance claim data during the period of January 1989 and July 1992 were analyzed by focusing on diagnosis of both inpatients and outpatients, and especially the fifteen most frequent diseases in ambulatory care and the seven most frequent diseases in hospitalizatio. In addition, the same analyses were made on the changes in medical care utilization by specialty department. This was because the five departments, such as family medicine, ENT, eye, dermatology and rehabilitation, were exempted from applying the regulated health care delivery system in tertiary hospitals. The study revealed that a remarkable alleviation effect in the crowdness was noted for tertiary hospitals. This effect was most conspicuous for the most frequent mild diseases of both inpatient and outpatient care. For example, the fifteen most frequent OPD care at tertiary facilities have decreased as much as by 40%, of which 34% belonged to the cut in initial visits. Meanwhile, the proportion of those who used general hospitals and private practitioner's clinics have increased due to the shift of patients. The cases from the five special departments were also decreased, but not so much as other departments. A problem was noted that, as time passed by, the decreasing tendencies of crowdness at tertiary hospitals due to the regulated system became slightly smaller. Therefore, through complementary remedies are needed for the future implementation.

• 임상간호연구
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• 제19권3호
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• pp.321-332
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• 2013

Purpose: Korean health insurance extended application of the Diagnosis Related Groups (DRG) payment system to tertiary and general hospitals from July, 2013. This study was done to develop a DRG fee adjustment mechanism applied to levels of nurse staffing to assure quality nursing service. Methods: Nurse stafffing grades among hospitals in Korea were analyzed. Differences and ratio of inpatient costs by nurse staffing grades in DRG fees and differences of DRG fee between tertiary and general hospitals were compared. Results: In 2013, nurse staffing grades in tertiary and general hospitals had improved, but other hospital nurse staffing grades remained at the 2001 level. Gaps of inpatient costs between first and seventh nurse staffing grades were over 10% in 4 out of 7 DRG diagnosis; However differences of DRG fee between tertiary and general hospitals were only 4.51% and 4.72% respectively. A DRG fee adjustment mechanism was developed that included nurse staffing grades and hospitalization days as factors of the formula. Conclusion: Current DRG fees motivate hospitals to decrease nurse staffing grades because cost reduction is bigger than compensation. This DRG fee adjustment mechanism reflects nurse staffing supply to motivate hospitals to hire more nurses as a reasonable compensation system.

• 한국지반공학회:학술대회논문집
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• 한국지반공학회 2002년도 암반역학위원회 학술세미나 논문집
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• pp.3-17
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• 2002

Tertiary Pohang basin distributed in south weatern part of the korean peninsula, is composed of Chunbuk formation as the basal conglomerate, Hakjon formation, Duho formation and intrusive basalt which is 15 Ma by absolute age data. The basement of the basin is represented by Cretaceous sedimentary rocks, Hakjon welded tuff and Chilpo welded tuff and rhyolite. The fault systems at the basement of the Pohang basin are consist of NNE direction fault, WNW to EW trend fault. NNE fault is not only strike-slip fault but also normal fault. n fault has sinistral strike-slip sene and the EW fault is strike-slip and normal fault. In the Tertiary basin, the fault system is represented by nm strike-slip fault, EW normal fault and NNE thrust fault. By these fault relationships and geometries, it is interpreted that NNE sinistral strike-slip fault and nomal fault have acted at Creceous times. At Tertiary tines, NNE dextralstrike-slip fault and EW normal fault has created. Progressively Tertiary Pohang basin was influenced by the trenspression to make thrust fault and fold, namely as inversion tectonics.

• 한국정보과학회논문지:컴퓨팅의 실제 및 레터
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• 제6권1호
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• pp.21-35
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• 2000

MIDAS-II는 한국전자통신연구원에서 개발한 바다 DBMS의 저장 시스템이다. 본 논문에서는, MIDAS-II가 대용량 멀티미디어 데이타 서버의 저장 시스템으로 기능하도록 광 디스크 쥬크박스 또는 테이프 라이브러리와 같은 3차 저장 장치를 효율적으로 장착하기 위한 확장에 대하여 기술하였다. 복수개의 저장 매체(platter, 예를 들어 디스크 또는 카트리지 테이프)로 구성된 3차 저장 장치용 볼륨 구조를 위하여 기존 MIDAS-II 디스크 볼륨 구조를 확장하여 3차 저장 장치 볼륨의 용량을 Tera 바이트급으로 확대하였다. 그리고 3차 저장 장치에 저장된 LOB(Large Object) 데이타를 효율적으로 처리하기 위하여 기존 MIDAS-II LOB 구조를 확장하였다. 또한 MIDAS-II 공유 메모리 구조, 프로세스 구조, 유틸리티 등을 확장하였고, 기존 응용 프로그램 운용에 변화를 주지 않기 위하여 MIDAS-II API 함수들의 프로토 타입을 그대로 유지한 채 그 내부 기능만 확장하였다. 또한 3차 저장 장치로부터의 데이타 검색 성능을 평가하여 본 논문의 3차 저장 장치 장착을 위한 MIDAS-II 확장의 적정성을 확인하였다. 이상의 확장 및 성능 평가는 모두 SunOS 5.4 환경에서 수행되었다.