• 제목/요약/키워드: Total payment

검색결과 255건 처리시간 0.032초

일개 대학병원의 환자군별 진료서비스 변이와 포괄수가제 적용에 따른 진료수익 변화 (Studies on the variations of hospital use and the changes in hospital revenues of 10 KDRGs under the PPS)

  • 전기홍;송미숙
    • 보건행정학회지
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    • 제7권1호
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    • pp.100-124
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    • 1997
  • In order to suggest the strategies for participation in the PPS(Prospective Payment System), analyses were performed based on variations in utilization pattern and changes in revenues of hospitals in 10 selected KDRGs. The data was collected from the claims data of a tertiary hospital in Kyunggido from September 1, 1995 to August 31, 1996. The studies consisted of 1, 718 inpatients diagnosed for lens procedures, tonsilectomy &/or adenoidectomy, appendectomy with complicated principal diagnosis, Cesarean section, or vaginal delivery without any complications. The resources used in each KDRG were measured including average length of stay, total charges, number of orders, intensity of medical services, frequencies of medical services, the rate of non-reimbursable charges, and the rate of non-reimbursable orders. Then, the changes in hopital revenues due to the composition of medical fee schedules under the PPS were estimated as follows: 1) The variations in average lenght of stay, total charges, number of orders, the intensity of medical services, the frequency of medical services, the rate of non-reimbursable charges, and the rate of non-reimbursable orders among the 10 KDRGs were comparatively small. 2) The average lenght of stay was the longest(6.0 days) for appendectomy with complicated principal diagnosis, while it was the shortest(2.1 days) for two vaginal deliveries. Statistically differences existed in the average length of stay among physicians and among the dates of admission in several KDRGs. 3) The total charges were the highest for lens procedures(1, 716, 000 won), while the lowest charges were for two vaginal deliveries(558, 000 won). Statistically differences in the total charges were found among physicians in several KDRGs: however, there were no differences with the dates of admission. 4) The number of orders was the greatest(155) for appendectomy with complicated principal diagnosis, while it was the smallest(75) for the two vaginal deliveries. Statistical differences in the number of orders did not exist among physicians in the KDRGs. 5) Significant differences were found in the intensity of medical services, and in the frequency of medical services among physicians in the KDRGs. 6) The rate of non-reimbursable charges for each KDRG was not related to the rate of non-reimbursable orders. The rate of non-reimbursable orders was the highest(36.0%) for lens procedures, while the lowest rate(11.6%) was for appendectomy with complicated principal diagnosis. The rate of non-reimbursable charges was the highest(39.4-39.7%) for vaginal deliveries, while the lowest rate(13.1%) was for tonsillectomy &/or adenoidectomy(<17 ages). 7) If the physician's practicing style were not change under the PPS, the hospital revenuses could be increased by 10%, and the portion of patient payment could be decreased by 1.4-22.4%. However, the non-reimbursable charges for showed little change between two reimbursement systems. Based upon the above findings, this hospital could be eligible for participation in the PPS(Prospective Payment Systm). However, the process of diagnosis and treatment should be standardized, inentifying methods to reduce cost and to assure quality of medical care. Furthermore, consideration should be given to finding ways to increase patient volume.

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응급실 경유 정신 및 행동장애 입원환자들의 총진료비 비교 : 주상병과 부상병 환자 중심으로 (A Comparative Study on Total Payment of Mental and Behavioral Disorders Patients Admitted through the Emergency Room: Focusing on Main & Sub Sick)

  • 최현식;이현숙
    • 한국콘텐츠학회논문지
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    • 제14권10호
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    • pp.562-569
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    • 2014
  • 본 연구의 목적은 응급실을 경유한 정신 및 행동장애 중 기분[정동]장애만을 주상병으로 하는 입원환자와 정신 및 행동장애를 부상병으로 동반한 기분[정동]장애 입원환자의 총진료비에 미치는 영향 요인을 알아보고자 한다. 본 연구는 건강보험심사평가원 2009년 표본자료에서 응급실 경유 입원환자가 '정신 및 행동장애'(F00-F99)중에서 주상병 코드가 기분[정동] 장애(F30-F39)인 환자와 부상병 코드가 '정신 및 행동장애'(F00-F99)를 가진 환자를 추출하여 753명을 분석 대상으로 사용하였다. 본 연구에서 수집된 자료는 통계 프로그램 SPSS 18(Statistical Package for the Science)을 이용하여 빈도분석, t-test, ANOVA, 다중회귀분석을 실시하였다. 연구결과는 주상병의 경우, 총진료비에 영향을 미치는 변수들은 연령을 제외한 모든 성별(p<.01), 응급실 도착경로(p<.001), 진료 결과(p<.001), 입원일수(p<.001) 변수들이 통계적으로 유의한 것으로 나타났다. 또한 부상병의 경우, 총진료비에 영향을 미치는 변수들은 살펴보면, 모든 변수 즉 성별(p<.01), 연령(p<.001), 응급실 도착경로(p<.001), 진료 결과(p<.001), 입원일수(p<.001) 등이 통계적으로 유의한 것으로 나타났다. 앞으로 정부는 장기적이고 지속적으로 국민의 정신건강을 위해 효율적인 방안을 마련하고 효과적인 예방 및 관리, 정신건강 중재 프로그램 개발, 정신건강관련 진료지침, 맞춤형 치료 및 상담서비스 등 사전 사후 체계적인 정신건강증진 종합대책을 추진해야 할 것이다.

한일간(韓日間) 논의 공익적(公益的) 기능별(機能別) 가치평가(價値評價) 비교분석(比較分析) (Comparative Analysis of Multi-functional Public Values of Paddy Fields in Korea and Japan)

  • 임재환
    • 농업과학연구
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    • 제26권2호
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    • pp.70-76
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    • 1999
  • Rice farming is not only the most important income resources of Korean farmers but also the roots of Korean traditional culture. Paddy fields have acted as an food supply base but also have contributed to the public multi-functions such as flood control, water conservation, controlling soil erosion, providing recreational and resting spaces, water purification, air cleaning, oxygen supply and air cooling and so on. The public multi-functions of paddy except rice production have not been evaluated before UR negotiation and starting WTO system. Under the drastic changes of rice economic settings as price decrease of rice and downward decrease of farm income, Korean and Japanese farmers might have lost their intention to grow rice in paddy fields without the direct payment system to compensate rice income decrease. To adapt the direct payment system, the total public value of multi-function of paddy should be identified in terms of money. According to the research results, the total value of multi-functional value of paddy in Korea were estimated 21,596thousand won which is higher than rice production value by 2.1 times. On the other hand the total value of Japanese paddy were amounted to 21,390 Yen which is more than that of Korea by 10times outstandingly. Likewise Japanese have evaluated the paddy field very important enterprise from the view point of food security and multi -functions of paddy to their socio-economic life and environmental sustainability in Japan.

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치료방사선과 의료서비스에 대한 원가산정 (Analysis of the Payment Rates and Classification of Services on Radiation Oncology)

  • 신경환;신현수;표홍렬;이규찬;이윤태;명희봉;염용권
    • Radiation Oncology Journal
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    • 제15권2호
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    • pp.167-174
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    • 1997
  • 목적 : 치료방사선과 의료서비스에 투입된 자원을 토대로 의료서비스별 원가를 산정하여 적절한 수가수준을 알아보고자 본 연구를 시행하였다. 대상 및 방법 : 현행 '의료보험요양급여기준 및 진료수가기준(95년 12월판)'을 검토후 적절치 못한 수가항목을 재조정하고 이를 토대로 원가조사표를 개발한 후 40개병원을 대상으로 조사를 실시하여 의뢰하여 적절한 자료가 수집된 24개 병원의 자료를 분석하였다. 원가자료는 1995년도 1년간 발생한 비용자료로서 의료서비스별 원가를 산출후 의료장비의 가동률에 근거한 조정원가를 계산하였다. 현행 보험수가와의 비교를 위하여 3차병원 가산율 30%를 적용한 후 이를 본연구 결과로 산출된 조정원가와 비교하였다. 결과 : 의료서비스별 추정원가 및 조정원가를 산출한 후 이를 현행 보험수가와 비교한 결과 방사선치료계획의 경우 5.05배-6.58배, 차폐물제작은 2.22배, 체외조사는 1.57배-2.86배, 강내치료 및 조직내치료는 3.82배-5.01배, 전신조사는 1.12배-2.55배씩 조정원가에 비하여 현행 보험수가가 낮은 가격을 보이는 것으로 나타났다. 또한 현행 진료수가기준의 진료행위 분류체계는 각 진료행위의 원가를 적절히 반영하기에는 부적절하다고 판단되며 전신조사의 경우 적절한 재분류 시약 5배의 수가 차이를 보이는 것으로 생각된다. 결론 :치료방사선과의 현행 의료보험수가제도에서의 문제점은 보험수가의 수준이 낮다는 점과 진료행위 분류체계가 부적절하게 되어있다는 점이다. 향후 수가 책정시 이러한 문제점이 적절히 반영, 해결되도록 하여야 할 것으로 판단된다.

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포괄수가제도 당연적용 효과평가 (The Effect of Mandatory Diagnosis-Related Groups Payment System)

  • 최재우;장성인;장석용;김승주;박혜기;김태현;박은철
    • 보건행정학회지
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    • 제26권2호
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    • pp.135-147
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    • 2016
  • Background: The voluntary diagnosis-related groups (DRG)-based payment system was introduced in 2002 and the government mandated participation in the DRG for all hospitals from July 2013. The main purpose of this study is to examine the independent effect of mandatory participation in DRG on various outcomes of patients. Methods: This study collected 1,809,948 inpatient DRG data from the Health Insurance Review and Assessment database which contains medical information for all patients for the period 2007 to 2014 and examined patient outcomes such as length of stay (LOS), total medical cost, spillover, and readmission rate according to hospital size. Results: LOS of patients decreased after DRGs (large hospitals: adjusted odds ratio [aOR], 0.87; 95% confidence interval [CI], 0.78-0.97; small hospitals: aOR, 0.91; 95% CI, 0.91-0.92). The total medical cost of patients increased after DRGs (large hospitals: aOR, 1.22; 95% CI, 1.14-1.30; small hospitals: aOR, 1.22; 95% CI, 1.21-1.23). The results reveals that spillover of patients increased after DRGs (large hospitals: aOR, 1.27; 95% CI, 0.70-2.33; small hospitals: aOR, 1.18; 95% CI, 1.16-1.20). Finally, we found that readmission rates of patients decreased significantly after DRGs (large hospitals: aOR, 0.28; 95% CI, 0.26-0.29; small hospitals: aOR, 0.59; 95% CI, 0.56-0.63). Conclusion: The DRG payment system compared to fee-for-service payment in South Korea may be an alternative medical price policy which can reduce the LOS. However, government need to monitor inappropriate changes such as spillover increase. Since this study also is the results based on relatively simple surgery, insurer needs to compare or review bundled payment like new DRG for expansion of various inpatient-related diseases including internal medicine.

데이터 주도 접근법을 활용한 소프트웨어 테스트 자동화 : 온라인 쇼핑몰 결제시스템 사례 (Software Test Automation Using Data-Driven Approach : A Case Study on the Payment System for Online Shopping)

  • 김성용;민대환;임성택
    • 한국IT서비스학회지
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    • 제17권1호
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    • pp.155-170
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    • 2018
  • This study examines a data-driven approach for software test automation at an online shopping site. Online shopping sites typically change prices dynamically, offer various discounts or coupons, and provide diverse delivery and payment options such as electronic fund transfer, credit cards, mobile payments (KakaoPay, NaverPay, SyrupPay, ApplePay, SamsungPay, etc.) and so on. As a result, they have to test numerous combinations of possible customer choices continuously and repetitively. The total number of test cases is almost 584 billion. This requires somehow automation of tests in settling payments. However, the record playback approach has difficulties in maintaining automation scripts due to frequent changes and complicated component identification. In contrast, the data-driven approach minimizes changes in scripts and component identification. This study shows that the data-driven approach to test automation is more effective than the traditional record playback method. In 2014 before the test automation, the monthly average defects were 5.6 during the test and 12.5 during operation. In 2015 after the test automation, the monthly average defects were 9.4 during the test and 2.8 during operation. The comparison of live defects and detected errors during the test shows statistically significant differences before and after introducing the test automation using the data-driven approach.

CVM을 이용한 바다낚시 자원풍도 증가에 대한 지불의사액 추정에 관한 연구 (Estimation of the Willingness to Payment of Sea-anglers about Increase in Abundance of Fish Resources Using CVM)

  • 남종오;박철형
    • Ocean and Polar Research
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    • 제38권3호
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    • pp.235-245
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    • 2016
  • The purpose of this study is to estimate the Willingness To Payment (WTP) of sea-anglers regarding the increase in the abundance of fish resources resulting from the Korean vessel buy-back program using the contingent valuation method. Data was collected through sample surveys of 352 sea-anglers across the nation in 2015. If a 20% increase in the abundance of fish resources resulted from the vessel buy-back program, WTP estimates of sea-anglers per recreational fishing trip were 9,570 won on truncated mean, 16,528 won on mean, and 35,830 won on median, respectively. Additionally, when the number of annual total recreational fishing trips in Korea were estimated as 22,700 thousand trips, the annual increase in national welfare through recreational fishing was estimated to be 217.2 billion won on the truncated mean, 375.2 billion won on the mean, and 813.3 billion won on the median, respectively.

가정간호수가 적정성 검증 및 수가체계 개선 방안 (Test on the Cost and Development on the Payment System of Home Health Care Nursing)

  • 유호신;정기선;임지영
    • 대한간호학회지
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    • 제36권3호
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    • pp.503-513
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    • 2006
  • Purpose: This study focused on analysing costs per home health care nursing visit based on home health care nursing activities in medical institutes. Method: The data was collected in three stages. First, the cost elements of home health care nursing services were collected and 31 home care nurses participated. Second, the workload and caseload of home care nursing activities were measured by the Easley-Storfjell Instrument(1997). Third, the opinions on improving the home health care nursing reimbursement system were collected by a nation-wide mailing survey from a total of 125 home care agencies. Result: The cost of home health care nursing per visit was calculated as 50,626\. This was composed of a basic visiting fee of $35,090{\\}({\fallingdotseq}355$)$ and travel fee of $15,536{\\}({\fallingdotseq}15$)$. The major problems of the home care nursing payment system were the low level of the cost per visit, no distinction between first visit and revisits, and the limitations in health insurance coverage for home health care nursing services. Conclusion: This study's results will contribute as a baseline for establishing policies for improvement of the home health care nursing cost and for applying a community-based visiting nursing service cost.

관광정보서비스, 결재서비스, 만족도, 재이용의도의 구조적 관계: 중국 시에청을 대상으로 (Structural Relationships among Tourism Information, Payment Service, Satisfaction, and Intention to Reuse: Focused on the Ctrip APP in China)

  • 이옌링;김영국
    • 아태비즈니스연구
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    • 제9권2호
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    • pp.123-136
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    • 2018
  • The purpose of this study is to investigate the effects of six factors (accuracy, perceived usefulness, perceived ease of use, security, instant accessibility, and ease of use) on re-use intention; and then to help to establish future marketing strategy. In order to achieve the study's objectives, this study conducted an online questionnaire on the Internet, Wenjuanxing. The total of 270 copies through APP-Wechat (Wicket), and 245 were used for analysis. For statistical processing, SPSS22.0 is used to analyze the influence relationship amongst factors for mobile tourism information service, a variety of analysis, such as factor analysis, reliability analysis, mass regression analysis, simple regression analysis were employed. The results of this study are summarized as follows. As a result of analyzing the factors affecting the satisfaction of consumers using chinese Ctrip mobile app, the perceived usefulness and perceived ease of use of mobile tourism information service attributes have a significant effect on user satisfaction. The accuracy of mobile information service were found to have no significant effect on satisfaction. The security, immediacy of access, and usability of the payment service of mobile APP were found to have a significant effect on satisfaction. And customer satisfaction has a significant effect on re-use intention.

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Examining Customers' Continuance Intentions towards E-wallet Usage: The Emergence of Mobile Payment Acceptance in Vietnam

  • PHUONG, Nguyen Ngoc Duy;LUAN, Ly Thien;DONG, Vu Van;KHANH, Nguyen Le Nhat
    • The Journal of Asian Finance, Economics and Business
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    • 제7권9호
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    • pp.505-516
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    • 2020
  • The purpose of the research is to identify antecedents of mobile wallet continuance intention in Vietnam. A self-administered questionnaire was distributed to collect data from a total of 276 respondents. Partial least squares structural equation modeling was employed for analyzing the data. Five mobile wallet features - mobile application quality, mobile wallet familiarity, situational normality, payment security, and feedback mechanism - are introduced as fundamental elements, which influence customer' continuance intention to use mobile wallet in Vietnam. The results indicate that mobile quality application and familiarity can significantly influence perceived ease-of-use (PEOU) and perceived usefulness (PU), but situational normality has an impact only on PEOU. PEOU and PU are positively related to satisfaction. On the other hand, payment security and feedback mechanism affect positively customer' trust. As a result, the positive effects that satisfaction and trust have on electronic wallet continuance intention are confirmed. The findings can be used to advise mobile wallet providers to improve their platform design and services to retain users. As a theoretical contribution, this study combines the Technology Acceptance Model, Unified Theory of Acceptance and Use of Technology to investigate the key determinants on continuance intention in the context of electronic wallet in Vietnam.