• Journal of Preventive Medicine and Public Health
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• 제52권1호
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• pp.41-50
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• 2019

Objectives: The aim of this study was to investigate cancer patients' utilization of tertiary hospitals in Seoul before and after the benefit expansion policy implemented in 2013. Methods: This was a before-and-after study using claims data of the Korean National Health Insurance Service from 2011 to 2016. The unit of analysis was inpatient episodes, and inpatient episodes involving a malignant neoplasm (International Classification of Diseases, Tenth Revision codes: C00-C97) were included in this study. The total sample (n=5 565 076) was divided into incident cases and prevalent cases according to medical use due to cancer in prior years. The tertiary hospitals in Seoul were divided into two groups (the five largest hospitals and the other tertiary hospitals in Seoul). Results: The proportions of the incident and prevalent episodes occurring in tertiary hospitals in Seoul were 34.9% and 37.2%, respectively, of which more than 70% occurred in the five largest hospitals in Seoul. Utilization of tertiary hospitals in Seoul was higher for inpatient episodes involving cancer surgery, patients with a higher income, patients living in areas close to Seoul, and patients living in areas without a metropolitan city. The utilization of the five largest hospitals increased by 2 percentage points after the policy went into effect. Conclusions: The utilization of tertiary hospitals in Seoul was concentrated among the five largest hospitals. Future research is necessary to identify the consequences of this utilization pattern.

• 한국병원경영학회지
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• 제12권4호
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• pp.119-142
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• 2007

Although Korea joined OECD in 1996, there has still seen much unbalance in medical care and welfare standard between urban and rural area. The unbalance of medical demand between urban and rural area deepened low utilization of rural hospitals. So it caused many hospital's failure and conversion in rural area. Many rural hospitals are in difficulty managing business because of low medical demand along with the shortage of medical manpower, medical equipment and facilities. The objectives of this study were to reveal the cause of low utilization of hospitals in rural area, and to increase utilization of those hospitals. In this study the improvement methods of rural hospital's utilization were presented by examining were placed in difficult management condition, in respect of hospital's management conditions, manpower input, patient medical treatment record, financial record, and actual output. The causes of rural hospital's low utilization were as follows; 1) changes in number and structure of population 2) rural people's preference for large hospitals and hospitals which located in urban area 3) rural hospitals lacking in hospital management skill. Consequently rural hospital's operation condition got more and more deteriorated. To raise rural hospital's utilization, method for social policy, method for health policy, and intrinsic method of hospitals were presented in turn. For rural residents to utilize medical service conveniently, it is necessary for rural hospitals operated normally. So government must insist that rural hospitals solve the problems which come out from their internal management problems. And also these rural hospitals should be supported and nurtured by the government until their management is operated normally.

• 보건행정학회지
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• 제9권2호
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• pp.118-138
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• 1999

This study presents the variations on drug utilization for outpatients' URI, gastritis. and hypertension by the type of hospital- tertiary hospital. general hospital. hospital. clinic. It investigated drug expenses. daily drug expenses. days of medication. the highest price of the drugs used. and the number of the different drugs used for each disease and type of hospital. This study also performed analysis to see how much the variations of variables related to drug use affect the variations of drug expenses. The dependent variable was drug expenses and the independent variables were days of medication. the average price of the drugs used. and the number of the different drugs used. Analysis of the drug utilization was performed on NFMI(National Federation of Medical Insurance) 1994 medical expense claim data. Patients with secondary diseases were excluded. In this study. 379 patients with URI, 386 patients with gastritis. 1.257 patients with hypertension were included. It was founded that there were large variation on drug utilization between the types of hospital for same diseases. Days of medication were longest in tertiary hospitals and shortest in hospitals or clinics. Clinics showed the lowest daily drug expenses in all of the diseases investigated. Daily drug expenses were highest in general hospitals or hospitals. which also tended to use drugs of higher price than other types of hospital. General hospitals and hospitals had larger variations in daily drug expenses and the highest price of drugs. It suggested that drug might be utilized overly in general hospitals and hospitals and some other factors might influence on drug utilization in these hospitals. It was found that the variations of drug expenses were affected by the variations of drug price and days of medication rather than the number of the different drugs. Then the strategy to reduce the variations of drug utilization and to improve the quality of drug utilization should focus on the drug price and days of medication. Further study is needed to assess the quality as well as the variation of drug utilization and to show the factors which affect them.

• 보건행정학회지
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• 제25권1호
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• pp.3-10
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• 2015

Background: Previous studies showed differences in healthcare utilization among insurance types. This study aimed to analyze the difference in healthcare utilization for percutaneous transluminal coronary angioplasty inpatients by insurance types after controlling factors affecting healthcare utilization using propensity score matching (PSM). Methods: The 2011 national inpatient sample based on health insurance claims data was used for analysis. PSM was used to control factors influencing healthcare utilization except insurance types. Length of stay and total charges were used as healthcare utilization variables. Patients were divided into National Health Insurance (NHI) and Medical Aid (MA) patients. Factors representing inpatients (gender, age, admission sources, and Elixhauser comorbidity index) and hospitals (number of doctors, number of beds, and location of hospitals) were used as covariates in PSM. Results: Tertiary hospitals didn't show significant difference in length of stay and total charges after PSM between two insurance types. However, MA patients showed significantly longer length of stay than that of NHI patients after PSM in general hospitals. Multivariate regression analysis provided that admission sources, Elixhauser comorbidity index, insurance types, number of doctors, and location of hospitals (province) had significant influences on the length of stay in general hospitals. Conclusion: Study results provided evidences that healthcare utilization was differed by insurance types in general hospitals. Health policy makers will need to prepare interventions to influence the healthcare utilization differences between insurance types.

• 한국병원경영학회지
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• 제15권1호
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• pp.49-69
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• 2010

The major purpose of this study is to find out relevant factors affecting utilization of Long Term Care Hospitals since the Elderly Long Term Care Insurance System was adopted in Korea. The sample hospitals of this study are 5 long term care hospitals located in 4 big cities and 1 local area. The research data were collected with structured questionnaire from 247 patients and patients' protectors in 5 sample hospitals. Analyzing methods are descriptive statistics, factor analysis and multiple regression with SPSS(version 12.0). Major results of this study are as follows. 1) Utilization and recommendation of patients is affected significantly by the level of hospital facilities (0.043), fee level(0.026), level of staff (0.000), and discomfort of services(0.001). 2) Level of staff is very positively correlated with utilization and recommendation of patients. 3) Discomport of services is very negatively correlated with utilization and recommendation of patients. On the basis of results this study conclude that the management of Long Term Care Hospitals is required conclude to improve the level of staff and facilities and to solve discomport problems of services for patients' marketing. And also more in-depth study on the utilization factors of long term care hospital in Korea is required.

• 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.

• Journal of Preventive Medicine and Public Health
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• 제23권4호
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• pp.451-464
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• 1990

The variation in resource utilization for hospitalized patients who had a group of similar diseases -- a Korean Diagnosis Related Group (KDRG) -- among the same type of hospitals was studied to assess the utillization variation due to the practice pattern of hospitals. Information about inpatients who were beneficiaries of the medical insurance for teachers and government officials discharged from 20 large university teaching hospitals in Seoul during 1986 and information about the hospitals were analyzed to achieve the study objective. A total of 20,223 non-outlier patients in 100 most frequent KDRGs were included in the analysis. Case charges after the review and length of stay (LOS) were used as measures of resource utilization during a hospitalization. A substantial variation among hospitals was found in most KDRGs : o the ratio of the maximum and the minimum among the mean case charges of hospitals was greater than 2 in 83 KDRGs ; o the difference between the maximum and the minimum among the mean case charges of hospitals was greater than 100,000 Won in 94 KDRGs : o the ratio of the maximum and the minimum among the mom LOS of hospitals was greater than 2 in 82 KDRGs ; o the difference between the maximum and the minimum among the mean LOS of hospitals was greater than 3 days in 94 KDRGs. The practice pattern of hospitals explained more than 20% of charge variation in 49 KDRGs and more than 20% of LOS variation in 43 KDRGs. The study results indicated need for a new health policy initiative for cost containment and quality assurance.

• 보건의료산업학회지
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• 제6권4호
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• pp.83-98
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• 2012

The objective of this study is to analyze the utilization patterns of national health insurance and medical aid inpatients in tertiary hospitals. For the analysis, the study utilize the nationwide data on '2010 Survey of Patients' of Ministry of Health & Welfare. The statistical methodology used in the study is the logistic regression model. This study has three major findings. First, utilization rate of national health insurance inpatients was higher than medical aid inpatients in tertiary hospitals. Second, the significant affecting demographic factors in utilizing tertiary hospitals were sex, age, surgery case, treatment result, inpatients residence region and short length of stay. Third, compared to other disease groups, the inpatients on 'congenital malformation, deformity and chromosomal abnormalities', 'factors influencing health status and contact with health services' and 'neoplasm' groups are more likely to utilize tertiary hospitals. Finally, according to residence region, Seoul residence inpatients in both of national health insurance and medical aid more likely to utilize tertiary hospitals than other region inpatients.

• 대한간호학회지
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• 제41권5호
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• pp.593-602
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• 2011

Purpose: In this study analysis was done of utilization of rooming-in care in South Korean hospitals in order to examine the factors related to mothers and hospitals that affect rooming-in care. Methods: With the involvement of 254,414 mothers who gave birth across 953 hospitals, the analysis used the health insurance qualification data of the National Health Insurance Corporations and Health Insurance Review and Assessment Service (2006). Factors associated with rooming-in care were analyzed using a GEE logistic regression analysis to consider factors related to both mothers and hospitals. Results: Only 45.1% of the mothers used rooming-in care. The results of the regression analysis revealed that individual factors of the mothers were not associated with rooming-in care, whereas group factors of the hospitals were. Rooming-in care use was primarily related to small hospital, location of hospital, and higher nurse staffing level. Conclusion: The findings of this study indicate that the utilization of rooming-in care is not associated with factors an individual mother, but rather with the group factors of the hospitals. Thus, a policy-based approach considering both of these types of factors is required to enhance the utilization of rooming-in care.

• 보건의료산업학회지
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• 제5권3호
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• pp.63-76
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• 2011

The objective of this study is to analyze the utilization patterns of other region inpatients in general hospitals located in Seoul area. For the analysis, the study utilize the nationwide data on '2008 Survey of Patients' of Ministry of Health & Welfare. The statistical methodology used in the study is the logistic regression model. This study has three major findings. First, the significant affecting sociodemographic factors in selecting general hospitals located in Seoul area was sex, age, type of payment and inpatients residence region. Second, compared to other disease groups, the inpatients on both 'congenital malformation, deformity and chromosomal abnormalities' and 'neoplasm' groups are more likely to utilize general hospitals in Seoul area. Furthermore, in 'neoplasm' disease group, inpatients with 'bones and articular cartilage malignant neoplasm' are more likely to utilize general hospitals in Seoul area. Finally, hospitals with more than 1,000 beds was chief factor in selecting Seoul-based hospitals by other region inpatients. In conclusion, the study showed that other region inpatients are more likely to utilize general hospitals located in Seoul area in case of severe disease, rare case and surgical case. Therefore, central and local authority is required to monitor local hospitals on quality of the medical service as well as support them to establish specialized medical centers by providing human and physical resources.