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Impact of a 'Proactive Self-Audit Program of Fraudulent Claims' on Healthcare Providers' Claims Patterns: Intravenous Injections (KK020) (부당청구 예방형 자율점검제가 의료기관의 청구행태에 미치는 영향: 정맥 내 일시주사(KK020)를 중심으로)

  • Hee-Hwa Lee;Young-Joo Won;Kwang-Soo Lee;Ki-Bong Yoo
    • Health Policy and Management
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    • v.34 no.2
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    • pp.163-177
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    • 2024
  • Background: This study aims to examine changes in fraudulent claim counts and total reimbursements before and after enhancements in counterfeit claim controls and monitoring of provider claim patterns under the "Proactive self-audit pilot program of fraudulent claims." Methods: This study used the claims data and hospital information (July 2021-February 2022) of the Health Insurance Review and Assessment Service. The data was collected from 1,129 hospitals assigned to the pilot program, selected from the providers who filed a claim for reimbursement for intravenous injections. Paired and independent t-tests, along with regression analysis, were utilized to analyze changing patterns and factors influencing claim behaviors. Results: This program led to a reduction in the number of fraudulent claims and the total amount of reimbursements across all levels of hospitals in the experimental groups (except for physicians below 40 years old). In the control group, general hospitals and hospitals demonstrated some significant decreases based on the duration since opening, while clinics showed significant reductions in specified subjects. Additionally, a notable increase was observed among male physicians over the age of 50 years. Overall, claims and reimbursements significantly declined after the intervention. Furthermore, a positive correlation was found between hospital opening duration and claim numbers, suggesting longer-established hospitals were more likely to file claims. Conclusion: The results indicate that the pilot program successfully encouraged providers to autonomously minimize fraudulent claims. Therefore, it is advised to extend further support, including promotional activities, training, seminars, and continuous monitoring, to nonparticipating hospitals to facilitate independent improvements in their claim practices.

Consideration of the Usefulness of 18F-FET Brain PET/CT in Brain Tumor Diagnosis (뇌종양진단에 있어 18F-FET Brain PET/CT의 유용성에 대한 고찰)

  • Kyu-Ho Yeon; Jae-Kwang Ryu
    • The Korean Journal of Nuclear Medicine Technology
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    • v.28 no.1
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    • pp.41-47
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    • 2024
  • Purpose: 18F-FET, a radiopharmaceutical based on a Tyrosine amino acid derivative using the Sodium-Potassium Pump-independent Transporter (System L) for non-invasive evaluation of primary, recurrent, and metastatic brain tumors, exhibits distinct characteristics. Unlike the widely absorbed 18F-FDG in both tumor and normal brain tissues, 18F-FET demonstrates specific uptake only in tumor tissue while almost negligible uptake in normal brain tissue. This study aims to compare and evaluate the usefulness of 18F-FDG and 18F-FET Brain PET/CT quantitative analysis in brain tumor diagnosis. Materials and Methods: In 46 patients diagnosed with brain gliomas (High Grade: 34, Low Grade: 12), Brain PET/CT scans were performed at 40 minutes after 18F-FDG injection and at 20 minutes (early) and 80 minutes (delay) after 18F-FET injection. SUVmax and SUVpeak of tumor areas corresponding to MRI images were measured in each scan, and the SUVmax-to-SUVpeak ratio, an indicator of tumor prognosis, was calculated. Differences in SUVmax, SUVpeak, and SUVmax-to-SUVpeak ratio between 18F-FDG and 18F-FET early/delay scans were statistically verified using SPSS (ver.28) package program. Results: SUVmax values were 3.72±1.36 for 18F-FDG, 4.59±1.55 for 18F-FET early, and 4.12±1.36 for 18F-FET delay scans. The highest SUVmax was observed in 18F-FET early scans, particularly in HG tumors (4.85±1.44), showing a slightly more significant difference (P<0.0001). SUVpeak values were 3.33±1.13 for 18F-FDG, 3.04±1.11 for 18F-FET early, and 2.80±0.96 for 18F-FET delay scans. The highest SUVpeak was in 18F-FDG scans, while the lowest was in 18F-FET delay scans, with a more significant difference in HG tumors (P<0.001). SUVmax-to-SUVpeak ratio values were 1.11±0.09 for 18F-FDG, 1.54±0.22 for 18F-FET early, and 1.48±0.17 for 18F-FET delay scans. This ratio was higher in 18F-FET scans for both HG and LG tumors (P<0.0001), but there was no statistically significant difference between 18F-FET early and delay scans. Conclusion: This study confirms the usefulness of early and delay scans in 18F-FET Brain PET/CT examinations, particularly demonstrating the changes in objective quantitative metrics such as SUVmax, SUVpeak, and introducing the SUVmax-to-SUVpeak ratio as a new evaluation metric based on the degree of tumor malignancy. This is expected to further contributions to the quantitative analysis of Brain PET/CT images.

Factors Affecting the Negative Perception of Public Hospitals among Local Residents (지역 주민의 공공병원에 대한 부정적 인식에 영향을 미치는 요인)

  • Eun Hye Choi;Jung Hee Cho;Kyoung Eun Yeob;Bo Hui Park;So Young Kim;Jong Hyock Park
    • Health Policy and Management
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    • v.34 no.2
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    • pp.211-221
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    • 2024
  • Background: The public health crisis caused by coronavirus disease 2019 emphasizes the need to expand and strengthen public hospitals. However, the overall perception of public hospitals remains negative. This negative perception can hinder the roles and functions of public hospitals, so this study aims to analyze the factors affecting negative perceptions of public hospitals. Methods: We used data from a survey on the public healthcare of Chungcheongbuk-do residents conducted by the Chungcheongbuk-do Public Health Policy Institute, and 1,916 adults aged 19 or older who responded to the survey were included in the study. Logistic regression analysis was used to analyze the impact of experiences with public hospitals use and evaluations of public healthcare and public hospital policies on the negative perception of public hospitals. Results: The experience of not using public hospitals (adjusted odds ratio [aOR], 1.69; 95% confidence interval [CI], 1.04-2.74) and negative evaluations of public healthcare and public hospital policies were found to significantly impact negative perceptions of public hospitals. In public healthcare policies, negative evaluations of the provision of essential medical care (aOR, 4.14; 95% CI, 2.59-6.62), regional disparities (aOR, 1.59; 95% CI, 1.02-2.49), coverage (aOR, 1.99; 95% CI, 1.25-3.16), and quality of care (aOR, 2.39; 95% CI, 1.50-3.80) were significantly associated with negative perceptions of public hospitals. In public hospital policies, negative evaluations of facilities and equipment (aOR, 3.74, 95% CI, 2.36-5.94), medical specialties and services (aOR, 1.91; 95% CI, 1.21-3.01), and quality of medical service (aOR, 2.71; 95% CI, 1.72-4.25) were also significantly associated with negative perceptions of public hospitals. Conclusion: This study emphasizes the need to improve perceptions of public hospitals by considering the experience with public hospitals use and evaluation of public healthcare and public hospital policies.

A Case Study on the Willow Tree Fence(樹柵) in Gasan(假山) of Cheonggyecheon, Hanyang in the Joseon Dynasty Period (조선시대 한양 청계천 가산(假山)의 버드나무 수책(樹柵)에 관한 연구)

  • SHIM Sunhui;KIM Choongsik
    • Korean Journal of Heritage: History & Science
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    • v.57 no.2
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    • pp.118-141
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    • 2024
  • This study investigates and analyzes ancient literature records and iconographic materials to examine the Willow Tree Fence(樹柵) built on Gasan(假山) Cheonggyecheon(淸溪川) within the Hanyangdoseong, which was deliberately created to prevent flood damage during the Joseon Dynasty. Although there have been research cases related to the willow tree, it is difficult to find research conducted with the purpose of identifying its archetypal value by investigating and analyzing specific use cases of the willow tree and its historical background. Accordingly, this study aims to identify examples of the Willow Tree Fence(樹柵) created in Cheonggyecheon(淸溪川) during the Joseon Dynasty and reinterpret their value by illuminating the background of construction and regional characteristics. The main contents of this study are as follows. It is presumed that floods during the Joseon Dynasty were a great hazard. Between the 16th and 18th centuries, Joseon suffered severe damage from floods. By the time of King Yeongjo, all Four Mountains(四山) of the capital had become bare mountains, which was the cause of frequent floods. In the year of Gyeongjin(庚辰, the 26th year of King Yeongjo's reign, 1760), King Yeongjo dredged the channel bottom of Cheonggyecheon(淸溪川), which overflowed every rainy season, with the Juncheon Project(Channel-Dredging, 濬川事業) and planted willow trees on the mountain on both sides of the Ogan Water Gate(五間水門), as measures to prevent flood damage and soil loss. was implemented. In the <Doseongdo(都城圖)> in 《 Gwangyeodo(廣輿圖)》 produced in the mid-18th century during the reign of King Yeongjo, Gasan(假山), built in front of the Ogan Water Gate(五間水門) is visible, and in the record 『Sinjeung Donggukyeoji Seungnam(新增東國輿地勝)』 In the record, it appears that willows were planted on both sides of the mountain in the year of Gyeongjin(1760). With <Hanyangdoseong Map(漢陽都城圖)> produced in the 46th year of King Yeongjo's reign(1770), it is confirmed that willow trees formed a thick forest on Gasan Mountain near the Ogan Water Gate(五間水門) in the late 18th century. In addition, the Juncheon Project(Channel-Dredging, 濬川事業) and the creation of the Willow Tree Fence(樹柵) continued from the 15th century, the early Joseon Dynasty(朝鮮前期), to the end of the 19th century, the late Joseon Dynasty(朝鮮後期), through the records of ancient literature such as 『Annals of the Joseon Dynasty(朝鮮王朝實錄)』, 『Seungjeongwon Diary(承政院日記)』, and 『Records of Daily Reflections(日省錄)』. This study is meaningful in informing that the willow tree was a unique cultural heritage and traditional landscape resource by investigating the composition and use of the Willow Tree Fence in the Joseon Dynasty, which was a great basis for preventing floods and flood damage, as well as forming a beautiful landscape.

Egg Development and Morphology of Larva and Juvenile of Liparis tanakae in the Coastal Waters off Yeosu (여수 연안산 꼼치(Liparis tanakae)의 난발생 및 자치어 형태발달)

  • Kyung-Ae Jung;Na-Young Jeon;Sang-Hun Cha;Sung-Hoon Lee;Tae-Sik Yu;Keong-Ho Han
    • Korean Journal of Ichthyology
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    • v.35 no.4
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    • pp.263-269
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    • 2023
  • This study aims to contribute to the research on resource recovery for the rapidly declining population of Liparis tanakae by observing the larval development process and the morphology of juveniles based on their growth. Natural spawning eggs collected in Yeosu were used for observing the process of egg development and larval morphology. The water temperature during the rearing process was maintained at 12.3~13.5℃ (average 12.7℃). The fertilized eggs had an egg diameter ranging from 1.57 to 1.79 mm (average 1.71 mm) and were spherical and adhesive. Within 4 hours 35 minutes after fertilization, they reached the two-cell stage, and after 74 hours 10 minutes, the formation of the yolk sac began. At 106 hours post-fertilization, a caudal fin appeared at the tail tip. Hatching began at 526 hours, and the larvae developed with the yolk sac positioned just behind the eyes. The newly hatched larvae had both the mouth and anus open. Melanophores appeared inside the lower jaw and around the tail on the third day after hatching. By the 16th day after hatching, most of the yolk was absorbed, and melanophores were visible in the head region. Finally, on the 63rd day after hatching, the head region significantly developed, and the body shape and mouth were similar to those of an adult fish, signifying the transition to the juvenile stage. This study will serve as valuable data for aquaculture techniques related to the conservation and restoration of fish species based on the hatching and juvenile morphology of Liparis tanakae.

A Study on the Design of Sustainable App Services for Medication Management and Disposal of Waste Drugs (약 복용 관리와 폐의약품 처리를 위한 지속 가능한 앱 서비스 디자인 연구)

  • Lee, Ri-Na;Hwang, Jeong-Un;Shin, Ji-Yoon;Hwang, Jin-Do
    • Journal of Service Research and Studies
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    • v.14 no.2
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    • pp.48-68
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    • 2024
  • Due to the global pandemic aftermath of the coronavirus, the importance of health care is being emphasized more socially. Due to the influence of these changes, domestic pharmaceutical companies have introduced regular drug delivery services, that is, drug and health functional food subscription services. Currently, this market is continuously growing. However, these regular services are causing new environmental problems in which the number of waste drugs increases due to the presence of unused drugs. Therefore, this study proposes a service that not only promotes health management through regular medication adherence to reduce the amount of pharmaceutical waste but also aims to improve awareness and practices regarding proper medication disposal. As a preliminary survey for service design, a preliminary survey was conducted on 51 adults to confirm their perception of drug use habits and waste drug collection. Based on the Honey Comb model, a guideline for service design was created, and a prototype was produced by specifying the service using the preliminary survey results and service design methodology. In order to verify the effectiveness of the prototype, a first user task survey was conducted to identify the problems of the prototype, and after improving this, a second usability test was conducted on 49 adults to confirm the versatility of the service. Usability verification was conducted using SPSS Mac version 29.0. For the evaluation results of the questionnaire, Spearmann Correlation Analysis was conducted to confirm the relationship between frequency analysis and evaluation items. This study presents specific solutions to the problem of waste drugs due to the spread of drug subscription services.

Violations of Information Security Policy in a Financial Firm: The Difference between the Own Employees and Outsourced Contractors (금융회사의 정보보안정책 위반요인에 관한 연구: 내부직원과 외주직원의 차이)

  • Jeong-Ha Lee;Sang-Yong Tom Lee
    • Information Systems Review
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    • v.18 no.4
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    • pp.17-42
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    • 2016
  • Information security incidents caused by authorized insiders are increasing in financial firms, and this increase is particularly increased by outsourced contractors. With the increase in outsourcing in financial firms, outsourced contractors having authorized right has become a threat and could violate an organization's information security policy. This study aims to analyze the differences between own employees and outsourced contractors and to determine the factors affecting the violation of information security policy to mitigate information security incidents. This study examines the factors driving employees to violate information security policy in financial firms based on the theory of planned behavior, general deterrence theory, and information security awareness, and the moderating effects of employee type between own employees and outsourced contractors. We used 363 samples that were collected through both online and offline surveys and conducted partial least square-structural equation modeling and multiple group analysis to determine the differences between own employees (246 samples, 68%) and outsourced contractors (117 samples, 32%). We found that the perceived sanction and information security awareness support the information security policy violation attitude and subjective norm, and the perceived sanction does not support the information security policy behavior control. The moderating effects of employee type in the research model were also supported. According to the t-test result between own employees and outsourced contractors, outsourced contractors' behavior control supported information security violation intention but not subject norms. The academic implications of this study is expected to be the basis for future research on outsourced contractors' violation of information security policy and a guide to develop information security awareness programs for outsourced contractors to control these incidents. Financial firms need to develop an information security awareness program for outsourced contractors to increase the knowledge and understanding of information security policy. Moreover, this program is effective for outsourced contractors.

The effect of restrictions on oral health-related activities of adults in Korea on quality of life: Using the 8th Korean National Health and Nutrition Examination Survey (우리나라 성인의 구강건강 관련 활동 제한이 삶의 질에 미치는 영향: 국민건강영양조사 제8기 1차년도(2019)자료 활용)

  • Mi-Jeong Kim;Cha-Young Lim
    • Journal of Korean Dental Hygiene Science
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    • v.6 no.2
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    • pp.173-182
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    • 2023
  • Background: This study aims to investigate the effect of restrictions on oral health-related activities of young adults, middle-aged, and elderly in Korea on the quality of life and contribute to the development of intervention strategies to improve the quality of life by improving the importance of oral health care and healthy lifestyle habits of adults. Methods: The 8th National Health and Nutrition Survey was used, targeting adults categorized into three age groups: young adults aged 19 to 29, middle-aged adults aged 30 to 49, and prime-aged adults aged 50 to 64. Demographic characteristics and EQ-5D, HINT-8 and oral-related toothache experience, chewing problems, speaking problems, and complaint of discomfort to chew analyzed. T-test and one-way ANOVA were performed to find out the difference in quality of life according to the restrictions on oral activities of adults, and linear regression analysis was performed to investigate the factors affecting the quality of life of adults. Results: The differences between EQ-5D and HINT-8 according to the restrictions on oral health-related activities of young, middle-aged, and prime-aged were statistically significant in all oral activity restriction variables(p ≦0.05). Factors affecting EQ-5D of all adults were statistically significant in all variables such as region, gender, household monthly income, education level, basic living status, economic activity, subjective oral health status, toothache experience, chewing problem, speaking problem, and complaint of discomfort to chew(p ≦0.05). Factors affecting HINT-8 of all adults were statistically significant in variables such as gender, household monthly income, education level, basic living status, economic activity, toothache experience, chewing, speaking, and complaint of discomfort to chew(p ≦0.05). Conclusions: Various measures are needed to improve the quality of life in old age by allowing adults to face physically, mentally, and socially prepared old age. Based on the results of this study, an adult oral health program should be developed to improve the oral health and quality of life of adults.

Does an extensive diagnostic workup for upfront resectable pancreatic cancer result in a delay which affects survival? Results from an international multicentre study

  • Thomas B. Russell;Peter L. Labib;Jemimah Denson;Fabio Ausania;Elizabeth Pando;Keith J. Roberts;Ambareen Kausar;Vasileios K. Mavroeidis;Gabriele Marangoni;Sarah C. Thomasset;Adam E. Frampton;Pavlos Lykoudis;Manuel Maglione;Nassir Alhaboob;Hassaan Bari;Andrew M. Smith;Duncan Spalding;Parthi Srinivasan;Brian R. Davidson;Ricky H. Bhogal;Daniel Croagh;Ashray Rajagopalan;Ismael Dominguez;Rohan Thakkar;Dhanny Gomez;Michael A. Silva;Pierfrancesco Lapolla;Andrea Mingoli;Alberto Porcu;Teresa Perra;Nehal S. Shah;Zaed Z. R. Hamady;Bilal Al-Sarrieh;Alejandro Serrablo;Somaiah Aroori
    • Annals of Hepato-Biliary-Pancreatic Surgery
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    • v.27 no.4
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    • pp.403-414
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    • 2023
  • Backgrounds/Aims: Pancreatoduodenectomy (PD) is recommended in fit patients with a carcinoma (PDAC) of the pancreatic head, and a delayed resection may affect survival. This study aimed to correlate the time from staging to PD with long-term survival, and study the impact of preoperative investigations (if any) on the timing of surgery. Methods: Data were extracted from the Recurrence After Whipple's (RAW) study, a multicentre retrospective study of PD outcomes. Only PDAC patients who underwent an upfront resection were included. Patients who received neoadjuvant chemo-/radiotherapy were excluded. Group A (PD within 28 days of most recent preoperative computed tomography [CT]) was compared to group B (> 28 days). Results: A total of 595 patents were included. Compared to group A (median CT-PD time: 12.5 days, interquartile range: 6-21), group B (49 days, 39-64.5) had similar one-year survival (73% vs. 75%, p = 0.6), five-year survival (23% vs. 21%, p = 0.6) and median time-to-death (17 vs. 18 months, p = 0.8). Staging laparoscopy (43 vs. 29.5 days, p = 0.009) and preoperative biliary stenting (39 vs. 20 days, p < 0.001) were associated with a delay to PD, but magnetic resonance imaging (32 vs. 32 days, p = 0.5), positron emission tomography (40 vs. 31 days, p > 0.99) and endoscopic ultrasonography (28 vs. 32 days, p > 0.99) were not. Conclusions: Although a treatment delay may give rise to patient anxiety, our findings would suggest this does not correlate with worse survival. A delay may be necessary to obtain further information and minimize the number of PD patients diagnosed with early disease recurrence.

Buddhist Sculptures from Seongbulsa Temple in Hwanghae-do Province as Seen through Gelatin Dry Plates and Archival Materials from the Collection of the National Museum of Korea (국립중앙박물관 소장 유리건판과 기록자료로 본 황해도 성불사(成佛寺)의 불교조각)

  • Heo Hyeonguk
    • Bangmulgwan gwa yeongu (The National Museum of Korea Journal)
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    • v.1
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    • pp.278-305
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    • 2024
  • Gelatin dry plate photographs dating to the Japanese colonial era and the official documents from the Japanese Government-General of Korea Museum in the collection of the National Museum of Korea are significant materials documenting cultural heritage in North Korea before it was severely damaged in 1950 during the Korean War. There has been an increase in recent years in studies of Buddhist sculptures in North Korea based on these photographs and documents. This paper presents some new comments on the Buddhist sculptures at Seongbulsa Temple in Hwangju, one of the most famous temples in Hwanghae-do Province, based on the related existing research outcomes. This paper aims to facilitate a more comprehensive understanding of the Buddhist sculptures at Seongbulsa Temple by chronicling its history based on historical records, examining its current status, and exploring in detail the production dates and backgrounds of the Buddhist sculptures featured on gelatin dry plates. Prior to Korea's liberation from Japan in 1945, Seongbulsa housed at least seven sculptural items: two Bodhisattva statues, four Buddha statues, and a triad. Two items are from the early Goryeo period, one is from the late Goryeo period, three are from the early Joseon period, and one is from the late Joseon period. Among them, two surviving items are noteworthy. One is the early Goryeo-era Stone Seated Bhaishajyaguru Buddha photographed in Eungjinjeon Hall at Seongbulsa Temple. A close examination of a schematic drawing of the sculpture's pedestal made at the time it was photographed reveals that its material accords with the materials used for the headless Stone Seated Bhaishajyaguru Buddha and pedestal currently found in the old Sangwonam Hermitage site in the Inner Geumgang Valley of Jeongbangsan Mountain. This accordance could mean that the statue is a new significant example of early Goryeo Buddhist sculpture in North Korea. The other notable sculpture is the Gilt-bronze Seated Amitabha Buddha Triad created in 1454 (the second year of the reign of King Danjong) and discovered in Geungnakjeon Hall at Seongbulsa. This statue is currently in the collection of the Sariwon History Museum in Hwanghae-do Province. It is an important example of a dated small gilt-bronze Buddhist statue from the early Joseon period found in North Korea. This paper is a case study of Buddhist sculptures in North Korea, focusing on Seongbulsa Temple. Further utilization of the National Museum of Korea's gelatin dry plates will contribute to developing the study of the history of Korean Buddhist sculpture.