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Development of Case Management System and Analysis of Economic Feasibility under the Fee-For-Service Reimbursement (행위별 수가 지불제도 하에서의 사례관리시스템 개발 및 경제성 분석)

  • Choi, Mi Young;Chae, Young Moon;Tark, Kwan Chul;Kim, In Suk;Chun, Ja Hae
    • Quality Improvement in Health Care
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    • v.11 no.1
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    • pp.46-60
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    • 2004
  • Background : Recently, we have experienced various changes in the healthcare environment. Healthcare organizations are facing a financial crisis due to more competitive relationships among themselves as well with low health insurance fees. The purposes of the current study were: (1) to develop a data warehouse-based system for evaluating and monitoring the case management activities, and (2) to measure and analyze its effects. Methods : In order to collect the data for the study, the database on discharged patients was utilized at a university hospital located in Seoul from June 1, 2002 through December 31, 2002. Initially, a data warehouse was built for the case management system. The case management activities were analyzed using structured methodology to establish the case management system. Results : The findings of this study were as follows: (1) A case management system was developed to make it possible to monitor of healthcare quality and resource utilization. The Case management System included monitoring functions regarding utilization reviews, critical pathways, and clinical indicators. (2) Utilizing the case management system, unplanned readmissions were documented among total discharged patients during two months from November 1, 2002 through December 31, 2002. The unplanned readmission rate was 2.3%(276 patients) in total of 11,960 discharged patients. Among them 81 patients(0.7% of total discharges, 29.3% of unplanned readmission) were readmitted to the same physician in charge under the same diagnosis. No significant differences were found in the demographic variables such as gender and age among the patients. (3) After implementing the case management system, 2.9% of average length of stay reduced. Applying cost-benefit analysis, the 2.9% reduction of length of stay represents net profit of ${\backslash}$ 279,592,000 in the year of 2004. In addition, applying value acceleration analysis, cumulative net benefit of ${\backslash}$ 1,481,000,000 was expected by the year of 2007. Also we were able to expect ${\backslash}$ 247,800,000 of cumulative benefit for the prospective 5 years in value linkage analysis. It represents average ${\backslash}$ 787,700,000 of pure net benefit a year. Conclusion : The value of present study would be not only implementing the knowledge management system into the existing case management activities, but also evaluating its effects and estimating its financial benefits. This study suggested that the case management system would be a supportive tool for monitoring and improving the quality of healthcare, and a cost-effective tool for increment of healthcare organization's financial benefit.

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A Study on Treatment and Recycling of Waste Fluid Sand from the Fluidized Bed Incinerator (유동상식 소각로에서 발생되는 폐유동사(廢流動床) 처리 및 재활용 방안)

  • Lee, Seung-Won
    • Journal of Environmental Science International
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    • v.29 no.11
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    • pp.1015-1024
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    • 2020
  • Using the waste(sand wastr and boiler ash) in fluidized bed inciverator, lightweight aggregate concrete was produced and a recycling plan was prepated. The first, the result of the leaching test shows that the waste fluid sand and boiler ash did not exceed the effluent standard. This indicates that there is no harmful effect for recycling. The second, in the lightweight aggregate test using waste fluid sand and boiler ash, the sample that combined cement, waste fluid sand, and sand showed the highest compressive strength, and the mix proportion was 10: 7: 3. Lightweight aggregate concrete that combined cement, waste fluid sand, boiler ash, and sand had a low compressive strength by and large. The third, the same results were identified in the relation between the content of SiO2 and that of Na2O. As the SiO2 content is lowered, the overall viscosity and plasticity of the concrete also decrease, which is not a good condition to form concrete. As for Na2O, as the content increases, the viscosity of the sample and the viscosity of the cement are remarkably lowered, and the strength of the finished concrete is lowered. Therefore, it was concluded that the higher the content of SiO2 and the lower the content of Na2O, the more suitable it is to mix with cement to produce concrete. Fourth, from the fluidized bed incinerator currently operated by company A in city B, a total of 14,188 tons/year were discharged as of 2016, including 8,355 tons/year of bottom ash (including waste fluid sand) and 5,853 tons/year of boiler ash. The cost for landfill bottom ash and boiler ash discharged is 51,000 won/ton, and the total annual landfill cost is 723,588,000 won/ year. Assuming that the landfill tax to be applied from the year 2018 is about 10,000 won/ton, and if there is no reduction in waste disposal charge, an additional landfill tax of 141,880,000 won/year will be imposed. Consequently, the sum total of the annual landfill cost will be 865,468,000 won/year. Therefore, if the entire amount is used for recycling, the annual savings of about 8.7 billion won can be expected.

An Intelligent Intrusion Detection Model Based on Support Vector Machines and the Classification Threshold Optimization for Considering the Asymmetric Error Cost (비대칭 오류비용을 고려한 분류기준값 최적화와 SVM에 기반한 지능형 침입탐지모형)

  • Lee, Hyeon-Uk;Ahn, Hyun-Chul
    • Journal of Intelligence and Information Systems
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    • v.17 no.4
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    • pp.157-173
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    • 2011
  • As the Internet use explodes recently, the malicious attacks and hacking for a system connected to network occur frequently. This means the fatal damage can be caused by these intrusions in the government agency, public office, and company operating various systems. For such reasons, there are growing interests and demand about the intrusion detection systems (IDS)-the security systems for detecting, identifying and responding to unauthorized or abnormal activities appropriately. The intrusion detection models that have been applied in conventional IDS are generally designed by modeling the experts' implicit knowledge on the network intrusions or the hackers' abnormal behaviors. These kinds of intrusion detection models perform well under the normal situations. However, they show poor performance when they meet a new or unknown pattern of the network attacks. For this reason, several recent studies try to adopt various artificial intelligence techniques, which can proactively respond to the unknown threats. Especially, artificial neural networks (ANNs) have popularly been applied in the prior studies because of its superior prediction accuracy. However, ANNs have some intrinsic limitations such as the risk of overfitting, the requirement of the large sample size, and the lack of understanding the prediction process (i.e. black box theory). As a result, the most recent studies on IDS have started to adopt support vector machine (SVM), the classification technique that is more stable and powerful compared to ANNs. SVM is known as a relatively high predictive power and generalization capability. Under this background, this study proposes a novel intelligent intrusion detection model that uses SVM as the classification model in order to improve the predictive ability of IDS. Also, our model is designed to consider the asymmetric error cost by optimizing the classification threshold. Generally, there are two common forms of errors in intrusion detection. The first error type is the False-Positive Error (FPE). In the case of FPE, the wrong judgment on it may result in the unnecessary fixation. The second error type is the False-Negative Error (FNE) that mainly misjudges the malware of the program as normal. Compared to FPE, FNE is more fatal. Thus, when considering total cost of misclassification in IDS, it is more reasonable to assign heavier weights on FNE rather than FPE. Therefore, we designed our proposed intrusion detection model to optimize the classification threshold in order to minimize the total misclassification cost. In this case, conventional SVM cannot be applied because it is designed to generate discrete output (i.e. a class). To resolve this problem, we used the revised SVM technique proposed by Platt(2000), which is able to generate the probability estimate. To validate the practical applicability of our model, we applied it to the real-world dataset for network intrusion detection. The experimental dataset was collected from the IDS sensor of an official institution in Korea from January to June 2010. We collected 15,000 log data in total, and selected 1,000 samples from them by using random sampling method. In addition, the SVM model was compared with the logistic regression (LOGIT), decision trees (DT), and ANN to confirm the superiority of the proposed model. LOGIT and DT was experimented using PASW Statistics v18.0, and ANN was experimented using Neuroshell 4.0. For SVM, LIBSVM v2.90-a freeware for training SVM classifier-was used. Empirical results showed that our proposed model based on SVM outperformed all the other comparative models in detecting network intrusions from the accuracy perspective. They also showed that our model reduced the total misclassification cost compared to the ANN-based intrusion detection model. As a result, it is expected that the intrusion detection model proposed in this paper would not only enhance the performance of IDS, but also lead to better management of FNE.

Economic Effects Analysis of Self-Produced Forages for Dairy Cows and Hanwoo (자가 생산 풀사료 사양의 경제적 효과분석)

  • In Ho Choi;Jae Seong Choi;Ji Yung Kim;Kyung Il Sung;Byong Wan Kim
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.44 no.1
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    • pp.40-49
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    • 2024
  • This study divided the area capable of producing domestic forage into grazing pasture, hay production area, and silage crop area, calculated the required area according to the forage production volume, and examined whether self-sufficiency in forage leads to cost savings. When the self-sufficiency rate of forage for dairy cows and Hanwoo is 80%, the improvement in profitability per heaf ranges from 3% to 9%, typically around 5%, which is considered a significant benefit for both corporate and individual businesses. The average profit per ranch is expected to increase about KRW 50 million per year, and the country as a whole is expected to reduce forage costs by KRW 0.9 trillion per year. Recently, efforts are being made by the government and local authorities to cultivate summer forage at the rice fields for improving self-sufficiency in forage feed to stabilize rice supply and demand. Furthermore, it is also necessary to conduct research on reducing the cost of concentrated feed and TMR (Total mixed ration).

Study on shipment time of low-temperature stored apple (저온저장 사과의 출하시기에 대한 실태조사 연구)

  • Yu, Chang-Hwan;Kim, Yun-Ho
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.7
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    • pp.554-564
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    • 2017
  • The purpose of this study is to assist farmers in determining the optimal time for the shipment of stored apples by investigating the market trends, storage status and release dates of low-temperature stored apples. We surveyed 300 apple cultivation farms in Daegu, Gyeongbuk Province, which is the main producer of apples, and examined the cultivars, cultivation areas, storage conditions, and shipment status of apples. The main results are as follows: the proportion of apples cultivatedat different ripening times was surveyed. According to the results, the proportions of early, middle and late varieties were 78.3%, 63.7% and 96.0%, respectively. Also, 48.7% of the farm households surveyed had cold storage facilities. The average storage cost per apple box(15kg) was 978.3 won for self-storage and 1,771.8 won for consignment storage. For the six(6) months between November and April, the proportion of shipped apples was 91.6% of the total stored apples. The (average total?)annual apple shipment, including apples stored in general storage warehouses, was 744.4 boxes. The (average total?) annual shipment of cold storage apples was 616 boxes. The stored apples were mainly shipped to 'wholesale markets', which have the highest sales share, followed by 'production site collectors' and then 'supermarkets'. The most common shipping method of the apples was by general trucks, followed by low-temperature trucks, and finally by delivery services. The analysis of the factors influencing the decision to release apples by period showed that it was affected by the storage cost, loss rate, and customary shipping in the off-season(from May to August). On the other hand, in the general release season(from November to April), the statistically significant decision factors for the release of apples were the future expected price, storage cost and decision of the leading farmer groups. For farmers with a high share of general shipment, the deciding factors for the release of apples were the future expected price, storage cost, high income expectation, and decision by leading farmers.

Design of a Logistics Decision Support System for Transportation Mode Selection considering Carbon Emission Cost (탄소배출비용을 고려한 물류의 최적 운송수단 의사결정 시스템 설계)

  • Song, Byung-Jun;Koo, Je-Kwon;Song, Sang-Hwa;Lee, Jong-Yun
    • The KIPS Transactions:PartD
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    • v.18D no.5
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    • pp.371-384
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    • 2011
  • This paper considers logistics decision support system which deals with transportation mode selection considering transportation and carbon emission cost. Transportation and carbon emission costs vary with the choice of transportation modes and to become competitive companies need to find proper transportation modes for their logistics services. However, due to the restricted capacity of transportation modes, it is difficult to balance transportation and carbon emission costs when designing logistics network including transportation mode choice for each service. Therefore this paper aims to analyze the trade-off relationship between transportation and carbon emission cost in mode selection of intermodal transportation and to provide optimal green logistics strategy. In this paper, the logistics decision support system is designed based on mixed integer programming model. To understand the trade-off relationship of transportation and carbon emission cost, the system is tested with various scenarios including transportation of containers between Seoul and Busan. The analysis results show that, even though sea transportation combined with trucking is competitive in carbon emission per unit distance travelled, the total cost of carbon emission and transportation for the sea transportation may not have competitive advantage over other transportation modes including rail and truck transportation modes. The sea-based intermodal logistics service may induce detours which have negative impacts on the overall carbon emission. The proposed logistics decision support system is expected to play key role in green logistics and supply chain management.

Analysis of VoLTE Charge Reduction under VoLTE Growth (VoLTE 활성화에 따른 요금 인하 여력 분석)

  • Lee, Sang-Woo;Jeong, Seon-Hwa
    • The Journal of Korean Institute of Communications and Information Sciences
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    • v.41 no.1
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    • pp.92-100
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    • 2016
  • It is informed that the Voice over LTE(VoLTE) which serves voice and message on IP networks is better in terms of economies of scale than the legacy voice service on 2G/3G circuit-switched networks because of its technological and cost efficiency. In addition, services of voice and data are running on a single LTE network and as a result VoLTE has the more economies of scope. But, there is no study about how much technology-efficiency VoLTE has compared to circuit-based voice service and how much voice charge can be reduced as VoLTE grows up. This paper analyzes empirically cost-efficiency of VoLTE against circuit-based voice service and quantifies the reduction of voice charge as 2G/3G voice traffic shifts to VoLTE. The results describe the first is that the average cost of the total voice traffic rises shortly just after the investment of LTE network for providing VoLTE but it will soon have a capacity available to reduce the charge due to VoLTE's outstanding cost efficiency on the assumption that voice traffic is fixed, and the second is that the charge can be cut to 60% of the current rate in case of all the voice traffic moves to VoLTE. The latter proves partially the validation of data-focusing pricing plan. Our results are expected to become basic data for network operators' establishing pricing strategies and for policy makers' inducing price cutting.

Economic Value of the Sirolimus Eluting Stent($CYPHER^{TM}$) in Treating Acute Coronary Heart Disease (관상동맥질환 치료를 위한 시롤리무스 방출 스텐트 ($CYPHER^{TM}$)의 경제성 분석)

  • Lee, Hoo-Yeon;Park, Eun-Cheol;Park, Ki-Dong;Park, Ji-Eun;Kim, Young;Lee, Sang-Soo;Kang, Hye-Young
    • Journal of Preventive Medicine and Public Health
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    • v.36 no.4
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    • pp.339-348
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    • 2003
  • Objective : To quantify the economic value of the Sirolimus fluting Stent ($CYPHER^{TM}$) in treating acute coronary heart disease (CMD), and to assist in determining an adequate level of reimbursement for $CYPHER^{TM}$ in Korea. Methods : A decision-analytical model, developed by the Belgium Health Economics Disease Management group, was used to investigate the incremental cost-effectiveness of $CYPHER^{TM}$ versus conventional stenting. The time horizon was five years. The probabilities for clinical events at each node of the decision model were obtained from the results of large, randomized, controlled clinical trials. The initial care and follow-up direct medical costs were analyzed. The initial costs consisted of those for the initial procedure and hospitalization, The follow-vp costs included those for routine follow-up treatments, adverse reactions, revascularization and death. Defending on the perspective of the analysis, the costs were defined as insurance covered or total medical costs (=sum of insurance covered and uncovered medical costs). The cost data were obtained from the administrative data of 449 patients that received conventional stenting from five participating Korean hospitals during June 2002. Sensitivity analyses were peformed for discount rates of 3, 5 and 7%. Since the major clinical advantage of $CYPHER^{TM}$ over conventional stenting was the reduction in the revascularization rates, the economic value of $CYPHER^{TM}$, in relation to the direct medical costs of revascularization, were evaluated. If the incremental cost of $CYPHER^{TM}$ per revascularization avoided, compared to conventional stenting, was no higher than that of a revascularization itself, $CYPHER^{TM}$ would be considered as being cost-effective. Therefore, the maximum acceptable level for the reimbursement price of $CYPHER^{TM}$ making the incremental cost-effectiveness ratio equal to the cost of a revascularization was identified. Results : The average weighted initial insurance covered and total medical costs of conventional stenting were about 6,275,000 and 8,058,000 Won, respectively. The average weighted sum of the initial and 5-year follow-up insurance covered and total medical costs of conventional stenting were about 13,659,000 and 17,353,000 Won, respectively. The estimated maximum level of reimbursement price of $CYPHER^{TM}$ from the perspectives of the insurer and society were $4,126,897{\sim}4,325,161$ and $4,939,939{\sim}5,078,181$ Won, respectively. Conclusion : By evaluating the economic value of $CYPHER^{TM}$, as an alternative to conventional stenting, the results of this study are expected to provide a scientific basis for determining the acceptable level of reimbursement for $CYPHER^{TM}$.

The Analysis of Hospital Characteristics affecting Blood Transfusion to the patients under Knee or Hip Total Replacement Arthroplasty (슬관절과 고관절 전치환술 환자의 수혈에 영향을 미치는 병원특성 요인 분석)

  • Oh, Ji-Young;Kim, Sang-Mi;Lee, Seong-A
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.16 no.6
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    • pp.4031-4039
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    • 2015
  • The problems related with blood supply shortage and the stability of blood transfusion are on the rise, as it is expected that the blood doners will decrease but the blood use amount for aged population will increase, owing to low birth and aged population increase. The purpose of this study is to analyze the hospital characteristics which affect patients receiving and non-receiving blood transfusion for the knee and hip total replacement arthroplasty. Data were collected from Health Insurance Review and Assessment Service's 2011 sample data, and 5,370 inpatients were abstracted from them. Logistic regression analysis was performed, using SPSS 20. Independent variables used are hospital characteristics variables and patient characteristics variables. Hospital characteristics variables are hospital type, ownership, residence and the number of usable beds, and patient characteristics variables are gender, age, severity, type of anesthesia, main diagnosis, whether or not of anemia and insurance class. At the result of this study, it was found that hospital type, region, gender, age, severity, main diagnosis and whether or not of anemia were the factors that mostly affected the blood transfusion for knee arthroplasty. And hospital type, residence, gender, age, severity, type of anesthesia and whether of not of anemia were the factors that mostly affected the blood transfusion for hip arthroplasty. In addition to that, it is expected that this research which analyzed the present state of blood transfusion and its influence factors are cost effective, and would make a good use of preliminary data for good quality of medical service.

Determinants of Management Performance in the Offshore Fishing Industry: After the Introduction of Fisheries Structure Improvement Policy for the Resource Management (근해어업의 경영성과 결정요인에 관한 연구: 자원관리형 어업구조개선 정책 도입 이후)

  • Tae-Heorn Ha;Seok-Kyu Kang
    • The Journal of Fisheries Business Administration
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    • v.55 no.3
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    • pp.1-13
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    • 2024
  • The purpose of this study is to examine the determinants of management performance in the remaining offshore fishing industry after the resource management-oriented fisheries structure improvement policy by the fisheries vessel buy-back program and Total Allowable Catch (TAC). The results of the analysis of the determinants of management performance of offshore fishing can be summarized as follows. First, based on the management performance determinant model of offshore fishing, it is confirmed that the government's resource-managed fishing structure improvement policy, such as the fishing boat reduction project and the TAC policy, is improving the management performance of the resource-managed remaining fishing boat. Second, looking at the specific management performance determinants based on the management performance model of offshore fishing, the leverage ratio (TLTA), which is the total debt ratio, shows a statistically significant positive (+) relationship with management performance, which increases management performance directly proportional to the leverage ratio. The increase in the leverage ratio (total debt ratio) was expected to lead to a high interest cost burden, resulting in a reverse (-) financial leverage effect; however, rather a positive (+) financial leverage effect occurred with a high profit covering interest costs. The total catch (TCATCH) has a positive (+) relationship with management performance at a statistical significance level of less than 1%, indicating that an increase in catch is improving or increasing the management performance of fishing companies. The selling price (UPRICE) shows a positive (+) relationship with management performance at a very high statistical significance level of less than 1%, and it can be seen that high fishing prices are a major factor in improving or increasing the management performance of offshore fishing. On the other hand, fishing vessel tonnage (TON), fishing vessel horsepower (RHP), and operating days (WDAYS), which indicate have a statistically significant negative (-) relationship with management performance, which deviates from the existing fisheries common sense that the size of fishing vessel tonnage and fishing vessel horsepower and the increase in the number of operating days is proportional to management performance. As a result of the increase in fishing vessel tonnage, horsepower, and the number of operating days, it was confirmed that the higher the fishing cost, such as oil costs, is worsening the management performance of fishing companies. Participation in TAC has a statistically significant positive (+) value with management performance, indicating that the remaining offshore fishing companies participating in TAC are improving or increasing management performance compared to offshore fishing companies that do not. Third, there are conflicting results depending on the industry as a result of estimating the management performance determinants of offshore fishing by TAC participation, and TAC participation had a negative impact on management performance in anchovy boat seine and southern west sea bottom trawl in fishing industry while TAC participation had a positive impact on management performance in large stow nets on anchor in fishing industry.