• Korea Journal of Hospital Management
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• v.2 no.1
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• pp.1-21
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• 1997

In order to analyze the shifts in the volume and profits of Computed Tomography(CT) and Magnetic Resonance Imaging(MRI) utilization for a year before and after the implementation of insurance coverage for CT, this study has been undertaken examining CT and MRI cost data from 'Y' University Hospital situated in Seoul, Korea. Following are the results of this study: 1. The medical insurance payment for CT, implemented on January 1, 1996, increased CT utilization from January 1996 to April 1996 due to low insurance premiums: however, from May 1996 the number of CT cases significantly decreased as a result of strengthened medical cost reviews and the new 'Detailed standards for approval of CT' announced near the end of April 1996 by the insurer. 2. Since the implementation of insurance coverage for CT, CT fee reduction rates for reimbursements by the insurer to the hospital were 50% and 40% for January and February, respectively, and 31% and 15% for March and April. A significant point in the lowering of the reduction rate was reached in May at 11%; furthermore, since June the reduction rate fell below the average reduction rate for reimbursements for all procedures. If the 'Detailed standards for approval of CT' had been announced before the implementation of insurance coverage for CT, CT utilization would not have been so high due to the need to meet those 'standards'. In addition, loss of hospital profits resulting from the reduction for reimbursements would not have occurred. 3. The shifts in MRI utilization showed that there was no particular change with the beginning of insurance coverage for CT, and the introduction of the 'Detailed standards for approval of CT' made MRI utilization increase because MRI is free of restrictions imposed by the insurer. 4. The relationship between CT utilization and MRI utilization showed that they were supplementary to each other before insurance coverage for CT, but that CT was substituted for MRI because of strengthened medical cost reviews after t~e beginning of insurance coverage for CT. 5. The shifts in volume by patient characteristics showed that the number of inappropriate case patients, according to the insurer's "Standards for approval", decreased more than the number of appropriate case patients after the introduction of insurance coverage for CT. Therefore, the health insurance fee schemes for CT have influenced patient care. 6. The shifts in profits from CT utilization showed a net profit decrease of 31.6%. In order to match the pre-coverage profit level, 5,471 more cases would need to be seen and productivity would need to be increased by 32.7%. This profit decrease resulted from a decrease of CT utilization and low reimbursements. With insurance coverage, net profits from CT were 24.4%, and a margin of safety ratio was 39.6%. Because of the net profits and margin of safety ratio, CT utilization fees for insured appropriate cases could not be considered inappropriate. 7. The shifts in profits from MRI utilization before and after the introduction of CT coverage showed that in order to match pre-CT coverage profit levels, 2,011 more cases would need to be seen and productivity would need to be increased by 9.2%. The reasons for needing to increase the number of cases and productivity result from cost burdens created by adding new MRI units. But with CT coverage already begun, MRI utilization increased. Combined with a minor increase in the MRI fee schedule, MRI utilization showed a net profit increase of 18.5%. Net profits of 62.8% and a 'margin of safety ratio' of 43.1% for MRI utilization showed that the hospital relied on this non-covered procedure for profits. 8. The shifts in profits from CT and MRI utilization showed the net profits from CT decreased by 2.33billion Won while the net profits from MRI increased by 815.7million Won. Overall, these two together showed a net profit decrease of 1.51billion Won. The shifts in utilization showed a functional substitutionary relationship, but the shifts in profits did not show a substitutionary relationship. From these results, We can conclude that if insurance is to be expanded to include previously uncovered procedures using expensive medical equipment, detailed standards should be prepared in advance. The decrease in profits from the shifts in coverage and changes in fees is a difficult burden that should be shared, not carried by the hospital alone. Also, a new or improved fee schedule system should include revised standards between items listed and the appropriateness of the fee schedule should constantly be ensured. This study focused on one university hospital in Seoul and is therefore limited in general applicability. But it is valuable for considering current issues and problems, such as the influence of CT coverage on hospital management. Future studies will hopefully expand the scope of the issues considered here.

• The Korean Journal of Air & Space Law and Policy
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• v.23 no.2
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• pp.173-205
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• 2008

Space debris have frequently caused damage to space objects like satellites in orbits and sometimes have fallen on the earth. Such increase in space debris will lead to the high possibility of threatening space activities of mankind. However, it is not so easy for the damage caused both by identified and by unidentified space debris to be recovered since in the regime of the current international law, there is no legislation of prescribing the damage done by space debris. For overcoming the limitation it seems desirable that either the Liability Convention should partly be amended or new international law regime should be established. For instance, 'space debris' should be included in the new definition of 'space object' and the range of launching should also be defined clearly by making the concept of 'launching' somewhat more specified. Moreover, the subject of international liability for damage caused by space debris should be divided into two classes: the subject before and after registration. While in case of before-registration launch states should be held liable for any damage jointly or individually, in case of after-registration 'the state of registry' or 'owner' of the space debris should be. In the event of damage being caused elsewhere than on the surface of the earth to a space object of other State, 'fault-based liability' is currently applied. But it needs to be changed into 'absolutely liability'. In this paper, 'Liability Pool', 'Insurance', 'Market-Share Liability' are presented as aid devices of the damages resulting from unidentified space debris. They should be defined through the amendment of the Liability Convention or another international treaty. Some day there comes a time when our country shall possess many of the astronomical price of satellites. It means that we can't be free from the damage by the increasing number of space debris. Provided that our satellites are damaged by such space debris, it will do the satellites damage and cause impaired functioning or troubles in operation. As a result, if we are not paid for the damage by space debris, we will be confronted with tremendous economic loss because it is necessarily connected with the excess burden of taxation. Thus, an international agreement regarding the measures of the compensation for space debris damage must be made very soon.

• Asia pacific journal of information systems
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• v.19 no.4
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• pp.101-124
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• 2009

According to Wikipedia, virtual reality (VR) is defined as a technology that allows a user to interact with a computer-simulated environment. Due to a rapid growth in information technology (IT), the cost of virtual reality has been decreasing while the utility of virtual reality advertisements has dramatically increased. Nevertheless, only a few studies have investigated the effects of virtual reality advertisement on consumer behaviors. Therefore, the objective of this study is to empirically examine the effects of virtual reality advertisement. Compared to traditional online advertisements, virtual reality advertisement enables consumers to experience products realistically over the Internet by providing high media richness, interactivity, and telepresence (Suh and Lee, 2005). Advertisements with high media richness facilitate consumers' understanding of advertised products by providing them with a large amount and a high variety of information on the products. Interactivity also provides consumers with a high level of control over the computer-simulated environment in terms of their abilities to adjust the information according to their individual interests and concerns and to be active rather than passive in their engagement with the information (Pimentel and Teixera, 1994). Through high media richness and interactivity, virtual reality advertisements can generate compelling feelings of "telepresence" (Suh and Lee, 2005). Telepresence is a sense of being there in an environment by means of a communication medium (Steuer, 1992). Virtual reality advertisements enable consumers to create a perceptual illusion of being present and highly engaged in a simulated environment, while they are in reality physically present in another place (Biocca, 1997). Based on the characteristics of virtual reality advertisements, a research model has been proposed to explain consumer responses to the virtual reality advertisements. The proposed model includes two dimensions of consumer responses. One dimension is consumers' rational response, which is based on the Information Processing Theory. Based on the Information Processing Theory, product knowledge and perceived risk are selected as antecedents of intention to purchase. The other dimension is emotional response of consumers, which is based on the Attitude-Structure Theory. Based on the Attitude-Structure Theory, arousal, flow, and positive affect are selected as antecedents of intention to purchase. Because it has been criticized to have investigated only one of the two dimensions of consumer response in prior studies, our research model has been built so as to incorporate both dimensions. Based on the Attitude-Structure Theory, we hypothesized the path of consumers' emotional responses to a virtual reality advertisement: (H1) Arousal by the virtual reality advertisement increases flow; (H2) Flow increases positive affect; and (H3) Positive affect increases intension to purchase. In addition, we hypothesized the path of consumers' rational responses to the virtual reality advertisement based on the Information Processing Theory: (H4) Increased product knowledge through the virtual reality advertisement decreases perceived risk; and (H5) Perceived risk decreases intension to purchase. Based on literature of flow, we additionally hypothesized the relationship between flow and product knowledge: (H6) Flow increases product knowledge. To test the hypotheses, we conducted a free simulation experiment [Fromkin and Streufert, 1976] with 300 people. Subjects were asked to use the virtual reality advertisement of a cellular phone on the Internet and then answer questions about the variables. To check whether subjects fully experienced the virtual reality advertisement, they were asked to answer a quiz about the virtual reality advertisement itself. Responses of 26 subjects were dropped because of their incomplete answers. Responses of 274 subjects were used to test the hypotheses. It was found that all of six hypotheses are accepted. In addition, we found that consumers' emotional response has stronger impact on their intention to purchase than their rational response does. This study sheds much light into practical implications for both IS researchers and managers. First of all, while most of previous research has analyzed only one of the customers' rational and emotional responses, we theoretically incorporated and empirically examined both of the two sides. Second, we empirically showed that mediators such as arousal, flow, positive affect, product knowledge, and perceived risk play an important role between virtual reality advertisement and customer's intention to purchase. In addition, the findings of this study can provide a basis of practical strategies for managers. It was found that consumers' emotional response is stronger than their rational response. This result indicates that advertisements using virtual reality should focus on the emotional side, and that virtual reality can be served as an appropriate advertisement tool for fancy products that require their online advertisements to give an impetus to customers' emotion. Finally, even if this study examined the effects of virtual reality advertisement of cellular phone, its findings could be applied to other products that are suited for virtual experience. However, this research has some limitations. We were unable to control different kinds of consumers and different attributes of products on consumers' intention to purchase. It is, therefore, deemed important for future research to control the consumer and product types for more reliable results. In addition to the consumer and product attributes, other variables could affect consumers' intention to purchase. Thus, the future research needs to find ways t control other variables.

• Radiation Oncology Journal
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• v.26 no.1
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• pp.65-73
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• 2008

Purpose: Women with breast cancer diagnosed at an age of 40 years or younger have a greater prevalence of germline BRCA1 and BRCA2 mutations than the prevalence of women with breast cancer diagnosed at older ages. Several immunohistochemical characteristics have been identified in breast cancers from studies of Caucasian women with BRCA1/2 mutations having familial or early-onset breast cancers. The aim of this study is to determine whether early-onset breast cancer in BRCA1 or BRCA2 mutation carriers, who were not selected from a family history, could be distinguished by the use of immunohistochemical methods and could be distinguished from breast cancer in women of a similar age without a germline BRCA1 or BRCA2 mutation. We also analyzed the prognostic difference between BRCA1/2 related and BRCA1/2 non-related patients by the use of univariate and multivariate analysis. Materials and Methods: Breast cancer tissue specimens from Korean women with early-onset breast cancers were studied using a tumor tissue microarray. Immunohistochemical staining of estrogen receptor(ER), progesterone receptor(PR) and HER-2, as well as the histology and grade of these specimens, were compared. The prognostic impact of immunohistochemical and histological factors as well as the BRCA1/2 mutation status was investigated separately. Results: There were 14 cases and 16 deleterious BRCA1/2 mutations among 101 patients tested. A family history(4/14) and bilateral breast cancers(3/9) were high risk factors for BRCA1/2 mutations. BRCA1/2-associated cancers demonstrated more expression of ER-negative(19.4% versus 5.1%, p=0.038) and HER-2 negative than BRCA1/2 negative tumors, especially for tumors with BRCA1 tumors The BRCA1/2 mutation rate for patients with triple negative tumors(negative expression of ER, PR and HER-2) was 24.2%. Tumor size, nodal status, and HER-2 expression status were significantly associated with disease free survival, as determined by univariate and multivariate analysis, but the BRCA1/2 status was not a prognostic factor. Conclusion: Breast cancer that occurs in women with a germline BRCA1 or BRCA2 mutations have recognizable immunohistochemical features, which may be useful in identifying individuals that are more likely to carry germline mutations. Although the BRCA1/2 mutation status was not a prognostic factor in Korean women with early-onset breast cancer, more cases with a longer follow-up period are needed for further study.