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Analysis of utilization and profit for CT and MRI after implementation of insurance coverage for CT (CT 보험급여 전후의 CT 및 MRI검사의 이용량과 수익성 변화)

  • Suh, Chong-Rock;Yu, Seung-Hum;Chun, Ki-Hong;Nam, Chung-Mo
    • 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.

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FEA estimates of margin design in all ceramic crowns (완전 도재관을 위한 지대치 형성시 변연 형태에 따른 응력 분포의 유한요소법적 비교)

  • Han, Sang-Hyun;Cho, Jung-Hyeon;Lee, En-Jung;Jeong, Suk-In;Oh, Nam-Sik
    • The Journal of Korean Academy of Prosthodontics
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    • v.46 no.1
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    • pp.1-11
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    • 2008
  • Statement of problem: Over the past decade, increased demand for esthetically pleasing restorations has led to the development of all-ceramic systems. Recent reports suggest that the all-ceramic crowns have excellent physical properties, wear resistance, and color stability. In addition, numerous ceramics have excellent biocompatibility, a natural appearance, and improved physical bonding with resin composite luting agents. However, the brittle nature of ceramics has been a major factor in their restriction for universal usage. Functional occlusal loading can generate stress in the luting agent, and the stress distribution may be affected by the marginal geometry at the finish line. Tooth preparation for fixed prosthodontics requires a decision regarding the marginal configuration. The design dictates the shape and bulk of the all ceramic crowns and influences the fit at the margin. Purpose: The purpose of this study was to evaluate the stress distribution within marginal configurations of all- ceramic crowns (90-degree shoulder, 110-degree shoulder, 135-degree shoulder). Material and methods: The force is applied from a direction of 45 degrees to the vertical tooth axis. Three-dimensional finite element analysis was selected to determine stress levels and distributions. Results and conclusion: The result of stress level for the shoulder marginal configuration was more effective on stress distribution at 135-degree shoulder margin. But the stresses concentrated around at 135-degree shoulder margin. The stress decreased apically at the surface between cements and alumina core, and increased apically at the surface between alumina core and veneering porcelain.

Analyses of the Test Problems for Admission at the Science Education Center for Gifted Youth (과학영재교육센터 학생선발문항 분석 및 선발방법에 대한 제언)

  • Lee, Sang-Bub;Lee, Kwang-Pill;Choi, Sang-Don;Hwang, Suk-Geun
    • Journal of The Korean Association For Science Education
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    • v.19 no.4
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    • pp.604-621
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    • 1999
  • We analyze the admission test problems used in 1998 at the Science Education Center for Gifted Youth at Kyungpook National University (SECGY, KNU). The test consists of two parts, an evaluation of the scientific thinking skills and an evaluation of the achievement for Mathematics and Sciences, the former of which includes evaluations of scientific process skills and logical thinking skills. The problems for the test of scientific thinking skills were developed and standardized by the Korea Education Development Center, while those of the achievement for Mathematics and Sciences were made at SECGY. We calculate the indices of the difficulty and discrimination for each problem to determine whether or not the test is appropriate to apply for selecting number of gifted students among the recommended students from 389 middle schools in Taegu-city and Kyungsang-pook-do Province. We find that both indices of most problems for the test of scientific thinking skills were out range of the appropriate level and. moreover, even those problems which fall into the appropriate range showed very low efficiencies for distractors. We, thus, conclude that the problems of the test of scientific thinking skills are inappropriate to use as a test for admission to SECGY. On the other hand, the problems of the achievement test showed extreme results; the Mathematics problems appeared to be too difficult, whereas the Physics problems appeared too easy. However, overall scores showed a normal distribution, indicating that those problems played crucial role in selecting gifted students. We finally propose several suggestions in developing the test problems and in selecting students at the SECGY.

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Factors Affecting Problematic Drinking by University Students in Chuncheon Area (춘천지역 대학생의 문제음주에 영향을 미치는 요인)

  • Kim, Yoon-Sun;Kim, Bok-Ran
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.43 no.6
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    • pp.934-942
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    • 2014
  • The purpose of this study was to investigate factors affecting problematic drinking by university students in the Chuncheon area. Lifelong drinking rate of subjects was 98.1%. Problematic drinking rates according to AUDIT (alcohol use disorders identification test) were as follows: 21.3% 'no problem', 58.0% 'at-risk drinking', 10.0% 'alcohol abuse' and 10.7% 'alcohol dependence'. Research has shown that problematic drinking is more prevalent among freshmen, early drinkers, those with hypochondria, and students who are less satisfied with their campus life or whose own parents are frequent drinkers. It has been shown that more serious problematic drinking is associated with higher 'positive alcohol outcome expectancies' and 'coping motives for drinking', and 'recognition level of drinking cultures' is considered less desirable. Multiple regression analysis revealed that 'coping motives for drinking' was the most significant variable affecting the problematic drinking of university students. Developing and fostering various alcohol-reducing programs that largely focus on 'coping motives for drinking' will greatly contribute to solving problematic drinking.

Inhibitory Activities of Water Extracts of Black Ginseng on HCl/Ethanol-Induced Acute Gastritis through Anti-Oxidant Effect (흑삼 열수 추출물의 항산화 효과를 통한 염산/에탄올로 유발된 위염 억제 작용)

  • Kim, Min Yeong;Kwon, O Jun;Noh, Jeong Sook;Roh, Seong-Soo
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.45 no.9
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    • pp.1249-1256
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    • 2016
  • Black ginseng (BG) obtained by a 9-fold steaming process of Panax ginseng has been reported to have anti-oxidative, anti-obesity, and anti-diabetes effects. The current study evaluated the protective effect of BG by steaming time in an HCl/ethanol-induced acute gastritis model. BG was divided into four samples according to steaming-drying processing (Gin1, Gin3, Gin6, and BG). High performance liquid chromatography analysis, free radical scavenging activity, and total phenol and flavonoid contents were examined in ginseng and four BG samples. Compared with ginseng, BG showed a stronger radical scavenging effect and higher contents of total phenol and flavonoids. To evaluate the anti-gastritic effect of BG, mice were distributed into five groups: normal mice (N), acute gastritic mice with distilled water (CON), acute gastritic mice with 100 mg/kg of ginseng (Gin0), acute gastritic mice with 100 mg/kg of BG (BG), and acute gastritic mice with 10 mg/kg of sucralfate (SC). After 1 hour of pre-treatment with water, extracts (Gin0 and BG), or drug (SC), experimental groups except for N were orally administered 0.5 mL of 150 mM HCl/60% ethanol (v/v) mixture. Blood was collected 1 hour later from the heart, and gastric tissue was harvested. Reactive oxygen species (ROS) levels were measured in serum, and related protein expression was examined by Western blot assay. In HCl/ethanol-induced acute gastritic mice, treatment with ginseng or BG improved mucosal damage in the histological evaluation. The serum ROS level significantly decreased in the BG-treated group compared with the CON group. Furthermore, expression of inflammatory cytokines significantly decreased in the BG-treated group compared with the CON group. Based on these results, antioxidant and anti-gastritic activities of ginseng were enhanced by streaming-drying processing, in part due to an increase in biological active compounds.

An Ethnography of Child-Rearing Experiences of Korean Mothers Living on Koje Island (우리나라 어머니의 자녀 양육의 의미 - 거제지역을 대상으로 -)

  • Lee, Soo-Yeon
    • Women's Health Nursing
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    • v.7 no.4
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    • pp.518-535
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    • 2001
  • Nursing practices should be based on the understanding of human beings. In order to understand human beings, it is important to study the lifestyles and thoughts of people in their natural environment. In this sense, the cultural aspects of a society need to be studied for a culture-bound nursing service. Child care, which is an important element of nursing, is also strongly influenced by the culture of a society. Therefore, a cultural study is necessary to understand the child-rearing practices of any society. The major purpose of this dissertation is to provide basic foundations for developing a culture-based theory for nursing intervention through studying traditional cultural elements of child care in Korean society. The study examined child-rearing practices in a small village on Koje Island in the southern part of Korea. It utilized ethnographic methodologies including participatory observations and in-depth interviews. The study participants were 9 Korean mothers living on Koje Island. The average age was 52. The data were collected between July in 1998 and December in 1999. The average number of interviews per person was 7-8, and the duration of each interview was approximately 2 hours. The data were analyzed using the Spradley Analytical Method. The following 9 major child-rearing aspects of mothers on Koje Island were discovered as a result of the study: 1. Firstly, mothers on Koje Island were mostly concerned about the "Old Birth Goddess' Curse", especially during their child's early years. This concern was evidenced by their careful behavior when their child was very young and by their praying to the Old Birth Goddess not to be jealous of their babies. 2. Secondly, they wished their children to live a different and better life than themselves. It was represented by their strong motivation toward their children's education as well as their expectation for their children's success. In traditional Korean culture, Korean people think that the rise and fall of the household depend on their offsprings. Therefore, Korean mothers wish their children attain to a higher level of social status through education. 3. Third, mothers are concerned about their children's righteousness. Mothers on Koje island expect their children to live with discretion, justice, strength, respect, harmony, and to do their best in life. 4. Next was an 'anticipation of their children's happy marriage'. The attributes of this category were an 'anxiety about their children's married life', and 'an expectation of a good spouse for their children'. Because Korean people believe that only a son can continue the bloodline of a family, especially Korean mothers have a great concern of the possibility of their daughters not having a son after marriage. Also they have different expectations toward their daughter-in-laws than son-in-laws. 5. Korean mothers also derived their satisfaction from their son. It was characterized by 'excessive affection toward their son', 'dependency on their son', and 'being afraid of their married daughter having a girl like themselves'. Korean society has been a patriarchy. Therefore, a son is beloved as someone who will take care of his old parents, be in charge of ancestral rites, and provide a daughter-in-law who can conceive a son. 6. The sixth category concerned 'the differences in their expectations for their children'. The attributes in this category were 'different expectations depending on their children's gender', 'different expectations depending on their children's ability', and a 'great sympathy toward children with low abilities'. Korean mothers expect their son to become better than their daughter. 7. The seventh category was related to their 'roles in child-caring practices'. Traditionally a child was raised in an extended family system in Korea So it was not the sole duty of a mother to bring up the child. Korean mothers used to receive much help rasing children from their in-laws, and family members. On the other hand, many children grew up by themselves, because their mothers were very busy taking care of housework. Furthermore, many children also grew up in poverty. 8. Mothers also had issues related to 'conflicts in child rearing'. They were characterized by 'lack of understanding', 'rudeness of children', and 'giving vent to one's anger'. 9. Finally, mothers regretted not doing their best in child-rearing practices. It was characterized by a 'bitter feeling of repentance', 'feeling irritated', and 'feeling of unsatisfaction'.

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Growth Performance, Humoral Immune Response and Carcass Characteristics of Broiler Chickens Fed Alkali Processed Karanj Cake Incorporated Diet Supplemented with Methionine

  • Panda, K.;Sastry, V.R.B.;Mandal, A.B.
    • Asian-Australasian Journal of Animal Sciences
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    • v.18 no.5
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    • pp.677-681
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    • 2005
  • A study was conducted to see the effect of dietary incorporation of alkali (1.5% NaOH, w/w) processed solvent extracted karanj cake (SKC) supplemented with methionine on growth performance, humoral immune response and carcass characteristics of broiler chickens from 0 to 8 weeks of age. One hundred and twenty, day- old broiler chicks were wing banded, vaccinated against Marek' disease and distributed in a completely randomized design (CRD) into 3 groups of 40 chicks each, which was further replicated to 4 and fed on diet containing soybean meal and those of test groups were fed diets containing alkali (1.5% NaOH) treated SKC partially replacing soybean meal nitrogen of reference diet (12.5%) without or with supplementation of methionine (0.2%). Individual body weight of chicks and replicate-wise feed intakes were recorded at weekly intervals throughout the experimental period. Feed consumption from 1 to 14, 28, 42 and 56 d of age was recorded for each replicate and feed conversion efficiency (weight gain/feed intake) for the respective period was calculated. Mortality was monitored on daily basis. On 28$^{th}$ day of experimental feeding, two birds of each replicate in each dietary group (8 birds/diet) were inoculated with 0.1 ml of a 1.0% suspension of sheep red blood cells (SRBC) and the antibody titre (log 2) was measured after 5 days by the microtitre haemmagglutination procedure. After 42 days of experimental feeding, a retention study of 4 days (43-47 d) duration was conducted on all birds to determine the retention of various nutrients such as DM, N, Ca, P and GE. On 43$^{rd}$ day of experimental feeding, one representative bird from each replicate of a dietary treatment (4/dietary group) was sacrificed, after fasting for two hours with free access to water, through cervical dislocation to observe the weight of dressed carcass, primal cuts (breast, thigh, drumstick, back, neck and wing), giblet (liver, heart and gizzard), abdominal fat and digestive organs. The body weight gain of chicks fed reference diet and those fed diet incorporated with NaOH treated SKC (12.5% replacement) with or without methionine supplementation was comparable during 0 to 4 weeks of age. However, dietary incorporation of alkali processed SKC replacing 12.5% nitrogen moiety of soybean meal resulted in growth retardation, subsequently as evidenced by significantly (p<0.05) lowered body weight gain during 0 to 6 weeks of age in birds fed diet incorporated with alkali processed SKC at 6.43% without methionine as compared to those supplemented with methionine or reference diet. Dietary incorporation of alkali (1.5% NaOH) processed SKC replacing 12.5% of soybean meal nitrogen in the diet of broiler chickens had no adverse effect on feed conversion ratio during all the weeks of experimental feeding. The humoral immune response (HIR) as measured by the antibody titre in response to SRBC inoculation was comparable among all the dietary groups. No significant difference in the intake and retention of DM, N, Ca, P or GE was noted among the chicks fed reference and alkali processed SKC incorporated diets with or without methionine supplementation. None of the carcass traits varied significantly due to dietary variations, except the percent weight of liver and giblet. The percent liver weight was significantly (p<0.05) higher in the birds fed diet incorporated with alkali processed SKC as compared to that in other two groups. Thus solvent extracted karanj cake could be incorporated after alkali (1.5% NaOH, w/w) processing at an enhanced level of 6.43%, replacing 12.5% of soybean meal nitrogen, in the broiler diets up to 4 weeks of age, beyond which the observed growth depression on this diet could be alleviated by 0.2% methionine supplementation.

Clinical Aspects of Pulmonary Radioactivity Observed in Radiocolloid Liver Scintigraphy (간 스캔에서 관찰되는 폐 방사능에 관한 임상적 고찰)

  • So, Young;Lee, Kang-Wook;Lee, Heon-Young;Lee, Won-Woo
    • The Korean Journal of Nuclear Medicine
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    • v.36 no.3
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    • pp.185-194
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    • 2002
  • Purpose: We studied clinical aspects and courses of patients with pulmonary radioactivity on liver scintigraphy and speculated the mechanism of pulmonary uptake of radiocolloids. Materials and Methods: Forty-nine patients with pulmonary radioactivity were classified into 5 disease groups-liver disease, infection, cancer, ischemic necrosis of liver, etc.- and their presence or absence of chronic liver disease (CLD), Child-Pugh class, serum levels of AST and ALT, results of follow-up liver scintigraphy and clinical course were checked. Results: Of total 49 patients 25 had CLD; there were 23 liver disease patients, 16 infection patients, 7 advanced cancer patients, 2 ischemic necrosis of liver patients, and 1 hemolytic anemia patient. Reversible rise of serum levels of AST and ALT was observed in all patients with liver disease and ischemic necrosis of liver; on one-way ANOVA, these rise were statistically significant (p<0.01). Serum level of ALT of liver disease group patients without CLD was significantly higher than that of infection group patients without CLD (p<0.05). Among 17 patients who underwent follow-up liver scintigraphy, 13 showed no pulmonary radioactivity. Total 12 patients died during follow-up and most of them were terminal cancer patients or CLD patients of Child-Pugh class C. Conclusion: Pulmonary radioactivity of radiocolloid liver scintigraphy could be attributed to the mobilization of reticuloendothelial system (RES) cells by the activation of RES cells in severe infection and terminal cancer, and also by the extensive liver destruction in liver diseases.

Susceptibility Loci Associations with Prostate Cancer Risk in Northern Chinese Men

  • Wang, Na-Na;Xu, Yong;Yang, Kuo;Wei, Dong;Zhang, Yao-Guang;Liu, Ming;Shi, Xiao-Hong;Liang, Si-Ying;Sun, Liang;Zhu, Xiao-Quan;Yang, Yi-Ge;Tang, Lei;Zhao, Cheng-Xiao;Wang, Xin;Chen, Xin;Hui, Juan;Zhang, Yu-Hong;Zhu, Ling;Yang, Fan;Zhang, Yu-Rong;Yang, Ze;Wang, Jian-Ye
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.5
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    • pp.3075-3078
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    • 2013
  • Background: KLK3 gene products, like human prostate-specific antigen (PSA), are important biomarkers in the clinical diagnosis of prostate cancer (PCa). G protein-coupled receptor RFX6, C2orf43 and FOXP4 signaling plays important roles in the development of PCa. However, associations of these genes with PCa in northern Chinese men remain to be detailed. This study aimed to investigate their impact on occurrence and level of malignancy. Methods: All subjects were from Beijing and Tianjin, including 266 cases with prostate cancer and 288 normal individuals as controls. We evaluated associations between clinical covariates (age at diagnosis, prostate specific antigen, Gleason score, tumor stage and aggressive) and 6 candidate PCa risk loci, genotyped by PCR- high resolution melting curve and sequencing methods. Results: Case-control analysis of allelic frequency of PCa associated with PCa showed that one of the 6 candidate risk loci, rs339331 in the RFX6 gene, was associated with reduced risk of prostate cancer (odds ratio (OR) = 0.73, 95% confidence interval (CI) =0.57-0.94, P = 0.013) in northern Chinese men. In addition, subjects with CX (CC+TC) genotypes had a decreased risk for prostrate cancer compared to those carrying the TT homozygote (OR =0.64, 95% CI = 0.45- 0.90, P = 0.008). The TT genotype of 13q22 (rs9600079, T) was associated with tumor stage (P=0.044, OR=2.34, 95% CI=0.94-5.87). Other SNPs were not significantly associated with clinical covariates in prostate cancer (P > 0.05). Conclusions. rs339331 in the RFX6 gene may be associated with prostate cancer as a susceptibility locus in northern Chinese men.

GROWTH OF SOUTH AND WEST COAST PACIFIC OYSTER SPATS(CRASSOSTREA GIGAS) AFTER CROSS-TRANSPLANTATION (남해산 및 서해산 참굴(Crassostrea gigas)종패의 상호 이식 후의 성장)

  • CHUNG Jong Rak;KWAK Hi-Sang
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.3 no.2
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    • pp.129-136
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    • 1970
  • As an attempt to determine if the morphological differences between the southern and western oysters are due simply to the local ecological factors or are based on their fundamental genetic nature, oyster seeds produced in 1968 at Tong-Young, Ye-Chun, and Ko-Hung on the south coast and at Kan-Wol-Do on the west coast were cross-transplanted during May of 1969 to compare their growth. The spats were placed in plastic baskets which permitted free water flow through and the baskets hung from a wooden rack located at a tidal zone of less than I hour exposure at a depth chosen to keep the baskets submerged in water at all times. Twice a month the growth of the spats were measured along with the air and water temperature and salinity. The early summer spats, which were $17-240\%$ larger, in size, than the late summer spats at the time of cross-transplantation, grew more slowly than the late summer spats when exposed to identical environmental conditions, shortening the initial gap to a $5-20\%$ level as the first year of the growth phase came to an end in December. The growth of the Kan-Wol-Do spats lagged considerably behind the southern spats at all localities tested, whereas there were no significant differences among the latter groups. This suggests that the morphological differences between southern and western Pacific oysters in Korea are a manifestation of genetic variety and that Pacific oysters cultured along the south coast are of an identical variety as they are commonly believed to be. The seasonal changes in temperature and salinity even during rainy season in both the southern and western coastal areas are well within the range suitable for successful spawning, and spat fall. However, since the results were based on twice-a-month measurements with no data covering the critical period before and after spawning, they can only serve to indicate at best the general pattern of changes in the environmental conditions of each growing area.

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