• 한국병원경영학회지
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• 제6권3호
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• pp.130-147
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• 2001

This study is about major symptoms of elderly and medical services for elderly in long-tenn care facilities. The subject of this study was 298 patients over 00 years old staying in two geriatric hospitals and two nursing homes. The symptoms and medical services were level of patient classification from RUG(Resource Utilization Group)-III which is applied for both Medicare and Medicaid for skilled nursing facilities reimbursement system in US and designed for measuring patient characteristics and medical staff time. This classification is explained by each patient resource(staff time) utilization level which is called CMI(Case-Mix Index). In this study, the symptoms and services were compared by facility type and they were categorized by level and compared by CMI. Major findings are as follows; 1. There were more elderly who have cognitive function problems in nursing homes than patients in geriatric hospitals. There were more patients with behavioral problems in geriatric hospitals than residents in nursing homes. These results were both statistically significant. 2. The patients in geriatric hospitals received significantly more nursing rehabilitation services, rehabilitation services and extensive services than residents in nursing homes. Other hands, special care services were provided significantly more to residents in nursing homes than elderly in geriatric hospitals. 3. ADL and depression variables had higher CMI when the symptoms were heavier condition. The CMI were not matched with levels of cognitive function problems and behavioral problems. 4. The CMI matched well significantly with levels of nursing rehabilitation services, special care services, and clinically complex services provided for the patient in geriatric hospitals and only nursing rehabilitation services in nursing homes. The CMI for rehabilitation services level and extensive services had regular trends. From the result of this study, the resource utilization level and services provided for elderly in each long-term care facilities were figured out. For the further study, it needs to have more concern about RUG-ill which classification variables were just analyzed.

• Journal of Preventive Medicine and Public Health
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• 제26권2호
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• pp.293-309
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• 1993

With expanded and extended coverage of the national medical insurance and fast growing health care expenditures, appropriateness of health service utilization and quality of care are concerns of both health care providers and insurers as well as patients. An accurate patient classification system is a basic tool for effective health care policies and efficient health services management. A classification system applicable to Korean medical information-Korean Diagnosis Related Groups (K-DRGs)-was developed based on the U.S. Refined DRGs, and the performance of the developed system was assessed in this study. In the process of the development, first the Korean coding systems for diagnoses and procedures were converted to the systems used in the definition of the U.S. Refined DRGs using the mapping tables formulated by physician panels. Then physician panels reviewed the group definition, and identified medical practice patterns different in two countries. The definition was modified for the differences in K-DRGs. The process resulted in 1,199 groups in the system. Several groups in Refined DRGs could not be differentiated in K-DRGs due to insufficient medical information, and several groups could not be defined due to procedures which were not practiced in Korea. However, the classification structure of Refined DRGs was retained in K-DRGs. The developed system was evaluated fur its performance in explaining variations in resource use as measured by charges and length of stay(LOS), for both all and non-extreme discharges. The data base used in this evaluation included 373,322 discharges which was a random sample of discharges reviewed and payed by the medical insurance during the five-month period from September 1990. The proportion of variance in resource use which was reduced by classifying patients into K-DRGs-r-square-was comparable to the performance of the U.S. Refined DRGs: .39 for charges and .25 for LOS for all discharges, and .53 for charges and .31 for LOS for non-extreme discharges. Another measure analyzed to assess the performance was the coefficient of variation of charges within individual K-DRGs. A total of 966 K-DRGs (87.7%) showed a coefficient below 100%, and the highest coefficient among K-DRGs with more than 30 discharges was 159%.

• 디지털융복합연구
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• 제17권12호
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• pp.535-543
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• 2019

본 연구는 손상환자의 미충족의료 관련요인을 총괄적으로 조사·파악하여 미충족의료에 관련이 있는 요인을 제시하기 위하여 시행되었으며, 연구대상은 국민건강영양조사에 응답한 손상 환자 중 미충족의료 경험이 있는 2169명을 대상으로 시행하였다. 연구방법은 빈도 백분율, Chi-square test, 다중회귀분석을 사용하였고, 이는 SPSS/WIN 23.0 Program를 이용하여 분석하였다. 연구결과, 스트레스가 있을수록, 우울감을 느낄수록, 자살생각을 할수록 미충족의료와 관련이 있는 요인으로 나타났으며, 이는 향후 미충족의료가 발생하지 않도록 의료이용 제도를 개선하고 정책 결정을 하는 데 기여할 수 있을 것으로 사료된다.

• Journal of Preventive Medicine and Public Health
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• 제25권4호
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• pp.399-412
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• 1992

This study was designed to investigate factors relating to fiscal deficit for regional health insurance. The financial statements for the fiscal year 1990 of nationwide 254 regional medical insurance societies were analyzed. Important findings are summarized below: 1. There were differences in the main reason fur the financial deficit among regions when deficit and surplus societies were compared by regions. The total revenue per enrollee, especially revenue from the premium contribution of a deficit society was significantly smaller than that of a surplus society in large cities and counties. On the other hand, the total expenditure per enrollee of a deficit society was larger than that of a surplus society in small cities. 2. Both low premium rate at the beginning of health insurance program and less effort to increase the premium rate were main factors for the smaller revenue from the contribution of a deficit society in large cities and counties. 3. Larger expenditures per covered person of a deficit society in small cities were explained with larger medical expenditures especially for out-patients services rather than larger administrative expenses. 4. A regression analysis showed that utilization rates in out-patient services were significantly associated with income and numbers of total medical care institution per capita within a region where a health insurance society located. Also expenses paid by insurer per visit were associated with the proportion of utilization for tertiary care hospitals as well as the proportion of utilization of public health centers.

• Journal of Preventive Medicine and Public Health
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• 제39권5호
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• pp.411-418
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• 2006

Objectives: The purpose of this study was to determine whether the disabled have worse access to primary care than the non-disabled. Methods: We used the National Disability Registry data and the National Health Insurance data for the calendar year 2003, and we analyzed 807,380 disabled persons who had been registered until December 2001 and we also analyzed 1,614,760 non-disabled persons for nine ambulatory care sensitive conditions (ACSCs). The rates of physician visits and hospitalizations for the patients with ACSCs were compared between the disabled and the nondisabled. Multiple logistic regression analysis was used to evaluate the association between medical care utilization and disability and to assess the association between hospitalization and the number of physician visits while controlling for potential confounders. Results: The numbers of physician visits per 100 patients were $0.78{\sim}0.97$ times lower for the disabled than that for the non-disabled with five of nine ACSCs. The numbers of hospitalizations per 100 patients were $1.16{\sim}1.77$ times higher for the disabled than that for the non-disabled with all the ACSCs. While the ORs of a physician visit for the disabled were significantly lower than that for the non-disabled with all the ACSCs (OR: $0.44{\sim}0.70$), and the ORs of hospitalization for the disabled were significantly higher (OR: $1.16{\sim}1.89$). The lower physician visit group (number of physician visits ${\leq}$1) was more likely to be hospitalized than the higher physician visit group (number of physician visits ${\geq}$2) (OR: $1.69{\sim}19.77$). The effect of the physician visit rate on hospitalization was larger than the effect of disability on hospitalization. Conclusions: The results suggest that the disabled were more likely to be hospitalized for ACSCs due to their lower access to primary care.

• 융합보안논문지
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• 제11권4호
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• pp.77-83
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• 2011

의료정보 기술의 빠른 발전과 더불어 새로운 의료정보 서비스 개발에 대한 연구가 많이 진행되고 있다. 의료서비스를 향상시켜 환자들에게 많은 도움을 주는 방법이다. 하지만 정보보안에 대해 대비없이 기술만 발전한다면 의료서비스 체계에 위험과 위협의 요소를 만드는 것이다. 오늘날 현안과제인 공중망을 통한 안정적인 접근문제, Ad hoc을 이용한 센서네트워크 보안, 비통합 의료정보 체계의 보안취약성과 같은 보안의 취약성을 해결하지 않을채 의료정보시스템은 발전과 활용에 큰 제한을 받게 된다.. 서로 다른 보안 정책을 가진 의료정보시스템 환경에서 보안정책이 출동할 경우 해결할수 있는 매커니즘이 필요하다. context-aware와 융통성있는 정책을 통해 의료정보의 통합성과 비밀성이 보장되어야 한다. 다른 도메인간 원거리 통신시 접근제어 정책이 보호 되어야 한다. 본 논문에서는 의료정보시스템의 접속자가 다양화, 다변화 되는 환경에서 Security agent 역할 기반의 보안시스템 아키텍쳐 설계방안을 제안한다. 제안된 시스템아키텍쳐는 현장에서 설계작업에서 하나의 모델로 활용이 가능할 것으로 기대한다.

• 한국산학기술학회논문지
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• 제16권1호
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• pp.617-626
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• 2015

본 연구는 제 5기 전체(2010~2012)국민건강영양조사 자료를 이용하여 우리나라 노인의 신체활동 정도와 의료이용과의 관련성을 파악하기 위하여 실시하였다. 연구결과에서 비활동적인 신체활동군과 비교하여 활동적 신체활동군의 경우에 입원이용 가능성이 0.54배(OR;95% CI, p<0.001), 외래이용은 0.73배(OR;95% CI, p=0.040), 약국이용은 0.75배(OR;95% CI, p<0.007) 더 낮으것으로 나타났으며, 의료이용 횟수도 감소하는 것으로 나타났다. 또한, 최소 신체활동군의 경우에 비활동적 신체활동군과 비교하여 입원 의료이용 가능성이 0.64배(OR;95% CI, p<0.001) 낮고, 이용횟수도 감소하는 것을 확인하였다. 결론적으로 노인의 신체활동 정도에 따라서 의료이용과의 관련성을 확인하였다는 데 의의가 있으며, 신체활동을 활발하게 실천하는 것이 노인의 건강증진과 삶의 질을 향상시킬 뿐만 아니라 의료비 지출의 감소에도 도움이 될 것으로 사료된다.

• 보건행정학회지
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• 제26권1호
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• pp.4-11
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• 2016

Background: Hospital admissions for ambulatory care sensitive conditions (ACSCs), which are widely used as an indicator of poor access to primary care, can be used as an efficiency indicator of healthcare use in countries providing good access to health care. Korea, which has a national health insurance (NHI) system and a good supply of health care resources, is one such country. To quantify admission rates of ACSC and identify characteristics influencing variation in Korean health care institutions. Methods: By using NHI claims data, we computed the mean ACSC admission rate for all institutions with ACSC admissions. Results: The average ACSC admission rate for 4,461 institutions was 1.45%. Hospitals and clinics with inpatient beds showed larger variations in the ACSC admission rate (0%-87.9% and 0%-99.6%, respectively) and a higher coefficient of variation (7.96 and 2.29) than general/tertiary care hospitals (0%-19.1%, 0.85). The regression analysis results indicate that the ACSC admission rate was significantly higher for hospitals than for clinics (${\beta}=0.986$, p<0.05), and for private corporate institutions than public institutions (${\beta}=0.271$, p<0.05). Conclusion: Substantial variations in ACSC admission rates could suggest the potential problem of inefficient use of healthcare resources. Since hospitals and private corporate institutions tend to increase ACSC admission rates, future health policy should focus on these types of institutions.

• 간호행정학회지
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• 제13권3호
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• pp.345-351
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• 2007

Purpose: The purpose of this study was to identify the relationship between patient characteristics and patient satisfaction. Methods: A cross-sectional questionnaire survey was conducted in an acute care hospital. The subjects were 317 patients discharged from general medical and surgical nursing care units during September, 2005. Patient satisfaction was measured using the short-form satisfaction scale of Hwang and Park(2001). Additional information about patient characteristics, including general demographics and health care utilization variables, was collected from the hospital information systems. Multiple regression analysis was performed to determine patient characteristics influencing patient satisfaction. Results: Patients were satisfied with hospital care with an average of 4.10 on a five-point Likert scale. Patient characteristics explained 13.5% of the variance of patient satisfaction. The significant factors influencing patient satisfaction were patients' age and perceived health status. There was no significant relationship between structural variables and patient satisfaction. Conclusion: This study showed that patients' characteristics were significant factors explaining patient satisfaction. Therefore, these characteristics should be adjusted in reporting patient satisfaction as an indicator for hospital-level or department-level rating.

• 차세대컨버전스정보서비스기술논문지
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• 제7권2호
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• pp.127-140
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• 2018

건강관리 서비스를 통한 고령자의 건강증진 효과에 관련한 연구는 그 동안 많이 진행되어 왔지만 정작 건강관리 서비스를 효과적으로 제공하기 위해 고령자들의 니즈를 파악한 연구는 미흡한 실정이다. 본 연구는 이러한 문제점을 해결하고자 도시, 농촌간의 지역별 특징과 수요를 분석을 통해 고령자 건강관리 서비스의 방향성을 제시하였다. 이를 위해 도심지역과 농촌지역별 고령자의 건강관련 프로그램 이용현황 및 건강관리방법과 건강관리 서비스 형태 및 콘텐츠에 대한 지역별 수요 분석을 통하여 맞춤형 건강관리 서비스 모델의 개선 방향을 제시하였다.