• Journal of Periodontal and Implant Science
• /
• v.48 no.1
• /
• pp.3-11
• /
• 2018

Purpose: This study utilized a strong quasi-experimental design to test the hypothesis that the implementation of a policy to expand dental care services resulted in an increase in the usage of dental outpatient services. Methods: A total of 45,650,000 subjects with diagnoses of gingivitis or advanced periodontitis who received dental scaling were selected and examined, utilizing National Health Insurance claims data from July 2010 through November 2015. We performed a segmented regression analysis of the interrupted time-series to analyze the time-series trend in dental costs before and after the policy implementation, and assessed immediate changes in dental costs. Results: After the policy change was implemented, a statistically significant 18% increase occurred in the observed total dental cost per patient, after adjustment for age, sex, and residence area. In addition, the dental costs of outpatient gingivitis treatment increased immediately by almost 47%, compared with a 15% increase in treatment costs for advanced periodontitis outpatients. This policy effect appears to be sustainable. Conclusions: The introduction of the new policy positively impacted the immediate and long-term outpatient utilization of dental scaling treatment in South Korea. While the policy was intended to entice patients to prevent periodontal disease, thus benefiting the insurance system, our results showed that the policy also increased treatment accessibility for potential periodontal disease patients and may improve long-term periodontal health in the South Korean population.

• Health Policy and Management
• /
• v.32 no.2
• /
• pp.154-163
• /
• 2022

Background: The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit. Methods: We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. Results: In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated. Conclusion: High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.

• Health Policy and Management
• /
• v.32 no.2
• /
• pp.125-136
• /
• 2022

The costliness index (CI) is an index that is used in various ways to improve the quality of medical care and the management of appropriate treatment in medical institutions. However, the current calculation method for CI has a limitation in reflecting the actual medical cost of the patient unit because the outpatient and inpatient costs are evaluated separately. It is desirable to calculate the CI by integrating the medical cost into the episode unit. We developed an episode-based CI method using the episode classification system of the Centers for Medicare and Medicaid Services to the National Inpatient Sample data in Korea, which can integrate the admission and ambulatory care cost to episode unit. Additionally, we compared our new method with the previous method. In some episodes, the correlation between previous and episode-based CI was low, and the proportion of outpatient treatment costs in total cost and readmission rates are high. As a result of regression analysis, it is possible that the level of total medical costs of the patient unit in low volume medical institute and rural area has been underestimated. High proportion of outpatient treatment cost in total medical cost means that some medical institutions may have provided medical services in the ambulatory care that are ancillary to inpatient treatment. In addition, a high readmission rate indicates insufficient treatment service for inpatients, which means that previous CI may not accurately reflect actual patient-based treatment costs. Therefore, an integrated patient-unit classification system which can be used as a more effective CI indicator is needed.

• Health Policy and Management
• /
• v.19 no.3
• /
• pp.125-141
• /
• 2009

The purpose of this study was to examine the role of provider practice patterns in the difference in health expenditure between the two types of patients: Health Insurance and Medical Aid type 1. The study used the outpatient claim data for all Medicaid and health insurance patients of hypertension who received medical services from 8,454 primary care physicians during the first half of 2006. The data were stratified by patient's gender and age for the two groups of patients who received care from the same physician. The dependent variables were the differences in medical expenditure per case, patient days per case and medical expenditure per patient day between Medicaid patients and health insurance patients. Empirical results showed that physician characteristics, such as physicians under age 50, greater proportion of pediatric Medicaid patients, lower proportion of new Medicaid patients and the greater number of comorbidity of Medicaid patients are associated with the greater difference between the two types of patients (i.e., greater expenditure of Medicaid patients relative to health insurance patients). This study shows that factors associated with provider practice patterns need to be taken into account in Medicaid policy.

• Journal of Korea Multimedia Society
• /
• v.22 no.4
• /
• pp.480-490
• /
• 2019

Nowadays, Electronic Medical Record (EMR) has just implemented at few hospitals for Outpatient Department (OPD). OPD is the diversified data, it includes demographic and diseases of patient, so it need to be clustered in order to explore the hidden rules and the relationship of data types of patient's information. In this paper, we propose a novel approach for unsupervised clustering of patient's demographic and diseases in OPD. Firstly, we collect data from a hospital at OPD. Then, we preprocess and transform data by using powerful techniques such as standardization, label encoder, and categorical encoder. After obtaining transformed data, we use some strong experiments, techniques, and evaluation to select the best number of clusters and best clustering algorithm. In addition, we use some tests and measurements to analyze and evaluate cluster tendency, models, and algorithms. Finally, we obtain the results to analyze and discover new knowledge, meanings, and rules. Clusters that are found out in this research provide knowledge to medical managers and doctors. From these information, they can improve the patient management methods, patient arrangement methods, and doctor's ability. In addition, it is a reference for medical data scientist to mine OPD dataset.

• The Korean Society of Law and Medicine
• /
• v.19 no.1
• /
• pp.23-80
• /
• 2018

Since the 1960s, the United States' (U.S.) deinstitutionalization policy has reinstated people with mental illness into communities. Unfortunately, when untreated, some people with psychiatric disorders become homeless, and some commit serious crimes during a psychological crisis. Assisted Outpatient Treatment (AOT), also known as Kendra's Law in New York and Laura's Law in California, provides treatment, services and support to people with mental illness in the community. AOT has repeatedly been found effective and is recognized as an evidence-based practice. The response to the mental health crisis (crisis intervention) in the U.S. has also been successful in preventing worsening mental illness and related criminality and other issues. This paper provides an opportunity to create a platform from which to learn how to successfully apply the AOT and crisis intervention of the U.S. to South Korea within the cultural and societal context when establishing social services for people with mental illness in South Korea's communities.

• Korea Journal of Hospital Management
• /
• v.4 no.1
• /
• pp.41-65
• /
• 1999

This study was attempted to identify the factors affecting profitability of general hospital in Kyung-In Region. Operating profit to gross revenues and net profit to gross revenues were used as a proxy indicator for profitability of hospitals. The unit of analysis was hospital, and the data were collected 5 years data from 20 hospitals. The major findings are as follows; (1) The average operating profit rate was 1.03% and the net profit rate was -5.00% in twenty hospitals in the Kyung-In Region for the last five years. In terms of maximum surplus, the operating profit rate was 14% and net profit rate was 3.40%. In terms of maximum loss revenue, the operating profit rate was -16.56% and the net profit rate was -22.83%. (2) Since the year 1993, which was the starting year of this study, the operating profits and the net profits consistently decreased. (3) Analyzing the difference in profits among various hospital groups, the tertiary hospital group and the 501-1000 beds group exhibited the highest in operating profit rate. Also, among the higher grade number of beds in hospital group, per 100 beds group, the 41-50 beds group exhibited the highest in operating profit rate. There is a statistically significant difference in those groups(p<0.05, p<0.01). (4) In the health care delivery system, the profit gain in the secondary hospital was 51.5% and in the tertiary hospital was 72.4%. Based on the number of beds in each hospital group, the highest profit gain was 75.0% in the over 1001 beds group, and 71.4% in the 501-1000 beds group. Also, among the higher grade number of beds in hospital group, per 100 beds group, the 41-50 beds group exhibited 88.6% surplus. (5) According to the surplus difference based on the analysis of health care utilization, a group with over 31 patients in bed turnover rate, a group with over 96% in bed occupancy rate and group with over 9% in emergency cases to outpatient visits exhibited the highest profit gains. In addition, a group with over 301 patients in daily outpatient visits per 100 beds and group with 11-12 days average length of stay exhibited the highest profit gains. These results are statistically significant(p<0.05, p<0.01). (6) According to a stepwise regression analysis, the variables measuring the bed turnover rate, number of licensed beds, and number of outpatient visits per specialist explain 34.1% of the variation in operating profits. In terms of net profits, the new outpatient visits, the bed turnover rates and the number of general bed variables explain 30.6%. These results are statistically significant(p<0.01).

• Health Policy and Management
• /
• v.30 no.2
• /
• pp.164-177
• /
• 2020

This study aims to compare the experience of selected countries in operating separate payment system for new healthcare technology and to find implications for price setting in Korea. We analyzed the related reports, papers, laws, regulations, and related agencies' online materials from five selected countries including the United States, Japan, Taiwan, Germany, and France. Each country has its own additional payment system for new technologies: transitional pass-through payment and new technology ambulatory payment classification for outpatient care and new technology add-on payment for inpatient care (USA), an extra payment for materials with new functions or new treatment (C1, C2; Japan), an additional payment system for new special treatment materials (Taiwan), a short-term extra funding for new diagnosis and treatment (NUB; Germany), and list of additional payments for new medical devices (France). The technology should be proven safe and effective in order to get approval for an additional payment. The price is determined by considering the actual cost of providing the technology and the cost of existing similar technologies listed in the benefits package. The revision cycle of the additional payment is 1 to 4 years. The cost or usage is monitored during that period and then integrated into the existing fee schedule or removed from the list. We conclude that it is important to set the explicit criteria to select services eligible for additional payment, to collect and analyze data to assess eligibility and to set the payment, to monitor the usage or cost, and to make follow-up measures in price setting for new health technologies in Korea.

• Clinical and Experimental Pediatrics
• /
• v.59 no.1
• /
• pp.30-34
• /
• 2016

Purpose: Although Bednar's aphthae are common and regress spontaneously, these lesions may lead to feeding intolerance and are often misdiagnosed, rendering examinations useless. This study sheds new light on the clinical features of Bednar's aphthae. Methods: Sixteen neonates and infants were newly diagnosed with Bednar's aphthae via routine health check-ups in an outpatient clinic. Medical records were retrospectively reviewed, and the following parameters were analyzed; sex, gestational age, birth weight, mode of delivery, and perinatal problems. A physical examination was carried out during the next outpatient visit to examine the healing process and check for the existence of scars or complications. Results: Initial presentation included changes in feeding habits (n=10), longer feeding time, reduced intake, and increased irritability. In 6 patients, Bednar's aphthae were discovered incidentally, without prior symptoms. Feeding posture and method of feeding are important causes of Bednar's aphthae. Eleven patients were fed in a horizontal position, whereas 5 patients were fed in a semiseated position. Fifteen patients were bottle-fed, whereas 1 patient was exclusively breastfed. After correcting the feeding position, the ulcerative lesions disappeared within 1 month of diagnosis. During the follow-up period, lesions did not recur in any of the patients. Conclusion: This study suggests that Bednar's aphthae are caused by mechanical pressure. A diagnosis of Bednar's aphthae should be considered when lesions are found on the palate of infants and when symptoms seem to be feeding related. Proper education of parents can both treat Bednar's aphthae and easily prevent its recurrence.

• Health Policy and Management
• /
• v.17 no.2
• /
• pp.33-51
• /
• 2007

The disabled population is a vulnerable group, having very complex medical conditions, but little is known about differences in the level of access by type of disability. This study was performed to investigate the differences of health care utilization by the type of disability. The database was constructed from registry of the disabled and health insurance and medical aid claims data submitted to the Korea Health Insurance Cooperation during in the year 2003. The disability classified three groups according to the Disabled Welfare Act; physically disability with external dysfunction, physically disability with organic disease, and mentally disability. There were huge differences in health care utilization by the type of disability. For the inpatient care, those with a mental disability were more likely to utilize health care services in terms of average visit number of medical facilities and visit days per case, but the treatment amount per case was the highest in physically disabled with organic disease. For the outpatient care, those who the physically disabled with organic disease were more likely to utilize health care services in terms of average visit number of medical facilities, treatment amount per case, and the treatment days per case. Also, those who physically disabled with organic disease were more likely to utilize general hospital for both inpatient and outpatient care, and spent more out-of-pocket expenditure. As the number of persons with disabilities rises, the need to consider new approaches to protecting their health grows increasingly. Especially, Korean health care system should be refined to be more responsive to the needs of the type of disability.