• 한국병원경영학회지
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• 제22권2호
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• pp.58-69
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• 2017

Recently, with the increase in the number of private health insurance subscribers, interest in overuse of the medical service is increasing. This study analyzed the impacts of private health insurance (PHI) on medical institution selection in outpatient service utilization among persons with arthritis. In order to control patients' health status, we extracted outpatient episodes with the same disease (KCD6, M13) from Korea Health Panel. The unit of analysis was an outpatient visit with arthritis in 2014 (n=23,363). In the light of insurance coverage, we redefined three type of private health insurance (ex, indemnity, fixed benefit, and non-insured) as a test variable and two type of medical institution (ex, hospital and physician visit) as a dependent variable. We conducted a probit regression analysis to identify the impacts of PHI on medical institution selection controlling for heteroscedasticity. The results of this study showed that the insured with indemnity were more likely to choose hospital departments than clinics (marginal effect=0.0475, p=0.000). The impact of participation of fixed benefit PHI was not as clear as that of indemnity type (marginal effect=0.0162, p=0.047). In conclusion, this study confirmed that PHI, particularly indemnity type has a significant impact on the selection of medical institutions. Healthcare policy makers should consider that PHI not only affects the overall quantitative increase in healthcare utilization, but also influences the selection of medical institutions.

• Journal of Periodontal and Implant Science
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• 제48권1호
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• pp.3-11
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• 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.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제21권1호
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• pp.17-26
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• 2015

Purpose : This study examined the social and environmental change in the outpatient department of psychiatry, were analyzed disease characteristics and using characteristics of the mental illness. Thus, this aims to provide a material that can be used for efficient spatial composition of psychiatry. Methods : This study was conducted through a literature review, observation surveys, interviews. Results : Psychiatry is aware of the need to respond to the current needs of ambulatory space, there are concerns that the spatial configuration for your needs. In accordance with the results of studies conducted are as follows: 1) Specialty care programs and space needs based on segmentation and specialization of the disease 2) Considered in conjunction with the layout of essential space and other departments 3) Spatial composition and furnishings for characteristic of psychiatry 4) Spatial configuration taking into account the patient's characteristic. Implications : This study looked at the change of social change and the environment related to psychiatry. Grasp the present state of spatial composition in psychiatry. And the use characteristics of patients and guardians were investigated. Meanwhile, studies of psychiatric outpatient department is still lacking. As a result, its significance is to analyze the spatial composition requirements.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제16권3호
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• pp.37-48
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• 2010

This study analyzes the present condition of the elements of a healing environment of the waiting rooms in outpatient clinics of children' hospitals (3 hospitals in Seoul) so as to propose a design to build a healing environment within the children' hospital. And analyzing the importance, satisfaction and preference of the healing environment in the waiting rooms, this paper has come to the following conclusions: 1)The study shows that the space structure of outpatient clinics in children' hospitals are composed of 1 story or 2 stories and designed in a duplication design or a dispersed alcove design. 2)The waiting room of the SC Hospital, with an area of 66.56$m^2$, and the waiting room of the SU Hospital, with an area of 38.78$m^2$ received the highest score for its space. 3)As most patients visit the hospital with their guardian, the waiting room should also be someplace families can rest and share information with others. 4)It is essential to build an environment that eliminates stress elements that patients may come to face by minimizing noise and elements that obstruct the view for mental stability. 5)The results show that those who took part in the survey preferred the following, respectively, healing environment design for the waiting room in the outpatient clinic at children' hospital: Pleasantness>Easiness in finding one' destination>Artificial materials>Natural materials>Environment like that at home>Co-promotion spaces>Space that supports the patients'activities>Openness>Sociality>Safety/Security>Approachability and Privacy. The results also show that healing conditions respect these preferences.

• 가정간호학회지
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• 제18권1호
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• pp.32-39
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• 2011

Purpose: The purpose of this study was to investigate treatment types and the status of referral to home care services for patients with diabetic foot. Methods: A retrospective survey was conducted by reviewing medical records from January to December in 2008 at a university hospital. The subjects were 76 patients at the age of 20 years or older who were admitted, had home care services, or received outpatient care for diabetic foot. The data were analyzed using descriptive statistics. Results: Among the total of 9,317 patients diagnosed with diabetes, 5.03% (n=469) had diabetic foot. Admission (81.6%) was the most frequently used treatment type followed by outpatient care only (7.9%) and hemodialysis only (10.5%). Of the 76 admission cases, 44.9% received post-discharge care at outpatient clinics, 20.5% had both outpatient and home care services, and 16.7% were transferred to other hospitals. Readmission rate after discharge was 15.6% for one year. Conclusion: This study suggests referral to home care services should be encouraged to provide effective follow-up care to patients with diabetic foot after discharge from a hospital.

• 한국병원경영학회지
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• 제21권2호
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• pp.37-49
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• 2016

The purpose of this study is to investigate the level of competition between Public Health Centers (PHCs) and private clinics (PCs) by examining the number of patients that used PHCs vs. PCs, estimating the total amount of revenue generated from outpatient services at both PHCs and PCs, thereby analyzing the financial impacts on PCs derived from the PHCs. We utilized 2011 National Inpatient Sample data (NIS). Using the 20 table containing general information on each individual claims, we integrate it with the 40 table which contains all the diagnostic codes for each claim. Then, we disaggregate the bundled claims into the original individual claims. Overall, 3.1% of outpatient visits are made at PHCs while the rest was made at the PCs (96.9%). Among the total claim costs of 6.34 billion USD (as of 2011), PHCs occupy 2.0% (124 million USD), and 98.0% are contributed to PCs (6.21 billion USD). The estimated economic losses of PCs due to PHCs are summarized as follow; the maximum potential loss is estimated at 198 million USD in total and 7,099 USD per clinic when we include all patient types; the minimum loss is estimated at 71 million USD in total and 2,540 USD per clinic where Medical Aid recipients and the elderly (aged 65 and over) are excluded. Our results confirm the potential economic effect on PCs due to PHCs providing outpatient services. PCs and PHCs are the most important players providing primary care in Korea. Unnecessary competition between PCs and PHCs is not desirable. Health authorities should carefully examine the healthcare services currently provided by PHCs and their impacts on PCs.

• 보건행정학회지
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• 제29권3호
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• pp.262-276
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• 2019

Background: The most important thing to strengthen primary care is to prove that the continuity of primary care is an essential area for good health outcomes. The purpose of this study is to analyze the effect of outpatient continuity of primary care on the hospitalization experience of diabetes mellitus in new diabetic patients. Methods: Using the Korean National Health Insurance Service national sample cohort (NHIS-NSC 2011-2015) data, 3,391 new diabetic patients in 2012 were selected for the study. Multiple logistic regression was performed to investigate the effect of outpatient continuity of primary care on hospitalization in new diabetic patients. Results: The outpatient continuity of primary care in new diabetic patients was measured by the continuity of care index, which showed that 69.4% (n=2,352) were high level and 30.6% (n=1,039) were low level. Patients who had high continuity of primary care at the early stage of diabetes diagnosis showed 3.49 times more likely to maintain high continuity of primary care in the second year (95% confidence interval [CI], 2.72-4.49). Patients with low continuity of primary care for 2 years from the initial diagnosis of diabetes were 2.56 times more likely to be hospitalized due to diabetes than those who did not (95% CI, 1.55-4.25). Conclusion: This study identified the need for policies to increase the continuity of primary care for new diabetic patients and could contribute to lowering the admission rate of diabetic patients if the policy for this would work effectively.

• 한방안이비인후피부과학회지
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• 제16권1호
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• pp.130-140
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• 2003

Objectives : Lately the oriental medical treatment of Bell's palsy is various. In various treatments. this study reports the effect of our clinical treatment using aqua-acupuncture with hominis placenta and electroacupuncture treatment for Bell's palsy, The other purpose of this study is to compare the outcome of inpatient group with that of outpatient group. Materials and Methods : From March 1, 2003 to June 30, 2003, we observe 25 patients who visited to the department of oriental medical surgery, ophthalmology & otolaryngology, in oriental medicine hospital Sang-ji university with Bell's palsy. limited to patients who receive treatment more than 5th times and 4 weeks poured aqua-acupunture with homonis placenta both inpatient group and outpatient group, Inpatient group used electroacupunture treatment after 1 week after onset and outpatient group used electroacupunture treatment after 4 weeks after onset. Results and Conclusions : 40$\%$ were male and 60$\%$ female. Of 25 cases. 30's and 50's were 24$\%$ respectively, 40's, 60's and over 70 were 16$\%$ respectively, 20's were 4$\%$. 50$\%$ of male and 60$\%$ of female had the affected side at left side and right occured at 50$\%$ of male and 40$\%$ of female. The most common cause of Bell's palsy was nonspecific 36$\%$, followed by labor 28$\%$, stress 20$\%$, In 48$\%$ of all cases, 2~3 days were spent before a patient visited the hospital after onset, followed by 4~7 days (24$\%$), 44$\%$ were treated 11~20 times followed by those who received 21~30 times (28$\%$). The results of treatment with aqua-acupunture wth hominis placenta and electroacupunture treatment showed that 21 of 25(84$\%$) patients achived fair or more recovery. the overall therapeutic rate of inpatient group was 90.9$\%$, which was higher than that of outpatient group(78.6$\%$).

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제25권2호
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• pp.51-62
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• 2019

Purpose: This study aims to examine spatial characteristics of ambulatory care department Chronologically through case studies; and to consider the social implication of these spatial changes. Methods: In this study, a total of eight ambulatory care departments, one or two for each period, were selected in order to analyze the spatial characteristics. Results: First, since the 1990s, the outpatient department of the US has been changed into a patient-centered space by providing high quality outpatient medical services through individual exam room planning. Second, the exam room has been changed from open/semi-open/group exam room to individual exam room since 1990, and the trend is shifting from the cluster type to the modular type consisting of universal exam rooms in order to achieve the flexibility of exam room. Third, the diagnostic/testing area has been deployed to the ambulatory clinic to enable 'one-stop shopping' for patients-centered care since 1990s, however, it has been disappearing since 2000 due to Reduce medical expenses. Fourth, the Central Nursing Station type first appeared in the outpatient department In the 2000s, followed by the type of decentralized nursing station type since 2010s. And fifth, the area of medical support has been placing to be concentrated on one place due to the Lean Design strategy since 2010. Implications: In the future, it is expected that Korea will be more focused on efficiency, visual control, and flexibility in the planning of the ambulatory care department as in the case of the United States.

• 보건의료생명과학 논문지
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• 제8권2호
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• pp.135-142
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• 2020

본 연구는 강원도 영북지역에 주소를 둔 환자의 입원/외래 진료의 이용빈도를 분석하여 영북지역의 의료수요 및 의료이용 현황 파악을 하고자 국민건강보험공단 공공데이터포털(www.data.go.kr) 2003년 부터 2017년까지 건강보험 및 의료급여(입원/외래) 진료비 청구자료를 분석하였다. 다빈도 순위는 '진료건 및 %'에 따라 최빈도의 상병순으로 1-60순위까지의 순위를 선정하였다. 또한, 영북권 유일의 속초의료원 환자의 이용 추이를 병행 분석하였다. 분석결과 강원도 영북지역은 과거 급성기 질환에서 점차 만성인 비감염성 질환의 형태로 상병에 따른 외래 진료 이용과 입원환자의 이용이 증가하고 있다. 특히 조현병과 산과진료의 기능을 확충하고 지역사회의 건강관리에 필요한 구체적인 보건사업을 수행할 필요가 있으며 이를 통해 강원도 영북지역 주민의 삶의 질적 향상을 높여야 한다.