• Journal of Preventive Medicine and Public Health
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• 제26권3호
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• pp.442-456
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• 1993

Financial stability is the foremost prerequisite for the continuous growth and development of hospitals. The present study aimed at developing a deterministic model using the factors which affect the hospitals profitability and at discovering which factor affected the hospital profitability. The study conducted questionnaire surveys on all general hospitals, with the exception of special hospitals, with over eighty hospital beds. Of the 274 subject hospitals, 136 of them, consituting 49.6% of the whole, were used in the study. The results are as follows. 1. In the deterministic model, outpatient revenue was affected more by the number of physician visits than by outpatient service intensity. Inpatient revenue was found to be affected more by the number of discharged patients than by inpatient service intensity. However, the increase rate of the service intensity not only contributed in stepping up the operating margin by $4{\sim}8%$ in outpatient and $3{\sim}6%$ in inpatient, but it was statistically significant. 2. Among the factors which determined the operating cost within the deterministic model, the number of patients had a greater impact on the operating cost than the resource consumption per patient. 3. The resource consumption per patient were proved to have the greatest effect on the profitability within the probabilistic model. The management cost per adjusted patient, in particular, was proven to have a statistically significant effect on the profitability in all hospitals.

• 보건행정학회지
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• 제15권3호
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• pp.79-93
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• 2005

The purpose of the study is to identify Ambulatory Care Sensitive Conditions (ACSC) and their potential health insurance applicability in Korea, using the correlation and regression analysis with the empirical data provided by Korean Health Insurance Review Agency(KHIRA). Here, ACSC would be thought of as conditions that when timely and effectively treated in the outpatient medical services can help reduce the risk of hospitalizations. As for ACSC, reducing accessibility for outpatient visit results in increasing hospitalization. In this respect, the ACSC concept is popularly adopted as one of the performance indicators of the national health system. As one of main results, fortifying the accessibility to necessary health care in a way of sharing appropriately the role with private health insurance can lead to the efficiency of national health care delivery systems in view of total health care expense, in particular in a case of ACSC children. Lastly, we would like to strongly suggest that the disease treatment data set reported to KHIRA needs to be opened to private insurance companies only for illness experience investigation.

• 대한치과마취과학회지
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• 제11권2호
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• pp.133-140
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• 2011

Background: Dental treatment under outpatient general anesthesia is an option for disabled person, children and dentally disabled person who have the difficulty of cooperating voluntary with dental care. The aim of this study was to access the patients who had dental management under general anesthesia at Chungnam dental clinic for the disabled. Methods: This survey is consisted of 114 severely disabled and dentally disabled person who undergone dental treatment under general anesthesia from January to June 2011. Data were collected by individual dental and anesthesia records. Results: Of the 114 patients studies, the 45 patients was the dentally disabled and the 69 patients was the severely disabled. Rate of dental treatment among male patients was higher than among female patients. The dentally disabled was an similar age distribution. In the severly disabled, above 13-year-old was higher than below 12-year-old. The most popular induction method of general anesthesia was sevoflurane inhalation after induced sedative effect of nitrous oxide inhalation. The severly disabled who had definitely negative behavior was applied inhalation of high concentration sevoflurane. Conclusions: Chungnam Dental clinic for the disabled provide dental management for the disabled and the dentally disabled.

• 대한건축학회연합논문집
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• 제21권3호
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• pp.109-116
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• 2019

This study aimed to suggest a quantitative model analyzing overcrowding area under emergency evacuation situation in the outpatient department of hospital. Overall study process included the review on legal conditions of an emergency evacuation, the investigation of precedent research documents and the analysis of spatial configuration. The user movement with considering exit gates and the one without considering exit gates were analyzed for routine activity condition. An agent-based simulation was applied for the analysis. Also, user movement for the emergency condition was tested with evacuation simulation. The variation of simulation conditions revealed the difference between overcrowding spaces from situation change. At all nodes, visit frequencies derived from different conditions and situations were compared. The overcrowding spaces are to increase the risk of delaying emergency evacuation time which is critical for user safety. It suggests the need for dispersing overcrowding spaces under evacuation situation. The suggested analysis model can evaluate overcrowding spaces in the outpatient department of hospital and provide locational data for distributing evacuation design resources.

• 한국콘텐츠학회논문지
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• 제13권11호
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• pp.187-197
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• 2013

2007년 8월부터 건강보험 보장성 확대 정책의 일환으로 6세 미만 어린이 외래환자에 대한 본인부담금 경감제도가 시행되었다. 본 연구는 본인부담금 경감제도가 시행된 2007년 8월을 기준으로 제도 시행 전인 2006년 8월부터 2007년 7월까지와 제도 시행 후인 2007년 8월부터 2008년 7월까지 전후 1년 동안 외래진료 민감질환으로 외래를 방문한 6세 미만 환자들의 의료이용 변화를 분석하였다. 의료이용 변화는 제도 시행전후 외래 환자 수 증감율, 외래방문일수, 방문당 평균 진료비로 파악하였는데, 6~10세 환자를 대조군으로 설정하여 이중차이방법을 적용한 다중 회귀분석을 적용하였다. 제도 시행 후 외래진료 민감질환으로 외래를 방문한 환자는 대상군과 대조군 모두 증가하였는데, 특히 대상군에서 증가율이 높았다. 그러나, 대상군은 대조군에 비해 제도 시행에 따른 외래방문일수와 방문당 외래진료비의 증감율은 일정한 양상을 보이지 않고 그 차이 또한 적었다. 6세 미만 어린이 외래 본인부담 경감제도는 외래환자 수 증가라는 의료이용 변화를 가져왔으나, 실질적인 의료 접근성을 나타내는 외래방문일수, 방문당 평균 진료비는 큰 차이가 없었다. 따라서, 제도의 궁극적인 목표인 의료 접근성 향상을 달성하기 위하여 적극적인 제도홍보와 함께 소득계층별로 본인부담률을 상이하게 설계하는 등의 의료 취약계층에 초점을 둔 정책이 요구된다.

• Journal of Preventive Medicine and Public Health
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• 제25권1호
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• pp.53-63
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• 1992

There are increasing interest and need for information on health care consumer with the significance of hospital marketing and strategic planning being increasingly emphasized. This study was conducted to investigate the criteria for selection of medical facilities according to the characteristics of health care consumer by the types of medical services on a sample of 1,500 population aged 20 years and above. Major findings are as follows ; 1. When considering the criteria for selection of medical facilities into two factors, namely, quality or convenience factors, convenience factor was the major contributor for outpatient and dental services whereas it was quality factor for inpatient services. 2. Females and those residing in large cities selected medical facilities based on convenience factor in the outpatient services. In the case of inpatient service, persons who considered their present health status to be good and whose ages were 50 years old and above choose medical facilities based on quality factor. 3. Persons who considered medical facilities to be profit-making tended to choose medical facilities based on convenience factor for outpatient services. There were no differences in the cases of inpatient and dental services. 4. There was no significant difference on the criteria for selection of medical facilities according to the decision maker for selection or trust on medical facilities. On the use of health service information, selection of medical facilities was based on quality factor for those who made more use of the information in the cases of outpatient and dental services. 5. Analysis using the logistic regression model on the criteria for the selection of medical facilities with the characteristics of health care consumer as independent variables was performed. The selection of medical facilities was significantly related with residential area, sex, and use of information on medical facilities for outpatient services and with age, average monthly income, and perception of health status for inpatient services. For dental services significant association with residential area and use of information on medical facilities was seen. The results of this study, despite some limitations, can be used as baseline data for marketing and strategic planning of hospital management.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제22권4호
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• pp.7-17
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• 2016

Purpose: As our population ages and becomes an elderly society the number of elderly care hospitals is rapidly increasing. Because physical functions and spatial perception in the elderly decrease with age, these hospitals require more systematic and intelligent space designs. The design of these spaces are even more complex because they must accommodate medical programs to treat various different diseases and ailments and also because there are many first time patients and irregular short term patients that seek out outpatient treatment services. Also by analyzing the spatial configuration systems and systematic relationships between each of the functional spaces of the outpatient treatment service departments for hospitals specialized in care for the elderly by focusing on the hallway and corridor systems of these hospitals, the according characteristics and trends were examined. Methods: Based on preceding research, the types of hallway and corridor systems of these hospitals were categorized into five types, including gallery corridors, middle corridors, hall-type, mixed type and cyclic type corridors, and into six types according to function including by medical diagnosis, patient registration, examination, administration and convenience and shared common space to derive any interconnecting relationships between the corridor systems. Also by comprehensively examining the types and combined utilization of the corridor types and the integration and the intelligibility of the space syntax, any trends within the corridor system were derived. The elderly care hospitals examined in this research study were twelve hospitals that opened after the year 2000 in Korea with more that 150 sick beds with areas larger than $1000m^2$ and with all outpatient medical service related rooms located entirely on a single floor of the hospital. Results: The following results could be confirmed based on this research study. 1) The spaces where medical diagnosis and examination occurred were adjacent, and the movement lines for first time patients and re-visiting patients were taken into consideration by separating the treatment space. 2) This research study confirmed that the larger the size of the hospital was, there were more detailed categorizations of treatment services and that there was a tendency for treatment areas to be separated and independent from examination areas. 3) There was a tendency for integration and intelligibility to decrease the more complex and diverse the combination of hall types designed into the corridor systems of these hospitals was. cyclic type corridors dramatically decreased the intelligibility of the corridor systems of these hospitals. 4) The priority rank of these spaces were confirmed to be highest in the order of registration, diagnosis, examination, treatment, administration and shared common spaces. However it was confirmed for the local integration that the diagnosis scope had the highest priority rank. Implications: There were exceptional cases confirmed where the number of unit spaces did not have an absolute effect on integration and intelligibility. These results can be interpreted to mean that this can be overcome through efficient architectural planning.

• 보건행정학회지
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• 제25권3호
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• pp.185-196
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• 2015

Background: Issues concerning with the classification accuracy of Korean Outpatient Groups (KOPGs) have been raised by providers and researchers. The KOPG is an outpatient classification system used to measure casemix of outpatient visits and to adjust provider risk in charges by the Health Insurance Review & Assessment Service in managing insurance payments. The objective of this study were to refine KOPGs to improve the classification accuracy and to evaluate the refinement. Methods: We refined the rules used to classify visits with multiple procedures, newly defined chemotherapy drug groups, and modified the medical visit indicators through reviews of other classification systems, data analyses, and consultations with experts. We assessed the improvement by measuring % of variation in case charges reduced by KOPGs and the refined system, Enhanced KOPGs (EKOPGs). We used claims data submitted by providers to the HIRA during the year 2012 in both refinement and evaluation. Results: EKOPGs explicitly allowed additional payments for multiple procedures with exceptions of packaging of routine ancillary services and consolidation of related significant procedures, and discounts ranging from 30% to 70% were defined in additional payments. Thirteen chemotherapy drug KOPGs were added and medical visit indicators were streamlined to include codes for consultation fees for outpatient visits. The % of variance reduction achieved by EKOPGs was 48% for all patients whereas the figure was 40% for KOPGs, and the improvement was larger in data from tertiary and general hospitals than in data from clinics. Conclusion: A significant improvement in the performance of the KOPG was achieved by refining payments for visits with multiple procedures, defining groups for visits with chemotherapy, and revising medical visit indicators.

• 한국산학기술학회논문지
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• 제22권4호
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• pp.183-194
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• 2021

본 연구에서는 SGR 모형과 AR 모형으로 부터 개발된 유형별 외래 및 입원 환산지수 분리 모형을 바탕으로 실제 건강보험 진료비 자료를 사용하여 2020년도 환산지수를 추정하였다. 또한 유형별 환산지수 계약 하에서 병원의 단일 환산지수 조정률과 외래 및 입원으로 분리된 복수의 환산지수 조정률을 산출하였다. 마지막으로 환산지수 분리 모형이 의료전달체계를 확립하기 위한 수단의 하나로 효과적으로 사용되기 위한 정책적 방안을 제안하였다. 본 연구의 주요 결론은 다음과 같다. 첫째, r=0.1에서 2020년도 병원의 단일 환산지수 조정률은 2.0%이며 병원의 환산지수를 분리하는 경우 외래 및 입원 환산지수 조정률은 각 각 2.2%, 2.3%로 나타났다. 그리고 조정계수를 활용하여 외래 및 입원 환산지수를 결합하는 방안을 제시하였다. 둘째, 의료전달체계 확립을 위한 조치의 하나로 제안된 가산율 조정 방식 대신에 가산율과 환산지수를 연동하여 운영하는 방안을 제안하였다. 셋째, 병원⦁의원 등 유형별로 외래환산지수, 입원환산지수, 조정계수를 도입하는 것에 추가해 진료량에 대한 목표관리를 가능하게 하는 모형 개발이 필요하다.

• 한국환경보건학회지
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• 제45권1호
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• pp.30-41
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• 2019

Objectives: The effects of particulate matter and ozone on health are being reported in a number of studies. These effects are likely to be stronger on the elderly population, but studies in this regard are scarce. The purpose of this study was to examine the effects of particulate matter ${\leq}2.5{\mu}m$ and ozone on the acute health status of the elderly population. Methods: In order to analyze the health status of the elderly population, the NHIS-Senior Cohort data was used. In this study of people 60 years or older in Seoul, the number of outpatient visits and ER visits between 2002 and 2013 were calculated. Each disorder and the lag effect were analyzed separately. Particulate matter and ozone were analyzed using both the single exposure model and the adjusted multi-exposure model. Results: In the single exposure analysis with PM2.5 as the exposure variable, with each increase of $10{\mu}g/m^3$, the number of outpatient visits increased by 1.0081 times, vascular disease 1.0065 times, chronic pulmonary disease 1.0086 times, and diabetes 1.0055 times. In the multi-exposure model adjusting for ozone, the number of outpatient visits increased by 1.0066 times. There was a one-day lag effect and 1.0066 times increase between PM2.5 and ER visits in the multi-exposure model and 1.0057 times when adjusted for ozone (p value <0.10). There was a one-day lag effect in all multi-exposure models with ozone as the main variable, and when the particulate matter was adjusted, there was a one-day delay and 1.0143 times increase in ER visits. Conclusions: In our study, an increase in the number of outpatient and ER visits in the elderly population in accordance with the increase in PM2.5 and ozone was found. The association found in our study could also produce a socioeconomic burden. Future studies need to be performed in regards to younger populations and other air pollutants.