• 한국병원경영학회지
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• 제4권1호
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• pp.147-170
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• 1999

This study was performed to assess the financial performance of medical institutions and examine the affecting factors in Taegu metropolitan and Kyungpook province. The major results are as follows ; The liability to total assets was significantly different according to the ownership type of medical institution. It was the highest in the case of juridical person having a special status. The total assets turnover and value added to total assets were significantly different according to the type of medical institution, period of establishment, and ownership type of medical institution. They were higher in the tertiary medical institution, in private hospital and university hospital, and they were increased with establishment period of medical institution. The growth rate of patient revenues were significantly different according to the type of medical institution, period of establishment, and the growth rate of adjusted inpatient days were significantly different by period of establishment. The return on assets and net profit to gross revenues were the highest in private hospital. Private hospital went into the black, but other hospitals went into the red figures. According to the multiple regression analysis for the net profit to gross revenues, ownership type, period of establishment, and management strategy of medical institution were significant It was higher in private hospital and medical institution with prospector management strategy, and it was increased with establishment period of medical institution. In multiple logistic regression analysis for the status of financial performance in medical institution, period of establishment, management strategy of medical institution were significant It was better in medical institution with prospector management strategy and longer period of establishment.

• Journal of Preventive Medicine and Public Health
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• 제34권1호
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• pp.21-27
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• 2001

Objectives : To develop a model that will predict the mortality of patients undergoing Coronary Artery Bypass Graft (CABG) and evaluate the perfermance of hospitals. Methods : Data from 564 CABGs peformed in six general hospitals were collected through medical record abstraction by registered nurses. Variables studied involved risk factors determined by severity measures. Risk modeling was performed through logistic repression and validated with cross-validation. The statistical performance of the developed model was evaluated using c-statistic, $R^2$, and Hosmer-Lemeshow statistic. Hospital performance was assessed by severity-adjusted mortalities. Results : The developed model included age, sex, BUN, EKG rhythm, Congestive Heart Failure at admission. acute mental change within 24 hours, and previous angina pectoris history. The c-statistic and $R^2$ were 0.791 and 0.001, respectively. Hosmer-Lemeshow statistic was 10.3(p value=0.2415). One hospital had a significantly higher mortality rate than the average mortality rate, while others were net significantly different. Conclusion : Comparing the quality of service by severity adjusted mortality rates, there were significant differences in hospital performance. The severity adjusted mortality rate of CABG surgery may He an indicator for evaluating hospital performance in Korea.

• 한국병원경영학회지
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• 제2권1호
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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.

• Journal of Preventive Medicine and Public Health
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• 제31권2호
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• pp.199-214
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• 1998

This study was undertaken to explain weight control behavior and intention of obese children and adolescents as measured by the elements of the health belief model. A total of 732 obese students from 28 schools in Seoul metropolitan area and their mothers were assessed with a self-administered questionnaire. The analyzed results are as follows; 1. Among obese students, 45.3% of male students and 57.2% of female students, a significantly higher portion than male students, reported that they had tried to lose weight within the recent year. Exercise was the most frequently used method to lose weight followed by diet control, drug use, and specialized clinic visits, in descending order. 2. Male students were more likely to try to lose weight if they perceived a low threat level and their mother had a job, and female students were more likely to try to lose weight if they were younger in age, perceived a low threat level and had strong external motivating factors. 3. Female students showed a significantly higher level of intention to obesity control than male students, and the intention level of their mothers also showed the same trend. 4. In male students, the degree of weight dissatisfaction, weight control experience, the level of obesity related beliefs of students, the educational level of the mother and economic status of the family were significant predictors of intention to obesity control, and in females, age, the level of obesity related beliefs of students and intention of their mothers were significant. In the mothers of male students, obesity index of students, age of the mother and the level of obesity related beliefs of the mother were significant predictors of intention of the mother, and in the mothers of female students, obesity index of students, occupational status of the mother and obesity related beliefs of the mother were significant. 5. According to the path model of intention to obesity control, the degree of weight dissatisfaction had the most powerful effect in male students, and perceived net benefit level was the most important variable in female students. Since the weight control behavior and intention of obese students were more predictable by the degree of weight dissatisfaction than the obesity index, we can conclude that only the students dissatisfied with their weight are well motivated for obesity control. There can be a discrepancy between the mother and her child's beliefs and intention status(especially in male students), so the therapists should also assess the student's opinion as well as the mother's. In female students, the perceived net benefit level wag the most important predictor of intention to obesity control, therefore the intervention program should pay particular attention to the positive benefits of weight control rather than negative aspects(threats) of obesity.

• 한국정보통신학회논문지
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• 제25권12호
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• pp.1835-1845
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• 2021

본 논문에서는 블랙 아이스를 정확하게 인식하고 도로 노면 정보를 운전자에게 미리 알려줘서 속도를 제어하고 예방 조치를 취할 수 있도록 하기 위해 열화 도로 영상을 기반으로 블랙 아이스 검출하기 위해 lightweight 네트워크를 제안한다. 전이학습을 이용하여 블랙 아이스 인식 실험을 하였고, 블랙 아이스 인식의 정확도 향상을 위해 MobileNetV2 기반의 개선된 lightweight 네트워크를 개발하였다. 계산량을 줄이기 위해 Linear Bottleneck 및 Inverted Residuals를 활용하여 4개의 Bottleneck 그룹을 사용하고 모델의 인식률 향상을 위해 각 Bottleneck 그룹에 3×3 컨볼루션 레이어를 연결하여 지역적 특징 추출을 강화하고 특징 맵의 수를 늘렸다. 마지막으로 구축된 블랙 아이스 데이터 세트 대상으로 블랙 아이스 인식 실험을 진행하였으며, 제안된 모델은 블랙 아이스에 대해 99.07%의 정확한 인식률을 나타내었다.

• 보건교육건강증진학회지
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• 제28권3호
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• pp.31-42
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• 2011

Objectives: Busan had the highest mortality and the shortest life expectancy at birth among 16 provinces in Korea in 2008 and there were considerable health inequalities within the region. This study was performed to build up a priority setting framework in Healthy City Busan project. Methods: Analytic hierarchy process was used to determine the relative priority weight for different strategic and program dimensions along with the consistency of response. An on-site workshop-based meeting (calculating importance) and online survey (calculating risk) were conducted to obtain data from 8 experts. Results: The results showed that in strategic criteria "active health promotion & diseases prevention" and "building infrastructure for the Health City project" were two most important factors. In program criteria, considering both importance and risk scores, "making a healthy community" and "building community health centers" in disadvantaged areas were a top priority group. In addition, "enacting an ordinance for the Healthy City", "building the infrastructure for health impact assessment" and "making health care safety net for vulnerable population" were also higher priorities group. Conclusions: Our findings suggest that the Healthy City project in Busan should be focused on strengthening health equity and building infrastructure for sustainability of the project.

• Journal of Preventive Medicine and Public Health
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• 제33권4호
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• pp.484-494
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• 2000

Objective : To evaluate the relative benefits and the costs associated with the introduction of the new pharmaceutical provision called 'Mandatory Prescription System' which separates the role of physicians from that of pharmacists with respect to the prescription and dispensation of from the perspective of consumers (i.e., patients). Methods : The costs of the system were measured by considering both direct and indirect costs. Direct costs included additional payments for ambulatory care and dispensing fees that occurred under the new system. indirect costs consisted of transportation expenses and costs related to time spent for physician consultation, waiting for the prescriptions to be filled, and extra traveling. Benefits identified in this study were the reduction of drug misuse and overuse, and the overall decrease in drug consumption among the Korean population. Sensitivity analysis was peformed for the inclusion of benefits for outpatients of hospitals, price elasticity, and increased fees for established patients. Results : The net benefit was estimated to be about minus 1,862 billion won and the benefit-cost ratio was 0.478. This indicates that the costs of 'Mandatory Prescription' outweigh its benefits, relative to the previous system. The sensitivity analysis results for all the variables considered in this study consistently showed the benefit-cost ratio to be less than 1. Conclusion : The results of this study suggest that implementing Mandatory Prescription System in Korea might be inefficient from the consumer's perspective. The results of this study do not coincide with the results of previous studies, presumably because of the differences in study design and in which items of costs and benefits were considered.

• Asian Pacific Journal of Cancer Prevention
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• 제13권8호
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• pp.3767-3772
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• 2012

Objective: We estimated the total medical costs incurred during the 5 years following a cancer diagnosis and annual medical use status for the six most prevalent cancers in Korea. Methods: From January 1 to December 31, 2006, new patients registered with the six most prevalent cancers (stomach, liver, lung, breast, colon, and thyroid) were randomly selected from the Korea Central Cancer Registry, with 30% of patients being drawn from each cancer group. For the selected patients, cost data were generated using National Health Insurance claims data from the time of cancer diagnosis in 2006 to December 31, 2010. The total number of patients selected was 28,509. Five-year total medical costs by tumor site and Surveillance, Epidemiology, and End Results (SEER) stage at the time of diagnosis, and annual total medical costs from diagnosis, were estimated. All costs were calculated as per-patient net costs. Results: Mean 5-year net costs per patient varied widely, from $5,647 for thyroid cancer to $20,217 for lung cancer. Advanced stage at diagnosis was associated with a 1.8-2.5-fold higher total cost, and the total medical cost was highest during the first year following diagnosis and decreased by the third or fourth year. Conclusions: The costs of cancer care were substantial and varied by tumor site, annual phase, and stage at diagnosis. This indicates the need for increased prevention, earlier diagnosis, and new therapies that may assist in reducing medical costs.

• Journal of Preventive Medicine and Public Health
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• 제50권1호
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• pp.29-37
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• 2017

Objectives: The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization. Methods: We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates. Results: In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index. Conclusions: Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit.

• Journal of Preventive Medicine and Public Health
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• 제43권5호
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• pp.423-435
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• 2010

Objectives: The low benefit coverage rate of South Korea's health security system has been continually pointed out. A low benefit coverage rate inevitably causes catastrophic health expenditure, which can be the cause of the transition to poverty and the persistence of poverty. This study was conducted to ascertain the effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea. Methods: To determine the degree of social mobility, this study was conducted among the 6311 households that participated in the South Korea Welfare Panel Study in both 2006 and 2008. The effect of catastrophic health expenditure on the transition to poverty and the persistence of poverty in South Korea was assessed via multiple logistic regression analysis. Results: The poverty rate in South Korea was 21.6% in 2006 and 20.0% in 2008. 25.1 - 7.3% of the households are facing catastrophic health expenditure. Catastrophic health expenditure was found to affect the transition to poverty even after adjusting for the characteristics of the household and the head of the household, at the threshold of 28% or above. Conclusions: 25.1% of the households in this study were found to be currently facing catastrophic health expenditure, and it was determined that catastrophic health expenditure is a cause of transition to poverty. This result shows that South Korea's health security system is not an effective social safety net. As such, to prevent catastrophic health expenditure and transition to poverty, the benefit coverage of South Korea's health security system needs to the strengthened.