• The Korean Journal of Pain
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• v.31 no.1
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• pp.27-38
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• 2018

Background: Related to escalating health care costs and the questionable effectiveness of multiple interventions including lumbar facet joint interventions, cost effectiveness or cost utility analysis has become the cornerstone of evidence-based medicine influencing coverage decisions. Methods: Cost utility of therapeutic lumbar facet joint nerve blocks in managing chronic low back pain was performed utilizing data from a randomized, double-blind, controlled trial with a 2-year follow-up, with direct payment data from 2016. Based on the data from surgical interventions, utilizing the lowest proportion of direct procedural costs of 60%, total cost utility per quality adjusted life year (QALY) was determined by multiplying the derived direct cost at 1.67. Results: Patients in this trial on average received $5.6{\pm}2.6$ procedures over a period of 2 years, with average relief over a period of 2 years of $82.8{\pm}29.6$ weeks with $19{\pm}18.77$ weeks of improvement per procedure. Procedural cost for one-year improvement in quality of life showed USD $2,654.08. Estimated total costs, including indirect costs and drugs with multiplication of direct costs at 1.67, showed a cost of USD $4,432 per QALY. Conclusions: The analysis of therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain shows clinical effectiveness and cost utility at USD $2,654.08 for the direct costs of the procedures, and USD $4,432 for the estimated overall cost per one year of QALY, in chronic persistent low back pain non-responsive to conservative management.

• Health Policy and Management
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• v.20 no.4
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• pp.45-57
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• 2010

Background : If different cost efficiency indexes were informed to the same clinic depending on the inclusion or exclusion of pharmacy cost, it may impair the reliability of provider-profiling system. This study aimed to investigate whether the omission of pharmacy cost affects cost-efficiency rankings in medical clinics. Methods : Data for ambulatory care cost at 23,112 medical clinics were collected from the claims database, which was constructed after review by the Health Insurance Review and Assessment Service (HIRA) of Korea in April 2007. We calculated two types of cost efficiency indexes by inclusion or exclusion of pharmacy cost for a medical clinic. The agreement between the decile rankings of the two indexes was also assessed using the weighted kappa statistic of Landis and Koch. Results : When the cost efficiency index for total cost including pharmacy cost was compared with the index for total cost excluding it, the agreement between the two indexes was only 55%. The agreements between the two indexes were relatively low within specialties which have larger pharmacy volume of total cost and lower correlation between total cost with or without pharmacy cost included than the average level of all the specialties. Conclusion : These results suggest that the omission of pharmacy cost may result in contradictory outcomes that may be confusing to a medical institution and may impair the reliability of provider-profiling systems. It is very important to standardize profiling criteria for the reliability of provider profiling system.

• Environmental and Resource Economics Review
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• v.11 no.4
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• pp.659-687
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• 2002

This study used a discrete choice model to investigate an association between air pollution and hospital visits for acute respiratory symptoms with the national health interview survey conducted in 1998 in South Korea. The results showed that $NO_2$ and TSP were significantly related to hospital visits in a single-pollutant model, but when they were simultaneously considered, only $NO_2$ remained significant. It was estimated as $NO_2$ level increased by 10%(0.0027ppm) from 0.027ppm (the mean $NO_2$ level), hospital visits increase by 0.176%. This study also measured respondent's out-of-pocket expense and the time cost for commuting and waiting for the visit. We found that on the average, out-of-pocket expense is 5,600 won per hospital visit, but the total cost per hospital visit is measured at 33,440 won with time cost of commuting and waiting at 27,840 won. Time cost was over 63.6~83.3% of the total cost per hospital visit.

• Journal of Preventive Medicine and Public Health
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• v.11 no.1
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• pp.123-127
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• 1978

The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are estab-lished for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The 'AUT-OGRP System' was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The 'Departmental Method' was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying patterns of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among the study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables (i. e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death. rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The wei틴fed mean total case cost (TOTC) of the study hospitals for Medicare patients during the study years was $11,27.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($743.45). The weighted mean per diem total cost (DTOC) of the study hospitals for Medicare patients during the sutdy years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the hospital with the lowest average DTOC ($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variance to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of interhospital cost variation: 59.1 percent for TOTC and 44.3 percent for DTOC. Thsee results demonstrate that the casemix index is the most importand determinant of interhospital cost variation Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.

• The Journal of Fisheries Business Administration
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• v.43 no.2
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• pp.41-49
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• 2012

This study aimed to estimate the economic value of the recreational fishing in the Jeonnam marine ranching area as a part of the total socioeconomic evaluation of the Jeonnam marine ranching program. A travel cost method was applied to the estimation of economic value of the recreational fishing in the Jeonnam marine ranching area and input variables included annual fishing trip days, average travel cost per trip, average catch amount, monthly income, marriage, age, and personal perception on the marine ranching program. In the analysis, due to its characteristic of count data, both poisson model and negative binomial model were used. Model results indicated that a negative binomial model was statistically more suitable than the poisson model as the overdispersion problem occurred in the poisson model. All signs of the estimated parameters were estimated as previous studies showed. Based on the results, the economic value per trip of the recreational fishing in the Jeonnam marine ranching area was estimated to be 145,000 won and the annual total economic value of the recreational fishing in the Jeonnam marine ranching area was analyzed to be 2,514,000 won. In addition, the change of total value by catch rate showed that the economic value could be increased by 180,900 won as the catch increased by one kilogram.

• The Korean Journal of Health Service Management
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• v.3 no.2
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• pp.1-15
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• 2009

The purpose of this study is to analyze the internal factors that influence the performance of local government hospitals in Korea. There are 34 hospitals in korea as of 2008. Among these hospitals 5 are profit-making and the other loss-making in terms of profitability. Data was collected by Institute of local government hospital union. The major findings of this study was as follows : Firstly, 7 hospitals are high level, over than 100% of fixed ratio. But that result was better than the other study 5 years ago. Secondly, 29 hospitals are bellow 85% of bed occupancy rate. There are a number of hospitals didn't use the facilities and the personnel cost in total costs are high. And lastly, as a result of multiple regression analysis, the factors had on significant effect on normal profit to total assets are personnel cost(-), liability to total assets(-), average length of stay(-), outpatient visits to inpatient days(-). In conclusion, to improve the profitability of hospitals, the efforts to reduce personnel cost and to increase bed occupancy rate.

• Journal of the Korean Home Economics Association
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• v.44 no.8
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• pp.79-87
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• 2006

The purpose of this study was to estimate the minimum monthly food cost for the low income population. The food consumption data of 9,311 individuals from the 2001 Korean National Health and Nutrition Survey was used. The monthly food cost was calculated using the Consumer Food Price Database for the year 2001 provided by the Public Health Nutrition Laboratory, Seoul National University. The low income population (n = 1,310) was characterized as older age, lower income, smaller family size, lower education level, and lower energy intake as compared with the total population (n = 8,001). The estimated food cost showed that men in the low income population needed 15% more money for purchasing food to maintain the energy intake level at the average energy intake level of men in the total population. It was also estimated that women in the low income population needed 9% more money for purchasing food to maintain the energy intake level at the average energy intake level of women in the total population. There were differences in monthly food costs depending on the sex and age, and family size. The results of this study could be used as basic information to establish minimum food cost for the low income population in Korea.

• Journal of Technologic Dentistry
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• v.16 no.1
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• pp.78-104
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• 1994

Under the fee for service schedule of Korean health insurance system, rational fee for dental laboratory products based on the cost is required to be formulated. The purpose of this study was to find actual cost of dental laboratory products in case of a University Hospital. Materials of this study were used as follows : 1. Balance sheet at Dec. 31, 1992 and profit and loss report of the year 1992 of the sample hospital 2. Performance report of dental laboratory department. 3. Purchasing and other accounting bills of dental laboratory materials. The following methods were used. 1. Actual cost finding of dental laboratory department was performed. 2. Work sampling methods were used for measuring standard working time by the process of working. 3. To porcelain fused to metal crown(non-precious), Relative value of the cost of dental laboratory products was calculated as 1.00. 4. Fee and cost of those products were compared on the basis of Relative values. The results of the study can be summarized as follow : 1. Overall, it took longs time than other items. to product denture-related items. 2. When several teeth are made in a time, average production time is much sorter than when one tooth is made in a time. 3. The relative price cost of Dicor cast crown and denture related items are higher than the criterion items. 4. The material cost occupies average 11% out of the total price cost, proportion of personnel expenses is average as 60.0%. 5. Some of the components consisting of the price cost are not reflected adequately in setting the level of the reimbursement price. 6. Relative values of dental laboratory products price cost are varied in the range from 0.05 to 2.83, overall, the reimbursement price of dental products appears not to reflect adequately the price cost. On the basis of this study results, the following ideas would be suggested : 1. Fee Schedule of dental laboratory products should be renovated in order to reflect their costs. 2. Dental laboratory product manufacturers should be enlarged for the economy of scale which may be useful for cost- containment. 3. Dental laboratory producters themselves are required to be standardiqed according to the categories of skill.

• Journal of the Korean housing association
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• v.13 no.5
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• pp.89-99
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• 2002

The multifamily housing has various advantages in construction cost, land-use intensity. KRIHS(1997) recommended the proper scale of th multifamily housing as 800 households in constructability, 1,000 households in facility compactability, 500 households in social aspect. At the early planning stage of project, the size of the multiftmily housing has, until now, been maximizingly considered under the regulation on which has been emphasized at the building volume ratio, land area, etc., except for the expenditure during the maintenance stage. This paper aimed at providing the proper size of multifamily housing in aspect of area and household number with maintenance cost at the early stage of project. For these, it took 곧 average cost function which is made from the 3-rd quardratic form and analyzes the unit increasing rate of the average cost. It surveyed in nationwide focused on the central heating system using diesel and kerosene. The number of samples is 88 and items of management cost is 11. The results are as follows ; first, 3rd-order quadratic function is proper at explaining the cost variation, considering the multicollinearity and statistics. Second, the proper size of multifamily housing is recommended with 83,000 $m^2$ on management area, 820 or over the 2,630 household number in aspect of total management cost.

• Journal of Preventive Medicine and Public Health
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• v.14 no.1
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• pp.3-12
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• 1981

To identify the changes in professional care patterns after the introduction of medical insurance in Korea, professional care in hospitals and clinics of two succeeding years were compared. The hospitals and clinics selected for this study were those which located in Seoul city. Hospitals were classified into 3 categories: university hospital, general hospital and hospital. The diseases selected for this study were acute appendicitis and normal delivery. They were selected because their disease courses are considered to be fairly stable. The variables used for this study were length of stay, total hospital costs, costs of each components of cares. The information used for this study was obtained from the official forms requested by the medical facilities to the Korea Medical Insurance Corporation. The two periods studied were 3 months of each year from March 1st to May 31st in 1979 and 1980, The total number of normal delivery studied was 289 in 1979, 301 in 1980 respectively and the acute appendicitis was 92 and 111 respectively. In order to compare the quantity of medical care between 2 study periods the insurance price scores of 1979 were converted to prices of 1980. For statistical test of difference between 2 periods T-test and Welch's test were used. The result of the study were briefly summarized in below. 1. No significant difference was observed in the average length of stay of both disease between two study periods in all types of hospitals. 2. No significant difference was observed in the average total hospital costs of both diseases in all types of hospital, but in the private clinic the average clinic costs was rather decreased significantly in 1980. 3. More cost decrease were seen than cost increase in 1980 in all types of facilities, More cost changes by items were seen in acute appendicitis than in normal delivery between two study periods. The total hospital costs can be devided into 2 portions: charges for drug and material and for physician. In normal delivery, costs for physician's charges was significantly decreased in almost all the hospitals and costs for drug and material were not changed significantly in all the hospitals in 1980. In the university hospitals, however, the costs for drug and material were increased significantly in 1980. The cost decrease for physician's charge were mainly due to the decrease in the costs of laboratory test, treatment and physical therapy. The increase in the costs for the drug and material in the university hospitals was mainly due to the increase in the cost for drugs for oral administration and injection. 4. The proportion of components of medical care in the hospital has not been changed significantly, however, the cost for injection in normal delivery was characteristically increased in 1980 in all hospitals studied. In general the proportion of the costs for drug and material was tended to increase and the costs for physician was tended to decrease in 1980. The increase in the costs for drug and material were considered to be due to increase in the cost for drugs for oral administration and injection. The decrease in the costs for physician were due to decrease in the costs of laboratory test, treatment and physical therapy. Above mentioned changes in hospital and clinic care patterns are considered to be mostly influenced by the review criteria set by the K.I.C. for the assessment of the fee request made by clinics and hospitals.