The Influence of Disability on Prevalence of Obesity at Each Stage: Considering Severity and Type of Disability / 보건행정학회지

Background@#This study purposed to examine the difference in the prevalence of obesity at each stage among people with and without disabilities considering the severity and type of disability. @*Methods@#The study targeted a total of 1,315,967 people, including 68,418 disabled and 1,247,549 non-disabled, who completed the national health screenings. Logistic analysis and average marginal effect analysis were conducted in three stages (pre-obesity, obesity, severe obesity). Those analyses were conducted considering the severity and type of disabilities. @*Results@#People with disabilities were more likely to be at all stages of obesity than non-disabled people. In severely disabled people, the probability of obesity was higher than non-disabled people at all stages of obesity, but mildly disabled people had a higher only in the severe obesity stage, no difference in obesity stage, and a low in the pre-obesity stage. In physical and mental disabilities, the probability of obesity was higher than non-disabled people at all stages of obesity, but external physical function and internal organs disabled had a lower in the obesity and pre-obesity stage, and no difference in severe obesity stage. @*Conclusion@#This study found that people with disabilities had a higher relationship with obesity than people without disabilities. In addition, severity and types of disabilities have different effects on the stage of obesity. Therefore, it is necessary to care about the health inequality and health of disabled people considering their severity and types of disabilities.

Multilevel Analysis of Factors Related to Cost and Length of Stay in Acute Myocardial Infarction Patients with Coronary Stenting: Based on Korean National Health Insurance Service’s Customized Database in 2010 and 2015 / 보건행정학회지

Background@#This study aims to analyze the cost and the length of stay (LOS) of acute myocardial infarction (AMI) patients with coronary artery stenting according to the characteristics of individuals and institutions. @*Methods@#The data was collected from Korean National Health Insurance Service’s customized database in 2010 and 2015. Chi-square test, t-test, analysis of variance, and multilevel analysis were performed. @*Results@#The intraclass correlation coefficients for cost were 7.02% in 2010, 5.61% in 2015 and for LOS were 3.17%, 1.40%, respectively. The average costs were 9,067,000 won in 2010 and 9,889,000 won in 2015 (p<0.0001). However, the cost in 2015 was lower than the cost applying increased fee. The costs increased in aged 50–59 years, 60-69 years, and aged ≥70 years versus in aged under 49 years. The cost was higher in Charlson comorbidity index (CCI) 3 to 4 and ≥5 than in CCI 0. The costs were lower in male, medical aid recipients, metropolises, and local hospitals in other regions in 2010. LOS decreased from 8.1 days in 2010 to 7.4 days in 2015. It decreased in male, high income group, and the group of admission via emergency room. However, it increased in higher ages and medical aid recipients, and it also increased when CCI rose. The Internal Herfindahl Index was related to LOS in 2010. @*Conclusion@#The variation of hospital level was small compared to the patient level. Therefore, it is important to implement applicable policies at the patient level in order to reduce cost and LOS of AMI patients.

Medical Service Variation of Urinary Incontinence Surgery and Uterine Polypectomy Using a Multilevel Analysis / 보건행정학회지

Background@#This study investigates the influence factors of medical service variations using medical charge and the length of stay (LOS) for urinary incontinence surgery and uterine polypectomy. @*Methods@#The National Health Insurance claims data and Medical Resource Report by the Health Insurance Review & Assessment Service in 2016 were used. Frequency analysis, one-way analysis of variance, and Bonferroni post-hoc tests were executed for each surgery. A multilevel analysis was executed to assess the factors to the medical charge and LOS for each surgery in patient, doctor, and hospital level. @*Results@#Fifty-two point eight percent of urinary incontinence surgery and 87.1% of uterine polypectomy were distributed in general and tertiary hospitals. Among three levels, the patient level variation was 61.5% or 77.2% in medical charge and 93.9% or 96.3% in LOS, respectively. The doctor level variation was 29.6% or 22.6% in medical charge and 0.6% or 0.0% in LOS, respectively. The institution level variation was 8.9% or 0.2% in medical charge and 5.5% or 3.7% in LOS, respectively. Number of other disease and organizational type were main factors that affected the charge and LOS for urinary incontinence surgery and uterine polypectomy. @*Conclusion@#Medical service variations of the urinary incontinence surgery and uterine polypectomy were the largest for the patient level, followed by doctor level for the medical charge, and the institution level for the LOS.

Analysis of the Health Expenditure and Medical Usage Difference of the Baby Boomers between Male and Female: Depression as a Mediators / 보건행정학회지

BACKGROUND: This study purposed to compare the difference on medical utilization and health expenditure of baby boomer generation by depression between gender. METHODS: Korea Welfare Panel Survey 2016, provided by the Korea Institute for Health and Social Affairs, was used for the analysis. For the research, we used the two-part model, yes or no of use (part 1), and frequency of use (part 2) for medical utilization. The dependent variables are the whether or not to use of hospitalization services, outpatient services, length of stay, outpatient service visits, and health expenditure. And the independent variables are used as the predisposing (education, spouse presence), enabling (insurance type, private insurance, economic activity, income), and need (chronic disease, self-rated health, disability) factors in the Andersen behavior model. Depression was used as intervening variables. Structural equation model and multiple group analysis by gender were used. RESULTS: There were differences in the medical care usage and cost between men and women in baby boomer. For men, mediating effects of depression were present at the hospitalization (yes/no), length of stay, and health expenditure. On the other hand, for women, the mediating effect of depression was found only at the outpatient visits. Specially, depression was working at the medical services by the different way between gender. The size of effect (multiple group analysis) was affected by significant differences between men and women. CONCLUSION: This study found that the mediating effect of depression is increased medical usage and health expenditure and the effect factors are different by gender. Therefore, it is necessary to establish a medical care policy considering the socio-economic characteristics of baby boomers.

The Influence Factors on the Performance of Regional Public Hospitals / 보건행정학회지

BACKGROUND: This study is designed to estimate the factors that affect the level of three different performance (publicity, efficiency, profitability) among regional public hospitals. METHODS: The units of analysis are the regional 30 hospitals, which have the operating data during 22 years (from 1933 to 2014). The research method is used by fixed panel analysis. The publicity is measured by medicaid outpatient proportion and medicaid inpatient proportion. The efficiency is measured by two types of efficient score by DEA (data envelopment analysis). The profitability is measured by medical income to medical revenue and ROA (return on total asset). RESULTS: At first, the increase of bed gives negative affect to the publicity but give positive effect to the efficiency and profitability. Because it means the increase of the region population, it gives more profitability compare to hospital with small number of beds. The more the operating period is the higher effect to the publicity and efficiency because of it's refutation. The debt ratio gives negative effect to publicity, but positive effect to profitability. It is the normal belief that there is inverse relationship between publicity and profitability. The turnover rate of bed gives the negative affect to the publicity, but positive affect to the efficiency and profitability. That give us the implication that type of the inpatient make different effect the hospital performance. The ratio of labor cost give negative effect to all kind of performance. That means that the higher labor cost don't mean the higher publicity and labor cost control is very important factors to hospital performance. So the region hospital have to focus the labor factors more to make higher performance. CONCLUSION: As the conclusion, the independent variables give similar effect to the efficiency and the profitability, but give inverse effect to the publicity. That means that if an region hospital want to make the more publicity, it loss the higher efficiency and profitability. Specially publicity is higher negative relation with the profitability.

The Performance Evaluation of Public Municipal Hospitals: Data Envelopment Analysis and Panel Analysis / 보건행정학회지

This study aims to examine the performance of public municipal hospitals through the analysis of data envelopment analysis, efficiency, profitability, and publicness by using panel data during period from 2006 to 2010. The main findings of the study are as follows. First, as a result of efficiency analysis during the period from 2006 to 2010, it was revealed that the number of staff by each job category, labor cost ratio, the number of operating beds need to be decreased. Second, the performance data represented by the indicators of efficiency, profitability and publicness were complementary and showed a tendency of being increased or decreased in same direction. Third, from the result of panel analysis, the efficiency was mainly influenced by the structural factors, while the profitability was influenced by managerial factors, and the publicness by medical environment. In conclusion, in order to enhance the performance of public municipal hospitals in Korea, it is important to harmonize the effort for efficiency, financial and policy support by central and local government, and the continuous participation of community residents.

Factors Affecting the Outcome Indicators in Patients with Stroke / 보건행정학회지

BACKGROUND: The purpose of this study is comparison of the results between regression and multi-level analysis to find out factors influencing outcome indicators (in-hospital death, length of stay, and medical charges) of stroke patients. METHODS: By using patient sample data of Health Insurance Review & Assessment Service, patients admitted with stroke were selected as survey target and 15,864 patients and 762 hospitals were surveyed. RESULTS: For the results of existing regression analysis and multi-level analysis, models were assessed through model suitability index value and as a result, the value of results of multi-level analysis decreased compared to the results of regression, showing it is a better model. CONCLUSION: Factors influencing in-hospital death of stroke patients were analyzed and as a result, intra-class correlation (ICC) was 13.6%. In factors influencing length of stay, ICC was 11.4%, and medical charges, ICC was 17.7%. It was found that factors influencing the outcome indicators of stroke patients may vary in every hospital. This study could carry out more accurate analysis than existing research findings through analysis of reflecting structure at patient level and hospital level factors and analysis on random effect.

Comparative study on medical fees: caesarean section, cataract, and appendectomy surgeries among OECD countries

The question has been raised whether the medical fee schedule is very low in Korea. However, studies that empirically address this matter on a national scale are rare. This study attempted to determine the level of Korea's medical fees for caesarean section (C-section), cataract, and appendectomy surgeries by comparing and analyzing them with other Organization for Economic Cooperation and Development (OECD) countries' medical cost data obtained from other studies. There are two ways to compare the level of medical fees: one is a direct comparison, which obtains each country's medical fee schedule and compares them with each other. Another is indirect comparison, a method which compares data such as physician income. For direct comparison, fees were calculated using data provided by the OECD and Health Insurance Review and Assessment. For indirect comparison by physician income, data obtained from Korea Employment Information Services were used to represent Korean physician income. When compared with other OECD countries, the results suggest that, overall, the Korean fee schedule could be low, based on the fees for C-section, cataract, and appendectomy surgeries. The study results also confirm that Korean physicians' average earnings ranked relatively low among OECD countries. These results are meaningful in that they empirically support the contention that Korean medical fees could be low. In addition, under what is known as national health insurance, in which the medical fee schedule is determined by a single payer, an empirical analysis on medical fee levels, as in this study, has substantial political implications because it may be utilized for medical fee schedule negotiation in the near future. An attempt to directly research fees and the range of services of OECD countries is still needed in order to provide more established data.

Development of a revisit prediction model for the outpatient in a hospital / 대한의료정보학회지

OBJECTIVES: This study is for developing the prediction model of outpatient's revisit in target hospital. Using this model, hospital managers can make efficient customer relationship. METHODS: This is based on the medical record data of patients in target hospital (with 967 beds). They are divided into two groups, which are used each for different purpose. One(raw data) is used to make the prediction model of revisit and the other(test data) is used to evaluate the model. For raw data were used the 4,273 outpatient cases, where patients visited the first time between august and september in 2000, and visited till december in 2003. For the test data were used 9,392 outpatient cases, where patients visited the first time between august and september in 2003, and visited till december in 2006. That is, each data was selected from the outpatient's medical records for three-years. RESULTS: The decision tree model is better than the logistic regression model as prediction model of outpatient's revisit in target hospital. The decision tree model is evaluated more excellent in ROC curve and classification accuracy in test data. For predicting the outpatient's revisit, it is more useful to have 4 variables - non-insured expenses, special medical service, cooperation service with oriental medicine and visit via ER. We can predict the revisit of outpatients over 39.5% rate by these variables. CONCLUSIONS: By using decision tree model, target hospital can make more accurate prediction of outpatient's revisit and make good customer relation management. So, target hospital can use some CRM program including 4 variables. To make more useful model for other hospitals in Korea, each hospital managers need to understand more their hospital environment and patient's characteristics.

Study of Cohort Construction for Development of Early Alarm System (EMS) for Breast Cancer: based on women living in a rural area / 성인간호학회지

PURPOSE: 1) to construct cohorts according to risk scores calculated with the Gail Breast Cancer Risk Assessment Tool (Gail et al., 1989) (Gail) and the Breast Cancer Risk Appraisal (Lee et al,. 2003) (Lee) 2) to identify the distribution of risk factors and preventive behavior stages between the cohorts 3) to identify abnormal breast conditions in risk cohort. METHOD: Using convenience sampling, 775 rural women were selected. Risk appraisal was scored using Gail and Lee. Preventive behavior stages for BSE (Breast self examination) and mammography were measured using 4 stages of the Transtheoretical Model (Prochaska & DiClemente, 1983). RESULTS: 1) The risk cohort according to Gail was 12.3% (n=95), and Lee, 3.1% (n=24). 2) There were significant differences in the distribution of risk factors (age, family history, age at 1st live birth, age at menarche, number of breast biopsy, history of breast disease, and breast-feeding) between cohorts. 3) There was a significant difference in the distribution of the stage of BSE according to Lee. 4) Six women in the risk group detected masses or nodules and physician consultation and ultrasonography were recommended. CONCLUSION: On the basis of the constructed cohorts, further longitudinal studies of cohorts are recommended with interventions according to characteristics of cohorts.

An Application of Data Mining Approach to CQI Using the Discharge Summary / 대한의료정보학회지

This study provides an application of datamining approach to CQJ using the discharge summary. First, we found a process variation in hospital infection rate by SPC (Statistical Process Control) technique. Second, importance of factors influencing hospital infection was inferred through the decision tree analysis which is a classification method in data -mining approach. The most important factor was surgery followed by comorbidity and length of operation. Comorbidity was further divided into age and principal diagnosis and the length of operation was further divided into age and chief complaint. 24 rules of hospital infection were generated by the decision tree analysis. Of these, 9 rules with predictive prover greater than 50% were suggested as guidelines for hospital infection control. The optimum range of target group in hospital infection control were identified through the information gain summary.Association rule, which is another kind of datamining method, was performed to analyze the relationship between principal diagnosis and comorbidity. The confidence score, which measures the degree of association, between urinary tract infection and causal bacillus was the highest, followed by the score between postoperative wound disruption and postoperative wound infection.This study demonstrated how datamining approach could be used to provide information to support prospective surveillance of hospital infection. The datamining technique can also be applied to various areas for CQI using other hospital databases.

Model Development of Hospital Process Reengineering by Activity-Based Costing / 대한의료정보학회지

The purpose of this research is to suggest a model for hospital process and verily the model through analyzing the results before and after reengineering grounded on the activity -based costing. The summary of research is as follows: First, two reengineering-applicable processes for a case hospital are chosen based on the issues from the patient requirements analysis and current process analysis as well as the general characteristics of hospital operations: accounting and clinical laboratory e xami nation processes. The integration of payment-related functions principle is applied to an accounting process which includes three sub processes. while the automatic transition of laboratory output principle is applied to a clinical laboratory examination process. Second, the studs shows more than 50% reduction of activities: nine activities from nineteen by the principle of integration of payment-related functions, and nine activities from fourteen by the principle of automatic transition of laboratory output. Finally. activity-based cost analysis before and alter reengineering results in 44% cost reduction: 43.9% in payment-related subprocesses and 41.1% in a clinical laboratory examination process. Therefor this research finds an enormous gap between costs before and after reengineerring. The contributions of this research are two-fold: one is that activity-based costing methodology is practically valid for measuring the cost-performance analysis of hospital process reengineering, and another is that activity -based costing can he utilized not only an initiative of process engineering hut also as a tool for evaluating a variety of activities by a simulation technique.

Cost effective analysis in the primary care research

No abstract available.

Standardization Study for Discharge Abstract Data / 대한의료정보학회지

The purpose of this study was to identify important items from the medical records to be used in the standardized discharge abstract. Common items were identified by analyzing medical records from the 11 largest hospitals in Seoul. Non-common items were identified by a questionnaire survey from the directors of medical record departments of 152 teaching hospitals. The results of research was follows; 1. Thirty eight common items were included in the analyzed sheet of 11 hospitals. 2. Eighty two non-common items were identified from the analyzed. Of these,10 items were found to be important items for the discharge abstract. 3. Another 26(half) or 18(first quarter) important non-common items were identified from the survey. 4. It was notified in the non-common standardized items group that the importance of some items like the patient's occupation, underlying cause of death, nosocomial infection, complications, house staff code in charge of completing records, and items concerning quality improvement showed difference by the number of beds. The importance of house staff code who is responsible for completion of the record also showed statistically significant difference by the number of beds per medical record professional and by regions. The item of the types of nosocomial infection also showed statistically significant difference between the regions. Most hospitals obtain a lot of medical information from the computerized discharge abstract. One of the results of the study showed that the concerned sheet can housed as both the data for the medical insurance claims and the basic data for medical quality improvement. Therefore, the discharge abstract should be regarded as the most necessary sheet to be standardized. It was found that 92.8% of the directors of medical record departments of nationwide teaching hospitals acknowledged the necessity of standardization of medical record data set.

Standardization Study for Discharge Abstract Data / 대한의료정보학회지

The purpose of this study was to identify important items from the medical records to be used in the standardized discharge abstract. Common items were identified by analyzing medical records from the 11 largest hospitals in Seoul. Non-common items were identified by a questionnaire survey from the directors of medical record departments of 152 teaching hospitals. The results of research was follows; 1. Thirty eight common items were included in the analyzed sheet of 11 hospitals. 2. Eighty two non-common items were identified from the analyzed. Of these,10 items were found to be important items for the discharge abstract. 3. Another 26(half) or 18(first quarter) important non-common items were identified from the survey. 4. It was notified in the non-common standardized items group that the importance of some items like the patient's occupation, underlying cause of death, nosocomial infection, complications, house staff code in charge of completing records, and items concerning quality improvement showed difference by the number of beds. The importance of house staff code who is responsible for completion of the record also showed statistically significant difference by the number of beds per medical record professional and by regions. The item of the types of nosocomial infection also showed statistically significant difference between the regions. Most hospitals obtain a lot of medical information from the computerized discharge abstract. One of the results of the study showed that the concerned sheet can housed as both the data for the medical insurance claims and the basic data for medical quality improvement. Therefore, the discharge abstract should be regarded as the most necessary sheet to be standardized. It was found that 92.8% of the directors of medical record departments of nationwide teaching hospitals acknowledged the necessity of standardization of medical record data set.

Layout Planning Model for Medical Service Rooms / 대한의료정보학회지

The layout problem involves finding the best arrangement of physical components of the service system possible within the time, cost, and technology constraints of the situation. And the layout problem can be a very complex system design problem requiring the most sophisticated lay system analysis and design tools in order to develope satisfactory layout solutions. The objective of this layout study is to reorganize service rooms for minimizing overall patient's moving distance. In solving the service room layout problem, there exist a number of constraints on the building facilities in current location. All other service rooms can be moved if layout analysis indicates it would be beneficial. The first step is to analyze records in order to determine the number of trips made by patients between departments in two months. And a number of layout cases developed as methods to a good service room layout. The result is shortened total patient's layout distance of 252,880 meters.

Economic analysis of order communication system for hospitals / 예방의학회지

Hospitals have been very susceptable to changes in external environment. Accordingly, they have been experiencing great financial difficulty due to low insurance rates and increasing competition. As a remedy, hospitals have attempted to use computer in a strategic manner. Such system is called strategic information system (SIS) , and order communication system (OCS) is an example of SIS in hospital setting. While OCS has known to be effective in reducing waiting time for outpatients, many hospitals are reluctant to introduce this system mainly because there are no real data or methods for justifying the cost of the system. Cost-benefit analysis has been traditionally used for such purpose, but this method deals with limited portion of benefits and therefore not very useful for analyzing the economic feasibility of SIS. In this paper, information economics tools which expand cost with value was used to analyze the economic feasibility of OCS. To assist the analysis, financial simulation model was developed using simulation package, called IFPS (Interactive Financial Planning System).

A Development and Application of Decision Support System for Cost Analysis / 예방의학회지

Hospitals are experiencing an increasing amount of financial difficulty due to government control of hospital rates since national health insurance has been implemented. The decision support system(DSS) was developed to provide cost and revenue information for the services rendered by each department in an effect to reduce costs. This information may be used to identify the causes of financial loss if cost exceeds revenue and to conduct variance analysis or portfolio analysis to improve financial situation of hospitals. The DSS was developed using a micro-mainframe interface approach where the mainframe computer collects and summarizes daily cost and revenue data and the micro computer computes the cost for each department. The significances of this paper are to determine the cost allocation basis and methods which are suitable to Korean situation and to apply DSS technology to the cost analysis.

Economic Benefits of Implementing National Health Insurance by Measurement of Changes in the Consumer's Surplus / 예방의학회지

A change in the consumer's surplus was measured in order to evaluate the social benefit to be derived from expanding health insurance to the entire population. The most refined and correct way to measure a project's net benefit to society is to determine a change in the consumer's surplus. Benefits from introducing the health insurance program to the uninsured people can be classified into two elements. The first is the pricing-down effect(E1) which results from applying the insurance price system, which is lower than the actual price, to the uninsured patients. The second effect(E2) is a decrease in actual payment because an insured patient pays only a portion of the total medical bill(copayment). We collected medical price information from the data banks of 93 hospitals, and obtained information of medical utilization by referring to the results of other research and from data published by the Korean Medical Insurance Societies. The total net benefit was estimated as won214 billion, comprising the first effect(E1) of won57 billion and the second effect(E2) of won157 billion. The price elasticity of physician visits is less than that of hospital admissions; however, benefits from the increase in physician visits are greater than those from hospital admissions because there are considerably more of physician visits than hospital admissions. The sensitivity analysis also shows the conclusion that expansion of the health insurance program to the entire population would result in a positive net benefit. Therefore, we conclude that the National Health Insurance Program is socially desirable.

An Evaluation of a Patient Referral System using Intervention Analysis / 예방의학회지

The purpose of this study was to introduce the methodology of intervention analysis with time series data and to investigate the influence of the patient referral system on medical care utilization in Kangwha county. The data were obtained at the Kangwha Medical Insurance Society and we analysed the material based on the outpatient care fee. The results were as follows: 1. The average outpatient care utilization in the hospital decreased by 41.7% due to the patient referral system. 2. The utilization of the health institution increased by 278.8 persons per month due to the patient referral system. 3. The patient referral system did not influence the total outpatient care utilization. The methodology of intervention analysis, which detected the effect of intervention, will be helpful to the study of public health area.