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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
> Journal Vol & Issue
Health Policy and Management
Journal Basic Information
Journal DOI :
The Korean Society of Health Policy and Administration
Editor in Chief :
Volume & Issues
Volume 11, Issue 4 - Dec 2001
Volume 11, Issue 3 - Sep 2001
Volume 11, Issue 2 - Jun 2001
Volume 11, Issue 1 - Mar 2001
Selecting the target year
한국 보건정책의 과제와 진로
Health Policy and Management, volume 11, issue 2, 2001, Pages 1~5
의료정책의 이념지향과 지식기반
Health Policy and Management, volume 11, issue 2, 2001, Pages 6~15
Determinants of Multidimensional Outcomes of Patient Satisfaction in Operated Cataract Patients
Health Policy and Management, volume 11, issue 2, 2001, Pages 16~28
This study was to compare multidimensional outcomes of patient's satisfaction after cataract surgery and to identify factors influencing satisfaction after operation. Patient's satisfaction was measured with three dimensions : interpersonal care, physician explanation and hospital care. Overall satisfaction was measured as means of three dimensional scores. For the study, a prospective study was performed with 389 patients who had undergone cataract surgery for either one eye or both eyes. The surgery was performed by 20 ophthalmologists who were practicing at university hospitals and general hospitals. Patients were interviewed and clinical data (the visual acuity of operated eye, visual function, symptom score and satisfaction with vision) were obtained. The doctors were questioned with self-reported questionnaire forms. Medical records were also examined to understand surgery Process. The survey was conducted before(389) and after operation(327). Alter excluding cases with incomplete data, 3n cases were enrolled In this study. Both the overall satisfaction and the satisfaction with physician explanation increased after the operation whereas the satisfaction with interpersonal care and hospital care did not change significantly. Multiple regression analysis showed that the level of education, baseline satisfaction scores and the degree of vision improvement were statistically significant variables. The preoperative lower level of education, higher level of overall satisfaction (interpersonal care, physician explanation, hospital care scores) and the more the satisfaction with vision improvement were associated with the improvement of postoperative satisfaction scores.
A Study on The Determinants of the Medical Expenses in the Health Insurance System in Korea
Health Policy and Management, volume 11, issue 2, 2001, Pages 29~57
Since the inauguration of the medical insurance system in 1977, the increasing medical expenses which can be menace to tile finance of the medical insurance system, have become major concern in the medical insurance field In Korea. This study focuses on the determinants of the medical expenses in the health insurance in Korea and analyzes the impact of these factors on the increase in the medical expenses. The empirical work is done using the pooled cross-section and time-series data of the medical insurance for the self-employeds and the industrial workers from the year 1995 to 1997. The result of this study shows that the main determinants of the medical expenses in the health insurance are the ratio of the population of the aged to the total population, the frequency of the utilization, number of doctors per capita and the regime changes. Although the increasing trend in the medical expenses seems to be unavoidable, we probably need to add some efficiency to the medical expenses by suppressing the supply and the utilization of the unnecessary medical services. The fee-for-service reimbursement system of today can't suppress the supply of the unnecessary medical services effectively. So we need to convert the present fee-for-service system into DRG's which is known to reduce the medical costs. The increase in the medical expenses comes from a lot of factors. Therefore, we should develop more systematic and comprehensive measures to control the soaring medical expenses in consideration of the various factors such as demand, supply, and the organizational side of the medical system.
Organizational Determinants related with Relative Efficiency of the Community Mental Health Centers
Health Policy and Management, volume 11, issue 2, 2001, Pages 58~84
This study was conducted to explore the relationship between the efficiency and its organizational determinants of tile Community Mental Health Centers(CMHCs). Data are obtained from 81 personnel of 27 CMHCs from Sept. to Oct. in 1999(19 in Kyunggi province, 7 in Seoul City and 1 in Chunchon, Kangwon province). Major findings of this study are as follows. 1. DEA is a mathematical programming technique that optimizes the relative efficiency ratio of inputs over outputs for each decision-making unit(DMU). It produces a summary scalar efficiency ratio for each DMU of CMHCs. It assessed multiple inputs and multiple outputs simultaneously, and compared to specific peer group of CMHCs. 2. Organizational determinants of DEA efficiency of CMHCs we proved as advertisement(＋), location of CMHCs(in public facility)(＋), area of facility(＋), period of operation(＋), job satisfaction(＋), clarity of work-role(vague), cohesion(－), rate of certified personnel(＋), number of referral(＋), and voluntary service time(－).
Comparison of the Effect of Income-Redistribution before and after the Mergence of Medical Insurance Program for Self-employeds
Health Policy and Management, volume 11, issue 2, 2001, Pages 85~122
This study compared and analyzed the effect of income-redistribution, collecting data on the basis of the estimated details of insurance contribution and individual money wage lists for each one year before and after the combination of medical insurance program for industrial workers, by systematic sampling, extracting 4,160 families(14,764 people) among people applied to medical insurance program for self employees in Taegu City on the basis of Oct. 1st in 1998 with 227 associations of medical insurance program for self employees and medical insurance program for government employees and private school teachers combined, comparing the effect of income redistribution of before and after the combination of medical insurance program for self employees. The insurance contribution by household after the combination of medical insurance program for self employees showed the increase rate of average 20.9%, among them households of 68.8% increased and 31.2% decreased. The effect of income-redistribution was more positive because the degree of inequality was more deepened from 0.64 of the before-combination to 0.45 of the after-one in decile distribution ratio, from 0.26 to 0.34 in Gini -coefficient. Decile distribution ratio on the basis of insurance benefits by household was from 0.09 in the before-combination to 0.14 in the after-one, Gini-coefficient from 0.16 in the before-combination to 0.57 in the after-one was a little lowered. And decile distribution ratio of insurance benefits on the basis of insurance contribution was higher from 1.08 in the before-combination to 1.23 in the after-one, concentration index was a little lowered from 0.14 to 0.11, the effect of income-redistribution was improved in the phase of insurance benefits. The income-transfer rate of medical insurance program for self employees (the occupied rate of insurance benefits/ the occupied rate of insurance contribution) showed a lower trend in all of the before and after-combination towards upper classes, it was known that the income-transfer rate was higher from 1st degree to 7th degree in the after-combination in comparison with the before-one, but the effect of income¬redistribution was high because the income-transfer rate was lowered from 8th degree to 10th degree. The rate of medical insurance benefits (insurance benefits/ insurance contribution) increased from 0.79 in the before-combination to 1.07 in the after-one, and showed over 1.0 under 3th degree before the combination, but all of it was higher than 1.0 under 7th degree after the combination, the after-combination was more improved than the before-one in view of the rate of insurance benefits. As the result of above, on the basis of Oct. 1st in 1998 that 227 associations of medical insurance program for self employees was combined into one, we could say that the equality of imposing medical insurance contribution was more re-considered in the after-combination than in the before-one. But this study analyzed with classes divided, anyway, on the basis of insurance contribution, we have limit in explaining the correct effect of income-redistribution, because it was not analyzed according to classes of income, though it helps to analogize the effect of income-redistribution. So there must be analysis about the effect of income-redistribution, on the basis of the system, building up the system to grasp the correct income of the insureds of medical insurance program for self employees
Formulating Regional Relevance Index through Covariance Structure Modeling
Health Policy and Management, volume 11, issue 2, 2001, Pages 123~140
Hypotheses In health services research are becoming increasingly more complex and specific. As a result, health services research studies often include multiple independent, intervening, and dependent variables in a single hypothesis. Nevertheless, the statistical models adopted by health services researchers have failed to keep pace with the increasing complexity and specificity of hypotheses and research designs. This article introduces a statistical model well suited for complex and specific hypotheses tests in health services research studies. The covariance structure modeling(CSM) methodology is especially applied to regional relevance indices(RIs) to assess the impact of health resources and healthcare utilization. Data on secondary statistics and health insurance claims were collected by each catchment area. The model for RI was justified by direct and indirect effects of three latent variables measured by seven observed variables, using ten structural equations. The resulting structural model revealed significant direct effects of the structure of health resources but indirect effects of the quantity on RIs, and explained 82% of correlation matrix of measurement variables. Two variables, the number of beds and the portion of specialists among medical doctors, became to have significant effects on RIs by being analyzed using the CSM methodology, while they were insignificant in the regression model. Recommendations for the CSM methodology on health service research data are provided.
Development of the Model for Total Quality Management and Cost of Quality using Activity Based Costing in the Hospital
Health Policy and Management, volume 11, issue 2, 2001, Pages 141~168
Healthcare service organizations can apply the cost of quality(COQ) model as a method to evaluate a service quality improvement project such as Total Quality Management (TQM). COQ model has been used to quantify and evaluate the efficiency and effectiveness of TQM project through estimation between cost and benefit in intervention for a quality Improvement to provide satisfied services for a customer, and to identify a non value added process. For estimating cost of quality, We used activities and activity costs based on Activity Based Costing(ABC) system. These procedures let the researchers know whether the process is value-added by each activity, and identify a process to require improvement in TQM project. Through the series of procedures, health care organizations are service organizations can identify a problem in their quality improvement programs, solve the problem, and improve their quality of care for their costumers with optimized cost. The study subject was a quality improvement program of the department of radiology department in a hospital with n bed sizes in Metropolitan Statistical Area (MSA). The principal source of data for developing the COQ model was total cases of retaking shots for diagnoses during five months period from December of the 1998 to April of the 1999 in the department. First of the procedures, for estimating activity based cost of the department of diagnostic radiology, the researchers analyzed total department health insurance claims to identify activities and activity costs using one year period health insurance claims from September of the 1998 to August of the 1999. COQ model in this study applied Simpson & Multher's COQ(SM's COQ) model, and SM's COQ model divided cost of quality into failure cost with external and internal failure cost, and evaluation/prevention cost. The researchers identified contents for cost of quality, defined activities and activity costs for each content with the SM's COQ model, and finally made the formula for estimating activity costs relating to implementing service quality improvement program. The results from the formula for estimating cost of quality were following: 1. The reasons for retaking shots were largely classified into technique, appliances, patients, quality management, non-appliances, doctors, and unclassified. These classifications by reasons were allocated into each office doing re-taking shots. Therefore, total retaking shots categorized by reasons and offices, the researchers identified internal and external failure costs based on these categories. 2. The researchers have developed cost of quality (COQ) model, identified activities by content for cost of quality, assessed activity driving factors and activity contribution rate, and calculated total cost by each content for cost for quality, except for activity cost. 3. According to estimation of cost of quality for retaking shots in department of diagnostic radiology, the failure cost was ￦35,880, evaluation/preventive cost was ￦72,521, two times as much as failure cost. The proportion between internal failure cost and external failure cost in failure cost is similar. The study cannot identify trends on input cost and quality improving in cost of qualify over the time, because the study employs cross-sectional design. Even with this limitation, results of this study are much meaningful. This study shows possibility to evaluate value on the process of TQM subjects using activities and activity costs by ABC system, and this study can objectively evaluate quality improvement program through quantitative comparing input costs with marginal benefits in quality improvement.