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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 20, Issue 4 - Dec 2010
Volume 20, Issue 3 - Sep 2010
Volume 20, Issue 2 - Jun 2010
Volume 20, Issue 1 - Mar 2010
Selecting the target year
Consensus on definition and quality standard of clinical practice guideline using RAND method
Ji, Seon-Mi ; Kim, Soo-Young ; Sheen, Seung-Soo ; Heo, Dae-Seog ; Kim, Nam-Soon ;
Health Policy and Management, volume 20, issue 2, 2010, Pages 1~16
DOI : 10.4332/KJHPA.2010.20.2.001
Background : Clinical practice guidelines are an increasingly familiar part of clinical practice. Moreover, rigorously developed evidence based guidelines has been widely used. However, in Korea, some of published documents as clinical practice guidelines have shown considerable disparity in structure, contents and quality. This is mainly because there is no consensus on the definition and quality standard of clinical practice guidelines. The purpose of this study was to draw consensus on the definition and the quality standard about clinical practice guidelines. Method : We developed a questionnaire about the definition of clinical practice guidelines with inclusion criteria(23 items) and the quality standard(30 items). We selected 9 experts who had prior experience in developing and implementing guidelines. Rating methods for appropriateness of items were adopted from the RAND method. Consensus was drawn in three rounds. Results : Of the 47 items agreed, 40 items were determined to be appropriate. Clinical practice guidelines were defined as "scientifically and systematically developed statements to assist practitioners and patients on making decisions about appropriate health care for specific clinical circumstances." Narrative reviews, systematic reviews or health technology assessment without recommendations, translation of foreign guidelines, guidelines for patients only and training manuals were not considered as clinical practice guidelines. For the quality standard of clinical practice guidelines, 27 items were deemed necessary. Conclusions : The consensus on the definition with inclusion criteria and the quality standard of clinical practice guidelines carries an important meaning as the first attempt to draw a general agreement in our society. The unique achievement of the consensus reflects the current status of clinical practice guidelines that there has been a high tendency to adapt foreign guidelines. We hope efforts of this kind will continue to bring improvement in clinical practice guidelines.
Variation in hospital length of stay according to the DRG-based prospective payment system in the voluntarily participating providers
Choi, Sook-Ja ; Kwon, Soon-Man ; Kang, Gil-Won ; Moon, Sang-Jun ; Lee, Jin-Seok ;
Health Policy and Management, volume 20, issue 2, 2010, Pages 17~39
DOI : 10.4332/KJHPA.2010.20.2.0167
This study explored the impact on the DRG(Diagnosis-Related Groups)-based prospective payment system(PPS) operated by voluntarily participation providers. We analyzed whether the provides in the DRG-based PPS and in traditional fee-for-service(FFS) systems showed different the degree of variation in length of stay(LOS), and the providers' behaviors depending on the differences according to the varied participation periods. The study sample included all data 2,061 institutions participated in DRG-PPS in 2007 and all cases 473 FFS institutions which reported fee-for-service claims were reviewed same diagnosized diseases at least 10cases claims during three months We compared the differences of the LOS among health care institutions according to their type, region, and size. For DRGs showing significant differences in LOS, multiple regression analyses were performed to find out factors associated with LOS and interaction effect participation and hospital types or participation periods. The result provide the evidence that the DRG payment system operated by volunteering health care institutions had impact on resources use, which can reduce the institutions' the length of stay. While some DRGs had no correlation between participation periods and LOS, other DRGs, DRG participation period reversely linear relationship with LOS. That is to say, the longer participation year, the less reducing the LOS. These results support the future expansion of the DRG-based PPS plan to all health care services in Korea.
Cost Structure of Medical Services in Korean National Health Insurance
Oh, Young-Sook ; Kang, Gil-Won ;
Health Policy and Management, volume 20, issue 2, 2010, Pages 40~52
DOI : 10.4332/KJHPA.2010.20.2.040
Health insurance fees are set by relative value scales and conversion factors. Since 2008 the conversion factor has been classified into 7 according to the provider type, and a separate contract has been made respectively. As such classification of the conversion factor reflects only the different characteristics of providers, however, further classification to reflect the different cost structures of providers is proposed. Cost varies according to the type of not only providers but also services each provider supply. In fact different cost structures of providers are the result of their different services. This study analyzed the cost structure of medical services to propose a new approach to the classification of the conversion factor. This study analyzed the cost structure of medical services using cost data constructed in the revision study of relative value scales. The cost data consist of doctor's fee, support staff's fee, cost of medical equipments, cost of medical supplies and indirect cost. The proportion of each cost component to the total cost was analyzed in terms of service department and service type. 72 service groups are defined in terms of the combination of service department and service type. Through cluster analysis, 72 service groups were reduced into 7 clusters each of which has a similar cost structure. Conversion factor is contracted annually to reflect the change in the cost of providing medical services. So the classification of conversion factor has to be based on the cost structures of medical services, not the characteristics of providers. Service clusters derived in this study can be used as a new classification for health insurance fee contract.
Improving Priority-setting procedures for NHI benefit package
Yun, Hee-Suk ; Kwon, Soon-Man ; Kwon, Yong-Jin ;
Health Policy and Management, volume 20, issue 2, 2010, Pages 53~68
DOI : 10.4332/KJHPA.2010.20.2.053
In health care, the process of resource allocation becomes a controversial process of rationing, as scarce resources are allocated between the numerous health care interventions. Especially for the last few years, decisions to define and expand the benefit package of National Health Insurance have always become the object of fierce criticism. It is partly because we have not reached a collective agreement as to what the most important criteria for spending priorities are. This paper considers the procedures and the principles which could be used to determine rationing in health care, and emphasizes the need to have explicit principles which determine patient access to care and to have an evidence base to inform rationing decisions. Also, the need to set up a public committee is suggested to take rationing decisions on behalf of government and NHS and to present them as evidence-based decisions.
Factors Affecting Job Satisfaction of Biomedical Engineers Working in General Hospital in Korea
Lee, Hyun-Sung ; Lee, Yun-Hwan ; Lee, Soon-Young ; Park, Jae-Beom ;
Health Policy and Management, volume 20, issue 2, 2010, Pages 69~88
DOI : 10.4332/KJHPA.2010.20.2.069
The effective administration of hospital with innovation and human resource practices is a matter of grave concern because hospitals are becoming bigger and more specialized. Biomedical engineers who manage medical machineries and tools used to deliver healthcare services in a hospital setting play an important role in providing customers good quality services. Maintaining job satisfaction of biomedical engineers is, thus, important in the delivery of quality care. This is a descriptive cross-sectional study aiming to determine factors affecting job satisfaction of biomedical engineers working in general hospitals. The study population consisted of biomedical engineers at 79 general hospitals of 26 regions based on the registry of the Korea Medical Engineering Association (KMEA). The data were collected using a self-administerd questionnaire between May and July of 2009. Job satisfaction was assessed with 19 items covering 3 dimensions of work-external, work-internal, and organizational aspects (Cronbach's
), resulting in an average summary score. Statistical analysis was conducted with SPSS for Windows version 15.0. The mean score of job satisfaction was 3.50 (
). There were statistically significant differences in job satisfaction according to age, health status, job position, duration of work as a biomedical engineer, years in the current workplace, difficulty at work, intent to change job, and the amount of support from superiors and colleagues. In multiple regression analysis, the factors affecting job satisfaction of biomedical engineers were salary, health status, and support of superiors and colleagues (
). Effective motivation-plans, taking into account organizational characteristics and the working environment of the hospital, may help to improve the job satisfaction of biomedical engineers.
Factor related to regularity of breakfast of middle school students
Park, Jong ; Ryu, Yeon-So ; Kang, Myeong-Guen ; Min, Soon ; Kim, Hye-Sook ; Kim, Eun-A ;
Health Policy and Management, volume 20, issue 2, 2010, Pages 89~103
DOI : 10.4332/KJHPA.2010.20.2.089
Purpose : This study is descriptive research that confirms regularity of breakfast and related factor. Methods : The duration for investigation took place from April to May 2007 and 550 middle students of 6 middle school who lived in G city participated in investigation. The contents of the questionnaire consist of general trait, diet trait, life pattern and health state. Results : The significant variables of regularity of breakfast habit have some gender differences. For male students, recognition of importance of the breakfast, breakfast preparer, spare time before attendance and one's parents' breakfast habit are significant variables. On the other hand, for female students, recognition of importance of the breakfast, breakfast preparer and an income level are significant variables(p<.05). For male students, the cross ratio has 3.52 for recognition of importance of breakfast, 2.72 for one's parents' breakfast habit, 2.05 and 3.13 when one's mother prepare breakfast. For female students, the cross ratio is 3.24 score when one's mother prepare breakfast. Conclusion : The regularity of breakfast habits is related to recognition of importance of breakfast, mother's breakfast preparation and his or her parents'breakfast habit. It is necessary to propose the importance of breakfast to improve the regularity of breakfast habit and concern of parents for breakfast.
A study on the present status and improving management of the non-eligible people in Korean long-term care insurance system
Kwon, Jin-Hee ; Han, Eun-Jeong ; Lee, Jung-Suk ; Park, Chong-Yon ;
Health Policy and Management, volume 20, issue 2, 2010, Pages 104~127
DOI : 10.4332/KJHPA.2010.20.2.104
To vitalize the link program of Korean long-term care insurance system to community-based services for non-eligible people, we analysed the claim data from the Korean National Health Insurance Corporation (NHIC), and conducted a questionnaire survey to charging employees of elderly service department at local governments. The subjects were all 81,377 people, 57,454 of them were arranged to community-based services. The link program was more necessary among the missed subjects rather than the arranged people due to the need for physical or psychological assistance. By the result of the survey to the local government employees, 59.5% of subjects responded their proportion of link service was over 10% and under 20%, and 54.3% of them responded their job boundary are not clear. Major type of linking was notification the subject list to local government, 91.4%; proportion of periodical notification on the status of their service link were 57.1%, only 7.1% were followed to manage after the link. Difficult factors at the link process were pointed out the overload by other side work, deficiency of resources, rigidity of priority of link, and so on. Considering these results, to vitalize the community-based services to the non-eligible people, it may be essential the active participation of the subjects, construction of parts working in coordination among the institutions including NHIC, local governments, and service providers; development of various services for maintenance or promotion of the non-eligible peoples' health and functional status; and active participation of institutions from the third sector, and so on.
Oral Antihyperglycemic Medication Adherence and Its Associated Factors among Ambulatory Care with Adult Type 2 Diabetes Patients in Korea
Hong, Jae-Seok ; Kang, Hee-Chung ;
Health Policy and Management, volume 20, issue 2, 2010, Pages 128~143
DOI : 10.4332/KJHPA.2010.20.2.128
Objectives : This study aims to estimate the oral antihyperglycemic medications adherence among ambulatory care with adult type 2 diabetes patients and to identify factors affecting the medication adherence in Korea. Methods : This study used the Korean National Health Insurance Database. Study population was 40,082 patients who were 20 years of age or older and first diagnosed with type 2 diabetes (ICD-10: E11) in 2004. The patients were followed up for two years in order to measure adherence with oral antihyperglycemic medications. The level of medication adherence was measured by the medication possession ratio (MPR). Results : The average MPR in the study population was 49.5%. The appropriate adherence rate (MPR
80%) was 29.4% and showed variation according to the characteristics of individual patients. Multiple logistic regression analysis revealed that the odds of appropriate adherence increased with female (OR:1.21, CI:1.14-1.27), older age, increasing ambulatory care visits, health insurance (OR:1.53, CI:1.33-1.76), decreasing ambulatory care providers, using a specialized general hospital as their main attending medical institution (OR:10.08, CI:8.96-11.33), having co-morbidity, using polytherapy (OR:1.07, CI:1.01-1.13). Conclusions : The medications adherence for patient with type 2 diabetes is low in Korea, and shows variation according to the characteristics of patients. For proper management of diabetes, health care policy is expected to be enacted to improve medications adherence continuously. In particular, more intensive management is needed for patients with low medications adherence. Also, health care policy makers need to develop the program to induce health care utilization by a patient to be more concentrated with the same provider.