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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
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Volume & Issues
Volume 21, Issue 4 - Dec 2011
Volume 21, Issue 3 - Sep 2011
Volume 21, Issue 2 - Jun 2011
Volume 21, Issue 1 - Mar 2011
Selecting the target year
Effects of the benefit extension policy on the burdening of health care expenditure for households with patients of chronic or serious case
Choi, Jung-Kyu ; Jeong, Hyoung-Sun ; Shin, Jeong-Woo ; Yeo, Ji-Young ;
Health Policy and Management, volume 21, issue 2, 2011, Pages 159~178
DOI : 10.4332/KJHPA.2011.21.2.159
Korea ranks high among the OECD member countries with a high out-of-pocket share. In 2006, the government implemented in full scale the policy of extending the health insurance benefit coverage. Included in the policy are lowering the out-of-pocket share of patients of serious case and expanding the medical bill ceiling system to mention just a few. This study proposes to confirm effectiveness of the benefit extension policy by identifying changes in 'out-of-pocket expenditure as a share of the ability to pay' and 'incidence rate of catastrophic health care expenditure' of each individual household as manifested before and after the benefit extension policy was implemented. The 1st and 3rd year data from the Korea Welfare Panel Study (KoWePS), conducted by the Korea Institute for Health and Social Affairs (KIHASA), were used for the analysis, where low-income households and ordinary households are sampled separately. While the absolute amount of 'out-of-pocket expenditure' occurred to the average household increased for the period 2005-2007, the 'out-of-pocket expenditure as a share of the ability to pay' decreased. At the same time, the share decreased in the case of low-income households and households with patients of chronic or serious case as contrasted with ordinary households. 'Incidence rates of catastrophic health care expenditure' of ordinary households for 2007 stood at 14.6%, 5.9% and 2.8% at the threshold of 10%, 20% and 30%, respectively. The rates decreased overall between 2005 and 2007, while those of low-income households with patients of serious case statistically significantly increased. An analysis of this study indicates that it is related with the medical bill ceiling system regardless of incomes introduced in 2007.
An Empirical Study on the Effect of the Separation of Dispensary from Medical Practice
Yoon, Ji-Woong ; Kim, Yang-Kyun ; Beak, Byung-Su ;
Health Policy and Management, volume 21, issue 2, 2011, Pages 179~194
DOI : 10.4332/KJHPA.2011.21.2.179
Although there have been studies regarding the separating policy of dispensary and medical practice, little study have provided a concrete empirical evidence to what extent the policy objectives are achieved. In this paper, we try to provide empirical evidence whether the policy separating dispensary from medical practice achieved the policy objectives, which representatively are reducing the mis-use or over-use of anti-biotic prescriptions and medicines, and decreasing the government spending for the cost of pharmaceutical support. By comparing the average of the rate of change of the number of medicines prescribed, the rate of anti-biotics prescribed, and the government spending for the cost of pharmaceutical support between the areas where the separation policy was implemented and the exceptional areas, we concluded that it is difficult to conclude that the policy separating dispensary and medical practice achieved its policy objects, as it first announced to achieve in the introduction of the policy in 2000. However, the limitation of this study is that the data, that can thoroughly analyze the effect of separating policy of dispensary from medical practice, cannot be collected as expected. Hence, we could not use a parsimonious empirical model to evaluate the effect of the policy introduced in 2000. Rather we used a simple statistical method to extract enough empirical evidence fro m the data available. In the near future, we would expect to see more research that analyze the exact effect of policy separating dispensary and medical practice with concrete empirical model using more sophisticated dataset.
Inpatient Outcomes by Nurse Staffing Grade in Korea
Cho, Su-Jin ; Lee, Han-Ju ; Oh, Ju-Yeon ; Kim, Jin-Hyun ;
Health Policy and Management, volume 21, issue 2, 2011, Pages 195~212
DOI : 10.4332/KJHPA.2011.21.2.195
Objectives: This study investigates the relationship between nurse staffing levels and differences in patient outcomes in terms of average length of stay, in-hospital mortality rate and 30-day death rate in order to evaluate the effectiveness of a policy that differentiates fees for inpatients on the basis of nurse-to-bed ratios. Methods: We obtained information on inpatients from health insurance claims data published by the Health Insurance Review and Assessment Service(HIRA) in 2008, organizational factors(type of hospital, ownership) from the records of the hospital report system in 2008, and nurse staffing levels, which were graded on a scale of 1 to 7, from data compiled between December 15, 2007, and September 20, 2008. The data were segregated according to type of hospital and quarter and finally 3,517 records of 1,182 hospitals were analyzed using multi-level analysis. Results: The average length of stay in grade 1~6 hospitals was lower than that in grade 7 ones, but the difference was much below one day. No significant difference was found among different grades in tertiary hospitals. Further, variations in staffing levels did not result in any significant difference in the in-hospital mortality rate and 30-day death rate. Conclusions: High nurse staffing levels did not result in better patient outcomes compared with low staffing levels. We therefore recommend modifying the above nurse staffing policy so as to make it more effective in improving patient outcomes.
Organizational Accountability in Health Care : Developing a Model for Analysis
Lee, Geun-Chan ; You, Myoung-Soon ;
Health Policy and Management, volume 21, issue 2, 2011, Pages 213~248
DOI : 10.4332/KJHPA.2011.21.2.213
Past studies on organizational accountability have had similar limitations. First, empirical evidence of organizational accountability is rare as the majority of research takes a conceptual approach of the topic. Only a few of these studies are applicable to health care organizations (HCOs). To fill these gaps, we attempted to develop a model for analysis of organizational accountability for HCOs. Accountability for HCOs was conceptualized by two axes: answerability(X, horizontal) and value-creation(Y, vertical). Our concept building could relieve competing accountability mechanism which past studies stressed. Four elements of accountability(legal, economical, social, and clinical) were applied to specify each of the two features of organizational accountability. And then four types of accountability behavior were coordinated by this x-y axis : high A/high VC, high A/low VC, low A/high VC, low A/low VC. Finally, a multidimensional model of HCOs' accountability, enabling an empirically testable multi-level analysis, was proposed.
Effects of reimbursement restriction on pharmaceutical expenditures : A case of Ginkgo biloba
Kwon, Hye-Young ; Lee, Tae-Jin ;
Health Policy and Management, volume 21, issue 2, 2011, Pages 249~262
DOI : 10.4332/KJHPA.2011.21.2.249
Since May 1st in 2008, the products of ginkgo biloba extract have had to be used with the patient's out-of-pocket payment due to reimbursement restriction guidelines. This study aims to analyze the policy effects of reimbursement restriction on pharmaceutical expenditures using interrupted time series(ITS) analysis. We retrieved monthly NHI claims data for the period between May, 2005 and December 2009. The ingredients identified as a substitute for ginkgo biloba have similar indications based on the similar pharmacological activities. The effects of changes in reimbursement scope were evaluated both for all relevant pharmaceuticals within the same therapeutic class and for 2 separate groups : ginkgo biloba's and its substitutes. According to the study results, restrictions on reimbursement scope resulted in savings of the drug expenditures in the targeted therapeutic class. Direct restriction on ginkgo biloba was associated with a decrease in expenditure level by 60.1% and changes in trend from an average increase rate of 1.4% to an average decrease rate of 1.5% for the therapeutic class, with a dramatic decrease in expenditure level(-191.5%) for ginkgo biloba itself, but with an increased expenditure level(+50.1%) and changes in trend from an average increase rate of 2.0% to an average decrease rate of 1.0% for the substitute group. Further policy to restrict nicergoline was associated with additional decrease in expenditure level for the therapeutic class. Additionally, we could identify the balloon effect - a new policy squeezing one part results in bulging out elsewhere. After the restriction of ginkgo biloba, the utilization of and expenditures on its substitutes increased significantly. In conclusion, we demonstrated that consecutively introduced policies effectively reduced overall expenditures on the therapeutic class of interest. Some ingredients played as a substitute while others did not. Further studies need to be conducted to identify which factors determine a substitute.
An Hierarchical Structure Analysis of Hospital Selection Attributes
Cha, Jae-Bin ; Lee, Hoon-Young ;
Health Policy and Management, volume 21, issue 2, 2011, Pages 263~278
DOI : 10.4332/KJHPA.2011.21.2.263
As the competition among hospitals become intensified, hospital management is required to carry out more effective marketing and positioning of the hospital. Successful positioning of a hospital requires the knowledge about how the concrete attributes inherent in the medical service associated with the customer values that customers seek eventually in the medical service. Thus, it is required for hospital management to understand which hospital attributes should be emphasized in order to improve the customer values. The hierarchical structure of service attributes can provide valuable information about effective positioning and advertising. To obtain such knowledge, we employed the order analysis technique as an objective means-end chain method. Order analysis is useful for identifying the causal structure among attributes. Thus, we can examine the underlying causal relationship and eventually the vertical structure of hospital selection attributes. For this study, we conducted a survey to obtain 370 responses for the analysis. The result suggests that hospital management had better increase the scale of hospital, improve the services of health care providers, and modernize the hospital facilities and equipments so as to enhance customer values and eventually to lead them to recommend the hospital to others. Our findings would provide the valuable information for hospital management to develop the more effective hospital positioning and marketing strategies.
A Study on Disability Database and Applicable System to Provide Continuous and Comprehensive Rehabilitation Service
Lee, Hee-Yeon ; Ho, Seung-Hee ; Kang, Hyun-Gyu ; Lee, Seung-Young ;
Health Policy and Management, volume 21, issue 2, 2011, Pages 279~308
DOI : 10.4332/KJHPA.2011.21.2.279
Background : Demands have increased for a variety of welfare services and customized services for persons with disabilities(PWD). A management System focused on PWD was needed to provide for comprehensive services. The purpose of this study was to design a disability database and an application system in order to provide continuous and comprehensive rehabilitation service for PWD. Methods : We analyzed local and abroad disability-related policies and systems and derived the contents that should be included in the integrated database for PWD through a survey among rehabilitation specialists. Result : The integrated database for PWD was composed of 7 categories including General Characteristics, Health & Medicine, Assistance, Education, Employment, Economics and Daily & Social Life. The applicable system of integrated database for PWD was proposed to help conducting policies in such areas as follows ; 'welfare', 'education and culture', 'economic activity', 'social participation' and 'Health'. Conclusion : The main goal of disability policy and strategy should be established by systematically analyzing disability-related data integrating database of PWD. Accordingly, specific objectives and directions for disability policies should be set and efficiently managed and operated. The integrated database for PWD may be utilized for disability-related policies and service monitering, sustainable and integrated management and community participation and integration based on the rights of the disabled.
The relationship between emotional intelligence in leadership and organizational performance of nurses in general hospitals
Lee, Bo-Hye ; Choi, Man-Kyu ; Moon, Sang-Sik ; Jung, Min-Soo ; Kim, Jin-Hee ;
Health Policy and Management, volume 21, issue 2, 2011, Pages 309~328
DOI : 10.4332/KJHPA.2011.21.2.309
In order to effectively attain the objectives of an organization, it is important for the leader to provide an environment where members can co-exist and mutually advance, and also to have an emotional impact on them. This study examines the structural relationship among emotional intelligence in leadership, organizational commitment, job satisfaction, turnover intention, and organizational performance effects of emotional leadership in the nursing profession of a general hospital. A structured questionnaire was sent to 550 nurses in 11 general hospitals in Seoul Metropolitan City, among which 350 responses were used in the analysis. The independent variable, emotional intelligence in leadership, was measured by 18 items, including self-awareness, self-regulation, social awareness and relationship management. The dependent variable, organizational effectiveness, consisted of 46 items, including 15 items regarding organizational commitment, 20 items on job satisfaction, 3 items on turnover intention and 8 items on organizational performance. The structural equation modeling technique was used to identify the impact of emotional intelligence in leadership on organizational effectiveness. The results of the analysis show that the emotional intelligence in leadership of superior nurses has a significant impact on the nurses'organizational commitment and job satisfaction. While the direct effect on turnover intention and organizational performance was not significantly high, organizational commitment and job satisfaction were parameters in low turnover intention and high job performance. In conclusion, emotional intelligence in leadership is critical as nursing services in hospitals are based on interpersonal relationships. Therefore, by developing appropriate programs and training, hospitals can anticipate improved self-awareness, self-regulation, social awareness and relationship management of nurses, and further improve the effectiveness of the nursing profession.
Analysis and Improving ways of Factors affecting the Ill-defined Causes of Death of the Aged in Korea
Park, Sang-Hee ; Lee, Tae-Yong ;
Health Policy and Management, volume 21, issue 2, 2011, Pages 329~348
DOI : 10.4332/KJHPA.2011.21.2.329
This research analyzed 168,010 cases of death of the aged over 65 from 244,867cases of death excluding 7 unknown age cases from 244,874 all age cases of death by using the death data of the National Statistical Office for 2007 to figure out factors affecting the quality of causes of death statistics of the aged and to suggest the ways of improving the quality of death statistics of the aged in korea. This research tried to derive factors affecting ill-defined cause of death category in acordance with WHO's guidelines and to find causes of lowering the accuracy of causes of death statistics of the aged. This research identified the problems of causes of death statistics of the aged by using both demographic characteristics such as sex, age, marital status, educational attainment, residential region, region size and factors of death items as independent variable to find causes of ill-defined cause of death of the aged. Logistic regression analysis was executed to calculate the hazard ratio about the ill-defined causes of death of the aged and multiple regression analysis was conducted to derive factors affecting the ill-defined cause of death by regional groups through using these independent variables such as the component ratio of over age 65, female death rates, doctors insitutions rate, medical institutions rate, attaching rates of death certificate by neighborhood. As a results of this research, R-code was the highest of ill-defined causes of death, accounting for 82.1%, and senility death(R54) of R-code was the highest, accounting for 91.2%. through subdivided order distribution of the ill-defined causes of death of the aged. As ill-defined causes of death by regional groups, attaching rates of death certificate by neighborhood was the most important factor(p<0.05) and also showed regression model's description with 83.8% (
=83.8%). Furthermore, Jeon-nam was the highest in the regional groups and these regions such as Je-ju, Jeon-buk, Chung-nam were not only attaching the death certificate by neighborhood but also were high at the rate of ill-defined causes of death. Therefore, this research found that both reconsideration about death certificate by neighborhood and education for doctors who write death certificate were needed the most.