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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
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Health Policy and Management
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Journal DOI :
The Korean Society of Health Policy and Administration
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Volume & Issues
Volume 23, Issue 4 - Dec 2013
Volume 23, Issue 3 - Sep 2013
Volume 23, Issue 2 - Jun 2013
Volume 23, Issue 1 - Mar 2013
Selecting the target year
Simulation on the Change of Practice Pattern after the Introduction of 7 Diagnosis-related Groups Prospective Payment System in a University Hospital
Shin, Sam-Chul ; Kang, Gil-Won ; Kim, Sang-Won ;
Health Policy and Management, volume 23, issue 2, 2013, Pages 103~111
DOI : 10.4332/KJHPA.2013.23.2.103
Seven diagnosis-related groups (DRGs) prospective payment system is going to expand to all hospitals including university hospitals this year. However there are few studies on the change of practice pattern under prospective payment system in the university hospital setting. So This study was intended to predict the practice pattern change after the introduction of 7 DRGs prospective payment system in a university hospital setting. To predict the change of practice pattern, this study used simulation technique. Five hundred and nineteen patients classified as 5 DRGs in a university hospital were selected for simulation. The change of practice pattern were predicted based on clinicians' opinion. We also predicted payment change by service items. Major findings of this study are as follows. First, the total medical payment was reduced by 14.4%. The drug payment change (8.8%) took most of total payment reduction. The followings are the change of treatment material cost (3.2%), the change of laboratory tests cost (1.8%), the change of room charge (0.5%), and other payment change (0.1%), respectively. Second, most of the reduction in total medical payment resulted from the decreased amount of medical services themselves. The transfer of medical services to outpatient setting took up only 4.9% of the total payment reduction. The change of unit price or composition took up 5.5% of the total payment reduction. In this study we found that it is possible to reduce the inpatient services through practice pattern change in university hospital setting. However, it needs to be careful to adjust DRG payment after the reduction of provided services, because most of reduction was not due to service transfer but to service volume reduction. It is desirable to utilize the saving from practice pattern change as incentive to improve quality of care.
Impact of Price Control on Drug Expenditure and Factors Associated with the Drug Switch among Statins: Analysis of HIRA-NPS Data
Lee, Hye-Jae ; Lee, Tae-Jin ;
Health Policy and Management, volume 23, issue 2, 2013, Pages 112~123
DOI : 10.4332/KJHPA.2013.23.2.112
Background: Under the risk of financial sustainability of National Health Insurance, Korean government attempted a series of regulations over pharmaceutical prices. The first price-cut was implemented to the hyperlipidemial treatments, and the prices of statins were reduced on 15th, April in 2009. The purposes of this study are 1) to investigate the impact of this price-cut on pharmaceutical expenditure, and 2) to identify the factors associated with drug-switch among statins. Methods: Using the national patients sample data, this study conducted time series analysis on the expenditures, prices, and volumes of statin drugs. To understand the factors associated with drug-switch, the multinomial logit model was analyzed at the patients level. Results: The results of time series analysis demonstrated that the price-cut of hyperlipidemic medicines did not lead to the reduced expenditure, suggesting the increased volume was the major cause. The multinomial logit analysis identified the switch of healthcare provider as the significant factor that was highly associated with drug-switch, implying the physicians' preference was the major motivation of drug-switch. Conclusion: Without control of utilization, price regulation itself could not reduce pharmaceutical expenditure. This suggests that the pharmaceutical regulations should be implemented on the basis of understanding of provider behaviors. The findings of this study will form the first step for further empirical studies.
Economic Length of Stay and Opportunity Income of Appendectomy and Pneumonia Using Activity-based Costing
Kim, Sang Mi ; Lee, Hae Jong ; Shin, Dong Gyo ;
Health Policy and Management, volume 23, issue 2, 2013, Pages 124~131
DOI : 10.4332/KJHPA.2013.23.2.124
Background: This study aimed to measure the opportunity income by identifying the economic length of stay (ELOS) which is the intersection point of daily revenue and cost on appendectomy and pneumonia cases. Methods: The research subjects were 460 patients of appendectomy and 606 patients of pneumonia, discharged from a general hospital between July 1, 2009 and June 30, 2010. ELOS calculated with both of total revenue on diagnosis-related group (DRG) and fee-for service (FFS). The cost is calculated by activity-based costing system of the hospital. Results: Average length of stay (ALOS) of appendectomy was 4.48 days and its average revenue per case were 1,710,215 (1,989,105) won by DRG (FFS). The variable cost was 491,262 won which was 28.7% (24.7%) of DRG (FFS) total revenue. And 97.2% of the total variable cost was incurred within 2 days from admission. The ELOS was 4 (5) days in DRG (FFS). Shortening three days (two days) would increase opportunity income 52.0% (82.2%) in DRG (FFS). ALOS of pneumonia case was 4.86 days and its average revenue per case were 489,448 (761,426) won by DRG (FFS). The variable cost was 27,230 won which was 5.6% (3.6%) of DRG (FFS) total revenue. Thirty-eight point nine percent of the daily variable cost was incurred in discharge date. The ELOS was 2 (4) days in DRS (FFS). Shortening three days (one day) would increase opportunity income 27.6% (37.2%) in DRG (FFS). Conclusion: The ELOS would be used by strategic index for achieving minimum profit and developing the ways to get there. But we also should not pass over that the opportunity income obtained by the reducing ALOS may cause some problem of quality.
Effect of the Long-term Care Insurance Policy on Medical Expenditures for the Elderly
Han, Nam-Kyung ; Chung, Woojin ; Kim, Roeul ; Lim, Seungji ; Park, Chong-Yon ;
Health Policy and Management, volume 23, issue 2, 2013, Pages 132~144
DOI : 10.4332/KJHPA.2013.23.2.132
Background: The purpose of this study was to analyze the medical expense change and influencing factors after introducing longterm care insurance system. The study period was 2 years before and after introduction of the system. Methods: We analyzed data collected from two divided group lived in Incheon. Four hundred and eighty-five elderly who received long-term care wage for one year were selected for experimental group. For control group, 1,940 elderly were selected by gender and age stratified random sampling. Difference-In-difference analyses was used for evaluating policy effectiveness. Also multiple regression analyses were conducted to identify the factors associated with total medical expenditures. The control variables were demographic variables, economic status, diseases, and medical examination variables. Results: Difference-in-difference analyses showed that total average medical expenses among long-term patients has decreased by 61.85%. Of these, the hospitalization expenses have decreased by 91.63% and the drug expenses have increased by 31.85%. Multiple regression analyses results showed that total average medical expenses among long-term patients have significantly decreased by 46.5% after introducing the long-term care insurance. The hospitalization expenses have significantly decreased by 148.5%, whereas the drug expenses have increased by 53.6%. And outpatient expenses have increased by 10.4%, but the differences were not statistically significant. Conclusion: The results showed that total medical expenses and hospitalization expenses have decreased after introducing the long-term care insurance. These results could support the opinion that the health insurance spending among long-term patients will be reduced gradually by long-term care insurance through changing medical demand.
Satisfaction Gaps among Physicians, Nurses, and Patient Family in the Emergency Department
Kang, Kyunghee ;
Health Policy and Management, volume 23, issue 2, 2013, Pages 145~151
DOI : 10.4332/KJHPA.2013.23.2.145
Background: The objective of this study was to explore patient family's evaluation of emergency department (ED) service satisfaction and to compare these with ED staff perception of patient family's evaluation. Methods: Based on two surveys of the National Emergency Medical Center: the 2008 National Survey for Recognition and Satisfaction towards Emergency Medical Services and the 2008 Opinion Survey of Emergency Medical Service Providers, satisfaction gaps among physicians, nurses, and patient family were evaluated by Kruskal-Wallis tests and Wilcoxon-Mann-Whitney tests. Furthermore, the factors associated with satisfaction of emergency medical service were identified by ordinal logistic regression models. Results: There were statistically significant gaps among physicians, nurses, and patient family in overall satisfaction with ED visit, length of stay in ED, enough explanation, physicians/nurses kindness, and ED facilities. Age and income in the patient family model, the number of beds in hospital, job satisfaction and year of service in the physicians model, and the number of beds in hospital, job satisfaction and the number of patients per duty hour in the nurses model were statistically significant factors associated with evaluation/ perception of ED service satisfaction. Conclusion: Patient satisfaction is an important indicator of the quality of care and service delivery in the ED. To improve and understand satisfaction in ED service, a dyadic view of the evaluation of service quality and satisfaction-that is, from the perspectives of both the patient and the emergency medical service providers-should be concerned.
Developing the Inpatient Sample for the National Health Insurance Claims Data
Kim, Logyoung ; Sakong, Jin ; Kim, Yoon ; Kim, Sera ; Kim, Sookyeong ; Tchoe, Byongho ; Jeong, Hyoungsun ; Lee, Taerim ;
Health Policy and Management, volume 23, issue 2, 2013, Pages 152~161
DOI : 10.4332/KJHPA.2013.23.2.152
Korea has a single National Health Insurance program and all citizens are covered under this program, accounting 97% of the population, approximately 50 million people. Claims submitted by Health care providers are reviewed by Health Insurance Review and Assessment (HIRA) for the reimbursement. HIRA database contains not only individual beneficiary's information, but also healthcare service information such as diagnosis, procedures, prescriptions and tests for them. HRA database has gained attention as importance source for research due to its rich healthcare information and the demand of HIRA database has increased. Due to its tremendous size, however, researchers have had problems in accessing the database to conduct research. To meet this demand, we conducted a study to develop the inpatient sample data from HIRA database for research. This study has two purposes: 1) to determine a needed sample size; 2) to test reliability and validity of the sample data. We determined an adequate sample size to ensure representativeness and generality with additional consideration for convenience of calculation. The minimum sample size was 729,904 for the generality, and 488,861 for representativeness. After considering the convenience of calculation, our final sample size was 13% of the population, which was about 7.7 million beneficiaries. Age (5 years interval) and gender were used as stratification variables for sampling. In order to examine whether this sample data appropriately reflect population, we tested the reliability and validity of the sample data. From the sample data, we computed average expenditure of total claims per inpatient for 2011, frequency of top 30 disease, estimation of the number of stroke patients from the sample data, and then compared them to those from the population. Results confirmed reliability and validity of the sample data.
Relationship between Social Support, Psychosocial Factors, and Health Behaviors in the Elderly
Roh, Yun Ho ;
Health Policy and Management, volume 23, issue 2, 2013, Pages 162~175
DOI : 10.4332/KJHPA.2013.23.2.162
Background: The purpose of this study was to analyze the association between social support, psychosocial factors, and health behaviors of old adults in korean society. Methods: The data which was used in this study was extracted from the second wave of the Korean longitudinal study of aging in 2008. A total of 3,978 elderly aged 65 years or older were included in this study. We conducted
-test, t-test for the elderly health behavior in accordance with their social support and psychosocial factors. Also, multivariate logistic regressive analysis was performed in order to find how degree social support and psychosocial factors are associated with health behavior after adjusting sex, age, smoking (alcohol drinking), and other significant variables. The data was processed by SAS ver. 9.1 and Stata SE ver. 11. Results: Social support in older adults was significantly associated with lower smoking, alcohol drinking, exercise, and eating habit. Also, psychosocial factors were positively associated with smoking, alcohol drinking, regular exercise, and eating habit. Conclusion: health behaviors of old adults are likely to be vulnerable to social support and psychosocial factors. To increase effectiveness of the health policy for the elderly in Korea, it is important to adapt new strategy to include the empowerment of elderly's social networks, policy support to enhance subjective expectation, and life satisfaction.
Evaluating the Performance of the Emergency Medical Services Index
Eun, Sang Jun ; Lee, Jin-Seok ; Kim, Yoon ; Jung, Koo Young ; Park, Sue Kyung ; Lee, Jin Yong ;
Health Policy and Management, volume 23, issue 2, 2013, Pages 176~187
DOI : 10.4332/KJHPA.2013.23.2.176
Background: In 2006 Emergency Medical Services Index (EMSI), which summarizes the performance of regional emergency medical services system, was developed. This study assesses the performance of the EMSI to help determine whether EMSI can be used as evaluation tool. Methods: To build a composite score of the EMSI from predefined 24 indicators, 3 normalized values were calculated for each indicator, the normalized values of each indicator were weighted using 4 weighting methods, and the weighted values were aggregated into the final composite score using 2 aggregation schemes. The performance of EMSI was evaluated using 3 criteria: discrimination, construct validity, and sensitivity. Discrimination was the proportion of regions that did not include the overall median rank in the 5th to 95th percentiles rank interval, which was calculated from Monte Carlo simulation. Construct validity was a correlation among the alternative EMSIs. Sensitivity of EMSIs was evaluated by total shift of quartile membership and changes of 5th to 95th percentile intervals. Results: The total discrimination performance of the EMSI was 50.0%. Correlation coefficients between EMSIs using standardized values and those using rescaled values ranged from 0.621 to 0.997. Variation of the quartile membership of regions ranged from 0.0% to 75.0%. The total change in the 5th to 95th percentile intervals ranged from -19 to +17 places. Conclusion: The results suggested that the EMSI could be used as a tool for evaluating quality of regional EMS system and for identifying the areas for quality improvement.
Performance evaluation for Ten-years of Government Separation Policy on Prescription and Dispensing of Drugs: A Literature Review Study
Lee, Changwoo ; Shin, Euichul ; Park, Sojung ; Kim, Hojong ; Kim, Wonshik ;
Health Policy and Management, volume 23, issue 2, 2013, Pages 188~195
DOI : 10.4332/KJHPA.2013.23.2.188
Background: The separation of pharmaceutical prescription and dispensing law was implemented in July 1st of 2000. This law was initiated by government without a through consensus among related stakeholders in the process of policy decision, eventually raising contention about decision making process rather than the performance of the policy. Methods: Therefore, this study tries to identify the accomplishment of the policy goals; based on the last decade's research we assessed inhibition of unnecessary prescription, drug misuse and overuse prevention, prevention of drug-related sentinel events, reducing unnecessary drug utilization, and reducing nation's medical cost. Results: Assessment results represent that government-suggested goal of the policy lacks sufficient evidence to evaluate accomplishment. Conclusion: Unlike other studies that evaluate problems regarding drug dispensing policy in the policy decision process, this study is meaningful in that it evaluated the policy goal based on the last ten years of related study results.
The Role of 10 Medical Doctors Trained in the US under the US Military Government in Korean Public Health Administration
Shin, Young-Jeon ; Seo, Jae Hee ;
Health Policy and Management, volume 23, issue 2, 2013, Pages 196~206
DOI : 10.4332/KJHPA.2013.23.2.196
On September 24th of 1945, the existing Health Department under the Bureau of Economy and Trade was abolished complying with the Article 1 of the Ordinance of US military occupation "Establishment of Health Bureau". After the establishment of the Health Bureau, one of its first priorities was to select South Korean medical doctors and send them away to the US for training "in order to educate the talents necessary for the Health Bureau to address the public hygiene and health issues of Korea". Under the sponsorship of Rockefeller Foundation, the US Military Government sent 10 Korean medical doctors to three universities. After they came back to Korea from the training in the US, they played significant roles in building and managing the Korean health and medical system under the US Military Government as well as during the post-war of Korea and in the 1960s-1970s. Furthermore, they made a great contribution to expanding and transplanting the 'American-style' health and medical system in heath administration, health research and medical education in Korea. On the one hand, this means the limitation and elimination of an independent, progressive idea in the health and medical field as the influence of the US within the country after the liberation expanded. The lives of 10 doctor represent an important symbol of how the Korean health and medical field has been established under the domestic and overseas political conditions, 'colonization-liberation-military occupation of the Powers', and one part of the concrete history.