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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 7, Issue 2 - Oct 1997
Volume 7, Issue 1 - May 1997
Selecting the target year
The Patient Days and Medical Care Benefits of Finger-Amputated Patients due to Industrial Accident by Hospital and Patient Characteristics
Health Policy and Management, volume 7, issue 2, 1997, Pages 1~18
This study was conducted to analyze patient days and medical care benefits of finger-amputated patients due to industrial accident. The 161 personal data on medical care for finger-amputated patients due to industrial accident(88 in 1994, 73 in 1995) of Regional Labor Office and hospital characteristics were analyzed. The major results of this study were as follows : According to stepwise multiple regression analysis of patient days, number of amputated finger, location of hospital, bed capacity of hospital, presence of plastic surgery in hospital, number of orthopedic specialist per 100 beds, sick leave benefits per day were the major significant variables in order. In stepwise multiple regression analysis with medical care benefits as a dependent variable, presence of plastic surgery in hospital, number of orthopedic specialist per 100 beds, number of amputated finger, sick leave benefits per day, age, bed capacity of hospital were the major significant variables in order. The minimum optimal size with the lowest medical care benefits was a hospital with 300 beds. This shows that the economy of scale is also applicable for hospital industry. In summary, presence of plastic surgery in hospital, number of orthopedic specialist per 100 beds, number of amputated finger, sick leave benefits per day, bed capacity of hospital were the major significant variables in both patient days and medical care benefits.
The evaluation of the appropriateness of resource allocation in a community health center
Health Policy and Management, volume 7, issue 2, 1997, Pages 19~45
This study was performed to evaluate the appropriateness of resource allocation based on the ranking of health center function. Through the Delphi processes, health center functions were ranked in order of importance as follows; planning and research, followed by health education, health promotion, management of chronic diseases, health screening tests, welfare activities, mental health services, medical personnel management, medical services, prevention of communicable diseases, maternal and infant health services, housekeeping, management of oral hygiene, nutrition services, surveillance for community health services, family planning, and administration of the health center. In relation to the above priorities, the allocation of manpower was not appropriate. Even though the expert groups emphasized on functions such as planning and research, health education, and health promotion, they inputted more personnel for administration of a health center, maternal and infant health services, and medical services which were evaluated with lower importance. The budget allocation showed the same trends as the above. Although the functions such as planning and research, health education, and health promotion, and management of chronic diseases were evaluated highly, the budget was allocated accordingo to the the results of the former fiscal year rather than on the importance of function. However the budget for nutrition services, surveillance for the community health services, family planning, and administration of a health center was allocated according to priority. Based upon the above findings, community health center should be given the opportunity to make their own ranking of health center function and to allocate their resources including personnel and budget in order to improve the responsibilities and roles of the community health center.
Prioritisation of Medical Procedure for Health Technology Assessment
Health Policy and Management, volume 7, issue 2, 1997, Pages 46~64
Background & Objectives : Korea is face with the social need for health care technology assessment so that it is urgently needed to found principles and methodology in technology assessment in health care. As a groundwork for health care technology assessment, we tried to prioritize medical technology for assessment. Among medical technologies, procedure is somewhat difficult to assess, compared to drug or equipment. In this study, we aimed at the prioritisation of medical procedure to be assessed, in terms of efficay, safety, and adequacy. Method : For the standardized classification of medical procedure, ICD-9-CM(International Classification of Diseases 9th edition - Clinical Modification) was used. Among the list the procedures coming under otorhinolaringjology and thoracic surgery were selected by three family physicians. The list of procedure was mailed to the board certified surgeons of both disciplines, with the question asking about the necessity for assessment in terms of efficay, safety, and adequacy. Replied questionnaires were analyzed in each procedure. Results : Of 560 otorhinolaryngologist and 480 thoracic surgeon, 114 surgeons replied. Of otorhinolaryngological procedure, incision, excision, and destruction of inner ear : fenestration of inner ear : stapedectomy and its revision were the most urgent technology to assess in the aspect of safety. For adequacy, operations on Eustachian tube: fenestration of inner ear: incision, excision, and destruction of inner ear were highly ranked in necessity, and for efficary, operations on Eustachian tube; external maxillary antrotomy; fenestration of inner ear. Thoracic surgeons replied thoracic procedures, lung transplantation; heart transplantation; implantation of heart assist system [pump] are most important for evaluation in terms of safety; and heart transplantation; Lung transplantation; Implantation of heart assist system [pump] in terms of adequacy, and surgical collapse of lung [Artificia니 pnemothorax or pnuexoperitoeum]; lung transplantation; periarterial sympathectomy in terms of efficacy. As a whole, surgeons regard safety evaluation is more urgent than adequacy or efficary. In addition, otorhinolaryngological surgeons regard evaluation of their procedures more urgent than thoracic surgeons regard theirs. Conclusion : By the questionnaire to board certified physicians, we get some preliminary data for prioritisation of technologies to assess. Through the questionnaire like this, much information would be gathered for technology assessment, especially for medical procedure, if not enough. In the near future, well structured expert opinion gathering research, such as modified Delphi or nominal group technique, should be done succeedingly.
Development of a Payment System for Telemedicine
Health Policy and Management, volume 7, issue 2, 1997, Pages 65~88
In Korea, telemedicine is still under the beginning stage, but we expect that the developing 'Information Highway' will make this technology more common place and more easily used in coming soon. Currently, three hospitals are providing telemedicine services with their subsidiary hospitals which are far away from their remote place. However, the fee schedule of telemedicine services are not well-settled down, of course not reimbursed through current health insurance system. This study aims to develop new payment system for medical services provided through telemedicaine system. To design appropriate fee schedule for telemedicine services, we, first, review the current insurance payment system and telemedicine system both in domestic and foreign countries focusing on its payment system. A framework of telemedicine payment system is proposed in following steps based on information we acquired from this stage. Second. We decide the span of cost items which should be covered by telemedicine payment scheme. In hear, we suggest payment method for telemedicine services should be designed as dual structure which are telemedicine fee that should be reimbursed through payment scheme and any costs related to capital investment that should not be covered by payment system. Which is, payment system for telemedicine services should cover only service-related costs and any costs related to capital investment should be generated through third party such as government, health insurance association, etc. Finally, we suggest new fee schedules for telemedicine services. The key issues on developing telemedicine fee schedules are related with the determination of appropriate additional rate(
). The reasonable additional rate($\alpha$) must determine through careful evaluation of any additional efforts(e. g. : additional work hours which are related to providing telemedicine services). This study shows the process of how to determine appropriate additional rate(
Source of Drug Information among Private Practitioners and Hopital Physicians
Health Policy and Management, volume 7, issue 2, 1997, Pages 89~108
The purpose of this study is to investigate drug information sources which influence physician's prescriptions, and to compare the differences of drugh information sources between private practitioners and hospital physicians. In addition, the ultimate goal of this study is to provide better quality of drug information for both groups of physicians through the professional drug information system. 264 physicians, including general practitioners and all types of specialists who were working in hospitals and private clinics in Taejon and Chungnam area, participated in this study which was conducted by mail. The results are summarized as follows ; 1. Both physician groups received drug informations mainly from medical journals, but there were differences in secondary sources of drug information. Namely, hospital physicians got drug information from annual meetings and textbooks, and private practitioners got it from detail men and colleagues. 2. Drug effect was the first consideration for drug selection in both physician groups. But, in the 2nd consideration, private practitioners concerned about the price, insurance and rebates, but hospital physicians were not. 3. Only 9.2% of the private practitioners satisfied with the sufficiency of drug information, whereas 22.0% of hospital physicians satisfied with it. The most insufficient area of information was drug interaction in both groups and 91.9% of the physicians suggested that a professional drug information system should be introduced. 4. Both physician groups had contacted with detail men frequently. However, it was rare for them to contact with a pharmacist. This phenomenon was more severe in the case of private practitioners. 5. Neither physician groups knew very much about drug informatio centers. However, they would be willig to participate if a professional drug information system were established. Also, they indicated that the information most required was drug interaction.
A Study on Private Health Insurance in Korea
Health Policy and Management, volume 7, issue 2, 1997, Pages 109~146
This study explores the feasibility of activating private health insurance in Korea. The rationale for expanding private supplementary health insurance can be found in many cases of health care reforms in the European countries. Private health insurance can not only relieve the financial distress of the government health insurance programs but also offer the medical institutions incentives to improve the quality of medical care. In Korea there is no supplementary health insurance that reimburses for various kinds of diseases based on a well designed fee schedule. Recently, the cancer insurance is the best seller in the health related insurance market. As observed in the U. S. case, the cancer insurance which pays the predetermined amount (indemnity coverage) regardless of the medical charges incurred to the patient is limited in its coverage for the insured. To provide better protection against catastrophic diseases, the government should give insurance companies incentives to develop health insurance products that cover multiple diseases rather than a single disease. Consumers can hardly understand and compare complex insurance products. To resolve the information asymmetries, the government should publish a consumer report that compare various health insurance products in a user friendly way. In the long run, insurance companies will plan to sell health insurance products that charge risk related premium only when insurers accumulate the underwriting know-hows, the government shares data on various health statistics including claims and demographics, and risk pool for high risk patients is well established and subsidized by the government.
Job Requirements of Top Management in Korean Hospitals
Health Policy and Management, volume 7, issue 2, 1997, Pages 147~176
This research identifies the most important domains in health care administration from now to the year 2005 and differentiates job skill, konwledge, and ability requirements necessary for successful management. Fellows of the Korean Hospital Association from about thirteen percents of the country responded to mail inquiry. Five of eleven domains, in order of ranked importance, were health care delivery concepts, leadership characteristics, quality management, cost/finance and human resources management. Results indicated that while a business orientation is needed for organizational survival, and equal emphasis on person-oriented skills, knowledge, and abilities is required.