• The Korean Journal of Health Service Management
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• v.8 no.3
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• pp.13-25
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• 2014

This research was performed to investigate the characteristics and determination factors on tertiary hospital inpatients. The used data was the four waves of Korea Health Panel(2008, 2009, 2010, 2011), and the number of subjects was 4,430 cases of tertiary and general hospital admission. The statistical methodology used in the study is the logistic regression model. The significant affecting factors in utilizing tertiary hospital admission were gender, marital status, education, household income, residence region and ICD-10 classification. Man, graduating college/university, married, high-income were socio-economic affecting factors in tertiary hospital admission. Medical need factor of ICD-10 classification and residence region of inpatients was also significant affecting factors in tertiary hospital admission. The 81.4% of inpatients at tertiary hospital had chronic disease and the 12.9% of inpatients readmitted, the 68.2% had a selecting doctor and the only 26.7% of inpatients reinforced by private medical insurance. This study recommended the Korean government to provide proper rule for tertiary hospital admission in order to improve the equity and efficiency of health care system.

• Journal of Korean Academy of Nursing Administration
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• v.9 no.1
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• pp.63-73
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• 2003

Purpose : The purpose of this study is to analyze the comparison of organizational climate and job satisfaction of nurses between a secondary hospital and a tertiary hospital. Method : The subjects of this study were 50 nurses who were working in a secondary hospital and 50 working in a tertiary hospital. The data was collected by self-reporting questionnaires. The data were analysed using frequency, percentage, mean, standard deviation, t-test, ANOVA, Pearson's correlation coefficient, regression analysis. Result : 1) There was no statistical significance of the difference of organizational climate between a secondary hospital and a tertiary hospital. However, there was a statistical significance of the difference of job satisfaction. 2) In the organizational climate, there was a significant difference by income in a secondary hospital, and by position in a tertiary center. 3) In the job satisfaction, there was significant differences by age, marriage, position, and duration of working in a secondary hospital, otherwise. there was no significant difference in a tertiary hospital. 4) There was significant positive correlation between organizational climate and job satisfaction. Organizational climate significantly affected job satisfaction. Conclusion : It is suggested that the nursing organizational effectiveness program should be developed with reflecting on organizational characteristics that the nurses perceived.

• Health Policy and Management
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• v.23 no.1
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• pp.19-34
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• 2013

Background: The study describes the changes resulted from imposition on tertiary hospital outpatient coinsurance rate rise policy and in tertiary or general hospital drug coverage rise policy on healthcare service utilization. Methods: Accordingly, the hypothesis about outpatient healthcare utilization after rise policy in outpatient coinsurance rate and drug coverage was established, using interrupted time-series analysis and segmented regression analysis to test the hypothesis. 5-year analysis period (2007. 3-2012. 3) from the outset year was designated, the data about most common 10 high-ranking of the main diseases targeting visiting patient from age of 6 to 64 were collected. Results: The summary on the major research is followed. First, the medical expense and duration of treatment tends to be increased in case of imposition about rise policy in outpatient coinsurance rate in the tertiary hospital under the interrupted time-series analysis. It showed temporary increase and slow down on account of influenza A even after the policy enforcement. In segmented regression analysis, duration of visit and medical expense in the tertiary hospital increased temporally right after the policy implementation and the decreased rapidly depends on period. Both rise and fall is statistically significant. The second, In case of tertiary or general hospital outpatient drug coverage rise policy, all of the tertiary hospital healthcare service utilization variables by the interrupted time-series analysis, drug coverage policy in the general hospital deeply declined according to decreasing trend before policy implementation. The third, in case of segmented regression analysis, the visit duration and medical expense statistically declined right after the policy implementation in both the tertiary and general hospital. Meanwhile, administration day was statistically meaningful only for the decrease right after the policy implementation. Otherwise, general hospital changes are not statistically meaningful. And the medicine cost was statistically, meaningfully decreased after the increase in drug coverage. Conclusion: Finally, the result demonstrated according to the analysis is only 1 hypothesis is denied, the other 2 are partially supported. Then, tertiary hospital outpatient coinsurance rate increase policy comparatively makes decrease effect on long-term healthcare utilization, and tertiary or general hospital outpatient drug coverage policy showed partially short-term effect is assured.

• Korea Journal of Hospital Management
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• v.26 no.1
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• pp.55-70
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• 2021

Purpose: The purpose of this study was to examine the influencing factors of the patient leaning phenomenon in tertiary hospitals. Based on the results of this study, we intended to find implications for improving the problems of the delivery system imbalance in tertiary hospitals caused by patient leaning phenomenon. Methodology/Approach: Qualitative studies were conducted, using focus group interviews and in-depth interviews. The focus group interviews were conducted for 12 users of tertiary hospitals by 2 groups. And in-depth interviews were conducted for 6 tertiary hospital managers. This was considered to be the most effective approach to gather diverse and in-depth information about the influencing factor of patient leaning phenomenon in tertiary hospitals. Findings: In focus group interviews, the reason for choosing tertiary hospitals was the reliability of the hospital(physician, reputation, etc.). And the effect of the policy to strengthen coverage of National Health Insurance and private medical insurance was relatively small. In other words, we found that the individual's desire to receive medical services suitable for one's health status and disease condition was the biggest factor, rather than the cost and policy factors. Practical Implications: We suggested that the appropriate medical care provision should be strengthened according to the role and function of medical institutions. In addition, the education system needs to be reorganized to activate the referral program, expand community medical capabilities, and foster quality primary medical care.

• Korea Journal of Hospital Management
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• v.25 no.4
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• pp.13-28
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• 2020

Purposes: The purpose of this study is to analyze the institutional and personal factors that affect the medical utilization of patients transferred to tertiary medical institutions. Methodology: We retrospectively analyzed the 2 weeks electronic medical records of 1,556 patients, who were referred to the tertiary hospital, from June 15 to 26, 2015. The patient's personal characteristics, referral hospital, referral path, medical experiences and expenses were analyzed for 6 months after the patient's first visit. Findings: The largest proportion (848; 54.5%) of referrals was referred from primary clinic but the referrals of the same tertiary hospital level were one in seven (228; 14.7%) of the patients. Most patients (1,401; 90%) were referred from the clinics and hospitals directly and only one in ten (155; 10%) of the patients utilized the medical referral center. Patients who had been referred from tertiary care institutions had significantly higher medical costs than those referred to primary care (7,560,000 vs 2,333,000 won). The institutional factors including the numbers of visits to outpatient clinic, previous history of hospitalization and operation, consultation to other medical departments and hospitalization fee significantly influenced on medical utility pattern. Personal factors including patient's medical diagnosis and department of disease have a highly correlation with patient's referrals. Practical implications: The medical utilization of medical expenses and experiences is influenced by institutional and individual factors, and it is important to establish a referral system considering the institutional factors of the type of referral hospital.

• Korea Journal of Hospital Management
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• v.7 no.1
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• pp.19-40
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• 2002

The purpose of this study is to find out if there has been any change in the outpatient visit to tertiary care hospitals after the introduction of the new healthcare program that divides the roles of doctors and pharmacists and the reason for the change if there is any. Two tertiary care hospitals with the largest capacity of 1200 beds and two tertiary care hospitals with the lowest capacity of 600-700 beds were randomly selected. Data of the outpatient visits from March-May 2(xx), before the new healthcare system was adopted, were compared with the data from March-May 2001, after the new policy was adopted. Outpatient visits have decreased 5.8% after the new system. There has been a dramatic decrease, especially, in the department of OB-GYN and Pediatrics of tertiary hospitals. Decrease in re-visits is much higher than the first visits. Female patients decreased more than the male patients. Outpatient visits by economically active patients group aged 25-44 declined much. Tertiary hospitals in Seoul and Kyonggi Province, as well. Outpatient income of tertiary hospitals has dropped up to 14.7% due to the decline in outpatient visits and pharmaceutical income, and resell price system which in turn has caused the hospital financial deficits. While the new program has succeeded in lowering the use of antibiotics and injections, it has the pitfall of prescribing long days and expensive drugs. A full-fledged review of the system should be conducted for the establishment of the new system and I believe this study may be a useful references. Furthermore, more profound and overall studies on the chance in the patients use of hospitals are needed.

• Journal of Korean Clinical Health Science
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• v.3 no.1
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• pp.276-289
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• 2015

Purpose. To efficiently manage hospitals, this study aims to analyze the general characteristics, common-type balance sheet, common-type profit and loss statement and financial ratio of a tertiary general hospital and use the results as basic data for future hospital development by comprehending causes for problems and analyzing hospital management. Methods. By using information about a tertiary general hospital, located in A Metropolitan City, provided through Alio (www.alio.go.kr), a public organization information provider, Health Insurance Review & Assessment Service, and Ministry of Health and Welfare, this study used data during 3 years(2011 to 2013) by analyzing the general characteristics, common-type balance sheet, common-type profit and loss statement, industrial mean ratio and financial ratio of hospitals. Results. This study came to the following conclusions through the general characteristics, common-type balance sheet, common-type profit and loss statement, industrial mean ratio, financial ratio, circular chart and ROI by analyzing the data from 2011 to 2013. Conclusions. Overall, A Tertiary General Hospital showed an increase in fixed cost due to the construction of J Hospital and even in the size of capital and assets. It also showed an increase in medical profit, but the increase of its medical cost was higher, resulting in a financial loss. Especially, this hospital showed a slight decrease in net profit, featuring a reduction in inventory turnover. When the management of A Tertiary General Hospital was predicted based on such features, this hospital is expected to improve its profit structure through the opening of J Hospital, and it is necessary for this hospital to increase and sustain the turnover rate of inventories accumulated by managing them better.

• Journal of The Korean Society of Clinical Toxicology
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• v.17 no.1
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• pp.21-27
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• 2019

Purpose: Mortality rate in the health services research field is frequently considered as a proxy for measuring healthcare quality. We compared the mortality rate and hospitalization levels among patients with poisoning. Methods: A population-based study of hospital size and level based on the Korean health insurance and assessment service was conducted to identify the impact of hospital level on patient mortality. Results: We analyzed a total of 16,416 patients, of which 7,607 were from tertiary hospitals, 8,490 were from general hospitals, and 319 were from hospitals. The highest mortality rate of diagnosis regarding poisoning was T60.31 (other herbicides and fungicides, 16%), followed by T60.0 (organophosphate and carbamate insecticides, 12.7%). There was no statistical difference in mortality among hospital levels for gender. Among age groups, tertiary hospitals had lower mortality than general hospitals and hospitals for patients aged more than 70 years (11.9% mortality at tertiary vs 14.2% at general and 23% at hospital; p=0.003, adjusted z score=-6.9), general hospitals had lower mortality than tertiary hospitals and hospitals for patients aged 18 to 29 (0.6% at general vs 2.4% at tertiary and 3.7% at hospital; p=0.01, adjusted z score=-4.3), and hospitals had lower mortality than tertiary hospitals and general hospitals for patients between 50 and 59 years of age (0% at hospital vs 6.4% at general and 8.3% at tertiary; p=0.004). Conclusion: Overall, there was no significant difference between mortality and hospital level among poisoned patients. However, to establish an efficient treatment system for patients with poisoning, further studies will be needed to identify the role of each facility according to hospital level.

• Health Policy and Management
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• v.21 no.4
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• pp.527-540
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• 2011

Some patients tend to visit tertiary hospitals instead of non-tertiary hospitals for minor illnesses, which is a chronic problem within the Korean health care delivery system. In order to reduce the number of patients with minor severity diseases unnecessarily utilizing the tertiary medical services in Korea, the Ministry of Health and Welfare raised the outpatient co-insurance rate for the tertiary hospitals in July, 2009. Another increase in the prescription drug co-insurance rate by the general and tertiary hospitals is scheduled to take place in the second half of 2011. An increase in copayments may discourage the utilization rate of medical services among the underprivileged or patients who require complicated procedures. This study aims to analyze the diabetic patients' utilization rates of tertiary hospitals according to the Comorbidity score. Diabetic patients' data was gathered from the Health Insurance Claims Records in the Health Insurance Review & Assessment Service between 2007-2009. Comorbidity scores are measured by the Charlson Comorbidity Index and the Elixhauser Index. Chi-square and logistic regressions were performed to compare the utilization rates of both insulin-dependents (n=94,026) and non-insulin-dependents (n=1,424,736) in tertiary hospitals. The higher Comorbidity outcomes in the insulin-dependent diabetic patients who didn't visit tertiary hospitals compared to those who did, was expected. However, after adjusting the gender, age, location, first visits and complications, the groups that scored >=1 on the comorbidity scale utilized the tertiary hospitals more than the O score group. Non-insulin-diabetic patients with higher Comorbidity scores visited tertiary hospitals more than patients who received lower grades. This study found that patients suffering from severe diabetes tend to frequently visit the tertiary hospitals in Korea. This result implied that it is important for Korea to improve the quality of its primary health care as well as to consider a co-insurance rate increase.

• Korean Journal of Clinical Pharmacy
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• v.32 no.2
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• pp.106-115
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• 2022

Background: The World Health Organization (WHO) has focused on the need for interprofessional education (IPE) to improve interprofessional collaboration competency and patient health outcomes. Accordingly, most European and North American medical colleges have established IPE for students. However, IPE learning activity in medical wards for the clinical experience of pharmacy students has not been fully reviewed in Korea. Therefore, this study aims to examine the current status of IPE learning activities in wards at tertiary and secondary hospitals in order to identify ways to improve the program. Methods: The official document of cooperation consists of six self-administered questions regarding IPE learning activities in wards. The preceptor's response in each hospital was evaluated. Results: Of the 22 hospitals, 9 tertiary hospitals and 12 secondary general hospitals responded. For the introductory pharmacy practice experience (IPPE), participating in intensive care (IC) was provided at one secondary general hospital (8.3%) and no tertiary hospital. Ward rounds with medical staff members were provided at two tertiary hospitals (22.2%) and one (8.3%) secondary general hospital. A major barrier to executing IPE was lack of rewards and incentives for the faculty and preceptors who participated in the program. Conclusion: In both tertiary hospitals and secondary general hospitals, pharmacy students have limited exposure to IPE learning activities in wards at hospital, and IPPE at most hospitals was carried out in pharmacy settings only. This study suggests that it is necessary for the hospitals to improve and support IPE learning activities in wards in order to improve learners' competency.