Demand for high quality medical care has recently been increasing in step with high level of income and education. Patients prefer the use of large general hospitals to small community hospitals. Large hospitals, usually located at urban area, expand their capacities to cope with the increasing demand, therefore, they easily secure revenue necessary for growth and development of hospitals. However, small community hospitals are facing with serious financial difficulties caused from the reduction of patients in one hand and the inflation of cost in another. If small rural hospitals were closed, the closure would have negative impacts on local economies in addition to the decrease in access to medical care. Community leaders should have an insight on the contribution of community hospitals to local economies. They could make a rational decision on the hospital closure only with the understanding of hospital's contribution to the community. This study is designed to develop an economic model to estimate the contribution of rural hospital to local economies, and also to apply this model with a specific hospital. The contribution of a hospital to local economies consists of two elements, direct effect and multiplier effects. The direct impacts include hospital's local purchasing power, employee's local purchasing power, and the consumption of patients coming from outside the community. The direct impact induces multiplication effect in the local economy. The seed money invested to other industries grows through economic activities in the economy. The seed money invested to other industries grows through economic activities in the region. This study estimated the direct effect with the data of expenditure of the case hospital. The total effect was calculated by multiplied the direct effect with a multiplier. The multiplier was drown from the ratio of marginal propensity of income and expenditure. Beside the estimation of the total impacts, the economic effect from the external resources was also analyzed by the use of the ratio of patients coming outside the region. The results are as follows. 1. The direct economic contribution of the hospital to the local economy is 1,104 million won. 2. The value of multiplier in the region is 2.976. 3. The total economic effect is 3,286 million won, and the multiplication effect is 2,182 million won. 4. The economic contribution from the external resources is 245 million won which is 7.5% of the total economic effect.
Education ; Growth and Development ; Hand ; Health Expenditures ; Health Facility Closure ; Hospitals, Community ; Hospitals, General ; Hospitals, Rural* ; Humans ; Inflation, Economic ; Models, Economic

BACKGROUND: An animal model was used to study the effects of 85% oxygen pretreatment on the pulmonary toxicity of 100% oxygen exposure in rats. The hypothesis was that pretreatment of rat with 85% oxygen reduced mortality, decrease of compliance and pathologic changes. METHODS: 32 rats were divided into 4 groups. Group 1 breathed 85% oxygen for 72 hours and exposured to room air for 24 hours. Group 2,3,4 breathed 85% oxygen for 72 hours and exposured to 100% oxygen for 24, 48, 72 hours respectively. After the exposure, survived rats were intubated through a tracheostomy, and inflation and deflation lung-thorax compliances were calculated. Lung weight per body weight ratios were obtained and the lung specimens got prepared to be examined microscopically. RESULTS: Inflation and deflation lung-thorax compliances of group 2,3,4 were lower(P<0.05) compared to group 1. Lung weight per body weight ratios of group 2,3 were increased significantly(P<0.05) compared to group 1, but that of group 4 did not have any difference compared to group 1. Pulmonary pathologic findings did not show any significant differences between 4 groups. In group 3, 1 of 8 rats was died and in group 4, 2 of 8 rats were died. CONCLUSIONS: We concluded that the pulmonary oxygen toxicity provoked by 100% oxygen exposure was partially prevented by pretreatment of 85% oxygen exposure. And more studies about the method of preventing pulmonary oxygen toxicity should be performed.
Animals ; Body Weight ; Compliance ; Edema ; Inflation, Economic ; Lung ; Models, Animal ; Mortality ; Oxygen* ; Rats* ; Tracheostomy

China has a long history of the international trade of traditional Chinese medicine(TCM).And the export products mainly composed of Chinese herbal medicine and its extracts with Chinese patent herbal medicine and health care products as complementary items.The international trade of TCM faces problems of structural disequilibrium in export products and trade barriers.In this study,we used Michael Porter's diamond model to analyze the international competitiveness of TCM industry.We found that TCM industry in China was rich in production factors and broad in market demands,but lack of the related and supporting industries.In addition,compared with the herbal medicine manufacturers in European,American and Japanese,enterprises in China were weaker in the strategy making,market positioning and industry competing.The development of the international market of herbal medicine,the arrival of the aging society,and the introduced policies of the TCM,provide great opportunities for TCM industry' s development.In order to improve the competitiveness of the TCM industry,we propose to increase the international recognition of TCM by developing clinical study,cope with international trade barrier by strengthen international standardization research,and improve the competitiveness of TCM industry by economies of scale formed by the accumulation of the pharmaceutical industry.
China ; Drugs, Chinese Herbal ; economics ; Medicine, Chinese Traditional ; economics ; Models, Economic

Due to the quasi-public attributes of medical service, the supply mode and system could influence equity and fairness of general people's health. Based on the view of public economics, the purpose of this paper was to explain the economic nature of medical service supply. By analyzing the practice of public-private partnership (PPP) mode in medical care supply and the related public economic issues, we summarized the feasibility and risks of PPP model in Chinese medical care supply market. Finally, we discussed the innovative medical service system provided by government, public hospitals, and social capitals together. Therefore, to guarantee further development of this new medical service supply--PPP mode, we should pay attention to some practical problems, such as the share of cooperation cost and the balance between the benefit and risk among all partners.
China ; Delivery of Health Care ; organization & administration ; Models, Economic ; Public-Private Sector Partnerships ; economics

BACKGROUND: Coronary stent is known as an effective treatment in the intimal dissection after angioplasty and the prevention of restenosis. However, in-stent restenosis still remains a major concern in clinical stenting. METHOD: The Microstents were placed in 151 patients from May '96 to Aug '97 and performed follow-up coronary angiograms in 49 (32.5%) patients. To identify the clinical, angiographic and procedure-related variables that predict late restenosis within the stented artery, 49 patients (58+/-8 year:38 M, 11 F) were studied. Indications for stenting were 25 de novo (52.8%), 9 restenotic (18.7%), 8 suboptimal PTCA (16.7%) and 6 bail-out lesions (12.6%). All patients were treated with aspirin and ticlopidine for one month after stenting. The follow-up angiograms were obtained at 5+/-3 months and variables of 13 patients with restenosis were compared with those of 36 patients without restenosis. RESULTS: The in-stent restenosis rate was 26.5%. Univariate logistic regression analysis was used to determine how in-stent restenosis was influenced. Clinical diagnosis, presence of risk factors, lipid profiles, numbers of involved vessels, target arteries, lesion length, lesion types, stent length, maximal inflation pressure, predilation balloon size, reference vascular diameter, minimal luminal diameter, and stent to artery diameter ratio were analyzed. Among these variables, only lesion length before stent implantation was a predictor for in-stent restenosis (19.9+/-11.1 mm vs. 10.9+/-7.3 mm, p=.017). CONCLUSION: Lesion length before Microstent II implantation is the single predictor of late in-stent restenosis.
Angioplasty ; Arteries ; Aspirin ; Diagnosis ; Follow-Up Studies ; Humans ; Inflation, Economic ; Logistic Models ; Phenobarbital ; Risk Factors ; Stents ; Ticlopidine

OBJECTIVES: Postintubation tracheal ruptures (PTR) are rare but cause severe complications. Our objective was to investigate the tracheal pattern of injury resulting from cuff inflation of the tracheal tube, to study the two main factors responsible for PTR (cuff overinsufflation and inapplicable tube sizes), and to explain the context, why small women are particularly susceptible to PTR. METHODS: Experimental study performed on 28 fresh human laryngotracheal specimens (16 males, 12 females) within 24 hours post autopsy. Artificial ventilation was simulated by using an underwater construction and a standard tracheal tube. Tube sizes were selected according to our previously published nomogram. Tracheal lesions were detected visually and tracheal diameters measured. The influence of body size, sex difference and appropriate tube size were investigated according to patient height. RESULTS: In all 28 cases, the typical tracheal lesion pattern was a longitudinal median rupture of the posterior trachea. Appropriate tube sizes according to body size caused PTR with significantly higher cuff pressure when compared with oversized tubes. An increased risk of PTR was found in shorter patients, when oversized tubes were used. Sex difference did not have any significant influence. CONCLUSION: This experimental model provides information about tracheal patterns in PTR for the first time. The model confirms by experiment the observations of case series in PTR patients, and therefore emphasizes the importance of correct tube size selection according to patient height. This minimizes the risk of PTR, especially in shorter patients, who have an increased risk of PTR when oversized tubes are used.
Autopsy ; Body Size ; Female ; Humans ; Inflation, Economic ; Male ; Models, Theoretical ; Nomograms ; Respiration, Artificial ; Rupture* ; Sex Characteristics ; Trachea ; Ventilation

BACKGROUND: There have been few studies about pain using a big data. The purpose of this study was to identify the prevalence of pain, and trends of pain associated with chronic diseases and personal out-of-pocket medical expenditures over time. METHODS: Subjects were 58,151 individuals, using the Korea Health Panel from 2009 to 2013. Chi-square and multinomial logistic regression were conducted to identify the prevalence and odds ratios (ORs) of pain. Repeated measures ANOVA was used to find the trend over these 5 years. RESULTS: Prevalence of mild and severe pain was 28.1% and 1.7% respectively. The ORs of mild and severe pain were 1.6 and 1.4 in females compared with males. From 2009 to 2013, numbers of chronic diseases producing mild pain were 2.1, 2.4, 2.8, 2.9, and 3.1 and those producing severe pain were 3.0, 3.4, 3.9, 4.2, and 4.4, respectively. After applying the average South Korean inflation rate by year over 5 years, the annual, personal out-of-pocket medical expenditures (unit: ￦1,000) for mild pain were 322, 349, 379, 420, and 461, and those for severe pain were 331, 399, 504, 546, and 569, respectively (P < 0.0001). CONCLUSIONS: The pain prevalence was 29.8%. The numbers of chronic diseases and the personal out-of-pocket medical expenditures revealed increasing trends annually, especially in those with pain. Therefore, to eliminate and alleviate the pain, there needs to be further study for developing a systemic approach.
Chronic Disease* ; Female ; Financing, Personal ; Health Expenditures* ; Humans ; Inflation, Economic ; Korea* ; Logistic Models ; Male ; Odds Ratio ; Prevalence*

Drug Costs ; Ethics, Medical ; Health Care Costs ; Health Services Accessibility ; Humans ; Models, Economic ; Morals ; Physicians ; ethics ; Singapore ; United Nations

Physician payment system (PPS) is a principal incentive system to motivate doctors to provide excellent care for patients. During the past decade, physician remuneration in China has not been in proportional to physician's average work load and massive responsibilities. This paper reviewed the constitution of the PPS in China, and further discussed the problems and issues to be addressed with respect to pay for performance. Our study indicated that the lower basic salary and bonus distribution tied to "profits" was the major contributor to the physician's profit-driven incentive and the potential cause for the speedy growth of health expenditures. We recommend that government funding to hospitals should be increased to fully cover physicians' basic salary, a flexible human resource and talent management mechanism needs to be established that severs personal interest between physicians and hospitals, and modern performance assessment and multiplexed payment systems should be piloted to encourage physicians to get the more legitimate compensation.
China ; Models, Economic ; National Health Programs ; economics ; Physician Incentive Plans ; economics ; Physicians ; economics ; Salaries and Fringe Benefits ; economics

This study estimates the treated prevalence of schizophrenia and the annual costs associated with the illness in Korea in 2005, from a societal perspective. Annual direct healthcare costs associated with schizophrenia were estimated from National Health Insurance and Medical Aid records. Annual direct non-healthcare costs were estimated for incarceration, transport, community mental health centers, and institutions related to schizophrenia. Annual indirect costs were estimated for the following components of productivity loss due to illness: unemployment, reduced productivity, premature mortality, and caregivers' productivity loss using a human capital approach based on market wages. All costs were adjusted to 2005 levels using the healthcare component of the Consumer Price Index. The treated prevalence of schizophrenia in 2005 was 0.4% of the Korean population. The overall cost of schizophrenia was estimated to be $ 3,174.8 million (3,251.0 billion Won), which included a direct healthcare cost of $ 418.7 million (428.6 billion Won). Total direct non-healthcare costs were estimated to be $ 121 million (123.9 billion Won), and total indirect costs were estimated at $ 2,635.1 million (2,698.3 billion Won). Unemployment was identified as the largest component of overall cost. These findings demonstrate that schizophrenia is not rare, and that represents a substantial economic burden.
Adult ; Aged ; Cost of Illness ; Female ; Health Care Costs ; Health Expenditures ; Humans ; Korea ; Male ; Middle Aged ; Models, Economic ; Models, Theoretical ; Prevalence ; Schizophrenia/*economics/*therapy ; Sensitivity and Specificity