Hospitals are experiencing an increasing amount of financial difficulty due to government control of hospital rates since national health insurance has been implemented. The decision support system(DSS) was developed to provide cost and revenue information for the services rendered by each department in an effect to reduce costs. This information may be used to identify the causes of financial loss if cost exceeds revenue and to conduct variance analysis or portfolio analysis to improve financial situation of hospitals. The DSS was developed using a micro-mainframe interface approach where the mainframe computer collects and summarizes daily cost and revenue data and the micro computer computes the cost for each department. The significances of this paper are to determine the cost allocation basis and methods which are suitable to Korean situation and to apply DSS technology to the cost analysis.
Computers, Mainframe ; Cost Allocation ; Costs and Cost Analysis* ; National Health Programs

Most injury is caused by an external cause to the human body, resulting in morphological or functional disability. However, in the physical impairment related diseases, it is difficult for the disease to occur only by internal factors, and it can be said that internal factors and external factors are combined. Therefore, when the physical impairment is caused by disease, it is important to the apportionment analysis of injury to think about the cause of the physical impairment by considering both the external and internal factors. The most commonly used the apportionment guide is the “Rhim's trauma apportionment guideline” in impairment evaluation. But this guideline is often difficult to assess in certain diseases. Since the apportionment analysis of external factors can bring about a difference in degree according to the viewpoint of the assessor, the degree of the physical impairment may vary greatly depending on case by case. Especially, it is not reasonable to assess based on causal relation with common sense or emotional, and it is necessary to make rational assessment based on medical evidence and professional knowledge.
Brain Injuries ; Cost Allocation ; Human Body ; Spinal Injuries

PURPOSE: The purpose of this study was to identify nursing service costs associated with all health care costs incurred by the institution. METHODS: This study was an empirical case study research in which the nursing cost was separated from total medical cost. The nursing cost index was calculated through a cost allocation method after summarizing costs for personnel, raw materials and administration of each department in one public hospital. The 2014 budget plan, published in ‘Public Hospitals Alert’, was used as data and the data were analyzed using the Microsoft Office EXCEL 2013 program. RESULTS: When comparing total medical costs and nursing costs, the nursing cost were 27.14% of the total medical cost. The nursing cost per nurse per hour was calculated as ₩29,128 The nursing cost per inpatient per day was calculated as ₩157,970, and the administration cost per patient was calculated as ₩133,710. CONCLUSION: The results of the research present the process of cost allocation of specific cost elements in the hospital and evidence for administrative costs which in the past have been only vaguely formulated. These are the significant implications of this study.
Budgets ; Cost Allocation ; Costs and Cost Analysis ; Health Care Costs ; Hospital Costs ; Hospitals, Public ; Humans ; Inpatients ; Methods ; Nursing Services ; Nursing*

OBJECTIVES: This study aimed to develop an evaluation protocol of disability weights using person trade-off, and to test the reliability of the developed protocol in a Korean context. METHODS: To develop the valuation protocol, the Global Burden of Disease (GBD) and the Dutch studies were replicated and modified. Sixteen indicator conditions were selected from the Korean version of disease classification, which was based on that of the GBD Study, and the person trade-off method referred to the Dutch method. RESULTS: The disability weights were valued in a two step panel study. The first step was a carefully designed group process by three panels, using person trade-off to establish the disability weights for sixteen selected indicator conditions. The second step consisted of interpolation of the remaining diseases, on a disability scale, by the individual members of three panels. The members of three panels were all medical doctors, with sufficient knowledge of the consequences of a broad variety of diseases. The internal consistency of the Korean disability weights was satisfactory. Considerable agreement existed within each panel and among the panels. CONCLUSIONS: It was feasible to use a modified evaluation protocol from those used in GBD and Dutch studies. This would provide a rational basis for an international comparative study of disability weights.
Classification ; Cost of Illness ; Group Processes ; Humans ; Korea* ; Methods ; Resource Allocation ; Weights and Measures*

PURPOSE: High-fidelity simulation training is effective for learning crisis resource management (CRM) skills, but cost is a major barrier to implementing high-fidelity simulation training into the curriculum. The aim of this study was to examine the cost-effectiveness of self-debriefing and traditional instructor debriefing in CRM training programs and to calculate the minimum willingness-to-pay (WTP) value when one debriefing type becomes more cost-effective than the other. METHODS: This study used previous data from a randomized controlled trial involving 50 anesthesiology residents in Canada. Each participant managed a pretest crisis scenario. Participants who were randomized to self-debrief used the video of their pretest scenario with no instructor present during their debriefing. Participants from the control group were debriefed by a trained instructor using the video of their pretest scenario. Participants individually managed a post-test simulated crisis scenario. We compared the cost and effectiveness of self-debriefing versus instructor debriefing using net benefit regression. The cost-effectiveness estimate was reported as the incremental net benefit and the uncertainty was presented using a cost-effectiveness acceptability curve. RESULTS: Self-debriefing costs less than instructor debriefing. As the WTP increased, the probability that self-debriefing would be cost-effective decreased. With a WTP ≤Can$200, the self-debriefing program was cost-effective. However, when effectiveness was priced higher than cost-savings and with a WTP >Can$300, instructor debriefing was the preferred alternative. CONCLUSION: With a lower WTP (≤Can$200), self-debriefing was cost-effective in CRM simulation training when compared to instructor debriefing. This study provides evidence regarding cost-effectiveness that will inform decision-makers and clinical educators in their decision-making process, and may help to optimize resource allocation in education.
Anesthesiology ; Canada* ; Cost-Benefit Analysis* ; Curriculum ; Education ; Learning ; Resource Allocation ; Simulation Training ; Uncertainty

The disability adjusted life year (DALY), a single indicator of the burden of disease, is widely used to measure the burden of diseases, injuries, and risk factors. In this study, we review the relative sizes of the burden of disease worldwide and the characteristics of the burden of disease of the Korean population. Future research directions for study of the burden of disease in Korea are also suggested. In the Korean population, diabetes mellitus was the leading cause of the burden of disease (970 DALYs per 100,000 population) in 2002, followed by cerebrovascular disease (937 DALYs per 100,000 population) and asthma (709 DALYs per 100,000 population), which differed with the leading causes of the burden of disease globally: unipolar depressive disorder, ischemic heart disease, and cerebrovascular disease. In 2007, cirrhosis of the liver in males and cerebrovascular disease in females became the leading causes of the burden of disease of the Korean population with the epidemiologic transition. Despite the methodological difference with global burden of disease study, these findings represent the characteristics of the burden of disease in Korea. Though many studies have been conducted to measure the burden of disease in Korea, there is a need to go beyond these to combine policymaking for resource allocation, such as cost effectiveness analysis, with burden of disease studies.
Asthma ; Cost of Illness ; Cost-Benefit Analysis ; Depressive Disorder ; Diabetes Mellitus ; Female ; Fibrosis ; Humans ; Korea ; Liver ; Male ; Myocardial Ischemia ; Quality-Adjusted Life Years ; Resource Allocation ; Risk Factors

OBJECTIVES: This empirical study aimed to identify the differences in expenditures by household income level, as well as the patterns of dental care spending by dental services. METHODS: We analyzed the Korea Health Panel's data collected between 2008 and 2010. We calculated expenditures by service items by itemizing dental care services such as conservative, prosthetic, orthodontic, periodontal, surgical, preventive, dental implant care. Then we obtained the ratios of spending per item and per visit to overall out-of-pocket spending on dental care and used these as the weights for dental care cost allocation. Income quintiles were derived using the equivalence scale. Kakwani's concentration index was used to determine the degree of disparity by income quintile, and 95% confidence intervals were computed. RESULTS: Out-of-pocket expenditures on dental care steadily increased over time and income quintile. The analysis of dental care spending by income quintile revealed that the level of expenditure of the first income quintile was 3.6 times lower than that of the fifth income quintile. In terms of expenditure comparison between 2008 and 2010, the first quintile households showed an increased spending on prosthetic and periodontal treatments, whereas the fifth quintile households spent a relatively high proportion on orthodontic and dental implant care. The concentration index revealed that conservative services and root canal treatments was significant and positive, indicating that the demand for, and utilization of, these services increase as household income increases. In contrast, prosthetic services showed a significant negative trend, indicating that these services are not as common among those with higher incomes. CONCLUSIONS: To address the problems associated with the disparity in dental care expenditures based on income levels, it is necessary to establish policies that expand health insurance coverage and provide other supportive measures for low-income populations.
Cost Allocation ; Dental Care* ; Dental Implants ; Dental Pulp Cavity ; Family Characteristics* ; Health Expenditures ; Insurance, Health ; Korea ; Poverty ; Weights and Measures

PURPOSE: This analysis was conducted to evaluate the cost-effectiveness of gemcitabine-cisplatin chemotherapy for non small-cell lung cancer patients in an outpatient setting compared with the traditional inpatient setting. METHODS: A cost-effective analysis was conducted from a societal perspective. The effects of treatment, which was measured as an adverse event rate, were abstracted from a published literature search and empirical data from one university hospital. The costs included both direct and indirect costs. Direct costs included hospitalizations, outpatient visits, and lab tests. Pharmaceutical costs were excluded in analysis because they were same for both options. Indirect costs included productivity loss of patients as well as care-givers. In order to determine the robustness of the results, sensitivity analysis on treatment protocol was conducted. RESULTS: Literature search showed no difference in adverse effect rates between inpatient treatment protocol and outpatient treatment protocol. Therefore, this analysis is a cost-minimization analysis. Cost-savings in the outpatient setting was 555,936 won for one treatment cycle. Our sensitivity analysis indicated that the outpatient chemotherapy still showed cost-savings, regardless of changes in treatment protocol. CONCLUSION: The outpatient gemcitabine-cisplatin chemotherapy for non small-cell lung cancer resulted in cost savings compared to inpatient chemotherapy. More importantly, outpatient chemotherapy could improve the utilization of health service resources in terms of available beds.
Antineoplastic Combined Chemotherapy Protocols/*economics/therapeutic use ; Carcinoma, Non-Small-Cell Lung/*drug therapy/*economics ; Cisplatin/*economics/therapeutic use ; Cost Allocation ; Cost-Benefit Analysis ; Deoxycytidine/*analogs & derivatives/economics/therapeutic use ; Humans ; Lung Neoplasms/*drug therapy/*economics ; Outpatients

When thinking about priority setting in access to healthcare resources, decision-making requires that cost-effectiveness is balanced against medical ethics. The burden of disease has emerged as an important approach to the assessment of health needs for political decision-making. However, the disability adjusted life years approach hides conceptual and methodological issues regarding the claims and value of disabled people. In this article, we discuss ethical issues that are raised as a consequence of the introduction of evidence-based health policy, such as economic evidence, in establishing resource allocation priorities. In terms of ethical values in health priority setting in Korea, there is no reliable rationale for the judgment used in decision-making as well as for setting separate and distinct priorities for different government bodies. An important question, therefore, is which ethical values guiding the practice of decision-making should be reconciled with the economic evidence found in Korean healthcare. The health technology assessment core model from the European network for Health Technology Assessment (EUnetHTA) project is a good example of incorporating ethical values into decision-making. We suggest that a fair distribution of scarce healthcare resources in South Korea can be achieved by considering the ethical aspects of healthcare.
Cost of Illness ; Delivery of Health Care ; Ethical Analysis ; Ethics ; Ethics, Medical ; Health Policy ; Health Priorities ; Judgment ; Korea* ; Quality-Adjusted Life Years ; Resource Allocation ; Technology Assessment, Biomedical ; Thinking

Health conomics refers to the scientific discipline that compares the value of one healthcare program to another. It is a sub-discipline of Micro-economics. A health economic study evaluates the cost (expressed in monetary terms) and effects (expressed in terms of monetary value, efficacy or enhanced quality of life) of a healthcare program or product. We can distinguish several types of health economic evaluation: cost-minimization analysis, cost-benefit analysis, cost-effectiveness analysis and cost-utility analysis. Health economics studies serve to guide optimal healthcare resource allocation, in a standardized and scientifically grounded manner. Health economics research facilitates the translation of health technology assessment into useful information for healthcare decision-makers to ensure that society allocates scarce health care resources wisely, fairly and efficiently. Health economics usually evaluate the outcomes like clinical, economics and humanistic outcomes per costs. Health economics research include pharmacoeconomics, clinical epidemiology, decision analysis, modeling, risk assessment, patient-reported outcomes (quality of life), database analyses, observational studies, and patients registries.
Biomedical Technology ; Cost-Benefit Analysis ; Decision Support Techniques ; Delivery of Health Care ; Dietary Sucrose ; Economics, Pharmaceutical ; Humans ; Outcome Assessment (Health Care) ; Quality of Life ; Registries ; Resource Allocation ; Risk Assessment