BACKGROUND AND OBJECTIVES: The Korean National Health Insurance is based on 'fee for service' system, but recently 7 groups of diseases were forcibly applied to diagnosis related groups (DRG) system. In these 7 group of diseases, tonsillectomy and adenoidectomy were included in the otorhinolaryngology field. The objective of this research is to estimate the invested medical costs, profit and loss, and improvement points for the disease groups according to DRG and 'fee for service' system. SUBJECTS AND METHOD: We investigated 1,377 subjects who underwent tonsillectomy and adenoidectomy based on DRG between January 2011 to December 2013 at our hospital. The profit and loss of medical costs were calculated according to medical record data, medical service fee, and activity based costing (ABC). RESULTS: The total of 1,377 subject comprised of 905 patients younger than 17 years-old and 472 patients older than 18 years-old. A main moderate complication that was not one of the DRG diseases, postoperative bleeding, was only found in 19 patients (1.38%). Profit related to tonsillectomy and adenoidectomy studied for a 3 year-period was higher in the DRG system than in the 'fee for service' system; however, profit was reported as 62.9-67.5% of the actual prime costs. CONCLUSION: DRG system for tonsillectomy and adenoidectomy seems to have higher compensation rate than the 'fee for service' system does. However, the system is still insufficient to compare profit with the input medical cost. Furthermore, the present system of disease grouping needs to be improved to reflect actual medical prime costs.
Adenoidectomy* ; Compensation and Redress ; Diagnosis-Related Groups ; Fee-for-Service Plans ; Fees and Charges ; Hemorrhage ; Humans ; Medical Records ; National Health Programs ; Otolaryngology ; Tonsillectomy*

OBJECTIVE: To evaluate the relative benefits and the costs associated with the introduction of the new pharmaceutical provision called 'Mandatory Prescription Syste m' which separates the role of physicians from that of pharmacists with respect to the prescription and dispensation of from the perspective of consumers (i.e., patients). METHODS: The costs of the system were measured by considering both direct and indirect costs. Direct costs included additional payments for ambulatory care and dispensing fees that occurred under the new system. Indirect costs consisted of transportation expenses and costs related to time spent for physician consultation, waiting for the prescriptions to be filled, and extra traveling. Benefits identified in this study were the reduction of drug misuse and overuse, and the overall decrease in drug consumption among the Korean population. Sensitivity analysis was performed for the inclusion of benefits for outpatients of hospitals, price elasticity, and increased fees for established patients. RESULTS: The net benefit was estimated to be about minus 1,862 billion won and the benefit-cost ratio was 0.478. This indicates that the costs of 'Mandatory Prescription' outweigh its benefits, relative to the previous system. The sensitivity analysis results for all the variables considered in this study consistently showed the benefit-cost ratio to be less than 1. CONCLUSION: The results of this study suggest that implementing Mandatory Prescription System in Korea might be inefficient from the consumer's perspective. The results of this study do not coincide with the results of previous studies, presumably because of the differences in study design and in which items of costs and benefits were considered.
Ambulatory Care ; Cost-Benefit Analysis* ; Elasticity ; Fees and Charges ; Humans ; Korea* ; Outpatients ; Pharmacists ; Prescription Fees ; Prescriptions* ; Transportation

PURPOSE: The purpose of this study was to analyze the differences in perception between the students and faculty on course evaluation by the students and to pursue the improving of the course evaluation system. METHODS: This study targeted 61 faculty and 88 students of the School of Medicine at A University. A questionnaire survey was administered. RESULTS: Both the students and faculty members agreed with the need of a course evaluation system, but there were differences in perception between the two groups in terms of efficiency and factors affecting evaluation results. CONCLUSION: The department in charge of course evaluations of the school of medicine should review the differences in perception between students and faculty and use the reviewed content to improve the present course evaluation system.
Fees and Charges ; Humans ; Schools, Medical ; Surveys and Questionnaires

The purpose of this study is to review communication skills education in medical education. This analysis looks at the reasons why communication skills education is difficult and how to design an effective curriculum for communication skills education. Problems in communication skills education are discussed, especially in relation to the complexity of the communication between patients and physicians, the changing of the communication model, and curriculum composition. Findings show that it is necessary to design a spiral curriculum for communication skills education, to harmonize theory and practice of communication, to encourage student participation, and to provide feedback to students. To educate communication skills, this paper concludes, professors in charge of communication skills education must seriously consider their teaching and evaluating methods and practice what they teach.
Curriculum ; Education, Medical ; Fees and Charges ; Humans ; Learning

BACKGROUND AND PURPOSE: Stroke imposes a major burden on patients, their families, and the national healthcare system. The purpose of this study was to determine the itemized hospital charges in acute ischemic stroke patients according to their severity by partitioning the charges in detail and then examining whether stroke severity was a significant contributor to these charges. METHODS: This study analyzed data of first-time acute ischemic stroke patients who had been admitted to an academic medical center between September 2003 and April 2009. The patients' demographic and clinical characteristics were analyzed descriptively, and then eight categorized hospital charges as well as the total charge were compared among patients grouped according to stroke severity, using analysis of variance. Multiple regression analyses were conducted to test the influence of stroke severity on itemized hospital charges as well as the total charge, while controlling for other related factors. RESULTS: More-severe strokes were associated with a higher total charge. Significantly higher charges were associated with patients with more-severe strokes regarding all charged items except imaging studies. The charges for imaging studies were similar across all severities of stroke. While controlling for other factors, a significant impact of stroke severity was found in both the total hospital charge and most itemized charges. CONCLUSIONS: Itemized hospital charges for inpatients with acute ischemic stroke varied according to stroke severity. Stroke severity was a significant factor influencing the itemized charges of acute hospitalization of ischemic stroke patients.
Academic Medical Centers ; Cerebral Infarction ; Delivery of Health Care ; Fees and Charges ; Hospital Charges ; Hospitalization ; Humans ; Inpatients ; Korea ; Stroke

Medical insurance, which is mandatory in Korea, has been progressed in the way of expanding the relevant population and intensifying the guarantee. However, rapid increases in medical expenses led national health insurance into a state of financial crisis. The government considered the reason of financial crisis as fee-for-service and started reorganizing the terms of payment from fee-for-service to case-payment. Therefore, an expanded diagnosis related group (DRG) payment system is carried out to decrease the expense on health and to secure financial stability. At the same time, the new case-payment system, apposite to the medical case in Korean society, is under demonstration. DRG payment system is in execution for the 7 disease entities of the four departments requested for now. However, it is supposed to be carried out in all the hospitals from the second half of 2012 and be expanded to all the general hospitals from 2013. The new case-payment system is under development because it is difficult to apply DRG to all disease entities. These shake-ups in the payment system will be conducted from the year 2015, combining both the DRG and new case-payment system. Basically, the introduction of the new case-payment system will cause doctors' passive attitude in the treatment of patients. This would be an especially serious problem for the department of surgery whose charge for operation is very low. It would be worse for the vascular surgeons because only 80% of operational or interventional procedures will be compensated, the fee for ultrasound is included in the new case-payment system, and age-related severity is not reflected in the disease entity. If relaunch is inevitable, vascular surgeons should understand the new case-payment system exactly and point out the problems. Also, standard guidelines on treatment per procedure should be set up and used for the established case-payment system, which would be helpful in reducing unnecessary medical expenses.
Diagnosis-Related Groups ; Fee-for-Service Plans ; Fees and Charges ; Hospitals, General ; Humans ; Insurance ; Korea ; National Health Programs

BACKGROUND: As of July 2015, per diem payment was changed from fee for service Therefore, this study aims to analyse changes in medical charges and medical services before and after enforcement of the palliative care, targeting palliative care wards in a general hospital, and provide basic data needed for development of per diem payment. METHODS: The subjects of the study were a total of 610 cases consisting of 351 patients of service fee who left hospital (died) from July 2014 to June 2016 and 259 ones of per diem payment at Chosun University Hospital in Gwangju Metropolitan City. RESULTS: The results are summarized as follows. First, after the palliative care system was applied, benefit medical service charges and insurance increased significantly (p<0.001). As benefit medical service charges increased, benefit private insurance payment increased significantly (p<0.001). Second, after the per diem payment was applied, total private insurance payment to medical institutes decreased significantly (p=0.050) and non-benefit also decreased significantly (p=0.001). CONCLUSION: It is suggested that additional rewards in the obligatory palliative care items should be continuously remedied and monitored to provide good quality hospice palliative care.
Academies and Institutes ; Fee-for-Service Plans ; Fees and Charges ; Gwangju ; Hospices ; Hospitals, General ; Humans ; Insurance ; Palliative Care ; Reward

Digital radiographic systems allow the implementation of a fully digital picture archiving and communication system (PACS), and provide the greater dynamic range of digital detectors with possible reduction of X-ray exposure to the patient. This article reviewed the basic physical principles of digital radiographic imaging system in dental clinics generally. Digital radiography can be divided into computed radiography (CR) and direct radiography (DR). CR systems acquire digital images using phosphor storage plates (PSP) with a separate image readout process. On the other hand, DR systems convert X-rays into electrical charges by means of a direct readout process. DR systems can be further divided into direct and indirect conversion systems depending on the type of X-ray conversion. While a direct conversion requires a photoconductor that converts X-ray photons into electrical charges directly, in an indirect conversion, light-sensitive sensors such as CCD or a flat-panel detector convert visible light, proportional to the incident X-ray energy by a scintillator, into electrical charges. Indirect conversion sensors using CCD or CMOS without lens-coupling are used in intraoral radiography. CR system using PSP is mainly used in extraoral radiographic system and a linear array CCD or CR sensors, in panoramic system. Currently, the digital radiographic system is an important subject in the dental field. Most studies reported that no significant difference in diagnostic performance was found between the digital and conventional systems. To accept advances in technology and utilize benefits provided by the systems, the continuous feedback between doctors and manufacturers is essential.
Dental Clinics ; Fees and Charges ; Hand ; Humans ; Light ; Photons ; Radiographic Image Enhancement ; Radiography, Dental, Digital

The separation of pharmaceutical prescription and dispensing has been mandatory in Korea since July 1, 2000. This policy aimed to reduce drug abuse, prevent the distribution of drugs without a prescription, decrease medical costs and insurance premiums, and provide high-quality health-care services. However, the policy was launched without careful consideration of actual benefits to patients or the resulting national financial burden, and its initial aims remain unfulfilled. Koreans have complained that the policy is inconvenient; a 2008 survey revealed that 87% of people would prefer to have their medications dispensed at medical institutes, rather than at pharmacies. People wish to select a convenient dispensing site; the current policy particularly inconveniences disabled and elderly individuals. From 2000 to 2009, dispensing fees totaled 18,432.4 billion Korean won (16.4 billion US dollar), comprising 27% of all pharmaceutical costs. These fees have contributed to the accelerated rise in national health-care expenses (the most rapid in the world) and to the 2.2-fold increase in insurance-premium payments in 2009, in contrast to those in 2000. Pharmaceuticals continue to be dispensed without a physician's prescription and antibiotic abuse has not been controlled. The increasingly prevalent occurrence of multi-drug resistant bacteria constitutes a serious social problem. The Korean government should recognize the difficulties posed by the financial burden of this policy and its failure to achieve a separation between pharmaceutical prescription and dispensing. To improve this policy, we urge the government to undertake a fair and scientific re-evaluation, despite objections by interest groups to such actions.
Academies and Institutes ; Aged ; Bacteria ; Delivery of Health Care ; Fees and Charges ; Humans ; Insurance ; Insurance, Health ; Korea ; Pharmacies ; Prescription Fees ; Prescriptions ; Public Opinion ; Social Problems ; Substance-Related Disorders

OBJECTIVES: This study aims to investigate the trends and progress in oral health status, dental service items, and fees among children receiving community-based registered dental care over a three-year period. METHODS: The study subjects were selected from nine community children centers in J district of S city, in the Korean province of Gyeonggi-do. The sample included 222 children who had received care in 2011 and 2012, and 205 children, in 2013. The dependent variables were oral health status (df index and decayed-missing-filled teeth index), dental service items (total number of visits and dental fillings by type), and dental fees (total fees, National Health Insurance [NHI] coverage, and NHI non-coverage), analyzed by year. The percentages of dental caries and dental service items were tested using chi-square analysis, and the mean of each variable, including dental fees, was tested using the Kruskal-Wallis method, owing to non-parametric distribution. RESULTS: There was a statistically significant decrease in the rate of dental clinic visits for treatment, and an increase in the mean numbers of filled teeth and sealants performed per year. The rate and number of dental fillings increased steadily, whereas the services for oral health promotion and prevention were decreased. The number of dental visits and the total fees decreased steeply, especially within the second half of the last measured year: around 90,000 earned within that time, compared to 170,000 earned during the first year. CONCLUSIONS: Dental clinic visits should be encouraged on a regular basis for oral health promotion and prevention by both patients and providers using capitation payment systems, for example. It is necessary to monitor and provide training for all related staff by developing a manual for oral health examination and treatment, adjusted for the registered dental system. Policy measures addressing the needs of vulnerable social groups are needed more than ever. Therefore, it is important to provide as much targeted support and training to the registered dental system as possible.
Child Health Services ; Child* ; Dental Care ; Dental Caries ; Dental Clinics ; Dentists* ; Fees and Charges* ; Fees, Dental ; Gyeonggi-do ; Humans ; Insurance, Dental ; National Health Programs ; Oral Health* ; Tooth