PURPOSE: The purpose of this study was to describe the current status of utilization and costs of home health nursing care by the levels of medical institutes in Korea. METHOD: A secondary analysis of existing data was used from the national electronic data information(EDI) of 148 home health agencies for 6 months from May to Oct 2005 in total. RESULT: The 148 agencies had multiple services in cerebral infaction, essential hypertension, sequela of cerebrovascular disease, type 2 diabetes mellitus, etc.. The highest 10 rankings of 76 categories of home health nursing services were composed of 96.4% of the total services, such as simple treatment, inflammatory treatment, urethra & bladder irrigation, inserting indwelling catheter etc., in that order. The highest 20 rankings of 226 categories of home examination services were composed of 77.0% of the total home examination services. In addition, the average cost of home health care per visit was 46,088 Won (approximately equal to 48 Dollars, 1 Dollar=960 Won). The costs ranged from 74,523 Won (approximately equal to 78 Dollars, loss of chronic kidney function, N18) to 32,270 Won (approximately equal to 34 Dollars, other cerebrovascular diseases, I67). CONCLUSION: Results suggest that client characteristics of hospital based HHNC are not different from community based HHNC or visiting nursing services for elderly. The national results will contribute to baseline data used to establish a policy for the home health nursing care system and education.
Adult ; Aged ; Aged, 80 and over ; Community Health Nursing ; Costs and Cost Analysis ; Fees and Charges ; Female ; Health Services for the Aged/*economics/utilization ; Home Care Agencies/*economics/utilization ; Home Care Services, Hospital-Based/*economics/utilization ; Home Nursing ; Humans ; Korea ; Male ; Middle Aged

OBJECTIVES: The purpose of this study was to estimate the socioeconomic costs resulting from alcohol drinking among adolescents as of 2006 from a societal perspective. METHODS: The costs were classified into direct costs, indirect costs, and other costs. The direct costs consisted of direct medical costs and direct non-medical costs. The indirect costs were computed by future income losses from premature death, productivity losses from using medical services and reduction of productivity from drinking and hangover. The other costs consisted of property damage, public administrative expenses, and traffic accident compensation. RESULTS: The socioeconomic costs of alcohol drinking among adolescents as of 2006 were estimated to be 387.5 billion won (0.05% of GDP). In the case of the former, the amount included 48.25% for reduction of productivity from drinking and hangover, 39.38% for future income losses from premature death, and 6.71% for hangover costs. CONCLUSIONS: The results showed that the socioeconomic costs of alcohol drinking among adolescents in Korea were a serious as compared with that of the United States. Therefore, the active interventions such as a surveillance system and a prevention program to control adolescents drinking by government and preventive medicine specialist are needed.
Accidents, Traffic/economics ; Adolescent ; Alcohol Drinking/*economics ; Costs and Cost Analysis ; Efficiency ; Health Services/economics/utilization ; Humans ; *Models, Economic ; Republic of Korea ; Socioeconomic Factors

OBJECTIVES: To identify the effects of supplemental private health insurance on health care utilization and expenditure under the mandatory National Health Insurance(NHI) system in Korea. METHODS: The data were collected by the National Cancer Center in Korea. Cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer were included as study subjects. Data were gathered using a structured questionnaire from face-to-face interviews, the hospital Order Communication System (OCS) and medical records. Clinical, socio-demographic and private health insurance related factors were also gathered. The differences of health care utilization and expenditure were compared between those who have private health insurance and those who do not using t-test and multivariable regression analysis. RESULTS: Individuals with private health insurance spent larger inpatient costs than those without, but no differences were found in utilization in other service such as hospital admissions, hospital days and physician visits. CONCLUSIONS: We found that private health insurance exerts a significant effect on the health care expenditure in inpatient service. These study results can provide a rational basis to plan a national health policy regarding private health insurance. Further studies are needed to investigate the impacts of private health insurance on cancer patients' outcomes and survival rates.
Adult ; Aged ; Female ; Health Expenditures ; Health Services/economics/*utilization ; Humans ; Insurance, Health/*statistics & numerical data ; Korea/epidemiology ; Male ; Middle Aged ; Neoplasms/economics/*therapy ; *Private Sector ; Socioeconomic Factors

OBJECTIVETo explore the situation of equity in health service delivery in the experimental region of new rural cooperative medical scheme (NRCMS).

METHODSA household questionnaire survey was conducted to 2112 residents in the experimental county of NRCMS in Yuexi county with a stratified-cluster sampling on the situation of health service delivery, from July 1-15,2005. Data was analyzed with Epi Info 6.04 and SPSS 11.0 software and indices as rate, ratio, Gini coefficient, concentration index (CI) and chi-square test etc.

RESULTSThere was no significante difference of the treatment-seeking rate during two weeks among five groups economic condition residents (chi2 = 5.52, P > 0.05) and the rates were 48.14 per thousand, 82.90 per thousand, 65.88 per thousand, 48.72 per thousand and 50.66 per thousand respectively with CI = -0.026. Similarly, the hospitalization rates were 59.08 per thousand, 67.36 per thousand, 51.76 per thousand, 58.97 per thousand and 52.86 per thousand respectively in the last year and the CI = - 0.017. But there was a significante difference of rates on chronic disease among the five groups of residents with different economic conditions in the last six months (chi2 = 18.42, P < 0.01) and the rates were 295.40 per thousand, 243.52 per thousand, 230.59 per thousand, 225.64 per thousand and 176.21 per thousand and the CI = -0.055. When income reduced, the prevalence had been increasing among residents. Meanwhile, the collection funds showed unfair in residents with various income and the compensating fund of new rural cooperative medical scheme had not reduced the gap between rich and poor.

CONCLUSIONThere was an unequity of medicine expenditure and compensating fund in residents with various income in the experimental region. The low income residents had a high health service need and the government should improve NRCMS greatly to change the situation.

China ; Data Collection ; Delivery of Health Care ; Health Expenditures ; Health Services Needs and Demand ; Healthcare Disparities ; Humans ; Income ; Rural Health Services ; economics ; utilization

OBJECTIVES: There have been few studies examining the differences in health care utilization across social classes during the last year of life. Therefore, in this study we analyzed the quantitative and qualitative differences in health care utilization among cancer patients across educational classes in their last year of life, and derived from it implications for policy. METHODS: To evaluate health care utilization by cancer patients in the last year of life, Death certificate data from 2004 were merged with National Health Insurance data (n=60,088). In order to use educational level as a social class index, we selected the individuals aged 40 and over as study subjects (n=57,484). We analyzed the differences in the medical expenditures, admission days, and rates of admission experience across educational classes descriptively. Multiple regression analysis was conducted to evaluate the association between medical expenditures and independent variables such as sex, age, education class, site of death and type of cancer. RESULTS: The upper educational class spent much more on medical expenditures in the last one year of life, particularly during the last month of life, than the lower educational class did. The ratio of monthly medical expenditures per capita between the college class and no education class was 2.5 in the last 6-12 months of life, but the ratio was 1.6 in the last 1 month. Also, the lower the educational class, the higher the proportion of medical expenditures during the last one month of life, compared to total medical expenditures in the last one year of life. The college educational class had a much higher rate of admission experiences in tertiary hospitals within Seoul than the other education classes did. CONCLUSIONS: This study shows that the lower educational classes had qualitative and quantitative disadvantages in utilizing health care services for cancer in the last year of life.
Terminal Care/economics/*utilization ; *Social Class ; Patient Admission/statistics & numerical data ; *Neoplasms/economics/epidemiology/therapy ; Middle Aged ; Male ; Korea/epidemiology ; Humans ; Health Services/economics/*utilization ; Health Expenditures/*statistics & numerical data/trends ; Educational Status ; Death Certificates ; Aged ; Adult

OBJECTIVETo investigate the utilization of oral health services and to analyze the factors associated with oral health services for the community residents.

METHODSHousehold health interview and oral health condition survey were conducted to obtain information about oral health services. The respondents were recruited by a multi-stage random cluster sampling procedure. Multiple dummy regression analyses were performed for the assessment of the relative effect of behavioural factors on dental attendance.

RESULTSA total of 2003 families, 4459 people participated in this study. The people seeking dental treatment accounted for 11.3% (502/4459) per year. Young people (OR = 2.072), having medical insurance system (OR = 2.835), short distance to see dentist (OR = 3.535), oral health awareness (OR = 2.595), poor self-assessment of oral health status (OR = 2.014) were the main factors which influenced dental attendance of community residents.

CONCLUSIONSThe utilization of oral health service was low, particularly for middle-aged people and the elderly. Oral health education and medical insurance system should be strengthened.

Adolescent ; Adult ; Aged ; Dental Care ; economics ; utilization ; Dental Health Services ; economics ; utilization ; Health Services Accessibility ; statistics & numerical data ; Health Services Needs and Demand ; Humans ; Income ; statistics & numerical data ; Insurance, Dental ; statistics & numerical data ; Logistic Models ; Middle Aged ; Sampling Studies ; Self-Assessment ; Surveys and Questionnaires ; Urban Health Services ; utilization ; Urban Population ; Young Adult

OBJECTIVETo describe the costs of medical care and utilization of health service of patients with HIV/AIDS.

METHODSPatients with human immunodeficiency virus (HIV)/AIDS treated in the Beijing You'an Hospital were interviewed retrospectively during December 1999. Data on demographic characteristics, disease process, and utilization of health service and costs of hospital-based medical care were collected.

RESULTSA total number of 29 patients with HIV/AIDS were interviewed, including 17 (58.62%) asymptomatic HIV infections and 12 AIDS patients. Asymptomatic HIV infections had a mean of 6 outpatient visits, 1.3 hospitalizations and 58.6 inpatient hospital days per person-year. AIDS patients made, on average, 7.8 outpatient visits, 2.1 hospitalizations and 200.2 inpatient hospital days per person-year. The outpatient and inpatient medical costs were 13,729 RMB and 4,745 RMB for asymptomatic HIV infections, and 15,053 RMB and 22,242 RMB for AIDS patients per person-year respectively. For those who took both outpatient and inpatient medical care, the medical care costs, including costs of outpatient care and those of inpatient care, were 16,248 RMB for asymptomatic HIV infections and 36,795 RMB for AIDS patients.

CONCLUSIONDemands for health services and costs for medical care were high among patients with HIV/AIDS. Further study on utilization of health services and cost of medical care for patient with HIV/AIDS in a wider geographic coverage are needed.

Acquired Immunodeficiency Syndrome ; economics ; Adolescent ; Adult ; Child ; China ; Female ; HIV Infections ; economics ; HIV-1 ; Health Care Costs ; Health Services ; economics ; utilization ; Hospital Charges ; Hospitalization ; economics ; Humans ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVES: This study estimated the annual socioeconomic costs of food-borne disease in 2008 from a societal perspective and using a cost-of-illness method. METHODS: Our model employed a comprehensive set of diagnostic disease codes to define food-borne diseases with using the Korea National Health Insurance (KNHI) reimbursement data. This study classified the food borne illness as three types of symptoms according to the severity of the illness: mild, moderate, severe. In addition to the traditional method of assessing the cost-of-illness, the study included measures to account for the lost quality of life. We estimated the cost of the lost quality of life using quality-adjusted life years and a visual analog scale. The direct cost included medical and medication costs, and the non-medical costs included transportation costs, caregiver's cost and administration costs. The lost productivity costs included lost workdays due to illness and lost earnings due to premature death. RESULTS: The study found the estimated annual socioeconomic costs of food-borne disease in 2008 were 954.9 billion won (735.3 billion won-996.9 billion won). The medical cost was 73.4 - 76.8% of the cost, the lost productivity cost was 22.6% and the cost of the lost quality of life was 26.0%. CONCLUSIONS: Most of the cost-of-illness studies are known to have underestimated the actual socioeconomic costs of the subjects, and these studies excluded many important social costs, such as the value of pain, suffering and functional disability. The study addressed the uncertainty related to estimating the socioeconomic costs of food-borne disease as well as the updated cost estimates. Our estimates could contribute to develop and evaluate policies for food-borne disease.
*Cost of Illness ; Costs and Cost Analysis ; Efficiency ; Foodborne Diseases/*economics ; Health Services/economics/utilization ; Humans ; *Models, Economic ; *Quality-Adjusted Life Years ; Republic of Korea ; Severity of Illness Index ; Socioeconomic Factors

OBJECTIVES: This study was conducted to investigate the current status of outsourcing in Korean hospital information systems and the factors influencing its introduction. METHODS: The authors surveyed 136 hospitals located in Seoul and its surrounding vicinities from June 7 to June 23, 2006. The facilitators and inhibitors to outsourcing in hospital information systems were derived from literature and expert reviews. Multiple logistic regression analysis was applied to identify the major influencing factors on outsourcing in hospital information systems. RESULTS: Eighty-six (63.2%) of the 136 hospitals surveyed, which were mainly tertiary hospitals, responded to using outsourcing for their hospital information systems. "Hardware and software maintenance and support," "application development," and "management of service and staff" were the major areas of outsourcing. Outsourcing had been employed for 4~7 years by 45.5% of the hospitals and the proportion of the budget used for outsourcing was less than 20%. A need for an extension in outsourcing was agreed on by 76.5% of the hospitals. The multiple logistic regression analysis showed that both consumer satisfaction and security risk have an influence on hospital information system outsourcing. CONCLUSIONS: Outsourcing in hospital information systems is expected to increase just as in other industries. One primary facilitator to outsourcing in other industries is consumer satisfaction. We found that this was also a facilitator to outsourcing in hospital information systems. Security risk, which is usually considered an inhibitor to information technology outsourcing, was proven to be an inhibitor here as well. The results of this study may help hospital information systems establish a strategy and management plan for outsourcing.
Security Measures ; Outsourced Services/economics/*utilization ; Maintenance ; Logistic Models ; Korea ; Hospital Information Systems/*organization & administration ; Health Services Research ; Decision Making, Organizational ; Consumer Satisfaction ; Computer Security

INTRODUCTIONThere is a high prevalence of polypharmacy and inappropriate medication use in Singapore nursing homes. This study primarily explored the benefits of pharmacist reviews in local nursing homes. The secondary aims were to review the potential cost savings gained from following the pharmacists' recommendations and to identify the possible risks associated with polypharmacy and inappropriate medication use.

METHODSA retrospective period prevalence study was performed. We analysed the pharmacotherapy problems highlighted by pharmacists in three nursing homes and the rate of acceptance of pharmacists' recommendations. Data was collected in two phases: (a) a one-month pre-setup period, during which 480 patients were reviewed (i.e. one-time review before weekly pharmacist visits); and (b) a six-month post-setup period, during which the 480 patients were reviewed again. Pharmacotherapy problems were classified according to a clinical pharmacist recommendation taxonomy and potential risks were identified. Monthly cost savings were calculated and compared with the monthly costs of pharmacist reviews.

RESULTSA total of 392 pharmacotherapy problems were identified, with pharmacist recommendations noted for each problem. Among the 392 recommendations, 236 (60.2%) were accepted. The pharmacotherapy problems were analysed for potential risks, including falls (16.0%) and constipation (13.1%). The acceptance rates were higher during the post-setup period compared to the pre-setup period (p < 0.0001). Total direct acquisition cost savings during the pre- and post-setup periods were SGD 388.30 and SGD 876.69, respectively.

CONCLUSIONThe provision of pharmaceutical care to nursing home residents resulted in improved medication safety and quality of care.

Aged ; Drug Costs ; Drug Utilization Review ; economics ; statistics & numerical data ; Female ; Health Care Costs ; Humans ; Inappropriate Prescribing ; economics ; statistics & numerical data ; Male ; Nursing Homes ; Pharmaceutical Services ; economics ; Pharmacists ; Polypharmacy ; Prevalence ; Retrospective Studies ; Risk ; Singapore