BACKGROUND: This study investigates association modified category medical specialization (CMS) and hospital charge, length of stay (LOS), and mortality among lumbar spine disease inpatients. METHODS: This study used National Health Insurance Service–cohort sample database from 2002 to 2013, using stratified representative sampling released by the National Health Insurance Service. A total of 56,622 samples were analyzed. The primary analysis was based on generalized estimating equation model accounting for correlation among individuals within each hospital. RESULTS: Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had a shorter LOS (estimate, −1.700; 95% confidence interval [CI], −1.886 to −1.514; p < 0.0001). Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had a lower mortality rate (odds ratio, 0.635; 95% CI, 0.521 to 0.775; p < 0.0001). Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had higher hospital cost per case (estimate, 192,658 Korean won; 95% CI, 125,701 to 259,614; p < 0.0001). However, inpatients admitted with lumbar spine surgery patients at hospitals with higher modified CMS had lower hospital cost per case (estimate, −152,060 Korean won; 95% CI, −287,236 to −16,884; p=0.028). Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had higher hospital cost per diem (estimate, 55,694 Korean won; 95% CI, 46,205 to 65,183; p < 0.0001). CONCLUSION: Our results showed that increase in hospital specialization had a substantial effect on decrease in hospital cost per case, LOS, and mortality, and on increase in hospital cost per diem among lumbar spine disease surgery patients.
Hospital Charges ; Hospital Costs ; Humans ; Inpatients ; Length of Stay ; Mortality ; National Health Programs ; Spine

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

OBJECTIVE: Using the integrated database in hospital information systems, this study tried to analyze inpatient hospital fees for stroke patients and evaluate the impact of patients' demographic and clinical characteristics on the fees. METHODS: Inpatient charge data from patient management information system were merged to each patient's clinical data from electronic medical record. Demographic, clinical, health service utilization, and hospital fee data of 540 stroke patients were collected in the years 2000 and 2001. Inpatient charges were compared according to patient characteristics; in addition, the impact of those characteristics on hospital charges was analyzed using a multiple regression model. RESULTS: The average length of stay (LOS) was 19.6 days and the total inpatient charge was USD 4 418. Inpatient charges were significantly higher in patients with previous stroke history, diabetes, hemorrhagic type, and severity, respectively. Simultaneously, LOS, ICU use, surgical operations, stroke type, hopeless discharge, lesion location, echocardiography and hypertension were significant factors influencing patient hospital charges (R(2)=0.847). LOS was the most significant factor explaining 81% of variance accounted for the charges. The strategies of reducing LOS need to be developed. CONCLUSION: Hospital information systems and their databases play an important role in a broad spectrum of research in clinical medicine, and can be useful to support retrospective studies and prospective clinical trials. Active utilization of the integrated database in hospital information systems is suggested for knowledge extraction.
Clinical Medicine ; Echocardiography ; Electronic Health Records* ; Fees and Charges ; Health Services ; Hospital Charges ; Hospital Information Systems* ; Humans ; Hypertension ; Inpatients ; Length of Stay ; Management Information Systems ; Stroke

This study refers to the problem of long-term inpatient flow in a general hospital. In this study, a queueing simulation model was developed for the two departments in the hospital with a homogenous case mix and relatively many long-term inpatients in order to increase the tumover rate and hospital charges. Before the simulation run, the model was verified by the Kolmogorov-Smirmov test. The following results were generated by three alternative models of the special bed policies. 1. Alternative I: When long term inpatients were admitted to the wards belonging to departments A and B without transfer to other departments and special beds, the average turn-over rate decreased by 2-4% and the average hospital charges decreased by 70 million won. 2. Alternative II: When long-term inpatients were transferred to department C but the transfer of wards was determined by department C in order of clinical need, the average turnover rate increased by 4-13% but the average hospital charges decreased by 30 million won. This result was not greatly different from the present state. 3. Alternative III: When long-term inpatients were transferred to the special wards and department C simultaneously, the increase in the average turnover rate and hospital charges was equivalent to the increase of two beds in the special wards. When the special wards were allocated 16 beds, the average turnover rate of departments A and B increased by about 55% and 20% respectively. Also, the hospital charges increased by about 0.44 billion won. As a result, trasfer to department C and the use of 16 beds in the special wards for long-term inpatients of departments A and B is expected to maximize the hospital revenue. However, as the above special bed policy can not increase the turnover rate above 60%, there is a need for a more comprehensive policy to further increase the rate. The development of an elaborate model should include the number of long-term inpatients in all clinical departments, the special wards system or an increase of hospital beds to handle admission needs, and the resources of the hospital by department. When the alternative are evaluated, a cost-benefit analysis in addition to the turnover rate and the hospital charges should be considered.
Cost-Benefit Analysis ; Diagnosis-Related Groups ; Hospital Charges ; Hospitals, General* ; Humans ; Inpatients*

PURPOSE: When using the emergency room of a tertiary hospital, both patients and their relatives or friends sometimes experience dissatisfaction and complain. Patient satisfaction deserves attention not only because it is an intrinsically worthy goal but also because it is a potentially significant mediator for promoting health and well-being. This study aims to identify patient's official complaints and to improve the quality of care in the Emergency Department (ED). METHODS: We investigated retrospectively 144 official complaints of visitors in 4 tertiary university hospital emergency centers between January 1, 2001, and December 31, 2003. RESULTS: Among those 144 official complaints from the 4 hospital emergency centers were 116 appropriate complaints, as determined by the inclusion criteria, and 212 detailed descriptions of dissatisfaction. The seven major categories of dissatisfactions were analyzed: rudeness or lack of kindness, delayed waiting time, insufficient explanation of patient condition, distrust of treatment, absence of a specialist, poor emergency-department environment, and high treatment fee. CONCLUSIONS: Dissatisfaction related to the lack of kindness was the most common problem in all four university hospital emergency centers. The next most important problem was the delayed time or distrust of treatment. The concrete causes of the complaints varied with the hospital. To improve the quality of care for patients in the ED, the hospital staff should be more attentive and kind and should explain the patient's condition in more detail. Reducing the waiting time is also important.
Emergencies* ; Emergency Service, Hospital ; Fees and Charges ; Friends ; Humans ; Patient Satisfaction ; Retrospective Studies ; Specialization ; Tertiary Care Centers*

To identify the changes in profession care patterns after the introduction of medical insurance in korea, professional care in hospitals and clinics of two succeeding years were compared. The hospital and clinics selected for this study were those which located in Seoul city. Hospital were classified into 3 categories: university hospital, general hospital and hospital. The diseases selected for this study were acute appendicitis and normal delivery. They were selected because their disease courses are considered to be fairly stable. The variables used for this study were length of stay, total hospital costs, costs of each components of cares. The information used for this study was obtain form the official forms requested by the medical facilities to the Korea Medical Insurance Corporation. The two periods studies were 3 months of each year form March 1st to May 3st in 1979 and 1980. The total number of normal deliverly studied was 289 in 1979, 301 in 1980 respectively and acute appendicitis was 92 and 111 respectively. In order to compare the quantity of medical care between 2 study periods the insurance price scores of 1979 were converted to prices of 1980. For statistical test of difference between 2 periods T-test and Welch's test were used. The result of the study were briefly summarized in below. 1. No significant difference was observed in the average length of stay of both disease between two study periods in all types of hospitals. 2. No significant difference was observed in the average total hospital costs of both disease in all types of hospital, but in the private clinic costs was rather decreased significantly in 1980. 3. More cost decrease were seen than cost increase in 1980 in all types of facilities. More cost changes by items were seen in acute appendicitis than in normal deliverly between two study periods. The total hospital costs can be divided into 2 portions: charges for drug and material and for physician. In normal delivery, costs for physician's charges was significantly decreased in almost all the hospitals and costs for drug and material were not changed significantly in all the hospitals in 1980. In the university hospitals, however, the costs for drug and material were increased significantly 1980. The cost decrease for physician's charge were mainly due to the decrease in the costs of laboratory test, treatment and physical therapy. The increase in the costs for the drug and material in the university hospital was mainly due to the increase in the costs for drug for oral administration and injection. 4. The proportion of components of medical care in the hospital has not been changed significantly, however, the cost for injection in normal deliverly was characteristically increased in 1980 in all hospitals studied. In general in the proportion of the costs for drug and material was tended to increase and the costs for physician was tended to decrease in 1980. The increase in the costs for drug and material were considered to be due to increase in the cost for drugs for oral administration and injection. The decrease in the costs for physician were due to decrease in the costs of laboratory test, treatment and physical therapy. Above mention changes in hospital and clinic care patterns are considered to be mostly influenced by the review criteria set by the K.L.C. for the assessment of the fee request made by clinics and hospitals.
Administration, Oral ; Appendicitis ; Fees and Charges ; Hospital Costs ; Hospitals, General ; Hospitals, University ; Insurance* ; Korea ; Length of Stay ; Seoul

PURPOSE: The critical pathway (CP) is to standardize the clinical practice of specialists working to optimize care. The objective of this study was to develop a critical pathway for the surgical treatment of patients with colorectal or gastric cancer and to evaluate the results of the CP. METHODS: Twenty-one patients with colorectal cancer, who were managed according to the CP between August 2005 and November 2005, were compared with 18 patients for whom this pathway had not been used between June 2004 and September 2004. Forty-eight patients with gastic cancer, who were managed according to the CP between June 2005 and September 2005, were compared with 49 patients for whom this pathway had not been used daring the same period in 2004. The length of stay and the cost per patients were compared between the CP group and the non-CP group. RESULTS: For patients with colorectal cancer, the postoperative hospital length of stay in the CP group was significantly shorter (9.0 vs. 12.3 days, P<0.001), but for patients with gastric caner, there was no difference (10.6 vs. 11.4, P=0.134). The mean hospital charges were won5,037,816 and won5,263,508 for colorectal cancer and for gastric cancer, respectively, and won4,808,602 and won4,674,329, for the CP and the non-CP groups, respectively, but these differences were not significant. CONSLUSIONS: The critical pathway in colorectal and stomach surgery decreased the length of stay and might regulate hospital charges. Such a pathway could be easily designed and implemented at hospitals and could standardize clinical practice.
Colorectal Neoplasms ; Critical Pathways* ; Hospital Charges ; Humans ; Length of Stay ; Specialization ; Stomach ; Stomach Neoplasms*

PURPOSE: This study evaluated the efficiency and safety of the Foley catheter for esophageal removal of coins in children, compared to standard endoscopic extraction with respect to success rate, sedation, promptness and cost. METHODS: Twenty four children with coin lodgement in esophagus were managed with either a Foley catheter (n=14) or endoscopic extraction (n=10) from January 2007 through August 2010 at Kyungpook National University Hospital. A retrospective review of medical records and radiological findings was performed. RESULTS: Of the 14 patients who underwent Foley catheter extraction, successful and complication-free removal was achieved in 10 cases (71.4%). Of the 10 patients who underwent endoscopic extraction, all cases were successful (p=0.114). Sedation rate in the Foley catheter and endoscopic extraction group was 6/14 and 10/10 (p=0.006). The average wait time before the procedure and average hospital charge (US$) were 2.0+/-1.1 hours and 18.1+/-13.7 hours, and $113 and $428 for Foley catheter extraction and endoscopic extraction, respectively. CONCLUSION: Foley catheter extraction may be tried for the removal of esophageal coins in uncomplicated children. The technique is effective, safe, inexpensive and free of general anesthesia.
Anesthesia, General ; Catheters ; Child ; Endoscopy ; Esophagus ; Hospital Charges ; Humans ; Medical Records ; Numismatics ; Retrospective Studies

PURPOSE: This study was carried out to substantiate the application process of activity-based costing on the current cost of hospital home care (HHC) service. The study materials were documents, 120 client charts, health insurance demand bills, salary of 215 HHC nurses, operating expense, 6 HHC agencies, and 31 HHC nurses. METHOD: The research was carried out by analyzing the HHC activities and then collecting labor and operating expenses. For resource drivers, HHC activity performance time and workload were studied. For activity drivers, the number of HHC activity performances and the activity number of visits were studied. RESULT: The HHC activities were classified into 70 activities. In resource, the labor cost was 245wonper minute, operating cost was 9,570won per visit and traffic expense was an average of 12,750won. In resource drivers, education and training had the longest time of 67 minutes. Average length of performance for activities was 13.7 minutes. The workload was applied as a relative value. The average cost of HHC was 62,741won and the cost ranged from 55,560won to 74,016won. CONCLUSION: The fixed base rate for a visit in the current HHC medical fee should be increased. Exclusion from the current fee structure or flexible operation of traveling expenses should be reviewed.
Costs and Cost Analysis ; Fees and Charges ; Home Care Services, Hospital-Based/*economics ; Korea ; Task Performance and Analysis

BACKGROUND: Intracerebral hemorrhage (ICH) and cerebral infarction, which are two types of stroke, have different properties in terms of patient characteristics and hospital resource utilization. The two stroke types were evaluated in the present study with respect to the associated estimated inpatient charges, and their significant determinants. METHODS: The data of 497 stroke inpatients were collected from two academic hospitals in the year 2000~2001. The patients' demographic and clinical information were investigated retrospectively through medical records, and their payment data were extracted through the hospitals' information systems. The two types of stroke patient (i.e., ICH and cerebral infarction) were compared in terms of their demographic and clinical characteristics, and healthcare utilization. Multiple regression models were developed to examine the influence of demographic and clinical factors on inpatient charges. RESULTS: The mean length of hospital stay was 22.4 days for ICH patients and 18.3 days for those with cerebral infarction; the total inpatient charges were 5,777 and 3,908 thousand Korean won, respectively. While stroke severity, intensive care unit admission, surgery, and death were significant factors on inpatient charges for ICH patients (R2=0.426), additional factors such as diabetes, hospital, and department of care were significant for cerebral infarction patients (R2=0.342). CONCLUSIONS: The inpatient charges and their determinants differed between ICH and cerebral infarction. However, the length of hospital stay was found to be the most significant determinant of inpatient charges for both stroke types; stroke severity was also important with regard to the estimation of inpatient charges.
Cerebral Hemorrhage ; Cerebral Infarction ; Delivery of Health Care ; Fees and Charges ; Health Resources ; Hospital Charges ; Humans ; Information Systems ; Inpatients ; Intensive Care Units ; Length of Stay ; Medical Records ; Retrospective Studies ; Stroke