BACKGROUND: This study intends to clear that the current cost reimbursement system of Korean medical insurance of health care. METHODS: By using insured medical record of Federation of Korean Medical Insurance Societies used in the demand tendency research of the type of services from feburary 1st to 28th of the year 1990, authors analyze the characterist,ic of components of charges per case in the type of health care facilities. RESULTS: The charge per case in the out-patient care of primary health care facility is 13,498 won, which is 54.6% by comparison with the secondary health care facility and 30.7 % by comparison wit,h the tertiary health care facility. Among these charges the amount of the cost for medical examinations and oral drugs are 73.9% in the primary health care facility and 71.8% in the secondary and 67.5% in the tertiary. Consequently, the services in the primary care are chiefly composed with the medical examinations and oral drugs. In addition to this point the author also finds that the charge per case is 3.5 times, the cost for oral drugs is 5.6 times larger than those of primary care, and therefore tertiary health care facility conduct various diagnostic examinations and prescript more expensive. CONCLUSIONS: There is a difference of basic medical cost ratio between primary, secondary and tertiary health care facility. These points can be lead to the presumption that the diseases under the structure of current medical insurance are overlapped irrespective of the charact.erisitcs of the type of health care facilites, and this is profitable to the tertiary health care facilities which can conduct various types of services. In conclusion, the frame a policy is needed to encourage primary care which are nothing but simple structure of charges.
Delivery of Health Care ; Humans ; Insurance* ; Medical Records ; Outpatients ; Primary Health Care

PURPOSE: Hangang Sacred Heart Hospital Burn Center has operated the Nutritional Support Team (as known as NST) since 2003. From our experiences of active participation of NST, our authors believed the serum prealbumin level of Nutritional Assessment Index can be a useful testing index for assessing burn patients clinical condition. Therefore, we would like to verify the correlation of the prealbumin level with the patients prognosis. METHODS: The subjects are limited to those who has made at least a single visit to NST during their hospital stay from January 1, 2005 to December 31, 2008 at Hangang Sacred Heart Hospital Burn Center. The total number of NST patients were 129 patients in 2005, 124 patients in 2006, 131 patients in 2007, and 127 patients in 2008. It includes those patients who deceased due to the burn shock within a few days of first admission. Basically it includes any patients regardless of chance of survival rate who has seen the NST at least once during the study period. We obtained the lowest serum prealbumin level of NST patients from 2005 to 2008 and made comparison analysis within the subjects. RESULTS: The mortality rate of NST patients decreased in the study period from 2005 to 2008 as time passed by (47%-37%-24%-22%). However, the lowest serum prealbumin level of mean value was increased notably. The mean values of lowest prealbumin level were 6.07 in 2005, 6.73 in 2006, 9.53 in 2007 and 7.31 in 2008. The mean total body surface burned areas were 50.3% in 2005, 44.6% in 2006, 43.1% in 2007 and 47.2% in 2008. The lowest prealbumin level in the survived group is 2 to 3 gm/dl higher than the deceased group. The lowest prealbumin level in deceased group was shown mostly below 7 mg/dl and mortality rate was extremely increased to 35% to the group below 5 mg/dl. CONCLUSION: Our study suggests it is necessary to pay special attention if prealbumin level drops below 7 mg/dl in massive burn patients. If the level drops below 5 mg/dl or 6 mg/dl, it can be considered as nutritional condition of the patient is poor and need to make extra observations on several criteria such as nutritional supply, high in catabolism and progression of septicemia to assess proper needed care for burn patients.
Burn Units ; Burns ; Heart ; Humans ; Length of Stay ; Nutrition Assessment ; Nutritional Support ; Prealbumin ; Prognosis ; Sepsis ; Shock ; Survival Rate