OBJECTIVES: The purpose of this study was to classify determinants of cost increases into two categories, negotiable factors and non-negotiable factors, in order to identify the determinants of health care expenditure increases and to clarify the contribution of associated factors selected based on a literature review. METHODS: The data in this analysis was from the statistical yearbooks of National Health Insurance Service, the Economic Index from Statistics Korea and regional statistical yearbooks. The unit of analysis was the annual growth rate of variables of 16 cities and provinces from 2003 to 2010. First, multiple regression was used to identify the determinants of health care expenditures. We then used hierarchical multiple regression to calculate the contribution of associated factors. The changes of coefficients (R2) of predictors, which were entered into this analysis step by step based on the empirical evidence of the investigator could explain the contribution of predictors to increased medical cost. RESULTS: Health spending was mainly associated with the proportion of the elderly population, but the Medicare Economic Index (MEI) showed an inverse association. The contribution of predictors was as follows: the proportion of elderly in the population (22.4%), gross domestic product (GDP) per capita (4.5%), MEI (-12%), and other predictors (less than 1%). CONCLUSIONS: As Baby Boomers enter retirement, an increasing proportion of the population aged 65 and over and the GDP will continue to increase, thus accelerating the inflation of health care expenditures and precipitating a crisis in the health insurance system. Policy makers should consider providing comprehensive health services by an accountable care organization to achieve cost savings while ensuring high-quality care.
Cities ; Health Expenditures/*statistics & numerical data/trends ; Humans ; Regression Analysis ; Republic of Korea

OBJECTIVES: Organizational culture has been important in field of organizational behavior research for the past decade. Although there has been a growing interest in the organizational culture and organizational effectiveness, there is few research in health care field. This study was carried out to investigate the relationship of organizational culture and organizational effectiveness at general hospital. METHODS: Data was collected by self-administrated questionares. Organizational cultures were measured by using Likert scale. A general hospital in Kyunggi-Do was selected and survey was conducted to 675 workers. Data was analyzed with computer package, PC- SPSS. RESULTS: There were four types of organizational culture in this hospital : consensual culture, developmental culture, hierarchical culture, rational culture. Many workers recognized their culture as rational culture and developmental culture. This finding showed that the hospital had both human related and task related climate. There were some differences in recognition of sub-organizational culture by occupational group, but perceived organizational culture was in accordance with sub-organizational culture in general. Multiple regression analysis and multiple logistic regression analysis were conducted to find the relationship of organizational culture and organizational effectiveness. As a result, developmental culture showed a strong relationship with organizational commitment and job-satisfaction. CONCLUSIONS: These results showed that types of organizational culture were significantly related to organizational effectiveness and understanding the existing culture is essential to develope their organizational effectiveness.
Climate ; Delivery of Health Care ; Gyeonggi-do ; Hospitals, General* ; Humans ; Logistic Models ; Occupational Groups ; Organizational Culture*

Cervicogenic vertigo was known as Bow hunter's syndrome. Occlusion of vertebral artery causes vertebrobasilar insufficiency and we reported cervicogenic vertigo case which was treated by simple decompression of transverse foramen of C1. The patient was 48 years old female who had left side dominant vertebral artery and vertigo was provoked when she rotated her head to right side. Angiography showed complete obliteration of blood flow of left vertebral artery when her head was rotated to right side. The operation was decompression of left vertebral artery at C1 level. Posterior wall of transverse foramen was resected and vertebral artery was exposed and decompressed. After surgery, vertigo of the patient was disappeared, and angiography showed patent left vertebral artery when her head was rotated to right side. Vertigo caused by compression of cervical vertebral artery could be treated by decompression without fusion or instrumentation, especially in C1 transverse foramen.
Angiography ; Decompression* ; Female ; Head ; Humans ; Mucopolysaccharidosis II ; Vertebral Artery ; Vertebrobasilar Insufficiency ; Vertigo*

OBJECTIVES: With the increased use of computed tomography (CT) in clinics, dose reduction is the most important feature people seek when considering new CT techniques or applications. We developed an intensity-weighted region-of-interest (IWROI) imaging method in an exact half-fan geometry to reduce the imaging radiation dose to patients in cone-beam CT (CBCT) for image-guided radiation therapy (IGRT). While dose reduction is highly desirable, preserving the high-quality images of the ROI is also important for target localization in IGRT. METHODS: An intensity-weighting (IW) filter made of copper was mounted in place of a bowtie filter on the X-ray tube unit of an on-board imager (OBI) system such that the filter can substantially reduce radiation exposure to the outer ROI. In addition to mounting the IW filter, the lead-blade collimation of the OBI was adjusted to produce an exact half-fan scanning geometry for a further reduction of the radiation dose. The chord-based rebinned backprojection-filtration (BPF) algorithm in circular CBCT was implemented for image reconstruction, and a humanoid pelvis phantom was used for the IWROI imaging experiment. RESULTS: The IWROI image of the phantom was successfully reconstructed after beam-quality correction, and it was registered to the reference image within an acceptable level of tolerance. Dosimetric measurements revealed that the dose is reduced by approximately 61% in the inner ROI and by 73% in the outer ROI compared to the conventional bowtie filter-based half-fan scan. CONCLUSIONS: The IWROI method substantially reduces the imaging radiation dose and provides reconstructed images with an acceptable level of quality for patient setup and target localization. The proposed half-fan-based IWROI imaging technique can add a valuable option to CBCT in IGRT applications.
Cone-Beam Computed Tomography* ; Copper ; Humans ; Image Processing, Computer-Assisted ; Methods ; Pelvis ; Radiation Exposure ; Radiotherapy, Image-Guided*