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A Delphi Study on National Public Vaccine Research and Development Policy in Korea.

Somin LEE ; Sang Gu YEO ; Shin Jung KANG ; Soon Young HAN ; Sang Won LEE

Health Policy and Management.2015;25(2):140-148. doi:10.4332/KJHPA.2015.25.2.140

Vaccination is the most powerful and useful preparation against infectious diseases. However, developing vaccines costs a lot and requires extensive long-term efforts. Therefore, the government should research and develop vaccines with a national-level policy. To greatly enhance the success rate of vaccine development, the policy should be set up considering priorities such as the current status of domestic research, the importance for public health, the urgency of research. The Delphi technique was utilized to draft this survey, through a brainstorming stage, then two inquiries, and finally the final panel meeting where unresolved items were discussed, to draw the conclusion. Among the results, firstly, the highest ranked item on centralized fields for vaccine development by the Ministry of Health was 'self-sufficiency of vaccines.' Secondly, 'emerging infectious disease' was most highly ranked in prioritized fields of vaccine development and research. Thirdly, for the vaccine that needs to be improved and developed further by the government to improve its efficacy and safety, BCG (Bacille de Calmette) for tuberculosis was ranked the highest on both types (intradermal and subcutaneous injection) from National Immunization Programme (NIP) and non-NIP. As for the high risk pathogens, 'anthrax' and 'smallpox' were first and second, consecutively. Lastly, 'development and control of vaccine candidates' was ranked the highest for the area in need for technique development in order to improve domestic vaccine's research level. The results of this study will be put to good use as basic data for the national vaccine research and development (R&D) policy of the country. This study was first step and more studies should be carried out for the final decision of the national vaccine R&D priority.
Communicable Diseases ; Delphi Technique* ; Immunization ; Korea* ; Mycobacterium bovis ; Public Health ; Tuberculosis ; Vaccination ; Vaccines

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An Analysis on the Nurse Expansion Policies through Policy Network.

Yu Kyung KO ; Bo Hyun PARK

Health Policy and Management.2015;25(2):129-139. doi:10.4332/KJHPA.2015.25.2.129

BACKGROUND: Policy network theory was proved to be an appropriate analytic tool for the current social welfare policy making process. This study aimed to analyze policy making process related to the nurse expansion and policy output while focusing on the interactions and activities among various policy actors. METHODS: In this study, we used reports related to the need for expansion of nursing personnel journals, dissertations, newspaper articles, for hearings and debate policies for securing nurse data, and interviews. We examined three components of policy network, that is, policy actors, interactions, linkage of interest. RESULTS: For that to expand the nurse before the 2000s in expanding the supply of medical supplies have been conducted without much disagreement among policy actors under the government's initiative. However, there was lacked a close relationship between the expanding supply of nurses and inaccurate analysis of supply and demand. As the policy is applied between the various policy actors' needs and claims, conflict was intensified and many policy options had been developed. Government only took a role as a coordinator among policy actors in the 2000's. Also, it was difficult to find sufficient and clear evidence that policy-making process based on fair judgment. CONCLUSION: Therefore, it is urgently required to determine the policy through a social consensus to address the appropriate policy means and the process by correct analysis of the policy issues.
Consensus ; Equipment and Supplies ; Humans ; Judgment ; Nursing ; Nursing Staff ; Periodicals ; Policy Making ; Social Welfare

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The Theoretical Comparison of Malmquist and Luenberg Productivity Indices & Empirical Analysis.

Hyun Suk PARK ; Dong Hyun YANG

Health Policy and Management.2015;25(2):118-128. doi:10.4332/KJHPA.2015.25.2.118

BACKGROUND: We measured productivity changes of regional public hospitals using both global Malmquist productivity index-based on global production possibility set over all the periods-and the traditional Malmquist productivity index and analyzed the factors of productivity change. METHODS: The data used in this study is two annual inputs and two annual outputs of 32 regional public hospitals in Korea from 2005 to 2009 and the results such as distances and Malmquist productivity index and global Malmquist productivity index are obtained by an R program written for this study RESULTS: The results can be summarized as follows. Firstly, technical efficiencies of regional public hospitals are affected largely by scale efficiency than pure technical efficiency. Second, productivity progressed and technological change has more significant influence on productivity advance over the period between 2005 and 2009. Third, the circularity problem of the traditional Malmquist index is confirmed, and so the global Malmquist index without this problem are valid for the analysis. CONCLUSION: Though this study also has some limitations with the data of regional public hospitals with a short time span, it is the first study of hospitals using global Malmquist productivity index and later it can be expanded to private hospitals and longer time periods.
Efficiency* ; Hospitals, Private ; Hospitals, Public ; Korea

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Cost Analysis for Dentures Performed at Dental Clinics in Korea.

Seol Hee CHUNG ; Hye Jin LEE ; Ju Yeon OH ; Kyung Suk WOO ; Han Sang KIM

Health Policy and Management.2015;25(2):107-117. doi:10.4332/KJHPA.2015.25.2.107

BACKGROUND: The purpose of this study is to analyze the cost for the denture treatment in accordance with the government's plan to expand the National Health Insurance coverage for dental prothesis from July 1, 2012. METHODS: We developed the draft of classification of the treatment activities based on the existing researches and expert's review and finalized the standard procedures through confirming by Korean Dental Association. We also made the list of input at each stage of treatments. We conducted survey of 100 dental clinics via post from April 4 to May 20 in 2011 and 37 clinics took part in the survey. The unit of cost calculation is the process from the first visit for denture treatment to setting of denture and adjustment. The manufacturing process performed by dental technician was not included in the cost analysis. RESULTS: The process for the complete denture treatment was classified with 10 stages. The partial denture treatment was classified with 8 stages. The treatment time per each denture is about 5.6 hours for complete dentures and about 6.6 hours for partial dentures. The treatment cost were from 591,108 won to 643,913 won for complete denture and from 670,219 won to 738,840 won for partial denture in 2011, depending on the location, type of the clinics and the types of physician's income. CONCLUSION: This study shows the example of cost analysis for the treatment to set the fee schedule. Measures to get representative and accurate information need to be made.
Classification ; Costs and Cost Analysis* ; Dental Clinics* ; Dental Technicians ; Denture, Complete ; Denture, Partial ; Dentures* ; Fee Schedules ; Health Care Costs ; Humans ; Korea* ; National Health Programs

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An Analysis on the Determinants of Efficiency of the Pharmaceutical Firms using Stochastic Frontier Analysis.

Jin SAKONG ; Jeongkyu KIM

Health Policy and Management.2015;25(2):97-106. doi:10.4332/KJHPA.2015.25.2.97

BACKGROUND & METHODS: The purpose of this research is to estimate the efficiency of the pharmaceutical firms and the determinants of their efficiency. Stochastic frontier analysis(SFA) and panel study are applied to the data of 60 domestic pharmaceutical firms from 2006 to 2012. RESULTS & CONCLUSION: First, the result of the stochastic frontier analysis shows that overall efficiency of the pharmaceutical firms is increasing as time goes by. However, if firms are classified by the scale, the larger firms show more efficiency and if classified by the degree of innovativeness, the innovative firms show more efficiency compared to the non-innovative firms. This evidences show that the scale and R&D investment have significant relationships with the efficiency of the pharmaceutical firms. Therefore, it is necessary to increase the national level of investment for the fundamental researches to vitalize R&D of the new drugs. Second, the result of estimation of the determinants of efficiency shows that the firms with larger sales promotion expenses and entertainment expenses have less efficiency compared to the other firms. This can be explained by the structural characteristics of the small generic pharmaceutical firms. Therefore, the government had better make the pharmaceutical firms to reduce sales promotion and entertainment expenses and increase R&D expenses by introducing systems such as global budgeting system on medicine or reference pricing system.
Budgets ; Commerce ; Investments

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The Effects of Adherence and Hypertension Control on Complication among Newly Diagnosed Hypertension Patients.

Jin Ok HAN ; Jun YIM ; Jeong Soo IM ; Hee Young LEE ; Jong Heon PARK ; Dae Kyu OH

Health Policy and Management.2015;25(2):90-96. doi:10.4332/KJHPA.2015.25.2.90

BACKGROUND: This study aimed to research on how adherence and blood control could make a difference when it comes to develop complications. METHODS: The study's subjects were 255,916 patients who were newly diagnosed with hypertension in 2009 using data collected by National Health Insurance Cooperation. Patients are considered as a group under adherence if visit days and prescription days are more than 300 days. Patients are considered to have successfully controled their hypertension based on actual value measured by National Health Insurance Cooperation and the study takes a look at whether they were diagnosed with complications of cerebrocardiovascular disease in 2012. Chi-square test and logistic regression was used to analyze. RESULTS: Patients who were able to control their hypertension show 0.80 times chance of developing cerebrovascular disease, and 0.89 times chance of developing cardiocerebrovascular disease. The group of adherence shows lower chance of developing complication in general than the group of non-adherence. CONCLUSION: The study revealed that hypertension's constant treatment could control the blood pressure and prevent complications. It is important that encourages patients to effort for persistent treatment for reducing complication.
Blood Pressure ; Humans ; Hypertension* ; Logistic Models ; National Health Programs ; Prescriptions

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Factors Associated with Dental Revenue and Income of Self-Employed Dentist by Using a Quantile Regression Method.

Hyungkil CHOI ; Myeng Ki KIM

Health Policy and Management.2015;25(3):240-251. doi:10.4332/KJHPA.2015.25.3.240

BACKGROUND: Dentist's income is quite variable. We investigate the factors underlying the distribution of dental revenue and dentist income. METHODS: Financial and structural variables of private dental practices(N=13,967) were examined with 2010 Economic Census microdata which include non-insurance revenue. We conducted quantile regression method(QRM) and ordinary least square(OLS) in treating skewness and heteroskedasticity of distributions. The effective estimation for the upper and lower range of distribution becomes possible by QRM. RESULTS: Mid-career dentists are shown to have higher revenue and income. Male dentists achieve the higher revenue and income than female dentists in all quantiles. Group practices show lower income per owner than solo practices significantly. The revenue and income are increased with increasing size of clinics. The high cost in renting the clinic office is found to have a big positive effect on the revenue but a little positive effect on the income. Interestingly the density of dentists shows negative effect on the lowest quantile of the revenue but positive effect on the highest quantile. The lowest quantile of the revenue in the capital areas have the relatively high revenue. The lowest quantile of the income in metropolitan city show higher income than those in other areas significantly. CONCLUSION: The suggested QRM is shown to have more effective and efficient tool in finding out determinants of dentists' revenue and income of our concern. The results of this study are expected to be employed for dentists preparing for the opening practices in their organizational settings and locational selections. The distributional efficiency of dental human resources could be accomplished if policy makers guide dentists with this knowledge.
Administrative Personnel ; Censuses ; Dentists* ; Female ; Group Practice ; Humans ; Male ; Private Practice

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Factors Associated with Satisfaction as Surveyor and Reliability of Surveyors in Hospital Accreditation Program.

Kyung Sook KIM ; Sun Hee LEE

Health Policy and Management.2015;25(3):229-239. doi:10.4332/KJHPA.2015.25.3.229

BACKGROUND: The hospital accreditation program in Korea has been conducted since 2011 in order to improve patient safety and healthcare service quality. This study was conducted to find factors associated with satisfaction as surveyor and reliability of surveyors in hospital accreditation program. METHODS: This study was performed targeting 217 responded to the survey among 412 surveyors who had participated in the accreditation survey for acute care hospitals from December 2010 to February 2014. RESULTS: The average number of survey per surveyor is 2.35. We divided surveyors into those who participated in the survey more than 3 times and less than 3 times in order to judge the professionalism of surveyors according to the number of survey participation. Those factors that have an influence on the satisfaction as surveyors include: activity period as surveyor, role in the survey team, experience of survey in other fields, experience as consultant and the useful education and proper composition of survey team (p<0.05). Those factors that have an influence on the reliability for fellow surveyors include: number of beds of hospitals they belong, experience of survey in other fields, useful education, proper composition of survey team and difficulty in leadership interview (p<0.05). CONCLUSION: It is important to provide useful education and proper composition of survey team to increase the satisfaction as surveyors and the reliability for fellow surveyors.
Accreditation* ; Consultants ; Delivery of Health Care ; Education ; Humans ; Korea ; Leadership ; Patient Safety ; Personal Satisfaction

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The Effects of Hospital Resources on the Service Uses: Hospital Service Area Approach.

Jin Mi KWAK ; Da Yang KIM ; Eun Won SEO ; Kwang Soo LEE

Health Policy and Management.2015;25(3):221-228. doi:10.4332/KJHPA.2015.25.3.221

BACKGROUND: This study explored the relationship between hospital resources and services uses in outpatient/inpatient-based hospital service area (HSA) in Korea. METHODS: Study hospitals included all acute care hospitals except tertiary hospitals. Inpatient and outpatient hospital claims from the Korean National Health Insurance (NHI) program in 2010 were used to identify the service uses. Hospital resources and the degree of insurance premium in study areas were identified with the NHI corporation data. Study variables were computed by summing the service uses or hospital resources of study hospitals in each HSA. Service uses were represented by the total medical charges and number of visits/inpatient days. Hospital resources were measured by number of beds, number of doctors, and number of computed tomography (CT). The economic status of NHI enrollees in each HSA was controlled by the average monthly premium of NHI program per household in each HSA. The degree of using local hospitals was controlled with the localization index. RESULTS: Analysis results showed that hospital resources such as beds, CT were statistically related to the service uses. And also localization index was found to have positive significant relationships with service uses. CONCLUSION: Hospital resources such as beds, CT had not only positive impacts on inpatient service uses, but also influences on the outpatient setting. Health policy makers will require monitoring and assessing the hospital resources in Korea.
Family Characteristics ; Health Policy ; Health Resources ; Humans ; Inpatients ; Insurance ; Korea ; National Health Programs ; Outpatients ; Tertiary Care Centers

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The User Fee Introduction and Its Effect in the Health System of Low and Middle Income Countries: An Exploratory Study Using Realist Review Method.

Kyung Bok SON ; Chang Yup KIM

Health Policy and Management.2015;25(3):207-220. doi:10.4332/KJHPA.2015.25.3.207

BACKGROUND: The purpose of this exploratory study is to explain where, when and how the introduction of user fee system works in low and middle income countries using context, mechanism, and outcome configuration. METHODS: Considering advanced research in realist review approach, we made a review process including those following 4 steps. They are identifying the review question, initial theory and mechanism, searching and selecting primary studies, and extracting, analyzing, and synthesizing relevant data. RESULTS: User fee had a detrimental effect on medical utilization in low and middle income countries. Also previous and current interventions and community participation were critical context in user fee system. Those contexts were associated with intervention initiation and recognition and coping strategies. Such contexts and mechanisms were critical explanatory factors in medical utilization. CONCLUSION: User fee is a series of interventions that are fragile and dynamic. So the introduction of user fee system needs a comprehensive understanding of previous and new intervention, policy infrastructure, and other factors that can influence on medical utilization.
Consumer Participation ; Fees and Charges*

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