병원의 전략경영과정

이기효(Key Hyo Lee) 한국병원경영학회 1996 병원경영학회지 Vol.1 No.1

This article reviews the art and practice of strategic management process in hospitals today, in order to help hospital administrators for managing strategic management system in their hospitals. The strategic management process model in this article is based on an integrated approach combining traditional environmental model with resource-based model of strategy. The components of the model are consisted of five steps : (1) formulating objectives, strategic assessment by external environmental analysis, internal capability analysis, TOWS analysis and marketing audit, (3) strategy choice considering context and criteria of choice, (4) program implementation through operational planning, resource allocation, and conversion, and (5) control by monitoring and evaluating hospital outputs. This article deals with many aspects of issues inherent in every step on this strategic management process.

병원 경영전략의 유형과 성과

이기효(Key Hyo Lee),김원중(Won Joong Kim),박영석(Young Suk Park),권영대(Young Dae Kwon) 한국병원경영학회 1999 병원경영학회지 Vol.4 No.1

The overall objective of this article is to identify the strategic types of Korean hospitals in terms of Porter`s framework and to examine differences in performance of the hospitals across strategic types. A survey was conducted through structured questionnaire for 739 hospitals in Korea and the data from 120 hospitals were utilized in the final analysis. Study results indicate that the most frequently used strategy was `stuck-in-the-middle strategy`(26.7%), followed by `focused cost leadership strategy`(24.0%), `focused differentiation strategy`(20.8%), `cost leadership strategy`(15.8%), and `differentiation strategy`(13.7%). Overall, `focused differentiation strategy` showed superior performance in terms of profitability of services, ability to retain patients and growth in revenue, while `differentiation strategy` produced relatively low performance in general. Implications of these findings are also discussed.

미국 시장지향 의료체계의 성과와 시사점

이기효 ( Key Hyo Lee ) 한국병원경영학회 2004 병원경영학회지 Vol.9 No.1

The United States has a unique health care system, which is unlikely any other health care systems in the world. The major part of basic functional components of the system -financing, insurance, delivery, and payment- is in private hands. A market-oriented economy invites the participation of numerous private entities that are interested in carrying out the key functions of health systems. Due to this central feature, U.S.health care is not delivered through a network of interrelated components designed to work together coherently. For lack of standardization, the various components of the system fit together only loosely. The involvement of numerous players in the key functions leads to duplication, overlap, inadequacy, inconsistency, and waste, which add to the complexity and also make the system inefficient. Hence, cost containment remains an elusive goals. Moreover, the system falls short of delivering equitable services to all americans, though consumption of health care services is the largest in the world. On the other hand, United States leads the world in the latest and the best in medical technology, medical training, and research. It offers some of the most sophisticated institutions, products, and processes of health care delivery. This article discuss the characteristic features of the U.S. health care system and its performance, trying to seek its implication on Korean health care system.

편도적출술 및 아데노이드제거술과 충수절제술의 지역별 변이

이홍기,문옥륜,이기효,Lee, Hong-Ki,Moon, Ok-Ryun,Lee, Key-Hyo 대한예방의학회 1993 Journal of Preventive Medicine and Public Health Vol.26 No.3

The objectives of this study are two-fold : to identify geographic variations in the rate of tonsillectomy and adenoidectomy (T&A) and appendectomy and analyze the socioeconomic variables and health resources which affect geographic variation in the rate. The nationwide three month's cases of the two surgical procedures in 1991 are obtained from the record of the National Federation of Medical Insurance. The analysis shows two to ten-fold variations in the regional rates for the performance of two common procedures such as T&A and appendectomy. T&A shows a bigger regional variations than appendectomy. As a result of multiple regression, the factor of bed supply has been found significant for the dependent variable of the rate of T&A. The finding of large variations in the rate of surgical procedures throughout the country would have important implications for allocating scarce resources and managing quality of care. Further analysis is needed for the elaboration of the above implications.

알코올중독 입원환자의 공격성에 영향을 미치는 요인

조원준(Cho Won-Jun),이기효(Lee Key-Hyo),김원중(Kim Won-Joong) 한국보건복지학회 2007 보건과 복지 Vol.9 No.-

The purpose of this study is to examine affecting factors on aggression of alcoholic inpatients in psychiatric hospitals. and to propose implications for the effective treatment to their aggressiveness. For this, self-esteem, depression of alcoholic patients, and social supports were investigated. Data were collected from 156 alcoholic patients of the mental hospitals in the city of Susan and Kyong-Nam province. The major results are as follows; First. ANOVA analysis shows that aggressiveness behaviors are significantly higher among higher income groups. Second, regression analysis shows that self-esteem and income levels significantly affect aggressive behaviors: the higher self-esteem, the lower level of aggressiveness and the lower income level, the lower level of aggressiveness. These results imply that it is important to increase their self-esteem during their treatment and counsel ing to decrease patient's aggressiveness. The result that the income level affects aggressiveness indicates that individual treatments depending on their social status and circumstances are needed.

흡연이 비만에 미치는 영향분석과 건강보험에 대한 시사점

김대환 ( Dae Hwan Kim ),이기효 ( Key Hyo Lee ),정기택 ( Kee Taig Jung ) 보험연구원 2012 보험금융연구 Vol.23 No.2

비만은 개인의 의료비용뿐만 아니라 국민의료비를 증가시켜 보험료를 인상시키는 외부불경제(negative externality)를 수반하기 때문에 비만을 초래하는 원인들을 밝히려는 다양한 연구가 이루어져 왔다. 본 연구는 흡연이 비만에 주는 영향을 분석하였는데, 흡연변수에 존재하는 내생성을 통제하기 위해 샘플을 비흡연자로 한정하고 간접흡연 여부를 활용해 흡연이 비만을 감소시킴을 증명하였다. 즉, 비흡연자이지만 간접흡연을 하는 사람들은 비흡연자이면서 간접흡연도 하지 않는 사람에 비해 비만이 될 가능성이 0.66배로, 흡연이 비만율을 감소시키거나 금연이 비만율을 증가시킬 수 있음을 의미한다. 이는 흡연이 신진대사에 영향을 주거나 식욕을 저하시켜 비만율을 낮춘다는 의학적인 논리와 일치하는 결과이다. 때문에 금연정책이 흡연율은 낮추겠지만 비만율을 증가시켜 국민건강보험의 재정 및 개인의료보험의 손해율 개선에 미치는 순효과(net effect)는 기대보다 크지 않을 가능성이 있다. Although the obesity rate is low in Korea relative to developed countries, it has been rising due to high calory diet for life. Obesity attracts researchers` great attention since it creates not only higher personal medical costs, but also create the negative externality such as financial trouble of the public health insurance and higher insurance premium. Utilizing the most recent data sets of year 2008 and 2009 from Korea National Health and Nutrition Examination Survey, this study empirically investigates whether or not smoking affects obesity. In order to remove the potential endogeneity between smoking and obesity variable, we replace the smoking variable with secondhand smoking variable in the empirical model of logit. Empirical results prove that smoking decreases the likelihood of being obese. That is, if someone is a nonsmoker, she/he becomes more likely to be non-obese through secondhand smoking. This result consists with the medical rationale that smoking or nicotine causes weight loss since it burns calories and leads to the loss of appetite. Therefore, intensive antismoking campaigns could reduce cigarette smoking but the net effects of the antismoking campaigns on reducing financial trobles of the public health insurance and loss ratio of the private health insurance would be smaller than our expectation due to increasing obesity rates.

병원급 의료기관의 진료권별 병상소요 추계

문옥륜 ( Ok Ryun Moon ),이기효 ( Key Hyo Lee ),장동민 ( Dong Min Lang ) 한국보건사회연구원 1992 保健社會硏究 Vol.12 No.1

병상확충은 자원투입을 가장 많이 요구하기 때문에 병원급 의료기관 병상소요에 관한 분석은 보건의료자원의 합리적인 배분에 필수적인 요소이다. 이에 따라 본 논문은 효과적인 보건의료자원의 배분을 위한 기초자료를 제공하고자 전국 1407ß 의료보험 중진료권을 대상으로 병상소요를 추계하였다. 연구의 방법으로는 첫째, 인구 천명당 병상수, 둘째, 연간 병상공급 증가율, 셋째, 친화율 (RI), 넷째, 병상공급 과부족, 다섯째, 친화율을 이용하여 중진료권을 확대개편한 후 위 네가지 방법을 적용하는 방법을 사용하였다. 이러한 5가지 방법의 장단점이 검토되었으며, 각 방법을 사용한 진료권별 병상소요추계가 시도되었다. 그리고 이를 바탕으로 병상건립의 필요도가 큰 지역이 검토되었다. 본 연구의 결과는 미래의 의료이용에 관한 수요와 의료공급자의 행태변화를 반영하지 못하였기 때문에 이틀을 고려한 추후의 보다 심도깊은 연구가 수행되어야 할 것으로 보인다. Analysis of the hospital bed requirement is critical for the rational distribution of health resources, because this is the most expensive item in health services, so no effective health resource allocation is conceivable without considering it. This paper has applied five different indicators for measuring demand for hospital beds and discussed their advantages / disadvantages and limitations. The unit of analysis is the 1st level health service region, of which there are 140. The indicators employed in this analysis are : 1) the number of hospital beds for 1,000 population, 2) an- increase rate of hospital bed supply, 3) the percent of an age of residents taken care of by hospitals within a given region(Relevance lndexes ; RI), 4) the size of the gap between hospital supply and actual use, and 5) using the above fourth indicator by changing a health service region to a bigger region. The measure of relevance indexes(RI) was used extensively. The fact that this study has not considered future medical care demand and changing of provider behavior patterns calls for further comprehensive studies which would include the elements not dealt with in this analysis.

자가투약의 영향 요인

양진선 ( Jin Sun Yang ),이기효 ( Key Hyo Lee ) 한국보건행정학회 1996 보건행정학회지 Vol.6 No.2

우리나라 병원의 경영전략 실태

문옥륜(Ok Ryun Moon),이기효(Key Hyo Lee) 한국병원경영학회 1996 병원경영학회지 Vol.1 No.1

This paper investigates the current feature of management strategy of hospitals in Korea, and examines the relationships between adoption of a particular strategic orientation and the hospitals environmental and organizational characteristics, strategic behaviors and management improvement activities, and financial performance. Data were collected from CEOs of 88 hospitals among 650 hospitals for a 13.5% response rate using the self-administered questionnaire by mail survey. The major findings that obtained are as follows : 1. Only 37.2% of response hospitals carried out strategic planning. Most of these hospitals established the first strategic planning in 1991(81.3%) and renovated strategic planning by 4 or 5 years(56.3%), and modified strategic planning with flexibility(59.4%). Most strategic plans were documented, but informalized(68.8%). And only 29.0% of these hospitals had independent planning division. 2. Hospital services that CEOs assessed rank ordered for their impact on profitability are as follows : i ) diagnostic ultrasound facility, computerized tomography scanner, obstetric inpatient unit, therapeutic X-ray, and physical therapy at present. ii ) diagnostic ultrasound facility, physical therapy, computerized tomography scanner, emergency department, and health screening at future. And the services rank ordered that CEOs hoped to introduce are as follows : emergency department, physical therapy, health screening, volunteer services, and computerized tomography scanner. Using a typology developed by Miles and Snow(1978), the strategic orientation of response hospitals are shifting significantly from defenders in the past to analyzers in the present, and to prospectors in the future(p<.01). 4. With regard to hospital environmental and organizational characteristics such as ownership, physician training, location, bed size, and hospital management training career and specialty of CEOs, the four strategic orientation archetypes varied not significantly. But, hospitals with a analyser orientation in the present and a reactor orientation in the future perceived competition significantly higher than the other three archetypes(p<.05). 5. The four archetypes rank ordered in terms of appling strategic behaviors and management improvement activities are as follows : prospector, analyzer, reactor, and defender. 6. The four archetypes differed significantly in terms of their financial performance using revenue per bed(p<.05). Reactors and prospectors in terms of total revenue per bed, prospectors in terms of outpatient revenue per bed, and reactors and prospectors in terms of inpatient revenue per bed had the best performance.

암환자의 불안, 스트레스, 재발 우려가 삶의 질에 미치는 영향과 사회적 지지의 조절효과

전영희(Young-Hee Jeon),이기효(Key-Hyo Lee),김원중(Won-Joong Kim) 한국보건복지학회 2010 보건과 복지 Vol.12 No.-

The main purpose of this study was to analyze how emotional factors such as anxiety, stress, and concern for the cancer recurrence influence the life quality of patients who are suffering any neoplasm, and to reach conclusions to improve the life quality of the patients by investigating the controlling effects of social supports for the patients in relations with the emotional factors. For this study, 150 subjects who were undergone for cancer treatments as outpatients or inpatients in a general hospital located in Changwon city were enrolled for self survey with structured questionnaires. Among them, survey data of 148(98.7%) subjects were analyzed. Main results were obtained from multiple regression analysis. That is, when the controlling effect of social supports in relation with the emotional factors such as anxiety, stress, and concern for cancer recurrence of cancer patients were analyzed, emotional factors which were considered as independent variables had negative influence on life quality. However, social supports which were controlling variables had significantly positive influence on life quality. Among the social supports, only family support variable showed a significant controlling effect in relation between the emotional factors such as anxiety, stress, and concern for cancer recurrence and life quality. The results of this study suggest that the efforts to reduce concerns on the emotional factors are required to improve life quality of cancer patients. Additionally, this study implies that the family support is the most important factor to improve life quality of the patients.