활동기준원가(Activity Based Cost)를 적용한 치과 임플란트 원가산정

신호성,안은숙,Shin, Ho-Sung,Ahn, Eun-Suk 대한치과보철학회 2013 대한치과보철학회지 Vol.51 No.4

연구 목적: 의료환경의 변화에 따라 새로운 의료관리에 대한 필요성과 함께 의료기관의 원가관리에 대한 관심이 증가되었다. 본 연구는 치과의료기관에서 빈번하게 제공되는 치과 임플란트 서비스를 직원의 활동에 근거하여 자원 또는 원가를 배부하는 활동기준원가(Activity-Based Cost, ABC) 방법을 적용하여 원가를 산정하기 위해 시행되었다. 연구 대상 및 방법: 수도권 소재의 A 치과의료기관을 대상으로 치과 임플란트 원가산정을 실시하였다. 해당 기관의 총비용을 확인하기 위해 1사분기 세무회계자료를 사용하였고 기관 내에서 이루어지는 활동을 파악하기 위하여 활동분석표 작성을 요청하였다. 자료를 바탕으로 치과 임플란트에 해당하는 직접원가와 간접원가를 분리하고, 간접원가의 왜곡을 최소화하기 위해 원가동인(Cost driver)을 파악하여 활동별로 비용을 배분하는 활동기준원가 분석을 실시하였다. 결과:치과 임플란트 원가를 직접비와 간접비로 나누어 비교한 결과 각각 35.8%, 49.5%로 나타났다. 치과 임플란트 1개당 원가는 1,579천원 정도로 산정되었고, 임플란트 수술 및 시술 전 후 활동이 포함된 보철 시술 진료영역에 47만원(30%)이 소요되어 가장 많은 부분을 차지하였다. 연수 및 치과학 교육 등의 활동도 기타 진료에 비해 상대적으로 높은 비중을 나타내었다. 결론: 과학적인 치과 임플란트의 수가 산정을 위해서 치과 임플란트와 관련된 직접적인 진료 술식 이외에 시술 전 후 준비활동 등에 대한 고려가 충분히 이루어져야 한다. 임플란트 시술 전 후의 활동 및 교육, 연수활동 등은 간접비에 포함되는 부분이나 진료의 질을 담보하고 환자의 만족도를 향상시키기 위해 반드시 필요할 활동으로 이러한 활동들을 고려한 합리적 수가 산정이 필요하다. Purpose: There is a growing concern for the cost management of medical institutions. The purpose of this study was to estimate Activity-Based Costing (ABC) for dental implant cost. ABC refers to allocating resources or cost based on the activities of services. Materials and methods: A dental institution located in the metropolitan area was selected in this study. The tax accounting data of the institution were utilized to confirm total cost, and the institution was asked to make out clinical activities to figure out what activities were carried out. The direct cost and indirect cost for dental implant were separately estimated, and cost driver was analyzed to estimate the indirect cost accurately. Results: The rates of the direct and indirect cost respectively stood at 35.8 and 49.5 percent. The cost for a dental implant was found to be approximately 1,579 won, and the cost of prosthetic surgery and treatment that included implant surgery accounted for the largest portion of the cost, which was 470 thousand won (30%). And the weight of training and education on dentistry was relatively higher than that of the other kinds of treatment. Conclusion: In order to ensure accurate and scientific costing for dental implant, not only direct medical procedure but every pre- and post-procedure activity should fully be taken into account. Pre-activities, post-activities, education and training are included in the indirect cost, but all these activities are mandatory and associated with the quality of treatment and the satisfaction level of patients.

표준화사망비와 지역결핍지수의 상관관계: 지역사회 통합결핍지수 개발

신호성,이수형,추장민,Shin, Ho-Sung,Lee, Sue-Hyung,Chu, Jang-Min 대한예방의학회 2009 예방의학회지 Vol.42 No.6

Objectives : The aims of this paper were to develop the composite deprivation index (CDI) for the sub-district (Eup-Myen-Dong) levels based on the theory of social exclusion and to explore the relationship between the CDI and the standardized mortality ratio (SMR). Methods : The paper calculated the age adjusted SMR and we included five dimensions of social exclusion for CDI; unemployment, poverty, housing, labor and social network. The proxy variables of the five dimensions were the proportion of unemployed males, the percent of recipients receiving National Basic Livelihood Security Act benefits, the proportion of households under the minimum housing standard, the proportion of people with a low social class and the proportion of single-parent household. All the variables were standardized using geometric transformation and then we summed up them for a single index. The paper utilized the 2004-2006 National Death Registry data, the 2003-2006 national residents' registration data, the 2005 Population Census data and the 2005-2006 means-tested benefit recipients' data. Results : The figures were 115.6, 105.8 and 105.1 for the CDI of metropolitan areas (big cities), middle size cities and rural areas, respectively. The distributional variation of the CDI was the highest in metropolitan areas (8.9 - 353.7) and the lowest was in the rural areas (26.8 - 209.7). The extent and relative differences of deprivation increased with urbanization. Compared to the Townsend and Carstairs index, the CDI better represented the characteristics of rural deprivation. The correlation with the SMR was statistically significant and the direction of the CDI effects on the SMR was in accordance with that of the previous studies. Conclusions : The study findings indicated mortality inequalities due to the difference in the CDI. Despite the attempt to improve deprivation measures, further research is warranted for the consensus development of a deprivation index.

EuroQol-5 Dimension 건강가중치를 이용한 한국인의 건강수준의 형평성 측정

신호성,김동진,Shin, Ho-Sung,Kim, Dong-Jin 대한예방의학회 2008 예방의학회지 Vol.41 No.3

Objectives : Despite various government initiatives, including the expansion of national health insurance coverage, health inequality has been a key health policy issue in South Korea during the past decade. This study describes and compares the extent of the total health inequality and the income-related health inequality over time among Korean adults. Methods : This study employs the 1998, 2001 and 2005 Korean National Health and Nutrition Examination Surveys (KNHANESs). The self-assessed health (SAH) ordinal responses, measured on a five-point scale, resealed to cardinal values to measure the health inequalities with using interval regression. The boundaries of each threshold for the interval regression analysis were obtained from the empirical distribution of the EuroQol-5 Dimension (EQ-5D) valuation weights estimated from the 2005 KNHANES. The final model predicting the individuals' health status included age, gender, educational attainment, occupation, income, and the regional prosperity index. The concentration index was used to measure and analyze the health inequality. Results : The KNHANES data showed an unequal distribution of the total health inequality in favor of the higher income groups, and this is getting worse over time (0.0327 in 1998, 0.0393 in 2001 and 0.0924 in 2005). The income-related health inequality in 2005 was 0.0278, indicating that 30.1% of the total health inequality can be attributed to income. Conclusions : The findings indicate there are health inequalities across the sociodemographic and income groups despite the recent government's efforts. Further research is warranted to investigate what potential policy actions are necessary to decrease the health inequality in Korea.

식중독의 사회경제적 비용추정: 삶의 질 개념을 적용한 질병비용추정법을 이용하여

신호성,이수형,김종수,김진숙,한규홍,Shin, Ho-Sung,Lee, Sue-Hyung,Kim, Jong-Soo,Kim, Jin-Suk,Han, Kyu-Hong 대한예방의학회 2010 예방의학회지 Vol.43 No.4

Objectives: This study estimated the annual socioeconomic costs of food-borne disease in 2008 from a societal perspective and using a cost-of-illness method. Methods: Our model employed a comprehensive set of diagnostic disease codes to define food-borne diseases with using the Korea National Health Insurance (KNHI) reimbursement data. This study classified the food borne illness as three types of symptoms according to the severity of the illness: mild, moderate, severe. In addition to the traditional method of assessing the cost-of-illness, the study included measures to account for the lost quality of life. We estimated the cost of the lost quality of life using quality-adjusted life years and a visual analog scale. The direct cost included medical and medication costs, and the non-medical costs included transportation costs, caregiver's cost and administration costs. The lost productivity costs included lost workdays due to illness and lost earnings due to premature death. Results: The study found the estimated annual socioeconomic costs of food-borne disease in 2008 were 954.9 billion won (735.3 billion won-996.9 billion won). The medical cost was 73.4 -76.8% of the cost, the lost productivity cost was 22.6% and the cost of the lost quality of life was 26.0%. Conclusions: Most of the cost-of-illness studies are known to have underestimated the actual socioeconomic costs of the subjects, and these studies excluded many important social costs, such as the value of pain, suffering and functional disability. The study addressed the uncertainty related to estimating the socioeconomic costs of food-borne disease as well as the updated cost estimates. Our estimates could contribute to develop and evaluate policies for food-borne disease.

치과의료의 질과 질지표 측정

신호성(Hosung Shin) 대한치과의료관리학회 2020 대한치과의료관리학회지 Vol.8 No.1

지표면 열평형의 열-수리적 경계조건에 대한 수치해석

신호성(Shin, Hosung),정재형(Jeoung, Jae-Hyeung) 한국지반공학회 2021 한국지반공학회논문집 Vol.37 No.12

지역적 특성과 부하특성을 고려한 직접부하제어 알고리즘

신호성(Ho-Sung Shin),송경빈(Kyung-Bin Song),문종필(Jong-Fil Moon),김재철(Jae-Chul Kim),남봉우(Bong-Woo Nam) 대한전기학회 2006 대한전기학회 학술대회 논문집 Vol.2006 No.7

This paper presents direct load control algorithm based locational and electric load characteristics. Direct load control is defined that demand-side management program activities that can interrupt consumer load at the time of annual peak load by direct control of the utility system operator by interruption power supply to individual appliances or equipment on consumer premises. Korean power system is divided into 14-areas considering branches operating in KEPCO, and electric loads are classified into 19 load groups considering interruption costs in this paper. The purpose of proposed method is to decrease social losses by controlling electric loads mainly whose interruption costs are low. It is expected that the proposed algorithm can be used as the countermeasure for the emergency state of the electric power dispatch in a operation point of view.

우리나라 구강건강 의료의 질 지표 개발을 위한 기초연구

신호성(Hosung Shin),김민경(Minkyoung Kim),김보라(Bo-Ra Kim) 대한치과의사협회 2022 대한치과의사협회지 Vol.60 No.11

The aims of this study were to evaluate quality indicators that can be applied to the dental care delivery system in Korea. This study was performed with a three-step process. Firstly, authors searched for quality indicators developed in dentistry field. Among them, 80 quality indicators were selected as the indicators that used in dental institutions, and then 33-item preliminary list was extracted through evaluation by 9 experts consisted of dental clinicians and professors (college of dentistry and department of dental hygiene). Based on this 33-item preliminary list, a Delphi process was conducted twice by a stakeholder group consisting of 17 panels (dentists, dental hygienists, dental technicians, professors of dental colleges, and dental hygiene professors). Each item of the preliminary list was classified into 5 domains of importance, relevance, feasibility, reliability, and sensitivity. The panels were asked to rate from 0 to 3-point (very unnecessary - very appropriate) to the 5 domains of all items. As a result, the sealant treatment item received the most consent, and the item of whether unnecessary antibiotics is prescribed received the lowest preference. Among the 33 items, the items that received a score of 2.5 or higher were sealant, brushing, fluoride application, caries prevention, periodontal management, regular check-up, continuity of treatment, and evaluation of current symptoms. This study was performed as basic research. Based on international consensus on the definition of the quality of oral health care, development of new measures is necessary to produce quality indicators that suitable for the dental setting in Korea.

기후변화와 연령특성이 장염 발생에 미치는 영향

신호성 ( Shin Ho-sung ),윤시몬 ( Yun Simon ),정진욱 ( Jeong Jin-wook ),김정선 ( Kim Jeong Seon ) 한국보건사회연구원 2015 保健社會硏究 Vol.35 No.1

본 연구에서는 2004~2008년(5년) 기간의 건강보험심사평가원 전산청구자료와 기상청의 자동기상관측시스템에서 측정된 기후자료를 활용하여 온도와 강수량 변화와 연령 특성별 식품매개로 추정될 수 있는 장염질환 발생과의 상관관계를 모델링하였고, 기온 상승에 따른 노인 및 비노인 집단 간의 장염질환 발생양상 향후 변화를 예측하였다. 노인집단의 발생건수는 기온과 상관성을 보이나 비노인 집단처럼 뚜렷한 상관성은 관찰되지 않았다. 노인의 경우 2개의 변곡점 사이에서 기온과의 상관성이 명확하지는 않지만 두 번째 변곡점 이후에는 기온과의 양의 상관성이 상대적으로 관찰되었다. 변곡점 전후의 기울기는 단위기온 상승에 따른 시군구 주간 장염질환 발생건수를 나타내는데, 노인과 비노인을 모두 고려한 최종모형(전체)에서 24.3℃ 이후에서 기온이 1℃ 상승함에 따라 주간 시군구 발생건수도 5.7건 증가하는 경향이 나타났다. 최종적으로 주간 평균기온이 24.3℃ 이후 1℃ 상승함에 따라 시군구 평균 주간 장염질환 발생건수가 5% 증가하고, 비노인 집단에서 7.7건으로 노인집단의 1.8건 보다 4.3배 많은 증가속도를 보여줄 것으로 예측되었다. 또한 2050년 우리나라 평균기온이 24.3℃ 이후 3.2℃ 증가하면, 시·군·구 장염질환 발생건수가 16% 증가하는 것으로 나타났다. This study modeled the relation between changes in temperature and precipitation and occurrence of infectious enteritis by age based on the health insurance claim data from Health Insurance Review & Assessment Service (HIRA) from 2004 to 2008 and climate data measured by Automatic Weather System in Korea Meteorological Administration. The correlation was observed between food poisoning and temperature. The slope before and after the inflection point refers to the frequency of food poisoning during the daytime by city, county and district with increase in unit temperature. In a model in which both elderly and non-elderly people were considered, temperature rose by 1℃ after 24.3℃. Therefore, the frequency of the disease during the daytime by city, county and district also increased by 5.7. In sum, as average daytime temperature increases by 1℃ after 24.3℃, the frequency of the food borne presumptive eteritis during the daytime rose by 5% (a group of non-elderly people (7.7 cases) was 4.3 times greater than a group of elderly people (1.8 cases)). If Korea`s mean annual temperature increases by 3.2℃ after 24.3℃ in 2050, the frequency of the food borne presumptive disease would rise by 16%.

서비스풍토 속성이 고객감정과 고객 참여행동에 미치는 영향 : 통합적 모델 연구

신호성 ( Ho-sung Shin ),유재원 ( Jae-won Yoo ) 한국고객만족경영학회 2016 고객만족경영연구 Vol.18 No.3

본 연구에서는 기업의 서비스풍토 속성이 고객이 지각하는 고객감정과 감사인식을 통하여 고객 참여행동에 미치는 영향을 연구하고자 한 것으로 특히 서비스풍토와 고객감정의 관계에서 서비스품질의 조절효과에 초점을 두어 연구를 진행하였다. 먼저 의료서비스 이용자가 인식하는 서비스 풍토는 의료서비스 제공자가 제시하는 유, 무형의 서비스에 대한 고객의 기대와 평가에 직접적인 영향을 미치는 선행요인으로 설명할 수 있다. 자세히 보면 서비스 풍토는 고객이 느끼는 감정에 직접적인 원인이 되며, 이를 통해 서비스 고객의 감사인식을 고취시키는 역할을 한다. 또 이와 같은 심리적인 반응절차를 통해 기업에 긍정적인 성과요인으로 설명되는 자발적인 고객행동인 고객 참여행동과의 긍정적인 연관성에 대해 확인할 수 있었다. 이를 통해 최근 서비스의 중요성이 대두되고 있는 시점에서 관리자들에게 새로운 시장발굴과 수익가치 창출을 위해 고객과의 상호관계를 어떻게 활용할 것인지에 대한 중요한 시사점을 제공하고 있다. 기존의 척도를 바탕으로 작성된 설문지를 이용하여 국내에서 진행된 의료 서비스 관련 학술대회에 참가한 의료서비스 이용자 300명을 대상으로 의료 서비스 제공자와의 관계 및 이용자들의 고객행동에 대한 설문조사를 실시하였다. 수집된 자료를 바탕으로 본 연구에서 제시된 가설들을 검증하기 위하여 구조방정식(LISREL 8.5)을 이용하여 실증분석을 실시하였다. 분석결과 의료서비스 제공자의 유, 무형의 서비스를 통하여 서비스풍토가 고객감정에 정의 영향을 미친다는 것을 확인하였으며 지각된 고객감정은 고객감사에 정의 영향이 있는 것으로 나타났다. 또한 고객감사는 고객의 참여행동에 정의 영향을 미치는 것으로 파악되었다. 더욱이 본 연구를 통해 서비스 품질지각은 서비스풍토와 고객감정에서 관계를 강화시키는 조절효과가 있는 것으로 나타났다. 이에 본 연구를 통하여 고객이 인식하는 기업의 서비스문화가 고객감정과 고객감사 그리고 자발적 고객행동인 고객참여행동에 미치는 영향을 검증하였으며, 기업이 실질적으로 제공하는 핵심서비스와 문화라는 차별적인 영향요인들 간의 상호작용을 검정하여 기업이 관리해야 될 다양한 변수와 고객행동에 대한 연구결과를 실증적으로 확인하였다. This study examines the effect of service climate attributes on customer emotion and gratitude, and ultimately, on customer participation behaviors with the moderated effect of service quality. Service climate here is defined as dentists` perceptions of tangible and intangible service provided to customers. This results in customer emotions and acts as the antecedents of customer gratitude. This study identifies customer participation behaviors by including service climate attributes, service quality, customer emotion, and customer gratitude concepts in the comprehensive model. This study has some important implications when interactions with customer get more attention to pursue new market development and to find new profit opportunities. Firm`s positive resources are led to customer` positive emotion based on the conservation of resources theory. Customers then try to maintain that positive resources and keep the good relationship with the firm even at the service failure situations by attributing the failure to their mistakes not the firm`s fault. Customer gratitude, one of the key constructs of this study, is one`s positive response to other`s intentional benefits and help. It is said that gratitude is experienced more or less depending on the receiver`s perception of helpers` cost and intention. Put differently, the more employees make efforts to help their customers, the more customers get benefits and feel satisfied. Customer participation behaviors can be explained as the degree to which customers invest their physical and emotional efforts to the service delivery. The author conducted survey based on the prior literature with 300 dentists who participated in Seoul International Dental Exhibition and Scientific Congress to explore the relationships between their suppliers and customer participation behaviors. The date then was analyzed using structural equation modeling (LISREL 8.5). The author finds that service climate attributes have a positive impact on customer emotion and service quality moderates this relationship. Customer emotion has also positive impact on customer gratitude and customer gratitude and customer participation behaviors have a positive relationship. Consequently, this study finds that perceived uniqueness of service resources has a positive impact on customer emotion, customer gratitude, and customer participation behaviors and, therefore, the firms need to manage their various variables and customer behaviors.