방사선사의 전직의사와 관련된 요인분석

유승흠(Seoung Hum Yu),김창호(Chang Ho Kim),이선희(Sun Hee Lee),손태용(Tae Yong Sohn) 한국병원경영학회 1996 병원경영학회지 Vol.1 No.1

This study attempts to analyze the factors affecting the intention of transferring to another hospitals among radiology technologists. 344 cases were reviewed in 5 university hospitals and 1 general hospital. Self-administered questionaire were given to study the socioeconomic characteristics, working conditions, job satisfaction level, and the reasons for transfer among the technologists. The major findings were as follows : 1. Job position and hospital characteristics had a statistically significant relationship with the intention of transferring to another hospital. 2. Those who were not satisfied with their salaries and promotional opportunity showed a higher tendency towards to transfer. 3. Those who were less satisfied with the opportunity for developing the personal ability and had the negative attitude on their job showed a higher tendency to transfer. 4. Those who did not sustain good relationship with their superiors and co-workers scored high on the tendency to transfer. 5. In the result of multiple regression, recognition of radiation hazard, job satisfaction, satisfaction with salary levels, job attitude were significantly related to transfer. The above indicate that besides economic incentives, job satisfaction and organizational culture to promote their ability and form a good relationship with organization members were very important to decrease the intention of transfer. Since these results represent only 6 hospitals from a limited area, more hospitals nationwide, especially small and medium-sized institutions where there is a high turnover rate of employment, need to be examined in order to investigate the various factors that affect the intention of transfering.

병원 종합 물류시스템 운영에 대한 관련직원들의 인식

이광용 ( Kwang Yong Lee ),유승흠 ( Seoung Hum Yu ),손태용 ( Tae Yong Sohn ) 한국병원경영학회 1999 병원경영학회지 Vol.4 No.2

The purpose of this study is to identify influencing factors for successful introduction, implementation and management of HMRPS through assessment of the employees attitude toward HMRPS in technical, administrative, and organization behavioral areas. Data were collected from 157 HMRPS employee members' self-reporting questionnaire in three university hospitals in the city of Seoul and Kyonggi Province from November 5 to November 10, 1997. Relevant literature on industry company MPR system theory was reviewed to develop the theoretical framework. The results were as follows : The employee's recognition of tangible benefit were more significantly influenced success than intangible benefit for successful operation relating the HMRPS. Concerning the employee's recognition of the successful HMRPS and the factor of influenced success was significantly positive correlation between tangible and intangible benefits and success factor in technical, administrative, and organizational behavior area. This study showed that major factor affecting the employee's recognition of tangible and intangible benefit for successful HMRPS. For tangible benefits : Success factors in the technical areas were quality of the data and information, efficiency of inventory management and rescheduling of operation plan. Success factors in the administrative areas were : role of top management. Success factors in the organization behavioral areas were ; simplicity of the HMRPS, human resistance to change. For intangible benefits : Success factors in the organization behavioral areas were ; user involvement, simplicity of HMRPS, human resistance to change. Furthermore as the exact evaluation of successful factors of HMRPS implement is needed, research for the development of systemic variables of physical distribution system control, methods, capacity of system, duration and other environment in many of 30 hospitals or more, and for the empirical study for HMRPS.

신설 대학병원 행정직원과 기존 대학병원 행정직원의 갈등수준 비교 분석

김종래(Jong Rae Kim),유승흠(Seoung Hum Yu),손태용(Tae Yong Sohn) 한국병원경영학회 1997 병원경영학회지 Vol.2 No.1

질병군별 포괄수가제 ( DRG 지불제도 ) 시범사업에서 제왕절개산모의 의료서비스 - 서울시내 한 종합병원을 대상으로 -

이귀진(Kwi Jin Lee),유승흠(Seoung Hum Yu) 한국병원경영학회 1999 병원경영학회지 Vol.4 No.2

One Diagnosis Related Group(DRG) pilot study participating hospital was measured and analyzed to see if there were any changes after the DRG program. It was implemented in consideration of medical service utilization, hospital charges, and non-covered medical service charges by insurance in all Cesarean section cases by reviewing medical records for 3 years, including 1 year before pilot study as well as 1 and 2 years after, respectively. The results were as follows : Fist, the use of intramuscular antibiotics decreased statistically significantly, whereas intravenous use did not. Second, the administration period and charges of antianemic medication decreased significantly, where the prescription was appropriate. Third, the length of hospital stay decreased statistically significantly. Fourth, there were significant statistical differences in cost sharing between the insured and the insurer : cost sharing of the insured was reduced, whereas the share of the insurer increased. However, there was no change in the quality of care. Fifth, there were no statistically significant changes in the Cesarean section rate. As a result, if the fee schedule is reasonably high, hospitals can provide quality care. This DRG pilot study resulted expected outcomes : by paying a higher fee schedule than fee-for-service, then hospitals can provide quality care to their patients and increase hospital profits.

수정체적출술과 편도절제술에 대한 통원수술과 입원수술의 진료비 및 만족도 비교

서재명 ( Jae Myung Seo ),유승흠 ( Seoung Hum Yu ) 한국병원경영학회 1999 병원경영학회지 Vol.4 No.2

Objectives : This study was done to compare patient satisfaction and hospital charges of surgery performed in an outpatient basis(ambulatory surgical procedures). Methods : This retrospective study was performed in 20 (vitrectomy 11, tonsillectomy 9) randomly selected ambulatory surgical procedures patients and 50 (vitrectomy 26, tosillectomy 24) inpatients who received the same procedure at a general hospital in Seoul since January 1, 1998 to October 31, 1998. The operative procedures were vitrectomy and tosilletomy which could be performed on a ambulatory surgical procedures basis or on an inpatient basis. Results : The results of this study shows that the patients thought the expenses and the surgical operative time was an important factor in a ambulatory surgical procedures but there were no differences in the patient satisfaction by the method of surgery. The charges of vitrectomy and tonsilletomy were reduced up to 495,000 won and 380,000 won from 1,589,000 won 842,000 won inpatient surgery respectively. Conclusions : This study focused only on the charges of the surgical procedures and did not include the cost of patient helper, the lost salary due to missing days of work to care for a member of the family, transportation costs, and other indirect costs. Therefore, if those fees were included, ambulatory surgical procedures would be more economical. Therefore, by giving incentives at the fee schedule, the government health policies it would reduce the total hospital charges.

종합병원 자산관리 정도 및 요인 분석

이해종(Hae Jong Lee),서영근(Young Geun Seo),유승흠(Seoung Hum Yu),박은철(Eun Cheol Park) 한국병원경영학회 1996 병원경영학회지 Vol.1 No.1

The purpose of this study is to evaluate the level of fixed assets management of the factors affecting its management level. The surveyed data were gathered from 105 general hospitals among 263 general hospitals nationwide. The level of fixed assets management was measured by 11 dimensions of assets management. The results were as follows : 1. According to general characteristics of hospitals, the management level of public hospitals and corporatized hospitals was better than that of private hospitals. The management level was better as increasing beds. 2. In the structural characteristics of assets management, the management level of the hospitals which had the responsible person for assets management was better than that of the hospitals which had not. 3. In the operating characteristics of assets management, the hospitals that conducted education for the job had better level of assets management that did not it. The hospital that the discard of assets was decided by engineering department or management department were better in management level than the hospitals that it was decided by user department. The management level of hospitals which were computerized for assets management was better. 4. In the full model, the most factors affecting the level of assets management were the factors that were characterized by operation pattern of assets management, and the operating characteristics of assets management were explained to 23.1% of total 45.7%. Conclusively, the level of assets management was mostly affected by the operating characteristics of assets management which were education for the job, discard decision not by user department, computerization for assets management. Therefore, hospitals perform education of the job, discard decision by engineering or management department, and computerization for better level of fixed assets management.

CT 보험급여 전후의 CT 및 MRI검사의 이용량과 수익성 변화

서종록,유승흠,전기홍,남정모 한국병원경영학회 1997 병원경영학회지 Vol.2 No.1

In order to analyze the shifts in the volume and profits of Computed Tomography(CT) and Magnetic Resonance Imagine(MRI) utilization for a year before and after the implementation of insurance coverage for CT, this study has been undertaken examining CT and MRI cost data from 'Y' University Hospital situated in Seoul, Korea. Following are the results of this study : 1. The medical insurance payment for CT, implemented on January 1, 1996, increased CT utilization from January 1996 to April 1996 due to low insurance premiums : however, from May 1996 the number of CT cases significantly decreased as a result of strengthened medical cost reviews and the new 'Detailed standards for approval of CT' announced near the end of April 1996 by the insurer. 2. Since the implementation of insurance coverage for CT, CT fee reduction rates for reimbursements by the insurer to the hospital were 50% and 40% for January and February, respectively, and 31% and 15% for March and April. A significant point in the lowering of the reduction rate was reached in May at 11% : furthermore, since June the reduction rate fell below the average reduction rate for reimbursements for all procedures. If the 'Detailed standards for approval of CT' had been announced before the implementation of insurance coverage for CT, CT utilization would not have been so high due to the need to meet those 'standards'. In addition, loss of hospital profits resulting from the reduction for reimbursements would not have occurred. 3. The shifts in MRI utilization showed that there was no particular change with the beginning of insurance coverage for CT, and the introduction of the 'Detailed standards for approval of CT' made MRI utilization increase because MRI is free of restrictions imposed by the insurer. 4. The relationship between CT utilization and MRI utilization shoed that they were supplementary to each other before insurance coverage for CT, but that CT was substituted for MRI because of strengthened medical cost reviews after the beginning of insurance coverage for CT. 5. The shifts in volume by patient characteristics showed that the number of inappropriate case patients, according to the insurer's "Standards for approval", decreased more than the number of appropriate case patients after the introduction of insurance coverage for CT. Therefore, the health insurance fee schemes for CT have influenced patient care. 6. The shifts in profits from CT utilization showed a net profit decrease of 31.6%. In order to match the pre-coverage profit level, 5,471 more cases would need to be seen and productivity would need to be increased by 32.7%. This profit decrease resulted from a decrease of CT utilization and low reimbursements. With insurance coverage, net profits from CT were 24.4%, and a margin of safety ratio was 39.6%. Because of the net profits and margin of safety ratio, CT utilization fees for insured appropriate cases could not be considered inappropriate. 7. The shifts in profits from MRI utilization before and after the introduction of CT coverage showed that in order to match pre-CT coverage profit levels, 2,011 more cases would need to be seen and productivity would need to be increased by 9.2%. The reasons for needing to increase the number of cases and productivity result from cost burdens created by adding new MRI units. But with CT coverage already begun, MRI utilization increased. Combined with a minor increase in the MRI fee schedule, MRI utilization showed a net profit increase of 18.5%. Net profits of 62.8% and a 'margin of safety ratio' of 43.1% for MRI utilization showed that the hospital relied on this non-covered procedure for profits. 8. The shifts in profits from CT and MRI utilization showed the net profits from CT decreased by 2.33 billion Won while the net profits from MRI increased by 815.7 million Won. Overall, these two together showed a net profit decrease of 1.51 billion Won. The shifts in utilization showed a functional substitution relationship, but the shifts in profits did not show a substitutionary relationship. From these results, We can conclude that if insurance is to be expanded to include previously uncovered procedures using expensive medical equipment, detailed standards should be prepared in advance. The decrease in profits from the shifts in coverage and changes in fees is a difficult burden that should be shared, not carried by the hospital alone. Also, a new or improved fee schedule system should include revised standards between items listed and the appropriateness of the fee schedule should constantly be ensured. This study focused on one university hospital in Seoul and is therefore limited in general applicability. But it is valuable for considering current issues and problems, such as the influence of CT coverage on hospital management. Future studies will hopefully expand the scope of the issues considered here.

입원환자의 재선택 의향과 결정요인

설동원,유승흠,박은철,김은석 한국병원경영학회 1997 병원경영학회지 Vol.2 No.1

This study aims to measure in-patients' willingness to choose the same hospital, and to define the related factors. The willingness was measured by the fact whether in-patients would return to the same hospital for their future hospitalization and can be said as the essence of ascertaining patients' satisfaction. Data was collected from 236 patients hospitalized in two hospitals selected according to its superiority, one being superior in medical technique, the other being superior in facility and equipment. To enhance the comparability between the two hospitals, the department and the diagnosis were matched, and structured questionnaires were self-fill-up. The main findings are as follows. Hospitals were analyzed by their superiority : medical services, facility and equipment. In case of hospitals with superior medical services, the willingness was proportional to positive doctor-patient relationship, to satisfaction with the medical level, and to the acknowledgement of utility in cure. In case of hospitals with superior facility and equipment, the willingness was proportional to the satisfactory state of overall facility. Two types of hospitals were combined and analyzed. The willingness for choosing hospitals with superior medical services was stronger than that for choosing the other hospitals. The satisfaction with overall facility, satisfaction with medical level, acknowledgement of utility in cure, positive doctor-patient relationship, and better consultation produced higher willingness to choose the same hospital. The willingness for the option shows to what degree the hospital suffices patients' expectation. Patients' understanding views were obviously influential. The satisfaction level for medical aspect was more influential than the level for non-medical aspect.

병원 재고자산관리에 관한 병원직원의 태도와 만족도

오영환,유승흠,손태용 한국병원경영학회 1997 병원경영학회지 Vol.3 No.1

The purpose of this study is to investigate factors influencing the attitude and satisfaction with inventory management of hospitals. Data were collected from 344 employees in two hospitals located in Seoul and one hospital located in Choong-Chung Do, Korea, using a self-administered questionnaire. Items included in the self-administered questionnaire were hospital and socioeconomic characteristics of personnels such as the level of knowledge, practice, attitude, and satisfaction with inventory management of hospitals. Major findings were as follow : Job position was significantly associated with satisfaction with inventory management. According to age, sex, type of position and aptitude of personnel the level of positive attitude to and satisfaction with inventory management showed significant association. Generally, those who had higher level of knowledge and practice showed a higher tendency toward positive attitude of inventory management, except for those in medical support post. A higher tendency of satisfaction with inventory management was also observed, with the exception of personnel in nurse post. This study showed that major factors affecting attitude toward inventory management are level of knowledge and practice, and factors affecting satisfaction are job position and aptitude. The level of attitude and satisfaction explained by these factors were 46.8% and 12.2%, respectively. According to the results of this study, higher level of knowledge and practice, job position and aptitude appear to be essential for the implementation of effective inventory management. Factors affecting attitude and satisfaction of inventory management should be studied more in depth systematically so that other objective test and measurements can be developed.

강화도 정신과 역학 연구(Ⅱ) : 연구설계 Survey Design

남궁기,오희철,유승흠,이만홍,민성길,이호영,김일순,Yu, Elena 大韓神經精神醫學會 1989 신경정신의학 Vol.28 No.6

The Kangwha Psychiatric Epidemiologic Survey was done as the first step of Kangwha Health Project. Summary of the survey design were as follows. 1) 2195 subjects were selected by single stage random cluster sampling. 2) As a survey instrument the Korea version of NIMH-Diagnostic Interview Schedule were used, which was verified with a validity test by the present authors. 3) 30 lay-interviewers who were high school graduates or college students were trained for two weeks and 26 of them conducted home visiting survey for one month. 4) Out of total 2195 selected subjects, 1450 subjects were interviewed completely, thus the completion rate was 66.10%. 5) Data was sent to and analyzed in the University of Texas with DIS-Program which had been developed in Wasington University.