민간의료기관을 이용하는 결핵환자의 의료이용 분석

강길원,윤석준,김창엽,신영수,Kang, Gil-Won,Yoon, Seok-Jun,Kim, Chang-Yup,Shin, Young-Soo 대한예방의학회 1998 Journal of Preventive Medicine and Public Health Vol.31 No.4

In this study we analyzed the insurance claims data to investigate the medical care utilization pattern of tuberculosis patients in private sector. We selected the claims of principal or secondary diagnosis with tuberculosis from claims database of National federation of Medical Insurance, from December 1995 to November 1996. Both spell-based analysis and person-based analysis were carried out. In spell-based analysis, type and location of treatment facilities, distribution of diagnoses, number of outpatient/inpatient treatments were analyzed. Additionally in person-based analysis, number of tuberculosis patients, demographic characteristics, number of treatments per person, frequency and pattern of change in source of care were analyzed. The results were as follows 1. The number of treatments with tuberculosis was 863,641 from 1 December 1995 to 30 November 1996. The number of patients was 313.964. 2. Most of tuberculosis patients in private sector were treated in general hospital (45.8%) and clinics(42.2%) 3. About 77.7% of tuberculosis patients who were treated more than two times did not change the source of care. 18,9% of tuberculosis patients changed source of care only once. Even when we limited tuberculosis patient to those who were treated more than five times and whose treatment period were longer than six months, 94.7% of patients did not change source of care at all, or changed treatment facility only once. 4. The probability of change in source of rare was higher in pulmonary tuberculosis, in twenties, and in rural area respectively than other tuberculosis. In conclusion, healer shopping of tuberculosis patients was not serious as expected. However special attention is needed to pulmonary tuberculosis in twenties and rural area.

DRG 지불제도 도입에 따른 의료보험청구 행태 변화

강길원,박형근,김창엽,김용익,하범만,Kang, Gil-Won,Park, Hyoung-Keun,Kim, Chang-Yup,Kim, Yong-Ik,Ha, Beom-Man 대한예방의학회 2000 예방의학회지 Vol.33 No.4

Objectives : To evaluate the impacts of the DRG payment system on the behavior of medical insurance claimants. Specifically, we evaluated the case-mix index, the numbers of diagnosis and procedure codes utilized, and the corresponding rate of diagnosis codes before, during and after implementation of the DRG payment system. Methods : In order to evaluate the case-mix index, the number of diagnosis and procedure codes utilized, we used medical insurance claim data from all medical facilities that participated in the DRG-based Prospective Payment Demonstration Program. This medical insurance claim data consisted of both pre-demonstration program data (fee-for-service, from November, 1998 to January, 1999) and post-demonstration program data (DRG-based Prospective Payment, from February, 1999 to April, 1999). And in order to evaluate the corresponding rate of diagnosis codes utilized, we reviewed 820 medical records from 20 medical institutes that were selected by random sampling methods. Results : The case-mix index rate decreased after the DRG-based Prospective Payment Demonstration Program was introduced. The average numbers of different claim diagnosis codes used decreased (new DRGs from 2.22 to 1.24, and previous DRGs from 1.69 to 1.21), as did the average number of claim procedure codes used (new DRGs from 3.02 to 2.16, and previous DRGs from 2.97 to 2.43). With respect to the time of participation in the program, the change in number of claim procedure codes was significant, but the change in number of claim diagnosis codes was not. The corresponding rate of claim diagnosis codes increased (from 57.5% to 82.6%), as did the exclusion rate of claim diagnosis codes (from 16.5% to 25.1%). Conclusions : After the implementation of the DRG payment system, the corresponding rate of insurance claim codes and the corresponding exclusion rate of claim diagnosis codes both increased, because the inducement system for entering the codes for claim review was changed.

海山 全垂鏞의 抗日鬪爭

姜吉遠(Kang Gil-won) 역사학회 1984 역사학보 Vol.101 No.-

보험 급여 : DRG지불제도 소개

강길원 ( Kang Gil Won ) 대한신장학회 2003 추계학술대회 초록집 Vol.22 No.2

공동연구 : 민족주의 ; 후은김용구의 항일투쟁

강길원(Gil Won Kang) 전북대학교 인문학연구소 1986 인문논총 Vol.16 No.-

건강보험 상대가치 개정 연구의 성과와 한계

강길원 ( Gil Won Kang ),이충섭 ( Choong Sup Lee ) 한국보건행정학회 2007 보건행정학회지 Vol.17 No.3

Relative value scales introduced in 2001 remarkably improved health insurance fee schedule, but current relative value scales have many problems. In the beginning the government intended to introduce ``resource based relative value scales(RBRVSs)`` like USA, but political adjustment of RBRVS studied in 1997 weakened the relationship between relative value scale and resource consumption. So unbalance of health insurance fees are existing till now. Also relative value was not divided to physician work and practice expense, and malpractice fee was not divided separately To correct the unbalance of current relative value scales, the refinement project of health insurance relative value scales started in 2003. The project team divided relative value scales into three components, which are physician work, practice expense, malpractice fee. Physician work was studied by professional organizations like Korean medical association. To develop the practice expense relative value, project team organized clinical practice expert panels(CPEPs) composed of physicians, nurses, and medical technicians. CPEPs constructed direct expense data like labor costs, material costs, equipment costs about each medical procedures. The practice expense relative values of medical procedures were developed by the allocation of the institution level direct & indirect costs according to CPEPs direct costs. Institution level direct & indirect costs were collected in 21 hospitals, 98 medical clinics, 53 dental clinics, 78 oriental clinics, and 46 pharmacies. The malpractice fee relative values were developed through the survey of malpractice related costs of hospitals, clinics, pharmacies. Putting together three components of relative values in one scale, the final relative values were made. The final relative values were calculated under budget neutrality by medical depart?ments, that is, total relative value score of a department was same before and after the revision. but malpractice fee relative value scores were added to total scores of relative values. So total score of a department was increased by the malpractice fee relative value score of that department. This project failed in making ``resource based`` relative value scales in the true sense of the word, because the total relative value scores of medical departments were fixed. However the project team constructed the objective basis of relative value scale like physician`s work, direct practice expense, malpractice fee. So step by step making process of the basis, the fixation of total scores by the departments will be resolved and the resource based relative value scale will be introduced in true sense.

戊戌ㆍ已亥(1898-1899), 古阜等諸邑의 農民峰起

姜吉遠(Kang Gil-Won) 한국사연구회 1994 한국사연구 Vol.85 No.-

델파이법을 적용한 암연구수준의 평가

강영호,윤석준,강길원,김창엽,유근영,신영수,Khang, Young-Ho,Yoon, Seok-Jun,Kang, Gil-Won,Kim, Chang-Yup,Yoo, Keun-Young,Shin, Young-Soo 대한예방의학회 1998 Journal of Preventive Medicine and Public Health Vol.31 No.4

Globally, cancer research has been considered one of the most important field of biomedical researches. Recently, in Korea, there are increasing concerns about cancer research and the development of national cancer control programme. For the efficient investment in cancer research at the national level, strategic approach is needed based on the nationwide information about current status of research. However even the basic data on cancer research have not been systematically collected, and are not available when necessary. The aim of this study is to assess current status of cancer research. For this purpose, this study applied two round Delphi method in which fifteen experts in cancer research fields participated. They rated each items on the initial list at the first round, and modified their responses at the second round. Panels responded that pathogenesis of cancer, research & development of cancer drug, and oncogene, etc. are the most urgent and important research Holds. They assessed national level of cancer research as being 49.6% of the world highest level. Coefficient of variation tended to be lowered with the iteration. Predictive stability was evaluated to be lower in items of urgency than in items of importance and research level. Although this study shares the same limitations in the selection of the experts with many other Delphi studies, it provides a primary data that would be required to plan the national strategy of the cancer research.

처방전달체계에 대한 사용자 만족도에 영향을 미치는 요인

김창엽,하범만,강길원,김병익,김용익,이진석,Kim, Chang-Yup,Ha, Bum-Man,Kang, Gil-Won,Kim, Byoung-Yik,Kim, Yong-Ik,Lee, Jin-Seok 대한예방의학회 2000 예방의학회지 Vol.33 No.4

Objectives : To identify the factors affecting users' satisfaction with the Order Communicating System(OCS) and to highlight the factors important for the successful establishment of OCS. Methods : A Users Satisfaction survey was sent to 4,513 people, consisting of 1,503 doctors, 2,379 nurses, 255 pharmacists and 370 administrative workers in 16 hospitals which had introduced OCS. The response rate was 63.9%. Measurement of users' satisfaction was peformed with the instrument which was used in Doll's study. Some aspects of Doll's instrument were adjusted according to the aims of this study. The classifying sections of this survey included age, job and status classification, computer experience, OCS education, duration of daily OCS use, type of order entering, number of personnel in the Hospital Information System's department, cost of OCS, problem frequency, proportion of work managed by hand, OCS type, and Hospital establishment type. Results : There was a positive correlation between satisfaction level and managerial status throughout all job classifications. Irrespective of the importance of OCS education as a factor relating to users' satisfaction, the additional work load caused by OCS lowered users' satisfaction. Different factors affected users' satisfaction according to job and status classification. The composition of factors affecting the pharmacist and administrative worker satisfaction levels was simpler than that of the doctor and nurse levels. There were no statistically significant differences between the actual computer experience duration of daily OCS use and users' satisfaction with OCS. Conclusions : There was an understandable relationship between users' attitude to OCS and factors affecting users' satisfaction. The results of this study could be used as a basis for the successful expansion of the operation of OCS. But more detailed studies on users' satisfaction and further improvements of methodologies are required for the successful establishment of OCS.

우리나라 잠복결핵감염 검진전략의 경제성 분석

김상원 ( Sang Won Kim ),강길원 ( Gil Won Kang ),신삼철 ( Sam Chul Shin ),송승은 ( Seung Eun Song ) 한국보건행정학회 2013 보건행정학회지 Vol.23 No.4

Background: Although interferon-gamma release assay (IGRA) is now available alternatives to tuberculin skin test (TST) for detection of latent tuberculosis infection (LTBI), the cost of IGRA test is much higher than TST. So economic analysis of LTBI screening strategies have been done in many countries, but there are few reports in Korea. This study examined cost analysis of LTBI screening strategies in Korea. Methods: The economic outcomes were evaluated by five strategies. These were 1) TST alone, 2) IGRA alone, 3) combination of TST and IGRA (TST followed by IGRA) and 4) no testing no prevention, 5) no testing all prevention. Last two strategies were added to compare with three main LTBI screening strategies. Decision analysis model were used to perform economic analysis. A cohort study of Korean Institute of Tuberculosis and the data of published literatures were used to estimate the cost analysis. Results: In a base-case scenario which was assumed that TST specificity was 80%, TST alone was the least expensive strategy. In a alternative scenario which was assumed that TST specificity was 97%, the combination of TST and IGRA was the least expensive strategy. Sensitivity analysis shows that patients adherent rate to LTBI treatment, TST sensitivity, IGRA sensitivity and IGRA specificity did not have a significant impact on the outcomes. Conclusion: In Korea, for the diagnosis of LTBI at the time of child and adolescent, TST alone reduces medical costs compared with IGRA alone or combination of TST and IGRA.