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김양균,성주호 한국보험학회 2004 保險學會誌 Vol.69 No.-
The purpose of the study is to identify influence of health insurance status on ambulatory care (outpatient) visits as primary care accessibility and on hospitalization as health outcome caused by lack of primary care accessibility, and to explore the factors affecting outpatient visits, hospitalization caused by lack of outpatient visits.One of indicators to identify the relationship between access to health care service caused by health insurance status and health service utilization is Ambulatory Care Sensitive Conditions (ACSC), which are conditions that when timely and effectively treated in the outpatient setting can help reduce the risk of hospitalizations by preventing onset of an illness. The study chooses ACSC to test the relationship the lack of primary care and hospitalization among diseases.We use the available recent health care survey data (i.e. 1996 Medical Expenditure Panel Survey; MEPS96). We find out the positive relationship between hospitalization and no health insurance, and the negative relationship between outpatient visit and no health insurance. This indicates that reducing accessibility for outpatient visit caused by no health insurance results in increasing hospitalization. Furthermore, this result strongly suggests that the uninsured children is actually not able to care in early disease stage so that they are likely to hospitalization when their disease was more sever and then they need long stay for cure. As a result, fortifying the accessibility to necessary health care in a way of sharing appropriately the role with private health insurance can lead to the efficiency of national health care delivery systems in view of total health care expenditure, in particular in a case of ACSC children. Additionally, this kind of health policy may be expected to reform gradually the population structure such as aging, aged and super-aged society. 본 연구는 미국 의료심사원에서 공표한 실제데이터(MEPS96)를 의료보험통계분석 소프트웨어인 SUDAAN에 적용하여 심각한 질병상태는 아니지만 통근치료가 필요한 질환상태 ACSC(Ambulatory Care Sensitive Conditions: 중이염, 세균감염, 피부염, 위장염 등)에 있는 18세 이하 어린이들의 외래통근치료 빈도, 입원 빈도 및 평균 입원 일수 등을 종속변수로, 이에 영향을 미치는 주요 경제적 요인(사보험가입 여부, 국영보험가입 여부, 가정의 여부, 주거지역 등), 인구통계적 요인(연령, 인종, 성별) 그리고 건강상태(건강체, 표준체, 미달체 등) 등을 독립변수로 두어, 다변량분석 및 다중회귀분석을 수행함으로써 이들간의 상호 인과 관련성을 검증하였다. 우리는 민영건강보험시장 및 국민건강보험의 발전 방향 수립에 참조가 될 수 있는 다음과 같은 주요 시사점들을 도출하였다: 첫째, 사보험가입상태, 국영보험가입상태 및 비보험상태 순으로 외래통근치료 빈도와 양의 상호관련성이 높았으며, 둘째 입원 빈도와 평균입원 일수 등은 모두 외래 통근 치료 빈도와 음의 상호관련성이 있으며, 셋째 유아기(0세-5세) 는 청소년기(6세-18세)에 비하여 공통적으로 통근치료 빈도, 입원 빈도 및 평균입원일수 모두 높음을 알 수 있다. 특히 유아기의 입원빈도 및 평균입원일수는 청소년기에 비해 약 3배 이상 높게 산출되고 있다. 이는 생명표상에 유아기 사망률이 높게 나타나고 있음과 깊은 상관관계가 있음을 시사한다. 따라서 국민건강보험 및 민영건강보험의 보험적용범위를 유아기 질병 조기진단 방향으로 확대 적용할 필요성이 있으며, 이는 궁극적으로 질병악화로 인한 고액 의료비 지출을 조기에 차단하는 재정안정화 효과와 더 나아가 인구구조의 고령화 속도를 지연하는 간접적 효과를 기대할 수 있을 것이다. 이에 대한 국내 실증적 분석은 향후 연구과제로 두고자 한다.
Exploring the Appropriate Operation Ratio on Hospital Revenue Cost and Profit
김양균,성주호,강중철 한국데이터정보과학회 2007 한국데이터정보과학회지 Vol.18 No.1
Many previous researchers tried to analysis relationship between financial index of hospitals such as revenue, expenses, and profit and hospital outcome such as number of inpatient and outpatient or, between that financial index and hospital size including number of hospital beds. However, these studies did not find exact relationship between financial index and hospital efficiency and productivity. Therefore, purpose of the study explores exact relationship between hospital financial outcome and hospital efficiency and productivity using adjusted inpatient days concept from American Hospital Association. Through the empirical analysis, the researchers find that hospital profit has the U-shape quadratic function to operation ratio. 66.9% of operation ratio is changing point and hospitals with 55.8% through 75.0% of operation ration have experience deficit situation. Considering the hospital circumstance, Korean hospitals would be to maintain general hospital type with various specialty departments.
개방 공간에서 발생하는 수소-공기 혼합 가스 폭연에 대한 실험적/해석적 연구
김양균,박병직,Kim, Yangkyun,Park, Byoung Jik 한국안전학회 2021 한국안전학회지 Vol.36 No.1
Experimental and analytical investigations are performed to explore the explosion characteristics of a hydrogen-air mixture in open atmosphere. A hydrogen-air mixture tent of total volume of 27 m<sup>3</sup>, with 40% hydrogen volume, is used to observe overpressure at a distance from the ignition source. Vapor cloud explosion analyses are performed using the TNO multi-energy model and Baker-Strehlow-Tang model. The results of these analyses are compared with experiment done from this study and references. The experimental results with and without obstacles indicate that the overpressure values measured at a distance of 4.5-21.5 m from the ignition source are about 9.4-3.6 kPa and 6.5-2 kPa, respectively. This implies that the overpressure with obstacles is approximately 1.7 times greater than that without obstacles. Analytical observation indicates that the results obtained with the Baker-Strehlow-Tang model with M<sub>f</sub> = 0.2-0.35 are in good agreement with those of most of the previous studies, including that obtained from this study. Moreover, the TNO multi-energy model with a volume of 27 m<sup>3</sup> well predicts the overpressure obtained from this study. Further studies should considered explosions in semi-confined spaces, which is more suitable for hydrogen refueling stations.