Regional Disparity and Factors Influencing Unmet Medical Needs: A Study Based on the Sixth Korea National Health and Nutrition Examination Survey (2015)

임지혜 질병관리본부 2017 Osong Public Health and Research Persptectives Vol.8 No.5

Objectives: This study aimed to determine regional differences and the factors that affect unmet medical needs. Methods: Data from the 6th Korea National Health and Nutrition Examination Survey (2015) were used, and 4,946 health survey participants who provided responses on medical utilization and health behavior were included in the study. Results: A statistically significant difference was observed in the incidence rate of unmet medical needs in terms of region. The independent variables that affected unmet medical needs were sex, age, education, region, household income, insurance type, smoking status, self-reported health status, and stress awareness. Gender (female), lower education level, rural residents, lowest household income, poor self-reported health status, and stress awareness increased the probability of unmet medical needs. Conclusion: Our findings suggested that different policies and approaches should be considered for each population that is at risk to address the primary cause of the unmet medical needs. Further studies that include medical expenses and the relevant variables of an area should be conducted in the future.

재원일수 적정성 평가 방안 마련

임지혜,박기찬,정은선,이요셉 건강보험심사평가원 심사평가연구소 2018 연구보고서 Vol.2018 No.0

요양급여 적정성평가 지표관리 방안 - 지표별 목표 설정 및 모니터링을 중심으로 -

임지혜,윤여진,박소정,김정림 건강보험심사평가원 심사평가연구소 2020 연구보고서 Vol.2020 No.0

The focus of quality assessment has shifted from healthcare service use to clinical quality improvement. As of September 2018, the quality assessment in Korea examines 34 items with 408 measures. While quality assessment has expended in quality and quantity, the validity and confidence in assessment measures has decreased, affecting assessment efficiency negatively. In response, the Health Insurance Review & Assessment Service (HIRA), carried out a reshuffle of assessment measures from 2016 to 2019. Nevertheless, there is a lack of the measure lifecycle through measure development, implementation, maintaining, and retire. Against this backdrop, this study was designed to contemplate measure management based on effectiveness analysis of existing measures. For this study, 16 items were selected as target with measure that were continuously used 3 to 4 times in quality assessment as of 2019. The measurement type was analyzed for each measure, and distribution was observed based on descriptive statistics values, including average, standard deviation, applicable quartile, and minimum and maximum. Using AHRQ analysis of the U.S. and QOF analysis of the U.K., 95% performance achievement rate and average yearly fluctuation rate were analyzed. Results showed that there were ratio measures, case number measures, yes/no measures, and other measures. Among the 16 items, 79.49% were ratio measures, which was considered the most universal and suitable type to monitor achievement rate and average yearly fluctuation. As such, when AHRQ and QOF analysis were applied to ratio measures, most results were over 95% achievement rate, proving some level of quality improvement. Other measures were not suitable to use for performance achievement rate. Based on the analysis results, following suggestions were proposed for management of quality measures. Most measures does not come with a quality goal when measure development. To establish a measure lifecycle, there are five steps to follow: Step 1) the measure should be reviewed upon type of measurement, meaning of measures, and objective of measurement, Step 2) analysis method should be selected for the measure, Step 3) the results need to be analyzed, Step 4) validity of the measure should be reviewed, and Step 5) the type of measure management (maintaining, improvement, monitoring, retirement) should be decided. Also, for measures that are relatively new to assessment, the result of first assessment can be used as a benchmark for goal setting for next iteration. In conclusion, this study did not succeed in suggesting goal setting methods for existing measures, but it did propose a monitoring method based on assessment results. Form now on, newly developed measures should come with a goal and management frequency, and measure validation process needs to be added. To that end, a measure lifecycle should be put in place. Furthermore, a group of experts who contribute direction and thoughtful input to the measure development process requires to be formed to improve measure management and secure objectivity in operation.

요양급여 적정성평가 중기 발전방안

임지혜,이풍훈,심보람,박소정 건강보험심사평가원 심사평가연구소 2020 연구보고서 Vol.2020 No.0

The Quality Assessment in Healthcare Benefit was introduced in July 2000 based on the National Health Insurance Act in order to improve quality of care in balanced manner. Since the system adoption and implementation, some have criticized the lack of national-level goal for healthcare performance area and quality improvement, and inadequate structured approach with respect to the aim of quality. There have been growing demands for assessment system reform to ensure the quality measurement and to highlight the need for value-based payment system. As such, this paper examined the mid-term development plan for quality assessment to move towards quality and patient-centered value-based review and assessment system. The research consists of 4 methods, which are literature review, quality assessment material analysis, overseas case review, and advisory council. First, SWOT analysis was deployed on domestic reports to identify current status and issues of quality assessment in healthcare benefit. Second, the effect of quality assessment was checked by reviewing quality assessment results and healthcare Big Data. Third, value-based health system theories and value-based incentive program in the US were analyzed. And fourth, experts provided advice on improvement measures for further development of quality assessment. The study outcome showed that quality assessment system has achieved significant quantitative as well as qualitative improvements since 2010 thanks to continued quality report and expert opinion collection. However, some areas still need to be reinforced with addition of new measures, and quality goal is required each indicators could serve as benchmark for quality improvement. In the context of value-based assessment, limitations include unclear definition of value and insufficient amount of meaningful measures for value assessment. Furthermore, a concrete reimbursement model and execution plan need to be in place to switch from goal-based assessment to value-based assessment. As such, this paper proposed a framework of assessment system revision and suggested potential interventions to further improve quality assessment, along with 4-staged road map and concrete approaches to facilitate complementary development of goal-based assessment and value-based assessment. First state is to define values and organize quality indicators to improve internal performance. Second is to standardize assessment system and value measurement, and build on integrated quality management system for improved transparency and value connection. Third is to widen result utilization and executive value-based assessment for improved performance and value. And fourth is to develop a nationally integrated assessment system based on continued monitoring and performance charge management in order to support goal-based assessment and value-based assessment so they take firm root and receive continued monitoring.

요양급여 적정성 평가 질 지표 관리 방안

임지혜 건강보험심사평가원 심사평가연구소 2016 HIRA 정책동향 Vol.10 No.3

Matlab-Simulink를 이용한 IncCond MPPT의 여유계수에 관한 분석

임지혜,백승학,문은아,김현철,최연옥,조금배,백형래 대한전기학회 2011 대한전기학회 학술대회 논문집 Vol.2011 No.4

의료급여정신과 적정성 평가 개선방안

임지혜,권오탁,정은선,조재영,조현민,김지혜 건강보험심사평가원 심사평가연구소 2018 연구보고서 Vol.2017 No.0

고효율 확산스크러버-이온크로마토그래피를 이용한 대기 중 염기성 가스의 연속측정 방법에 관한 연구

임지혜,한진석,한상우,엄지원,이동수 한국대기환경학회 2015 한국대기환경학회 학술대회논문집 Vol.2015 No.11

도시철도 승강장폭원 설계기준에 관한 연구

임지혜,이영인 대한교통학회 2010 대한교통학회 학술대회지 Vol.63 No.-

δ Scuti형 변광성 BO Lyn의 근적외선 광도곡선 분석

임지혜,손정주 한국지구과학회 2016 한국지구과학회지 Vol.37 No.7

In order to investigate the light curve difference in visual and infrared wavelength of δ Scuti variable Bo Lyn, observations were performed using BOAO 1.8m reflecting telescope and an infrared detector, KASINICS, with J, H, and Ks filters. Infrared light curves of total 7 nights were obtained between March and April in 2011, and those were compared to the V-filter light curve to examine the differences in period, time of maxium light, amplitude, and shape. From the periodic analysis of infrared light curve, a single frequency of f1=10.712 cycle/day, P=0.09335±0.00002 days was obtained, and there was no difference in the period along different wavelengths. In the infrared light curve, a frequency of 2f1 was detected. This frequency well explains the asymmetric shape of light curve, one of the characteristics of high-amplitude δ Scuti variables. We compared the locations of the measured infrared maxima and the predicted maxima of V-filter, finding that the times of maxima were delayed about 0.3 phase at infrared wavelengths. Amplitude ratios were adopted to be ΔJ/ΔV=0.328, ΔH/ΔV=0.216, and ΔKs/ΔV=0.211, with the range of variation being smaller at longer wavelengths. It seems that the differences in the times of maxima and amplitude occurred because the changes in brightness of a pulsating variable star are mainly caused by the change in temperature. δ Scuti형 변광성 BO Lyn의 파장에 따른 광도곡선 차이를 알아보기 위해서 보현산천문대의 1.8m 반사망원경과 적외선 검출기 KASINICS를 이용한 측광 관측을 수행하였다. 2011년 3월 26일부터 4월 1일까지 총 7일간의 관측 자료로 J, H, Ks필터 광도곡선을 얻어 기존에 보고된 V필터에서의 광도곡선과 비교하여 주기, 극대점, 진폭, 형태에 대한 차이를 알아보았다. 적외선 광도곡선의 주기 분석 결과 단일 주파수해 f1=10.712 cycle/day, 주기 P=0.09335±0.00002 days의 값을 얻었으며, 파장에 따른 주기의 차이는 나타나지 않았다. 적외선에서는 2f1에 해당하는 주파수가 검출되었는데, 이는 고진폭 δ Scuti형 변광성의 특징인 비대칭적인 광도곡선의 형태를 잘 설명해준다. 극대점의 위치를 비교한 결과 계산된 V필터의 예상 극대점보다 관측된 적외선 극대점이 전체 주기의 약 0.3에 해당하는 만큼 더 늦게 나타났다. 진폭은 ΔJ/ΔV=0.328, ΔH/ΔV=0.216, ΔKs/ΔV=0.211로 파장이 길어질수록 변광의 폭이 더 작게 나타났다. 파장에 따른 극대점의 지연과 변광폭의 차이는 맥동변광성의 밝기 변화가 주로 온도변화에 기인하기 때문인 것으로 여겨진다.