의료기관들의 인증평가 준비와 비용지출에 대한 실태분석

김민지 ( Minji Kim ),정유민 ( Yumin Jung ),김경숙 ( Kyungsook Kim ),이선희 ( Sunhee Lee ) 한국병원경영학회 2015 병원경영학회지 Vol.20 No.3

While the influence of healthcare accreditation system to the quality improvement of hospitals has more increased, regarding the preparation costs for healthcare accreditation, it has never been empirically studied about the costs that are actually invested by hospitals. This study is going to determine the difficulties in the preparation process of accreditation and details of accreditation preparation costs for hospitals that participated in the healthcare accreditation system and acquired accreditation. The survey was performed in a self-reported form from February 28 to March 21 2014 for 189 acute hospitals accredited as a hospital from 2011 to February 2014. Of all questionaries of survey participants, 98 were recovered; the response rate was 51.9%. A total of 40 questionnaires were used except for 58 containing insincere answers. Main findings are followings: Firstly, findings showed that advanced general hospitals spent the most statistically significantly highest in terms of equipments and total costs among cost items for accreditation preparation. When accreditation preparation costs items were classified according to classification of hospitals, advanced general hospitals spent the most statistically significantly highest in the equipments and total costs. Also in terms of regional, Gyeonggi, Incheon regions were found to spend statistically significantly higher costs in the equipments costs. Secondly, as a result of the survey in the distribution of the total accreditation preparation costs, advanced general hospitals have disbursed the most out of all. However, the result in hospitals does not show significant difference to the expense of advanced general hospitals and that especially other regional hospitals spent higher costs. As such, all hospitals are under a heavy burden of higher costs on accreditation preparation, especially hospitals. The build-up of infrastructures by hospitals through an accreditation system consequently led to a higher initial investment; if the accreditation system is effective in improving the quality of health care and patient safety, appropriate responses are needed. In other words, financial support for investment costs needs to be given to allow hospitals to actively participate in the accreditation system.

우리나라 종합병원의 하방 경직적 원가행태 분석

양동현,이윤태,박광훈 한국보건행정학회 2005 보건행정학회지 Vol.15 No.1

The purpose of this empirical study is to investigate whether costs are “sticky” -that is, whether costs increase more when revenues rises than they decrease when revenues falls by an equivalent amount by using the financial data fromf korean general hospital.. Financial data used in this study were obtained from the Database of Korean Health Industry Development Institute and analyzed using multiple regression model in dummy variables. The main results of this study are as follows: First, we found, for 69 Korean general hospitals for 3 years(2000~2002), that total hospital costs, hospital labor costs, hospital administrative costs were sticky, these costs provided strong support for the sticky costs hypothesis 1, but hospital material costs were shown to be proportional to sales revenues. Second, this results provided strong support for the hypotheses that the degree of stickiness was lower in sales revenues declining that were preceded by revenue-declining periods(hypothesis 2-1), and that stickiness was less pronounced in a second successive year of revenue decline(hypothesis 2-2). Third, this results provided strong support for the hypothesis(hypothesis 3) that stickiness was greater hospitals that employ relatively more people to support their sales revenues(hypothesis 4) that stickiness was greater for hospital that used relatively more assets to support their sales revenues. After all, a managerial implication of this study was that sticky cost, for the general hospital, could be recognized and controlled.

의료행위 원가와 보상 정책에 기초한 상급종합병원 진료량관리 : 의료전달체계 확립을 중심으로

오동일 ( Dongil O ) 한국회계학회 2016 회계저널 Vol.25 No.4

비싼 진료비와 높은 본인부담률로 환자부담을 높여 의료수요를 억제하는 정책에도 불구하고 상급종합병원의 외래진료량은 증가하고 있고 이는 중증의 입원환자를 전문적으로 치료해야 하는 상급종합병원의 기능과도 상치되는 것이다. 본 연구는 환자 접근성을 제한하거나 경제적 부담을 통해 의료수요를 억제하는 정책 대신 진찰료, 의료행위 상대가치점수, 종별 가산율, 인센티브 제도와 같은 보상 정책에 변화를 가져와 의료공급자의 행태 변화를 유인할 수 있는 방안을 제시하였다. 즉 보상체계의 개념적 변화를 모색함으로써 외래환자의 상급종합병원 집중 현상을 완화하고 의료자원이 효율적으로 배분되고 입원환자와 연구 중심의 병원 기능을 회복시킬 수 있도록 하였다. 이를 위해 우선 상급종합병원의 외래 진료비가 지속적으로 증가하는 추세에 있다는 점과수요자 억제 정책의 하나인 환자 본인부담률 제도를 살펴보았으며 진료량 변동과 진료비증가의 관계도 고찰하였다. 현행 제도 내에서 적용 가능한 방안을 찾기 위해 상대가치의 기본 개념인 임상적 측면의 의사업무량과 의료행위 진료비용 측면에서 의료원가계산의 중요성을 살펴보았다. 의료행위 상대가치점수는 의료행위원가를 반영해 결정되는데 행위별원가보상율과 행위별 수익성은 확정된 상대가치점수에 크게 의존한다는 점을 알 수 있었다. 상급종합병원의 진료비 수입 증가가 의료행위 유형, 상대가치점수 및 보상체계의 변동에 의존하므로 진료량 관리를 위해서는 이들 요소들에 대한 조정을 필요로 한다. 첫째, 의료행위 원가보상율이 낮은 경우 원가보상율이 높은 의료행위로 의료공급이 늘어날 수 있고 진찰료 수준이 높은 경우 중증 환자에 대한 의료공급보다 경증의 외래 진료량이 늘어 날 수있다는 점에서 상급종합병원 진료량 관리를 위한 방안으로 진찰료 수준의 개편을 제안하였다. 둘째, 종별가산율을 포함한 보상정책의 변화를 제안하였다. 종별가산율은 병원 종별로중증 질환을 치료하는 기관의 시설, 장비 등과 관련된 차별화된 투자비용을 보상해 병원종별간에 동등한 원가보상율을 달성하려는 취지로 도입되었다. 현재 가산율은 그 동안 의료공급형태 및 환자구성의 변화와 더불어 그 근거가 모호하고 의료원가나 의료 질을 반영하고 있지 못하고 있다. 따라서 상급종합병원의 의료공급량 관리를 위해 현행의 단일 가산율을 외래와 입원 가산율, 또는 외래 경증 행위군과 기타 행위군 등 외래의료행위분류 체계에 따른 가산율로 분리 운용할 것을 제안하였다. 또한 상급종합병원이 제공하는 의료서비스 질 향상과 의료 자원의 효율적인 운용을 위해 의료 질 인센티브와 경영효율성 인센티브를 가산율 형태로 도입할 것을 제안하였다. 두 가지 인센티브와 수정 재산정된 가산율을 종합적으로 결합하는 보상체계를 설계함으로써 가치 기반 의료서비스에 근거한 보상이 가능할 수 있다. 본 연구에서 제안한 의료행위 원가에 기초한 보상 체계 개편에 대한 개념적틀이 최근 보건의료제도 변화를 반영하고 상급종합병원의 진료행태 변화와 원가관리를 촉진할 수 있을 것으로 기대해 본다. 마지막으로 의료행위 원가 계산, 상대가치점수 산정, 보상체계 설계 등 분야에서 의사 등 임상전문가와 회계교수 등 회계전문가가 공동으로 노력함으로써 진료량 관리뿐 만 아니라 의료전달체계 확립에도 기여할 수 있을 것이다. Despite of policy for controlling medical demand by charging expensive medical cost and high copayment rate, the not severe outpatient visit for tertiary hospital has been increasing. This is the contradiction of the function of tertiary hospital which has a role to take care of severe inpatients and to do research based on healthcare delivery system. When medical treatment is delivered, the hospital bill is made from RVS and a hospital type remuneration rate. This billing is to give a financial reward on the investment made by hospital to take care of a patient with critical or serious condition. But there are critics that not only the ground of a different remuneration rate are ambiguous but also it fails to reflect the quality of care and actual medical cost incurred. This paper suggested supply side policy that could induce the behavioral adjustment by changing a financial rewards instead of imposing restriction on patient’s accessibility or budget burden. This paper dealt the conceptual framework of incentives so as to mitigate the cohesion of outpatient to tertiary hospital and to reallocate medical resources by regaining the inpatient focused hospital. For this purpose first above all, the data related to the increase of medical revenue of tertiary hospital and family doctor were reviewed. The introduction of the family doctor should only be considered in the long term plan. To find an applicable short term way within current medical setting, physician work based on clinical concept, medical expense for practice, and medical cost accounting are reviewed. To set a reasonable schema, medical cost calculation is very important factor for determining RVU. A RVU of specific medical treatment shows cost coverage ratio and revenue of medical treatment. The revenue of hospital depends on the type of practice, the change of RVU, remuneration and incentives. So the management of outpatient volume needs the adjustment of these factors. It can be thought that if cost coverage ratio is lower than other practice, the frequency of other practice will be increased and if fees for outpatient are higher than fees for inpatient service, the volume for ambulatory care will be increased. To manage outpatient volume of tertiary hospital, five alternatives are considered. Firstly, high copayment rate imposed to outpatient is excluded because there exists a high limitation for low income family to visit hospital. Patient oriented policy should be supplemented by healthcare provider oriented policy. Secondly, if hospital’s medical revenue increases rapidly because of volume effect, an introduction of the floating conversion factor can be considered for restricting the rapid growth of outpatient revenue. Thirdly, the reconsideration of a consultation fee is proposed to correct the possible imbalance of RVU between healthcare type. Fourthly, this paper suggested new remuneration policy for controlling outpatient patient visit for a tertiary hospital. The current single hospital-type based incentive system was introduced to repay a initial investment by hospital and to balance the cost recovery rates between hospital type. But the current single hospital-type incentive system should be divided into the outpatient and inpatient type or the non-severe and severe patient-type based on ambulatory care sensitive conditions. Finally this paper recommended the incentives based on the quality of medical care and the managerial efficiency of resource utilization be introduced. Quality oriented reimbursement to reflect demands of value-based care can be achieved by the new adjusted remuneration rate and two newly introduced incentives. It is expected that the conceptual framework which is based on medical cost proposed in this paper could not only be able to reflect the current healthcare reform but also stimulate the behavioral change and attain efficient medical cost management. The limitation of this paper is expected to be cured in the next research which can be developed based on the concepts proposed in this paper. The role of accountant and academic scholar are much more anticipated than before for the cost analysis and setting cost calculation system to get the proper medical cost for healthcare policy setting. So collaboration of both professional can find the way to normalize the current entangled medical delivery system and to control the increase of non severe outpatient to the tertiary hospital which should focus on taking care of the inpatients and medical research.

병원 원가관리자의 원가인식 및 원가체계 구축 방향

노진원 ( Jin Won Noh ),이해종 ( Hae Jong Lee ),박현춘 ( Hyun Chun Park ) 한국병원경영학회 2014 병원경영학회지 Vol.19 No.1

It is necessary to calculate prime cost of medical services accurately in order to evaluate the adequacy of medical fee. This paper aims to identify cost analysts. perception on prime cost of medical services and needs in establishing a cost accounting system in hospitals, proposing future directions and guidelines for the calculation of medical fee. A self-administered questionnaire and telephone survey on operation of a hospital cost-accounting system was conducted in November, 2012, among cost analysts currently working in the hospitals and hospital administrators planning to implement the hospital cost-accounting system. Our study shows that most of the cost analysts were aware of the importance of calculating prime cost and responded that collection of the prime cost data from government is necessary although they are less likely to provide the data in the future concerning the risk of data misuse and data security. They also responded that lack of budget allocation and excessive workload were the main reasons for not estimating the prime cost and operating cost management information system. Results show that hospital cost analysts considered the data accuracy is the most critical factor in calculating prime costs of medical services. However, there was no investment budget allocated in some hospitals or limited to less than 100 million, indicating that hospitals are reluctant to invest on implementing the cost accounting system. Respondents stated the organization that collects the prime cost of medical services among hospitals should display strong analytical capabilities, ensure data security, and maintain independence, which is most demanded. There are 57 hospitals that calculated the prime cost of medical services for 2012 by each medical department and 20 hospitals that calculated the prime cost by fee-for-services, aiming to establish a cost accounting system. Our results indicate that hospitals should voluntarily provide the accurate prime cost for medical services in order to properly evaluate the adequacy of medical fee. Consequently, it is critical to establish an independent organization to collect and appraise the data. It is also recommended that government should implement various policies to encourage hospitals to participate in the data collection to achieve the data accuracy and representativeness

Determinants of Hospital Inpatient Costs in the Iranian Elderly: A Micro-costing Analysis

Ebrahim Hazrati,Zahra Meshkani,Saeed Husseini Barghazan,Sanaz Zargar Balaye Jame,Nader Markazi-Moghaddam 대한예방의학회 2020 Journal of Preventive Medicine and Public Health Vol.53 No.3

Objectives: Aging is assumed to be accompanied by greater health care expenditures. The objective of this retrospective, bottom-up micro-costing study was to identify and analyze the variables related to increased health care costs for the elderly from the provider’s perspective. Methods: The analysis included all elderly inpatients who were admitted in 2017 to a hospital in Tehran, Iran. In total, 1288 patients were included. The Mann-Whitney and Kruskal-Wallis tests were used. Results: Slightly more than half (51.1%) of patients were males, and 81.9% had a partial recovery. The 60-64 age group had the highest costs. Cancer and joint/orthopedic diseases accounted for the highest proportion of costs, while joint/orthopedic diseases had the highest total costs. The surgery ward had the highest overall cost among the hospital departments, while the intensive care unit had the highest mean cost. No statistically significant relationships were found between inpatient costs and sex or age group, while significant associations (p<0.05) were observed between inpatient costs and the type of ward, length of stay, type of disease, and final status. Regarding final status, costs for patients who died were 3.9 times higher than costs for patients who experienced a partial recovery. Conclusions: Sex and age group did not affect hospital costs. Instead, the most important factors associated with costs were type of disease (especially chronic diseases, such as joint and orthopedic conditions), length of stay, final status, and type of ward. Surgical services and medicine were the most important cost items.

유방암 수술 환자에 대한 가정간호서비스의 경제성 평가

고정연,윤주영 한국지역사회간호학회 2021 지역사회간호학회지 Vol.32 No.3

Purpose: This study conducted an economic evaluation of hospital-based home care services for the patients who had undergone breast cancer surgery. Methods: A total of 12,483 patients over 18 years of age who had received breast cancer surgery in 26 tertiary hospitals in 2018 were analyzed with the claim data from the Health Insurance Review & Assessment Service using cost-minimization analysis and societal perspectives. Results: There were 156 patients who utilized hospital-based home care services within 30 days after breast cancer surgery, and they received 2.17 (SD=1.17) hospital-based home care service on average. The average total cost was 5,250,028 KRW (SD=1,905,428) for the group receiving continuous hospital-based home care and 6,113,402 KRW (SD=2,033,739) for the group not receiving continuous hospital-based home care (p<.001). The results of the economic evaluation of continuous hospital-based home care services in patients who had undergone breast cancer surgery indicated a total benefit of 953,691,000 KRW, a total cost of 819,004,000 KRW, and a benefit-cost ratio of 1.16 in 2018. Conclusion: Continuous hospital-based home care was considered economically feasible as the total costs for the group receiving continuous hospital-based home care were lower than those of the group not receiving continuous hospital-based home care. Therefore, policy modification and financial incentives are recommended to increase the utilization of hospital-based home care services for patients who had undergone breast cancer surgery.

전략적 의사결정지원을 위한 병원 원가시스템으로서의 ABC구축 사례연구

나영,최권호 한국상업교육학회 2010 상업교육연구 Vol.24 No.3

본 사례연구에서는 급변하는 의료산업의 경영환경 하에서 “21세기 동북아 최고의 병원을 이룩한다”라는 비전으로 디지털 병원(e-Hospital)으로 도약하기 위하여 K병원이 통합 ERP(전사적자원관리 ; Enterprise Resource Planning)시스템의 일환으로 구축한 활동기준원가(ABC)시스템 설계사례를 중심으로 다루고 있다. 구체적으로 본 연구에서는 K병원의 ABC시스템의 설계에서 현행 원가관리의 문제점을 제시하고, 설계과정에서의 자원(Resource), 활동(Activity), 그리고 원가대상(Cost Object)의 정의와 배부기준을 보여주며, 설계과정에서의 특징과 비용배부에 대한 경로를 설명하고 있다. 또한 ABC시스템 구축 이후의 효율적인 시스템 운영을 위한 지침을 마련하여 이후 ABC 시스템을 구축하고자 하는 미래의 경영자 및 시스템 운영자에게 실질적인 도움이 되고자 하였다. 아울러 본 연구에서 제시된 K병원의 ABC모델은 국내에서는 처음으로 시도된 설계모델이다. 이는 의료환경변화에 적극적으로 대응하기 위하여 활동을 분석하여 비부가가치활동을 축소하거나 제거하고 투하된 자원을 부가가치활동으로 전환함으로써 서비스의 질적/양적 개선을 통한 수지개선의 목적으로 설계 및 구축되었다. 따라서 ABC(Activity Based Costing)를 통해 산출된 원가정보는 병원 경영자에게 신뢰성있는 원가정보를 제공함으로써 전략적 의사결정 지원, 활동중심의 정보관리 및 분석, 그리고 수익성 중심의 관리체계 확립 등과 같은 의료환경의 변화를 가져올 것으로 기대된다. This study examined the case of activity‐based costing (ABC) system constructed by K Hospital as a part of its integrated enterprise resource planning (ERP) system for leaping into an e-Hospital, aiming at the vision “The best hospital in the Northeast Asia in the 21st century” in the rapidly changing environment of the medical industry. This case study suggested problems of the current cost management under the design of K Hospital’s ABC system and presented both definitions and distribution criteria of resources, activities, and cost objects, and explained the characteristics of the design process including the path of cost allocation as well. The purpose of this study is to help future managers and system operators who would build ABC system to operate it efficiently after construction of ABC system by establishing guideline. K Hospital's ABC model examined in this case study is the firstly applied model to S Hospital in Korea. In order to respond to radical changes of medical environment, this model is designed and constructed to improve balance by minimizing or deleting non-added value activity and transferring that to value added activity through cost activity analysis. Thus, hospital cost information produced from ABC (Activity Based Costing) can provide reliable cost information to decision makers of hospital management and the changes such as strategic decision making supports, information management and analysis based on activities, and management structure established can be expected from this ABC model of K Hospital.

병원시장의 경쟁특성과 병원행태

박하영 ( Ha Young Park ),권순만 ( Soon Man Kwon ),정영호 ( Young Ho Jung ) 한국보건행정학회 2008 보건행정학회지 Vol.18 No.1

H ow health care providers compete and how competition among them affects their behavior are crucial questions in theory and health policy. In ordinary markets, competition improves social welfare. However in health care markets facing uncertainty and information asymmetry, competition can take the form of wasteful quality competition and result in cost increase. The purpose of this study is to examine the characteristics of hospital service markets and examine the impact of hospital competition on hospital behavior, more specifically hospital cost and the size of personnel. Based on patient discharge data of 2002 by the Ministry of Health and Welfare and Korea Institute for Health and Social Affairs, and health insurance EDI claims data of 2002, this study measures the degree of competition in the inpatient service market of hospitals, using variable radius method and Herfindahl index. The result of the study shows that the hospital service market consists of on average 3.13 government administrative units(shi, gun, or gu). Compared with hospitals, general or general specialized hospitals cover larger markets and operate in more competitive markets. Nearly 60% of patients use hospitals, which are not located in their government administrative units, meaning that market definition based on variable radius is better than the conventional method of market definition based on government administrative units. The results of multivariate analysis show that competition is not associated with high cost index of hospitals. But hospitals in more competitive markets employ larger(more intensive) input of personnel per 100 beds, implying that hospital competition in Korea can have the form of quality and cost-increasing competition.

서울지역 미세먼지 농도가 호흡기계 및 심혈관계의 외래 방문 및 입원과 진료비에 미치는 영향

이형숙 한국환경보건학회 2016 한국환경보건학회지 Vol.42 No.5

Objectives: The annual average of PM10 in Seoul was 45 μ/m3, which surpasses the WHO annual guidelines(20 μ/m3). Most previous analyses of the effects of PM exposure have been retrospective studies using singlehospital data, and fewer studies have attempted to address the relationship of PM10 and hospital costs. This studywas conducted to investigate the effects of the concentration of PM10 on hospital visits, admissions and hospitalcosts in patients with respiratory and cardiovascular diseases. Methods: Medical data from the National Health Insurance Service and the monthly average of PM10 fromNational Institute of Environmental Research were used to identify the effects of PM10 on hospital visits,admissions and hospital costs. We applied Poisson regression and linear regression to perform the analysis. Results: The relative risks for admissions per 10 μ/m3 increase in PM10 were 23.11%, 10.2% and 6.9% increasesfor acute bronchiolitis, asthma and bronchitis, respectively. The relative risk for hospital visits per 10 μ/m3 increasein PM10 were 10.4%, 6.7% and 5.9% for chronic obstructive pulmonary disease, asthma and chronic sinusitis,respectively. For cardiovascular disease, the relative risk for admissions per 10 μ/m3 increase in PM10 were 2.2%and 2.1% increases in angina and acute myocardial infarction, respectively. A 10 μ/m3 increase in the monthlyaverage of PM10 corresponded to 170,723,000 won (95% CI: 125,587,000-215,860,000 won), 123,636,000 won(95% CI: 47,784,000-199,487,000 won) and 78,571,000 won (95% CI: 29,062,000-128,081,000 won) increasesin hospital costs for asthma, acute tonsillitis and chronic sinusitis, respectively. Conclusion: Hospital admissions for respiratory and cardiovascular disease were associated with PM10 levels. PM10 exposure is also associated with increased costs for respiratory diseases.

병원경영을 위한 원가시스템의 이론적 고찰

김경환,남은우 高神大學校保建科學硏究所 1996 보건과학연구소보 Vol.6 No.-

Most hospital is not systematically equipped with the hospital accounting system as well as the cost accounting system of hospital which becomes the the basic for cost control. Therefore,in this study, we consider the problem on the concept,method and introduction of medical cost system in hospital. The top manager in the hospital is mostly the doctors, and thus does not meet the education on the specialized hospital management,and thus may express the negative viewpoint to the necessity of introducing the cost system. There is no method of the standardized cost accounting which is applicable to the size of hospital, and thus it is difficult to be enforced. As the problems of pratical application, the hospitals which are different in the characteristics have the problems how to standardize and simplify it and to divide the responsible accounting unit. That is to say, it can be mention to the number of many accounts, standard for wage distribution order of assistant. The hospital must introduce the cost accounting system for management efficiency. For the purpose of executing this system. we need to consider the above -mentioned problems sufficientl, and the understanding and support of top manage, is essential required.