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Do differences in profiling criteria bias performance measurements? Economic profiling of medical clinics under the Korea National Health Insurance program: An observational study using claims data
Hee-Chung Kang, Jae-Seok Hong
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-189
Abstract: Data on medical care benefit costs for outpatient care at medical clinics nationwide were collected from the NHI claims database. We calculated eight types of cost-efficiency index with different profiling criteria for each medical clinic and investigated the agreement between the decile rankings of each index pair using the weighted kappa statistic.The exclusion of pharmacy cost lowered agreement between rankings to the lowest level, and differences in case-mix classification also lowered agreement considerably.A medical clinic may be identified as either cost-efficient or cost-inefficient, even when using the same index, depending on the profiling criteria applied. Whether a country has a single insurance or a multiple-insurer system, it is very important to have standardized profiling criteria for the consolidated management of health care costs.With a greater emphasis on cost containment in many health care systems, it has become common to evaluate each physician's relative resource use [1-6]. The motivation for this economic profiling is primarily financial in that physicians identified as being inefficient are considered to be wasting health plan resources and these physicians can be encouraged to change their practice pattern [7].Previous studies have shown that differences in health status among patients may influence treatment costs within defined episode types and that the health care costs of treated patients may differ significantly among physicians [5-8]. Efforts to identify physician outliers who show extreme practice patterns and to encourage them to change their behaviors have become important for the management of health care costs [8,9]. The Korea National Health Insurance (NHI) program detects such outliers using economic profiles.The O/E ratio, which compares the observed cost (O) with the expected cost (E), is the measure typically used for provider economic profiling [5,10]. In this article, we refer to this score as cost efficiency; however, h
Calculus teaching and learning in South Korea  [PDF]
N. Karjanto
Mathematics , 2015,
Abstract: This article discusses an experience of teaching Calculus classes for the freshmen students enrolled at Sungkyunkwan University, one of the private universities in South Korea. The teaching and learning approach is a balance combination between the teacher-oriented traditional style of lecturing and other activities that encourage students for active learning and classroom participation. Based on the initial observation during several semesters, some anecdotal evidences show that students' learning is improved after implementing this student-oriented active learning approach, albeit a longer period of time is definitely needed to transform general students' attitude from passive learners to active ones.
A COMPARISON OF MORBIDITY PATTERNS IN PUBLIC AND PRIVATE PRIMARY CARE CLINICS IN MALAYSIA
MIMI O,TONG SF,NORDIN S,TENG CL
Malaysian Family Physician , 2011,
Abstract: Objectives: To compare the morbidity patterns in public and private primary care clinics; determine patients’ reasons forencounter (RFE) and diagnoses using the ICPC-2, and compare ten commonest diagnoses and RFEs.Methods: A cross-sectional study on randomly selected clinics was conducted nationwide. Doctors completed the PatientEncounter Record (PER) for systematically selected encounters for a week.Results: Response rate was 82.0% (public clinic) and 33% (private clinic) with 4262 encounters and 7280 RFE. Overall, thethree commonest disease categories encountered were respiratory (37.2%), general and unspecified (29.5%), and cardiovasculardiseases (22.2%). Public and private clinics handled 27% versus 50% acute cases and 20.0% versus 3.1% chronic cases i.e.33.7 and 5.6 chronic diseases per 100 RFE respectively.Conclusion: Doctors in public clinics saw more chronic and complex diseases as well as pregnancy related complaints andfollow-up cases while in private clinics more acute and minor illnesses were seen. Health services should be integrated andsupport given to co-manage chronic diseases in both sectors.
A comparison of public and private obstructive sleep apnea clinics
Zonato, A.I.;Bittencourt, L.R.;Martinho, F.L.;Baiard, P.;Togeiro, S.M.;Benedito-Silva, A.A.;Tufik, S.;
Brazilian Journal of Medical and Biological Research , 2004, DOI: 10.1590/S0100-879X2004000100010
Abstract: the aim of the present study was to compare the clinical findings and polysomnography results obtained at public and private clinics in brazil, the follow-up after diagnosis, and the therapeutic aspects related to continuous positive airway pressure. patients who snore and who have obstructive sleep apnea were retrospectively divided into two groups, i.e., public clinic (n = 307) and private clinic (n = 317). data concerning age, sex, body mass index (bmi), neck circumference, medical history, sleepiness scale, follow-up after diagnosis, and acceptance of continuous positive airway pressure therapy were collected. mean age was 50 ± 12 (range: 15-80) for public patients and 48 ± 12 years (range: 19-91) for private patients. mean bmi was 30 ± 6 (range: 19-67) for public patients and 31 ± 6 kg/m2 (range: 21-59) for private patients. the public clinic had a significantly higher frequency of women than the private clinic (m:f ratio of 2.0:1 and 6.9:1, respectively). the condition of private patients (apnea-hypopnea index = 31 ± 25) was more severe than that of public patients (apnea-hypopnea index = 25 ± 24 events/h; p = 0.0004). in the public and private clinics, 19 and 15% of patients were snorers, respectively, and 81 and 85% of them had sleep apnea. after diagnosis, follow-up was longer in the private group. the continuous positive airway pressure acceptance was similar for both groups (32 vs 35%), but patients from the public clinic abandoned treatment more than private ones (65 vs 13%). social status was significant in terms of the severity of obstructive sleep apnea age and gender distribution. private patients look for a diagnosis earlier in the course of the disease than public patients, adhere more to follow-up, and abandon continuous positive airway pressure treatment less than public patients do.
A comparison of public and private obstructive sleep apnea clinics  [cached]
Zonato A.I.,Bittencourt L.R.,Martinho F.L.,Baiard P.
Brazilian Journal of Medical and Biological Research , 2004,
Abstract: The aim of the present study was to compare the clinical findings and polysomnography results obtained at public and private clinics in Brazil, the follow-up after diagnosis, and the therapeutic aspects related to continuous positive airway pressure. Patients who snore and who have obstructive sleep apnea were retrospectively divided into two groups, i.e., public clinic (N = 307) and private clinic (N = 317). Data concerning age, sex, body mass index (BMI), neck circumference, medical history, sleepiness scale, follow-up after diagnosis, and acceptance of continuous positive airway pressure therapy were collected. Mean age was 50 ± 12 (range: 15-80) for public patients and 48 ± 12 years (range: 19-91) for private patients. Mean BMI was 30 ± 6 (range: 19-67) for public patients and 31 ± 6 kg/m2 (range: 21-59) for private patients. The public clinic had a significantly higher frequency of women than the private clinic (M:F ratio of 2.0:1 and 6.9:1, respectively). The condition of private patients (apnea-hypopnea index = 31 ± 25) was more severe than that of public patients (apnea-hypopnea index = 25 ± 24 events/h; P = 0.0004). In the public and private clinics, 19 and 15% of patients were snorers, respectively, and 81 and 85% of them had sleep apnea. After diagnosis, follow-up was longer in the private group. The continuous positive airway pressure acceptance was similar for both groups (32 vs 35%), but patients from the public clinic abandoned treatment more than private ones (65 vs 13%). Social status was significant in terms of the severity of obstructive sleep apnea age and gender distribution. Private patients look for a diagnosis earlier in the course of the disease than public patients, adhere more to follow-up, and abandon continuous positive airway pressure treatment less than public patients do.
Satisfaction with the Prenatal Clinics in Zanjan, Iran
Roghayeh Heidari,Sedigheh Borna,Fedieh Haghollahi,Mamak Shariat
Journal of Family and Reproductive Health , 2008,
Abstract: "nObjective: This study was performed to determine the level of satisfaction among women attending the prenatal clinics in the city of Zanjan, Iran. "n "nMaterials and methods: This descriptive cross-sectional study was performed from 2005 to 2006 in Zanjan. A total of 701 pregnant women with gestational age of 20 weeks or more who had undergone at least two prenatal visits in prenatal care centers were enrolled into the study. A questionnaire was filled by face to face interview with each mother including questions about the general physical environment of the clinic, whether the pregnancy was solicited, the communication skills of the personnel, the quality, feasibility and cost of prenatal care, as well as questions pertaining to demography and type of insurance. Data were entered into SPSS 11 software and subsequently analyzed using descriptive statistical tests including ANOVA. "n "nResults: Mean age of mothers was 26.23 ± 5.6 years. Among them 55.8%, 37.3% and 6.9% had up to primary, secondary, and high school level of education, respectively. Overall satisfaction rate was more than 99% in all aspects and dissatisfaction was mainly related to type of insurance. The dissatisfaction was also related to the trainings given in health center. Women with private insurance (free and military) showed the least dissatisfaction while the highest dissatisfaction was in women with social security or health services insurance. "n "nConclusion: Overall dissatisfaction rate was 1%. The dissatisfaction was related to the type of insurance. The dissatisfaction was also related to the level of the trainings given in health center.
The Black Markets of North Korea  [PDF]
Qifan Xiang
Modern Economy (ME) , 2019, DOI: 10.4236/me.2019.107113
Abstract: The aim of this paper is to provide insight into the foreign and domestic economies of North Korea, particularly concerning illicit black market activities. Regime doctrine of the Democratic People’s Republic of Korea has been adamant about the country’s sustained self reliance, often making claims of this nature through public broadcasts to its citizens. However, through sources demonstrated in this essay North Korea has been shown to be engaging in black markets across the globe, including high quality currency counterfeiting, arms dealing and drug production and trafficking. North Korea’s goal of obtaining nuclear weaponry as a means of deterrent against imperialist invasion has lead to numerous sanctions imposed by the United Nations in an attempt to obstruct these ambitions. As a result, North Korea has pursued illicit means of gaining funds for their nuclear program, namely the black market. Within the country itself, there has been a growing lack of trust of its citizens towards the state’s Public Distribution System in accommodating for their welfare. A nationwide famine which occurred in the mid to late 90s left the country destitute with millions dying of starvation. Following this, catastrophe black markets have emerged throughout the country offering a wide range of products previously unavailable through the state’s rationing system. Although North Korea maintains its claim to be a functioning communist state, this paper aims to dispute this through demonstrating the rise of the country’s participation in both internal and external commercial black markets. This paper consists of an introduction giving a brief overview of the paper’s aims and the divergence of regime rhetoric compared to reality. The following section outlines North Korea’s emergence as a sovereign state, the ideologies which define this regime; then to the difficulties the country has faced throughout the 20th century and the measures (sanctioned or otherwise) taken
Establishment of Modern Universities in Korea
Jeong-Kyu Lee
Education Policy Analysis Archives , 2001,
Abstract: The purpose of this study is to examine the historical factors which affected the rise of modern higher education during the late Choson period (1880-1910), and to analyze the implications of these historical factors on educational policies in contemporary higher education in Korea. The rise of modern higher education in Korea can be viewed as occurring in three principal phases: Confucian Choson Royal Government, Western Christian missionaries, and patriotic nationalists. The author points out that the major historical factors influencing the development of modern higher education were Confucianism, Christianity, and Korean nationalism. In particular, Confucianism and Christianity have had substantial impacts on the planning of educational policies in contemporary Korean higher education; the former is viewed as an original source of educational enthusiasm which has expanded Korean higher education, and the latter a matrix of modern Korean higher education which has embodied educational enthusiasm.
Politics of Race in East Asia: The Case of Korea and the Chinese community in South Korea  [cached]
Hyun Jin Kim
Provincial China , 2012,
Abstract: The influx of Chinese into Korea has a long history. The earlier migrants were rapidly absorbed into mainstream Korean society and quickly assimilated. However, the Chinese migrants who arrived in the late 19th and early 20th centuries, the huaqiao, chose to maintain their separate, non-Korean identity. This later led to open discrimination towards the huaqiao in post-independence Korea. The adoption of modern nationalism and racial theories in Korea also facilitated the disenfranchisement of the huaqiao, whose loyalty to the Korean national state was suspected and whose economic and social rights were appropriated. The recent revival of Chinese power has led to the mellowing of Korean attitudes towards China and the Chinese. The left-aligned political parties in Korea are especially in favour of cultivating closer ties with China. The composition of the Chinese community in Korea has also been altered by the influx of new migrants from mainland China. This has led to the renaissance of the once moribund Chinese communities in Incheon and Busan, both of which now boast sizable Chinatowns. Yet the huaqiao still face problems with integrating fully into Korean society and being openly huaqiao can still lead to unwelcome attention and prejudice from native Koreans. The integration of the Chinese community in Korea remains a challenge for Korea that still holds firmly to the old nationalist ideology of the 20th century.
Quality of care provided to febrile children presenting in rural private clinics on the Kenyan coast
TO Abuya, CS Molynuex, ASS Orago, S Were, V Marsh
African Health Sciences , 2004,
Abstract: Background: Private sector health facilities are diverse in nature, and offer widely varying quality of care (QOC). Objectives: The study aimed to describe the QOC provided to febrile children at rural private clinics on the Kenyan coast and stakeholder perspectives on standards of practice and opportunities for change. Methods: Data collection methods were structured observations of consultations; interviews with users on exit from clinic and at home and in depth interviews with private practitioners (PP) and district health managers. Findings: Private clinics have basic structural features for health care delivery. The majority of the clinics in this study were owned and run by single-handed trained medical practitioners. Amongst 92 observed consultations, 62% of diagnoses made were consistent with the history, examinations and tests performed. 74% of childhood fevers were diagnosed as malaria, and 88% of all prescriptions contained an antimalarial drug. Blood slides for malaria parasites were performed in 55 children (60%). Of those whose blood slide was positive (n=27), 52% and 48% were treated with a nationally recommended first or second line antimalarial drug, respectively. Where no blood slide was done (n=37), 73% were prescribed a nationally recommended first line and 27% received a second line antimalarial drug. Overall, 68 % of antimalarial drugs were prescribed in an appropriate dose and regime. Both private practitioners and district health managers expressed the view that existing linkages between the public and private health sectors within the district are haphazard and inadequate. Conclusions: Although rural PPs are potentially well placed for treatment of febrile cases in remote settings, they exhibit varying QOC. Practitioners, users and district managers supported the need to develop interventions to improve QOC. The study identifies the need to consider involvement of the for-profit providers in the implementation of the IMCI guidelines in Kenya Key Words: Quality of care, febrile illness, malaria, private practitioners, private clinics African Health Sciences Vol.4(3) 2004: 160-170
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