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Volume 11(1); October 1978
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Original Articles
Survey on Medical Malpractice Problem in Korea.
I Y Jang
Korean J Prev Med. 1978;11(1):3-7.
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AbstractAbstract PDF
No abstract available.
Summary
An Analysis on Medical Malpractice Problem in U.S.A..
J S Park
Korean J Prev Med. 1978;11(1):8-13.
  • 1,579 View
  • 19 Download
AbstractAbstract PDF
No abstract available.
Summary
A Survey on Health Status of Group Controlled Pulmonary Tuberculosis Patients.
K Y Jung
Korean J Prev Med. 1978;11(1):14-23.
  • 1,772 View
  • 22 Download
AbstractAbstract PDF
This survey was conducted on a total 672 pulmonary tuberculosis patients who were registered at certain health center in Busan, during the period from July 15th to August 31st, 1977, based on Modified Cornell Medical Index(CMI) consisting of 70 questions. Number of "Yes" response of an individual patients was collected by each large section of Modified CMI. The each number of "Yes" response was standardized by mean of Z scoring. Z score was obtained by following formula. Z=50+10(Xi-m)/s. M : means of "Yes" response by each section for all subjects. s : standard deviation of the mean. Xi : number of "Yes" response by each section in an individual patients. The results of obtained were as follows: 1. The number of investigated cases were 672 (459 males and 213 females). The most prevalent group was 20-24 years old group as 18.4%by age, moderate advanced group as 50.8% by radiological diagnosis, INH+PAS+SM group as 34.7% by antituberculotics and unemployed group as 59.9% by occupation. By bacteriological examination of sputum, the rate of negative group was 60.5% and, positive group was 39.5%. 2. Z score of complaints by sex was higher in female as 52.4 than in male as 48.9 in general. By radiological diagnosis, there was decreasing tendency with age in male but increasing tendency with age in female. 3. By age group, Z score of complaints was increasing tendency with age in male but there was non-significant differences in female. 4. By bacteriological examination of sputum, the Z score of complaints was increasing tendency with the more discharged bacteria in both sex generally. 5. By antituberculotics, INH group was revealed the highest Z score of complaints as 50.4 in male and INH+PAS group was the highest as 51.2 in female. 6. By occupation, agricultural and fisherman group was the highest as 53.5 and the next group was professional, technical and related workers, unemployed and sales workers in that order.
Summary
The Influence of Family Health Workers' Activities on Health Program Performance-Evaluative Research in the The Kang Wha Community Health Demonstration Project.
Kyung Seo
Korean J Prev Med. 1978;11(1):24-30.
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AbstractAbstract PDF
This study was designed to analyse effects of Family Health Workers' activities on the performance of a child immunization program an part of the evaluative research in the community health demonstration project in Kang Wha. Frequent shortcomings of evaluative research are problems in setting evaluative indices, difficulties in interpreting influences of socioeconomic changes due to lack of control and failure of demonstrating association between activity input and program performance. Specific objectives of this study was to improve the frequent shortcoming of evaluative research by isolating the effects of Family Health Workers' activities on the performance of the program through controlling other variable which also influenced the program performance. The target population consisted of 1240 children who were born between Jan. 1971 and Dec. 1075 in Sunwon Myun, and Naega Myun in Kwahg Wha Gun, Kyonggi Province. The data were collected in part through 20 Family Health Workers who interviewed the mothers of these children in their villages during Nov. 1977. Part of the data were obtained by summarizing Family Health Workers daily activity records. All data were grouped for each birth cohort according to the 20 villages. Dependent variable of the model is the measle immunization rate of each village and the independent variables are characteristics of baby, mother, household, travel time to the health sub-center, to Kang Wha Town, and the mean member of visits to the household by Family Health Workers as well as their other related activities and the year of birth of children according to village. The model was analysed by stepwise multiple regression technique. The summarized results show that overall R2 were 39.3% and mean number of Family Health Worker household visits, mean age of mother and mean economic status were significant variables in explaining the immunization rate. Therefore Family Health Workers' activities are one of the significant variables in influencing the increased immunization rate of children in villages of the project area.
Summary
A Survey on the Physical Integrated Value of Primary School Students on Busan Area.
Moon Kyu Joo
Korean J Prev Med. 1978;11(1):31-40.
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AbstractAbstract PDF
For the purpose of estimating the status of physical growth of primary school students in Busan area, the author had performed and investigation and analysis on the physical integrated value for past 6 years of random sampled 656 students (male 374, female 282). The summarized results were as follows : 1. The most rapid growth age of body-height was 7-8 years old ad 5.9cm in male and 10-11 years old in female as 6.5cm, and the growth curve of body-height was crossed at 10-11 years old. 2. The most rapid growth age of body-weight was 9-10 years old as 3.1kg in male and 10-11 years old in female as 3.9kg, and the growth curve of body-weight was crossed at 10-11 years old. 3. The most rapid growth age of chest-girth was 8-9 years old as 3.1cm in male and 9-10 years old in female as 2.9cm, and the growth curve of chest-girth was not crossed. 4. The most rapid growth age of sitting-height was 6-7 years old in both sex as 3.3cm and 3.4cm, and the growth curve of sitting-height was crossed at 8-9 years old. 5. Using the physical integrated value was much simple and desirable at comparing with the areas. And the physical integrated value of primary school students on Busan area compared to Korean standard physical status was relatively good as body-height +0.33, +0.30, body-weight +0.33, +0.35, chest-girth +0.65, +0.57 and sitting-height +0.10, +0.20 with each sex.
Summary
An Analysis of the Medical Aid Program on the Utilization Aspect in Rural Korea.
Han Joong Kim
Korean J Prev Med. 1978;11(1):41-48.
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AbstractAbstract PDF
To examine the result of the government Medical Aid Program which began in January, 1977 as a part of social security policy implementation, all the medical records of the clients and official statistics in the year were analyzed. The specific objectives this study pursues include the magnitudes and patterns of morbidity and utilization, and the characteristics of clients. One Korean rural area, Koje county was selected as the study area and subsequently all the clinics and hospitals assigned to work out the Aid Program are the subjects for the survey. A brief summary of the study results as follows: a. The clients of Koje county are 6.4% of the total population in the area, more than the average percentage of the clients in Korea. It reflects on low level of economic status of the residents of the area. b. The population structure of the clients indicates that the large proportions of young and old age group are overwhelming, while the middle age group share very small portions. 3c. The utilization rates for primary care are 2.0 persons, 11.6 visits and 22.6 treatment days per 100 persons per months. Annual hospitalization is rated as 13.7 cases and 164 days per 1,000 persons. The utilization rates are slightly lower than those expected rates during planning period but eventually become higher than those of general population in rural Korea. d. The factors which influence the utilization rates are identified with client group(low income vs indigent), age and sex. e. The utilization pattern for primary care demonstrates seasonal variation similar to the pattern of general rural population in the low income group, but none in the indigent group. f. The most common diseases revealed at the primary care clinics are the acute respiratory infection (26.9%), acute gastritis (10.8%), skin and subcutaneous infection (6.8%). The cases of acute conditions are outnumbered than the cases of chronic condition. g. The clinics, hospitals and other related health institutions are well cooperated in dealing health care services in their own capacities. Considering the above results Medical Aid Program generated satisfactory results at least in the utilization aspect.
Summary
The Type of Medical Service Desired by Those Communities Which at Present have None.
Dong Bae Lee
Korean J Prev Med. 1978;11(1):49-58.
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AbstractAbstract PDF
To try to determine the type of medical service wanted by the rural population, in Chungnam Province, a survey amongst the populations of 6 counties was conducted; Within the 6 counties, 2 local communities, which had no access to local medical services, were surveyed. The 12 communities were actively involved in Sae-Maul activities, and total number of households surveyed, was 822. The survey was conducted over a 1 month period, from July 16th, 1976, thru August 20th, and the followings are the results, summarized. 1. The largest number of respondents desired a combination of Public Health Center and Country Hospital, followed in order by Private Clinic and Modern Medical Facility. 2. The respondents, aged under 40 years, desired the Private Clinic type medical service, whilst those over 40 years of age, wanted the County Hospital, and as the numbers in this age bracket, were larger, so the ratio was much higher. 3. Sex, educational background, and occupation did not play any particular emphasis in the decisions. 4. Monthly income affected the responses to the survey. These in the lower-income bracket, wanted the County Hospital, and the ratio was high. These in the high income bracket desired the Modern Medical Service, accordingly. Those with an income of 50,000 won or less, amongst the low-income bracket, favored the Public Health sub-center type of service. The ratio for this service was very high.
Summary
Analysis on Health Cooperative Program for Employees of Seoul National University.
H S Cho
Korean J Prev Med. 1978;11(1):59-64.
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AbstractAbstract PDF
No abstract available.
Summary
Studies on Benzo(a)pyrene of the Suspended Particulate in Atmosphere of Seoul City.
Sook Pyo Kwon, Yong Chung, Dong Koo Lim
Korean J Prev Med. 1978;11(1):65-75.
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AbstractAbstract PDF
This study was carried out to investigate air pollution by total suspended particulate(T.S.P.), benzene soluble matter and benzo(a)pyrene in Seoul city. The sampling areas were divided into commercial(Kwang Hwa Moon), industrial(Ku Ro Dong) and residential area(Shin Chon). Sampling was undertaken by High Volume Air Sampler for four seasons from January 1977 to November 1977. The T.S.P. was extracted with Soxhlet apparatus by benzene and benzo(a)pyrene was separated by column chromatography and thin layer chromatography. The concentrations of benzo(a)pyrene were measured by means of fluorophotometer, and following results were obtained. 1. Arithmetic average concentration for 1-day averaging time of total suspended particulate were 275.6 microgram/m3 in Kwang Hwa moon, 325.9 microgram/m3 in Ku Ro Dong and 193.0 microgram/m3 in Shin Chon. 2. The seasonal variance of total suspended particulate at Ku Ro Dong and Shin Chon were 102.7 microgram/m3 99.6 microgram/m3 respectively and at Kwang Hwa Moon 39.9 microgram/m3. And the concentration of autumn is higher than of that spring at Ku Ro Dong and at Shin Chon, but at Kwang Hwa Moon, the seasonal variance is very little. 3. The concentrations of 50% frequency from geometric mean for 1-day averaging time were 264 microgram/m3 and 178 microgram/m3 at Kwang Hwa Moon, Ku Ro Dong and Shin Chon. And geometric standard deviation were 1.27, 1.38 and 1.41 respectively. 4. The concentrations of benzene soluble mater were 26.9 microgram/m3 Kwang Hwa Moon, 22.7 microgram/m3 at Ku Ro Dong and 15.5 microgram/m3 at Shin Chon, and the ratios to the T.S.P. were 9.8%(range 5.6-14.8%), 7.0%(range 2.4-14.4%) and 8.0%(range 5.5-22.1%) respectively. 5. The concentrations of benzo(a)pyrene were 8.5 microgram/m3 (range 0.8-29.9 microgram/m3 ) at Kwang Hwa Moon 10.9 microgram/m3 (range 1.1-52.0 microgram/m3 ) at Ku Ro Dong and 5.8 microgram/m3 (range 1.5-11.4 microgram/m3) at Shin Chon. 6. The results of this investigation were relatively high in compared with the recommended standards of suspended particulate in air of U.S. Environmental Protection Agency and observed levels of Benzo(a)-pyrene in U.S. city.
Summary
Change of Laboratory Parameters during Treatment of Lead Poisoning.
Byong Kook Yoo
Korean J Prev Med. 1978;11(1):76-82.
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AbstractAbstract PDF
In order to study the change of laboratory parameters of lead poisoning, 8 persons who had not been treated previously for lead poisoning (Group 1) and 6 persons who had been inadequately treated for few months for chronic lead poisoning at local clinic (Group 2) were examined. They had occupational exposure to lead for 3 to 18 years (mean, 7.6). In group 1 blood lead, urine lead, urine coproporphyrin and delta-aminolevulinic acid levels before our treatment exceeded the critical levels of lead poisoning. In group 2 urine lead level exceeded but blood lead, urine coproporphyrin and delta-aminolevulinic acid levels were within normal limits. All of them were treated with D-penicillamine for 4 months as inpatients at Industiral Accident Hospital. The dose of D-penicillamine was the same in all patients; 600 mg per day p.o. and the chelating agent was administer every other week. For laboratory analysis, 24 hour urine and 10 gm of whole blood were collected every 1 month on last day of non-administration period. The results were as follows: 1. It was found that urine lead level was decreased below the critical level of lead poisoning after 4 month's treatment with D-penicillamine and blood lead level was decreased more progressively below the critical level after 1 month treatment. 2. Urine coproporphyrin and delta-aminolevulinic acid levels were decreased progressively to normal range after 1 month treatment. 3. Two months after treatment, blood lead, urine lead, urine coproporphyrin and delta-adminolevulinic acid levels showed some increasing trends. 4. Urine lead level should be checked in a person who had been inadequately treated with chelating agents because blood lead, coproporphyrin and delta-adminolevulinic acid might be in normal range.
Summary
Inorganic Salts which effect on IDOL Value.
Hang Joon Kim
Korean J Prev Med. 1978;11(1):83-85.
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AbstractAbstract PDF
Idod (Immediate Dissolved Oxygen Demand) is a value of the oxygen demand after 15 minute of inoculation by inorganic reducing salts. Industrial development and urban enlargement are bringing water pollution deeply, and industrial waste waters are the source of the inorganic reducing salts. Author investigated the IDOD value change according to the inorganic salts and gained the following results: 1. IDOD value influenced by Na2SO3 is 81.4 ppm. 2. Generally sulfur compounds are highly effecting on IDOD. 3. The nitrite salt had little influence on IDOD.
Summary
A Study on the Mobile Medical Service Program.
Hung Bae Park, Dong Wook Choi
Korean J Prev Med. 1978;11(1):86-97.
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AbstractAbstract PDF
The mobile medical service has been operated for many years by a number of medical schools and hospitals as a most convenient means of medical service delivery to the people residing in such area where the geographical and socioeconomic conditions are not good enough to enjoy modern medical care. Despite of official appraisal showing off simply with numbers of outpatients treated and medical persons participated, however, as well recognized, the capability (in respect of budget, equipment and time) of those mobile medical teams is so limited that it often discourages the recipients as well as medical participants themselves. In the midst of rising need to secure medical service of good quality to all parts of the country, and of developing concept of primary health care system, authors evaluated the effectiveness of and problems associated with mobile medical service program through the community diagnosis of a village (Ope-Myun, Kwangju-gun) to obtain the information which may be helpful for future improvement. 1. Owing to the nationwide Sae-Maul movement powerfully practiced during last several years, living environment of farm villages generally and remarkably improved including houses, water supply and wastes disposal etc. Nevertheless, due to limitations in budget, time and lack of knowledge (probably the most important), these improvements tend to keep up appearances only and are far from the goal which may being practical benefit in promoting the health of the community. 2. As a result of intensive population policy led by the government since 1962, there has been considerable advances in understanding and the rate of practicing family planning through out the villages and yet, one should see many things, especially education, to be done. Fifty eight per cent of mothers have not received prenatal check and the care for most(72%) delivery was offered by laymen at home. 3. Approximately seven per cent of the population was reported to have chronic illness but since only a few(practically none) of the people has had physical check up by doctors, the actual prevalence of chronic diseases may reach many times of the reported. The same fact was observed also in prevalence of tuberculosis; the patients registered at local health center totaled 31 comprising only 0.51% while the numbers in two neighboring villages (designated as demonstration area of tuberculosis control and mass examination was done recently) was 3.5 and 4.0% respectively. Prevalence rate of all diseases and injuries experienced during one month(July, 1977) was 15.8%. Only one tenth of those patients received treatment by physicians and one fifth was not treated at all. The situation was worse as for the chronic patients; 84% of all cases either have never been treated or discontinued therapy, and the main reasons were known to be financial difficulty and ignorance or indifference. 4. Among the patients treated by our mobile clinic, one third was chronic cases and 45% of all patients, by the opinion of doctors attended, were those who may be treated by specially trained nurses or other paramedics (objects of primary care). Besides, 20% of the cases required professional managements of level beyond the mobile team's capability and in this sense one may conclude that the effectiveness(performance) of present mobile medical team is quite limited. According to above findings, the authors would like to suggest following for mobile medical service and overall medicare program for the people living in remote country side. 1. Establishment of primary health care system secured with effective communication and evacuation (between villages and local medical center) measures. 2. Nationwide enforcement of medical insurance system. 3. Simple outpatient care which now constitutes the main part of the most mobile medical services should largely be yielded up to primary health care unit of the village and the mobile team itself should be assigned on new and more urgent missions such as mass screening health examination of the villagers, health education with modern and effective audiovisual aids, professional training and consultant services for the primary health care organization.
Summary
A Study on Occupational Health Program and Development of Evaluation Criteria for Occupational Health.
Y S Lee, Y H Moon, Y K Kim, H K Chung
Korean J Prev Med. 1978;11(1):98-109.
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AbstractAbstract PDF
The study was carried out for 101 establishments in Kyong-In areas to evaluate the industrial health management status utilizing the scoring method by Webb's model during the period from 1 September to October 30, 1977. To compare the results, reevaluation was made with the 45 questions' model prepared by 6 Korean professionals who were specialized in industrial health fields. The results were as follows: 1. The mean rate of affirmative answers for 101 establishments was 51.6%. The mean weighted score rate of affirmative answers was 52.3%. 2. The mean rate of affirmative answers on components of the philosophy and facility resource for 101 establishments was higher than that of average rate. The mean rate of affirmative answers on components of the health evaluation and health management among the health service program was lower than that of average rate. 3. The mean rate of affirmative answers on components was higher among the establishments with more than 500 employees. The mean rate of affirmative answers of chemical establishment was lower than that of others. 4. The mean rate of affirmative answers on 45 questions' model for 101 establishments were 67.1%. The mean weighted score rate of affirmative answers was 70.0%. 5. In case of 45 questions' model, the mean rate of affirmative answers on components of philosophy and treatment was higher than that of average rate and the mean rate of affirmative answers on components of the facility resource and the health evaluation was lower than that of average rate. 5. The mean rate of affirmative answers of the 45 Questions' model was higher than that of Webb's model in size and class of 101 establishments. Author concluded that Webb's model must be suitable for evaluation higher condition of occupational health management than is presently used in Korean establishments. According to the results, however, there were no significant differences between Webb's model and the 45 questions' model. So it could be used to evaluate Occupational Health Program. For this objective, in Korean occupational situations, further study also must be made comprehensively thereafter.
Summary
Syhilis Screening Among some Industrial Workers in Korea.
Yong Tae Yum
Korean J Prev Med. 1978;11(1):110-122.
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AbstractAbstract PDF
A study on the morbidity of syphilils among 729 workers on Po Hang and Ul San Industrial Complexes at the routine periodical examination was performed. In addition to the morbidity, factors related to the disease infection such as educational level, religion, preventive measures taken by the workers, history of urethritis, and so on were studied and analysed to check significant relation. The result were as follows. 1. VDRL and RPR tests were undertaken to determine the sensitivity and specificity of RPR tests which was utilized for all the workers studied. It related 86.4% of sensitivity and specificity 87.7% of specificity from the RPR tests, and 81.8% of sensitivity and 90.1% of specificity from the VDRL tests compared with RPCF test. There were 87.4% of agreement rate vetween RPR and VDRL. Actually, RPR was more sentitive but less specific than VDRL , and found to be a satisfactory screening test for syphilis especially in the fields. 2. Among the workers in Po Hang Area 24.0% of them revealed reactive result, and in Ul San Area 5.2% revealed result showing 4.6 times of risk among workers on Po Hang Area. 3. There were no statistically significant differences between RPR reactive rates and personal characteristics such as educational level, region, history of urethritis experience, history of coitus with prostitute, and preventive measures of V.D taken by workers of evaluated by area of Po Hang and Ul San separately. 4. V.D. could be encountered as an occupational disease in certain conditions of working places and the psychosocial problems of workers. And so, It is necessary that the workers working in special estates such as on Po Hang Industrial Complex should be checked to be screened out by RPR test at periodical examination also should include RPR test be compared with. Regardless of the workmen's compensation, establishment of V.D. treatment clinic of system for such industrial workers is urgently needed. Health education regarding V.D. is another subject to be performed.
Summary
Variation of Hospital Costs and Product Heterogeneity.
Young Soo Shin
Korean J Prev Med. 1978;11(1):123-127.
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AbstractAbstract PDF
The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are established for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The "AUTOGRP System" was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The "Departmental Method" was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying pattern of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among this study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables(i.e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The weighted mean total case cost(TOTC) of the study hospitals for Medicare patients during the study years was $1127.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($745.45). The weighted mean per total cost (DTOC) of the study hospitals for Medicare patients during the study years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the lowest average DTOC($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variable to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of inter-hospital cost variation; 59.1 percent for TOTC and 44.3 percent for DTOC. These results demonstrate that the casemix index is the most important determinant of inter-hospital cost variation. Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix-related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.
Summary

JPMPH : Journal of Preventive Medicine and Public Health