Background
: Despite the development of medical knowledge and technology, it has long been pointed out that the treatment guidelines are not sufficiently based on evidence. It has not been yet studied how evidence based medicine if implemented when physicians make their therapeutic decision. The purpose of this study was to determine the degree of evidence based interventions in a university based family medicine outpatient clinic.

Methods : The degree of evidence based practice was evaluated using Ellis and Gills' method developed by the Evidence-Based Medicine Center in Oxford. The patients' records of an outpatient clinic of a university hospital were reviewed on the primary diagnosis - intervention. The evidence based guidelines were defined as traditional textbooks and the results of randomized controlled trials found on databases such as Medicine, Clinical evidence, Best evidence, and Cochrane. In case where there were no guidelines, consultation with the specialists was done. The degree of the evidence based therapeutic interventions was assessed by three levels.

Results : There were 179 primary diagnosis - intervention pairs, among them, 125 pairs (69.8%) of interventions were based on randomized controlled trial evidence and 19 pairs (10.6%) based on convincing non-experimental evidence. No evidence was found for 35 pairs (19.6%). As a result, 80.4% of the total 144 pairs were regarded as evidence-based medicine.

Conclusion : The result showed that considerable portion of the total cases were evaluated as based on clinical evidence, which is similar to the conclusions of the previous studies in other countries. We hope that future similar studies will be conducted in other institutions as well as in other specialities.

Background
: Primary health care institution has the important role for satisfying the national health care need primarily. In Korea, primary care has not taking the responsibility for resolving the increasing health need effectively and has been weakened. So, we intended to suggest what act as the cause of bringing the weakness of primary care and how can we solve this problem. We analyzed the characteristics of components of the charges per case among the types of health care facility for twenty common diseases in Korea.

Methods : We used Insured medical record of Federation of Korean Medical Insurance Societies from Feb. 1st to 28th of the year 1990, and we selected 16,445 cases from total 88,471,051 cases by using systemic random sampling.

Results : The charge per case was hightest in the tertiary health care institution and it was 2.9 times larger than that of primary care for the same disease. In the tertiary health care institution, the amount of cost for the oral drug was 54.3% and that for the medical examination was 17.0% of the charge per case, and compared with primary health care institution, the former was 20.6% and the latter was 4.1%, respectively. So, we found that the amount of cost for oral drug and medical examination in tertiary health care institution was greater than that of primary health care institution.

Conclusion : The charge per case of tertiary health care institution was about 3 times greater than that of primary health care institution for the same disease. In our study, we presume the higher medical cost of tertiary health care institution may be due to cost for the more expensive oral drugs and various diagnostic examinations than that of primary health care institution.