The purpose of this study was to estimate the magnitude of patient's actual cost-sharing for hospital services in the National Health Insurance which has been estimated with only a few hospitals or limited number of patients. Also we aimed at analysis of factors influencing the magnitude. Sources of analyzed data were two databases. 1997 medical benefits record of the National Federation of Medical Insurance and 1997 Statistics for Hospital Management from the Korea Institute of Health Services Management(KIHM). We merged two databases and related records for 224 hospitals. based on the identification details of each hospital. The average percent of patients' cost-sharing was 51.7% of total hospital revenues from the insurance. with 40.3% of revenue in inpatient and 67.4% in outpatient. respectively. The contributing hospital factors to the magnitude of cost-sharing were size of hospitals. teaching status. location. number of employed physicians. etc. Larger and university hospital. urban location. and with more physicians were positively correlated with higher level of cost-sharing. Additionally, the higher the expenses of inpatient's treatment was, the higher the size of patient's cost-sharing was. These findings suggest that present level of patients' cost-sharing is quitely high and it is urgent to reduce the patient's cost-sharing to the reasonable level. It would be necessary to extend the coverage of insurance benefits and to develop policies focusing on larger hospitals and inpatient services.

To assess the university health service organization(UHSO) and its school health programs a questionnaire survey for all of 186 four-year colleges in Korea was conducted from December 1. 1998 to March 31. 1999. The response rate was 91.9 percent(171 universities). The UHSO was established in 116 universities(67.8%L The most common name of UHSO. used in 61 universities(52.6%). was school health center. Only 45(38.8%) of the 116 universities surveyed had a committee to support and run the UHSO. The percentage of universities that had committee was higher in national universities and those with a large number of students. The average number of staff working in the UHSO was 3.5; 4.6 in national universities; and 7.1 in universities with more than 15.000 students. There were 43 universities(37.1%) which had a part-time physician and 104 universities (89. 7%) had full-time nurses. Only 4 universities(3.4%) had a independent facility for the UHSO while most of UHSO were housed in other building. The UHSO had an independent budget in 86 universities(74.1%). The average budget per university was 46.890.000 won: private universities had more budget with 59.170.000 won on average than national universities with 36.990.000 won. The average budget allocated per student was 4.362 won. A regular physical examination was performed in 72 universities(62.1%). The percentage of university that performed regular physical examination was higher in private universities than in national universities. Health counseling was performed in 113 universities(97.4%) and vaccinations in 87 universities(75.0%). Medical care services were performed in 87 universities(75.0%). and the private universities and those with over 10.000 students provided the student with more services. Environmental sanitation was executed in 73 universities(62.9%) and health education was conducted in 68 universities(58.6%)' The school health management activities were promoted in 104 universities(89.7%) out of 116 universities with UHSO. Only 12 universities(10.3%) published reports on the achievements and performance of the UHSO. Only 29 universities(25.0%) had a continuing education for employees of the UHSO.

The major concern for this research is to discuss and to offer some solutions to bring the effectiveness of existing notifiable diseases reporting system over the physicians' attitudes of reporting, the actual condition of performance and the reasons of inertia in notifiable diseases reporting through examining the physicians of medical institutions in nationwide such as pediatrics, internal medicine and family medicine. The actual conditions of notifiable communicable diseases(NCD) reporting was surveyed by mail objectifying an internal medicine, pediatrics and family medicine in nationwide on the basis of stratified random sampling method divided into the classification of medical institutions and areas. As a result of survey. the rate of respondents showed 145 persons from physicians, 105 persons from hospitals. 120 persons from general hospitals, and 51 persons from tertiary hospitals. The total number of respondents were 421 and was rated 59.0 %. The analysis of collected survey went through a descriptive analysis primarily to grasp physicians' attitudes on the notifiable communicable diseases reporting, and then upon the dependent variables. Following are major findings obtained form the data analysis. 1. The results of a descriptive analysis on physicians' attitudes towards reporting NCD were as follows: First, the respondents who didn't know that yellow fever is reporting NCD were 11.0% of clinic, 10.5% of hospital. 5.0% of general hospital. 11.8% of tertiary hospital. and in case of hepatitis B, were 26.9% of clinic, 35.2% of hospital. 35.0% of general hospital. 23.5% of tertiary hospital. Second, The rate of physicians' knowledge on penalties of not reporting the NCD by their medical institution were 35.2% of clinic, 45.7% of hospital. 36.7% of general hospital. 62.7% of tertiary hospital. Third, among the no-reporting physicians in whole, the major reason of not reporting NCD were uncertainty of diagnosis(78.9%), no need to report(46.4%), no adequate actions from PHC(29.1%), no knowledge of the cases being notifiable ones in the order of their frequencies(30.4%), meddling from PHC(29.1%), concerning of patient's privacy(26.3%). 2. To analyze the characteristics related to the physicians' behaviors to report NCD, univariate and multiple logistic regression analyses were applied to the variables related to physician, 4 medical facility, PHC, and reporting system. The result were as follows: First, the result of the univariate analysis on physicians' attitude to report NCD and characteristics related to reporting in odds ratio was in the case of hospital. 3.4 times higher positive responses on physicians' attitude to report NCD came up as compared to the clinic. Second, the result of the univariate analysis on physicians' action of reporting NCD and characteristics related to reporting by the classification of medical institutions showed that the odds ratio of hospital was 2.3 times, the odds ratio of general hospital was 2.0 times, the odds ratio of tertiary was 6.8 times significantly higher than clinic. And the medical institution with significantly higher positive attitudes rate by multiple logistic regression analysis was hospital that rated 2.5 times significantly higher than clinic. Also in the PHC related characteristics of reporting, the rate of action in reporting NCD was significantly higher in medical institution that were endowed with the good condition of reporting. In multiple logistic regression analysis, the medical institution that has a good conditions of reporting showed a significantly higher positive rate on the action of reporting than the others.

In this study, we investigate the welfare effect of mandatory prescription(MP) in Korea. An immediate effect of MP is the increase in the implicit price of prescribed medicine, which could be obtained easily from drug stores before MP. This will lower the quantity demanded. which will in turn reduce the abuse of drugs. The key to the cost-benefit analysis of MP, therefore, should be focused on this point; price increase in the cost side and quantity decrease in the benefit side. Since we do not have as much information as needed for the analysis, however, we made strong assumptions for the clarity of numbers; the severity of moral hazard of medical doctors related to the sales of hospital drugs, constant demand elasticity, constant benefit multiplier of reduced drug usage, and so on, With these rather strong assumptions, we find that i) the benefit side is much more sensitive to demand elasticity than the cost side effect ii) the larger the demand elasticity, the greater the size of net gain of MP, though the result depends on the size of the benefit multiplier. This analysis shows that we need to have more information on the specific institutional path of health benefit diffusion caused by the reduction of drug usage, which was the major target of MP.

The main purpose of this research is to measure and analyze how productive the health centers are and how much inputs(or outputs) in the inefficient health centers should be decreased(or increased) for efficiency. The evaluation of the performance of health centers gives a strong incentive to improve resource allocation in regional health planning. It has been, however, implemented very rarely until now. In this regard, this paper measures the performance of the health centers with a single indicator for multiple-outputs in terms of productivity(technical efficiency), based on Data Envelopment method. The 20 Kyungnam health centers which provide clinic services and specific primary health care services were analyzed. The results show that 50.0% of 20 health centers were productive with respective to overall technical efficiency, 65.0% were productive for pure technical efficiency, and 50.0% for scale efficiency. The inefficient group includes Geoje, Mahsan, Miryang, Sahchun, Tongyoung, Gosung, Nahmhae, Euryang, Hahmahn, Hahbchun health centers. The worst case was identified as Tongyoung health center which represented a 47.5% efficiency, compared with productive health centers. The empirical results for input-output analysis indicates that the low-productive health centers have excessive manpower in administration department, producing low outputs in clinical services and vaccination program. These findings imply that a systemic evaluation of the performance of the Korean health centers and the subsequent structural reform are strongly required.

The objectives of this study were to examine the utilization patterns of oriental medical care and to discover problems in its delivery. The data for this study were collected from a questionnaire survey mailed out from March 10 to April 9 1999 to 6.346 oriental medical clinic. The questionnaires were then distributed to two patients in each clinics. Of these questionnaires. 670 were completed and returned. The major statistical methods used for the analysis were the t-test. ANOVA, and x$^2$-test. The major findings are as follows: 1. Respondents reported visiting oriental doctors twice as often as they visited western doctors(All those completing the survey received the questionnaire at oriental medical clinics). 2. The number of reported visits to oriental physicians according to among gender, age, marital status, education, income and residence. Males, married respondents, the elderly and the residents of rural areas visited oriental physicians more frequently than females, singles, younger respondents and urbanites. Those people belonging to the middle income class and middle education level also more frequently visited oriental physicians. 3. There are several factors that restrict the utilization of oriental medical care, such as the limitation of the scientific diagnostic instrument use commonplace reliance upon western medical techniques, and the perception of high price for oriental medical care. It is very important to focus oriental medical care onto the fields of acupuncture, circulatory system disease, musculoskeletal system ailments, etc. to improve the utilization of oriental medical care. Other policies for the improvement of oriental medical care include the standardization of price, quality and quantity of oriental medicine.

The purpose of this article was to review the basic concept of the SERVQUAL scale and to evaluate its usefulness in health care settings. The SERVQUAL scale was developed by Parasuraman et al. in 1988. Its purpose was to provide an instrument for measuring the quality of service that would apply across a broad range of services with minor modifications in the scale. The SERVQUAL scale is based on gap theory, which indicates the difference between consumers' expectations and their assessment of the actual performance of a specific firm. It has five dimensions to define service quality. These dimensions include: (1) tangibles' (2) reliability' (3) responsiveness' (4) assurance' (5) empathy. While the SERVQUAL scale has been tested in a number of health care settings. the findings have been mixed. So. health care marketers should be cautious in their use of the SERVQUAL scale. However, it is rare to find instruments that are as well validated as SERVQUAL appears to be. As well the SERVQUAL scale provides valuable information about the quality of health care service.