• Health Policy and Management
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• v.5 no.1
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• pp.31-58
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• 1995

The Korean government achieved the universal coverage of health insurance in July 1989, and concomitantly introduced a new measure of regulated health care delivery system in using medical care. There are three reasons why the government took the new health care delivery system. Firstly, there was ample room for improving the allocative efficiency in the use of medical facilities. And the second one was to constrain the dramatic increase of medical demand under health insurance. Thirdly, and the most important reason was to alleviate the patient crowdedness in big general hospitals, particularly tertiary hospitals. There are essentially two different ways to control the use of health care : one is to cut the demand for health care, and the other to regulate behaviors of providers through the use of incentives/disincentives, demand-side approach or supply-side approach. The objective of this study is to examine whether or not medical care utilization behaviors under health insurance scheme have been changed among medical facilities such as clinic, hospital, general hospital and tertiary hospital in comparison with those before and after the introduction, particularly whether the patient crowdedness in tertiary hospitals has been alleviated or not. In order to conduct this study, the insurance claim data during the period of January 1989 and July 1992 were analyzed by focusing on diagnosis of both inpatients and outpatients, and especially the fifteen most frequent diseases in ambulatory care and the seven most frequent diseases in hospitalizatio. In addition, the same analyses were made on the changes in medical care utilization by specialty department. This was because the five departments, such as family medicine, ENT, eye, dermatology and rehabilitation, were exempted from applying the regulated health care delivery system in tertiary hospitals. The study revealed that a remarkable alleviation effect in the crowdness was noted for tertiary hospitals. This effect was most conspicuous for the most frequent mild diseases of both inpatient and outpatient care. For example, the fifteen most frequent OPD care at tertiary facilities have decreased as much as by 40%, of which 34% belonged to the cut in initial visits. Meanwhile, the proportion of those who used general hospitals and private practitioner's clinics have increased due to the shift of patients. The cases from the five special departments were also decreased, but not so much as other departments. A problem was noted that, as time passed by, the decreasing tendencies of crowdness at tertiary hospitals due to the regulated system became slightly smaller. Therefore, through complementary remedies are needed for the future implementation.

• Journal of Korean Academy of Nursing Administration
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• v.8 no.3
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• pp.441-456
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• 2002

Purpose : This research is, by investigating the relations between the cultural types of a nursing organization in a hospital and performance, to ascertain the cultural types to be able to improve performance. Method : The data were gathered from 487 nurses and 328 patients who were in eight general hospitals by using the self-report type of questionnaires. The period of data collection was from August 10, 2000 to September 10, 2000. For this research, the following tools were used; the tools for measuring the organizational characteristics, organizational culture, and job satisfaction, the tool for measuring organizational commitment, and the tool for measuring patients' satisfaction. For data analysis the SPSS Win 7.5 program was used. Result : 1) There was a significant difference in the organizational culture type according to the establishment type of hospital. 2) In the relationship between organization characteristics and organizational culture of a hospital were correlated with the type of each culture(p=0.00). 3) In the relation between the organizational culture type of hospital and its performance, there was a strong positive correlation between innovation-oriented culture and job satisfaction. And relation-oriented culture and task-oriented culture showed that they had a weak positive correlation with job satisfaction(p=0.00). There were a positive correlation between affective commitment and relation-oriented, innovation-oriented cultures(p=0.00), and there were no culture type significantly related to continuance commitment and there was a weak positive correlation among normative commitment and innovation-oriented culture, relation-oriented culture(p=0.00). 4) The types to have an influence upon nurses' job satisfaction were innovation-oriented culture and relation-oriented culture. These had 34.5% of influence with job satisfaction.. The type of organizational culture did not influence continuance commitment, but it had an influence on affective commitment and normative commitment. And relation-oriented culture and innovation-oriented culture had 21% of an influence with affective commitment, and they had 9.5% of an influence with normative commitment. Conclusion : As the above mentioned research results, the organizational culture type was found which had an influence upon nurses' job satisfaction and organizational commitment and patients' satisfaction in nursing service. These results are very significant in having showed the persons in charge of nursing administration a basic data for creation of an effective organizational culture.

• Korean Journal of Social Welfare Studies
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• v.47 no.3
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• pp.187-221
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• 2016

This study examines determining factors of effectiveness and satisfaction of Veteran Medical Service Delivery System. Especially, the association between the relevant variables of the effectiveness of the Veteran Medical Service Delivery System and the variables of the satisfaction from the perspective of beneficiaries was studied. Multi-level analysis was utilized to separate results of the evaluation of effectiveness in organizational-level and the evaluation of satisfaction in individual-level. This study tests key posited hypothesis by using survey data collected from 5 medical center of country(Seoul, Busan, Daejeon, Daegu, Gwangju). In terms of the result of the hypothesis testing on the effectiveness variable, integrity(${\beta}=.156$), accountability(${\beta}=.376$, financial sufficiency(${\beta}=.109$), and adequacy (${\beta}=.367$) are the determinants among various factors in evaluating veteran medical service delivery system, statistically reflecting the perception of directors of the veteran medical service delivery facilities on effectiveness. In other word, professionalism variable(${\beta}=0.99$) and effectiveness variable(${\beta}=-1.09$) are statistically reflecting the perception of directors of the beneficiaries satisfaction with employee. The findings suggests that the theoretical and practical implications will improve Effectiveness and Satisfaction of Veteran Medical Service Delivery System.

• Korean Journal of Clinical Laboratory Science
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• v.50 no.4
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• pp.525-534
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• 2018

This study evaluated the various qualifications that can be linked to employment similar to the medical laboratory technology major. The qualifications for employment outside the medical laboratory technology major are industrial health instructor, doping control officer, audiologist, sign language interpreter, health education specialist, claim adjuster, Korea life underwriter, administrative manager, hospital administrator, insurance review manager, and hospital coordinator. The qualifications for employment similar to the medical laboratory technology major include the clinical research coordinator, clinical research associate, anatomist, analytical chemistry analysts, hazardous materials industry engineers, biotechnologist, biosafety managers, biotechnology technicians, medical device quality officers, animal care nurse, industrial engineer hazardous material, bioprocess engineer, biosafety officer, certified technology consultant, director of medical device quality control, laboratory animal technician, animal nursing technician, and cruise medical manager. Therefore, it is necessary to conduct a social analysis survey of the various qualifications currently held by medical technologists. In addition, it will be necessary to investigate the current status of medical technologists working in other fields. In the future, medical technologists should expand the scope of their work through efforts to strengthen their individual work capacity, share cases, and strengthen their expertise.

• Health Policy and Management
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• v.28 no.4
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• pp.411-422
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• 2018

Background: Whether there is a difference in outcomes for trauma patients transferring to the helicopter emergency medical service (HEMS) according to their previous team composition is controversial. The purpose of this study is to evaluate the effectiveness of trauma team-staffed-HEMS (TTS-HEMS) when transferring to a trauma center. Methods: A retrospective comparison was conducted on patients transported to a trauma center over a 6-year period by the TTS-HEMS and paramedic-staffed-HEMS (119-HEMS). Inclusion criteria were blunt trauma with age ${\geq}15years$. Patient outcomes were compared with the Trauma and Injury Severity Score (TRISS) (30-day mortality) and the Cox proportional hazard ratio of mortality (in hospital). Results: There were 321 patients of TTS-HEMS and 92 patients of 119-HEMS. The TTS-HEMS group had a higher Injury Severity Score and longer transport time but a significantly shorter time to emergency surgery. The prehospital data showed that the trauma team performed more aggressive interventions during transport. An additional 7.6 lives were saved per 100 TTS-HEMS deployments. However, the TRISS results in the 119-HEMS group were not significant. In addition, after adjusting for confounders, the hazard ratio of mortality in the 119-HEMS group was 2.83 times higher than that in the TTS-HEMS group. Conclusion: HEMS was likely to improve the survival rate of injured patients when physicians were involved in TTS-HEMS. Survival benefits in the TTS-HEMS group appeared to be related to the fact that the trauma team performed both more aggressive prehospital resuscitation and clinical decision making during transportation.

• Health Policy and Management
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• v.31 no.1
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• pp.114-124
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• 2021

Background: In this study, we aimed to investigate the interaction effects of individual socioeconomic status and regional deprivation on the onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients. Methods: Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013 were used. A total of 50,954 patients newly diagnosed with type 2 diabetes from 2004 to 2012 and aged 30 years or above were included. We classified patients into six groups according to individual income level and neighborhood deprivation: 'high in advantaged,' 'high in disadvantaged,' 'middle in advantaged,' 'middle in disadvantaged,' 'low in advantaged,' and 'low in disadvantaged.' We calculated hazard ratios (HR) of onset of diabetes complication and diabetes-related hospitalization using the Cox proportional hazard model, with the reference group as diabetes patients with high income in advantaged regions. Results: In terms of the interaction effects of individual income level and regional socioeconomic level, even with the same low individual income level, the group with a high regional socioeconomic level (low in advantaged) showed low HRs for the onset of diabetes complication (HR, 1.04; 95% confidence interval [CI], 1.00-1.08) compared to the 'low in disadvantaged' group (HR, 1.10; 95% CI, 1.05-1.16). In addition, the 'high in advantaged' group showed slightly higher HRs for the onset of diabetes complication (HR, 1.06; 95% CI, 1.00-1.11) compared to the 'low in advantaged' and it appeared to be associated with slight mitigation of the risk of diabetes complication. For the low-income level, the patients in disadvantaged regions showed the highest HRs for diabetes-related hospitalization (HR, 1.29; 95% CI, 1.19-1.41) compared to the other groups. Conclusion: Although we need to perform further investigations to reveal the mechanisms that led to our results, interaction effects individual socioeconomic status and regional deprivation might be associated with on onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients.

• Health Policy and Management
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• v.30 no.4
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• pp.479-492
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• 2020

Background: As the prevalence of hypertension is increasing in Korea, the government is seeking policy actions to manage patients with hypertension more efficiently. In this paper, we aimed to identify factors associated with the use of medical care at hospitals among outpatients with hypertension. Methods: We analyzed a total of 15,040 cases of 3,877 outpatients with hypertension obtained from the Korea Medical Panel database from 2010 to 2016. The dependent variable was whether a patient with hypertension visited a hospital or not; and independent variables were the patient's various socio-demographic, health-related, and heath-status characteristics. We conducted a generalized linear mixed model analysis with logit link for all the cases and then conducted it stratified by gender. Results: As a result of a multivariable analysis, women were less likely than to visit at a hospital (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.32-0.61) and people aged 65 years and older than those aged less than 65 years (OR, 0.71; 95% CI, 0.57-0.89). Residents in Busan, Ulsan, and Gyeongnam were more likely than those in than Seoul, Gyeonggi, Incheon, and Jeju to visit a hospital (OR, 1.40; 95% CI, 1.05-1.86). The likelihood of visiting a hospital was high in people belonging to a group of: the highest level of annual household income (OR, 1.73; 95% CI, 1.30-2.29); Medical care aid recipients (OR, 1.94; 95% CI, 1.34-2.83); people having three or more complex chronic diseases (OR, 1.59; 95% CI, 1.19-2.11); people having diabetes (OR, 1.81; 95% CI, 1.41-2.32); or people having ischemic heart disease or cerebrovascular disease (OR, 6.80; 95% CI, 5.28-8.76). Also, we found that factors associated with the use of medical care at hospitals among outpatients with hypertension differed between genders. Conclusion: A variety of factors seem to be associated with the use of medical care at hospitals among outpatients with hypertension. Future research needs to find a way to help patients with hypertension visit an appropriate medical institution between clinics and hospitals.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.13 no.4
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• pp.1739-1750
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• 2012

This study was to develop the assessment of medical service outcome using administration data through compared with hospital standardized mortality ratios(HSMR) in various hospitals. This study analyzed 63,664 cases of Hospital Discharge Injury Data of 2007 and 2008, provided by Korea Centers for Disease Control and Prevention. We used data mining technique and compared decision tree and logistic regression for developing risk-adjustment model of in-hospital mortality. Our Analysis shows that gender, length of stay, Elixhauser comorbidity index, hospitalization path, and primary diagnosis are main variables which influence mortality ratio. By comparing hospital standardized mortality ratios(HSMR) with standardized variables, we found concrete differences (55.6-201.6) of hospital standardized mortality ratios(HSMR) among hospitals. This proves that there are quality-gaps of medical service among hospitals. This study outcome should be utilized more to achieve the improvement of the quality of medical service.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.6
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• pp.449-458
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• 2017

This research is a descriptive correlation research for comprehending the end of life care stresses, work environment, and reduction of nurses in geriatric hospitals and analyzing the factors influencing their burnout. We recruited 195 nurses from 8 geriatric hospitals in B metropolitan city and collected data on the end of life care stress, work environment and reduction using organized questionnaires. The data were analyzed with SPSS WIN 21.0 program. The average grade of end life care stress was $3.84{\pm}0.56$, nursing work environment $3.25{\pm}0.60$, and burnout $2.93{\pm}0.52$. There was a positive correlation between the end of life care stress and reduction(r=.206, p=.004) but a negative correlation between nursing work environment and reduction(r=-.431, p<.001). The most influential factor on the reduction was nursing satisfaction(${\beta}=-.302$), followed by work environment(${\beta}=-.294$), age(${\beta}=.286$), duty style(${\beta}=-.17$), and end of life care stress(${\beta}=.164$). The overall explanatory power was 41.2%.These results suggest that in order to minimize the reduction of nurses in geriatric hospitals, the provision of a supportive work environment which enhances their pride and responsibility as a nurse and offers incentives is required with effective distribution of duties, development of the end of life nursing education and administrative tools for reducing their stress.

• The Journal of the Korea Contents Association
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• v.19 no.6
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• pp.471-480
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• 2019

L-spine 3~4, L-spine 4~5, and L-spine 5~Sacrum 1 intervertebral disc(IVD) angle according to gender, age, body mass index(BMI), lumbar lordosis angle(LLA) were compared and analyzed. The anteriorposterior incidence angle of L-spine 3 ~ 4, L-spine 4 ~ 5 and L-spine 5~Sacrum 1 in body mass index were 5.66, 13.23 and 29.13 degrees in the head direction and L-spine 3 4, L-spine 4 ~ 5, L-spine 5~Sacrum 1 had 6.32 degrees, 16.09 degrees and 35.36 degrees in the head direction. The distortion area ratio comparison was performed with the phantom image using the proposed incidence angle. There was a significant difference in L-spine 4~5 and L-spine 5~Sacrum 1 IVD angle relative to body mass index and LLA(p<0.05), IVD angle and LLA were positively correlated(p<0.05).As a result of evaluating the usefulness of the image by applying the incidence angles of the disc angles according to the phantom angle of deviation to the head direction as 11 degrees for L4 and 26 degrees for L5, the distortion ratio area decreased from 14.90% to 12.11% in L4, And from 15.25% to 13.72% in L5. In anteriorposterior image of the Lumbar spine applying the incidence angle according to the measured disc angle, it is possible to reduce the distortion to purpose L4, L5. And improved the quality and diagnostic information of the target site.