• 한국노년학
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• v.30 no.4
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• pp.1197-1211
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• 2010

This research was concucted to present a model of advance directives(AD) when a patient, who is in consciousness, shows a preference for an end of life care as an act of preparing for an uncertain situation that may arise in the forseeable future. The subjects of the research are 383 doctors/nurese and adults, who live in six cities and provinces, to investigate the status of AD, attitude regarding a meaningless life-prolonging treatment, and moreover, an understanding of and a preference for AD. The research was done by the well-structured questionnaire. Also, SPSS 14.0 is used to analyse the collected data, focused on frequency analysis, avearage and standard deviation, X2 test. As the results of the study, the most of the surveyed doctors/nurese knew DNR orders and AD and a few of them used DNR orders and AD practically. Also, the result shows that there is a negative conception of meaningless life-prolonging treatment among the responents, in addition, most of them agreed upon the idea of introducing AD to Korea, filling it out and making it legally effective. As a method of making AD out, the respondents wanted to use a form that mixed living will with an Power of Attorney in a document. Also, considering the appropriate time, respondents prefered when they are diagnosed with terminal illness. At the moment, the introductory model for AD, which is suitable for the Korean culture and current situation is presented based on the result of this research. In the future, other researches should deal with specific measures that can lead to a social consensus to adopt AD in Korea.

• Health Policy and Management
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• v.33 no.2
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• pp.173-184
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• 2023

Background: The coronavirus disease 2019 pandemic has been challenging the healthcare service, i.e., the vitalization of the point of care accompanying self-testing in vitro diagnostic medical devices (IVDs). This study aims to suggest priority criteria to classify self-testing IVDs using the analytic hierarchy process technique. Methods: Two dimensions of the characteristics embedded in the IVDs and the diseases to be diagnosed with self-testing IVDs were parallelly considered and independently investigated. In addition, three expert panels consisting of laboratory medical doctors (n=11), clinicians (n=10), and citizens (n=11) who have an interest in the selection of self-testing IVDs were asked to answer to questionnaires. Priorities were derived and compared among each expert panel. Results: First of all, ease of specimen collection (0.241), urgency of the situation (0.224), and simplicity of device operation (0.214) were found to be the most important criteria in light of the functional characteristics of self-testing IVDs. Medical doctors valued the ease of specimen collection, but the citizen's panel valued self-management of the disease more. Second, considering the characteristics of the diseases, the priority criteria were shown in the order of prevalence of diseases (0.421), fatality of disease (0.378), and disease with stigma (0.201). Third, medical doctors responded that self-testing IVDs were more than twice as suitable for non-communicable diseases as compared to communicable diseases (0.688 vs. 0.312), but the citizen's group responded that self-testing IVDs were slightly more suitable for infectious diseases (0.511 vs. 0.489). Conclusion: Our findings suggested that self-testing IVDs could be primarily classified as the items for diagnosis of non-communicable diseases for the purpose of self-management with easy specimen collection and simple operation of devices, taking into account the urgency of the situation as well as prevalence and fatality of the disease.

• Health Policy and Management
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• v.24 no.2
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• pp.153-163
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• 2014

Background: This study aims to explore the effects of quality of care, image, and role performance perceived by community residents on medical service satisfaction to public hospitals. Methods: The subjects of this study were selected in the community residents around 39 district public hospitals. The questionnaire were included 4 factors and 16 items. The data were collected utilizing call-interview by a survey company. Results: The community satisfaction was positively correlated with quality of care, image, and role performance of public hospitals (p<0.001). As the results of multiple logistic regression, the significant variables of community satisfaction were quality of care (odds ratio [OR], 1.353; 95% confidence interval [CI], 1.211 to 1.511), image (OR, 1.487; 95% CI, 1.280 to 1.727), role performance (OR, 1.240; 95% CI, 1.085 to 1.416) among subjects having use experience of public hospitals. The significant variables of community satisfaction were quality of care (OR, 1.240; 95% CI, 1.175 to 1.309), image (OR, 1.328; 95% CI, 1.232 to 1.432), age (OR, 3.051; 95% CI, 1.385 to 6.724), monthly incomes (OR, 0.420; 95% CI, 0.198 to 0.892) among subjects not-having use experience of public hospitals. Conclusion: Public hospitals have to effort to improve image and satisfaction of community through providing quality of care, and role performance. It is possible to support them by the central and local government.

• Health Policy and Management
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• v.19 no.2
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• pp.21-35
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• 2009

Limited studies examined Medical Aid recipients' perception for amount of medical use. This study aimed to identify self-perception(optimal, under and overutilization) for amount, and real amount of medical use, and to determine factors associated with the perception. Subjects were 2,489 Medical Aid recipients among top 2% overusers in 2005. 200 case managers(CM) managing them conducted survey. CM interviewed them using 2005 medical claiming data from the Health Insurance Review & Assessment Service and structured questionnaire. Despite of overusers, perception of overutilization was only 26.9% and 23.6% in Class I and Class II, and that of underutilization was 21.4% and 18.7% respectively. In Class I, monthly total outpatient cost per capita of overutilization perception in 2006 was 206 thousand won higher than 150 thousand won of optimal utilization. Amounts of outpatient visit-days and prescribed cases of overutilization perception were higher than those of optimal and underutilization(p <0.0001). In Class II, overutilization perception had more prescribed cases(p 0.004). After adjustment of confounding factors including age and sex, the associated factors(odds ratio) with overutilization perception were hypertension(1.25), arthritis(1.32), depression(1.66), visit of multi medical institutions(3.09), and those of the underutilization were female(1.34), disabled(1.27), no family support(1.49), living in medium and small city(1.48), experience of unabled-visit to medical institution(2.54), frequent visit-recommendation from physician (1.36). In conclusion, education and consult are needed for subjects to improve the reasonable decision of medical use, and the self-care ability to manage diseases and symptoms. We suggest reinforcing the alternative service in community instead of costly medical institution.

• Health Policy and Management
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• v.21 no.3
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• pp.397-413
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• 2011

Purpose: The purpose of this study is to examine the relationship between the income level and the healthcare utilization by health insurance type in all cancer patients in year 2005. Methods: The target population was cancer patients with health insurance who used healthcare as a diagnosis code (C00-C97) from January 1 to December 31 of 2005. The Korea Central Cancer Registry Center's Cancer Patient Registry Data, the list of cancer patients of the National Health Insurance Corporation, and the claim data of the Health Insurance Review & Assessment Service were used. The I was the wealthiest, followed by II, III, IV. The V was the poorest in this study. For the analysis, the $x^2$-test, ANOVA (and Kruskal-Wallis test), and regression were used. Results: Outpatient and hospitalization medical expenses, and outpatient visit days of cancer patients with self-employed health insurance were highest in I (p<.001, respectively), and the hospitalization days were the highest in II (p<.001, respectively). Outpatient and hospitalization medical expenses, and outpatient visit and hospitalization days of cancer patients with occupational health insurance were the highest in I (p<.001, respectively). Outpatient and hospitalization medical expenses, and outpatient visit and hospitalization days in cancer patients were higher in I compared to V, and higher in II and III, IV compared to V (p<.001, respectively). Conclusion: Supporting plan for cancer patients' outpatient healthcare utilization are necessary. Moreover, we should make specialized strategy for low income cancer patients with self-employed health insurance when we develop quality improvement policy for inpatient service.

• Health Policy and Management
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• v.27 no.2
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• pp.149-156
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• 2017

Background: This study was conducted to evaluate the performance of the Hierarchical Condition Category (HCC) model, identify potentially high-cost patients, and examine the effects of adding prior utilization to the risk model using Korean claims data. Methods: We incorporated 2 years of data from the National Health Insurance Services-National Sample Cohort. Five risk models were used to predict health expenditures: model 1 (age/sex groups), model 2 (the Center for Medicare and Medicaid Services-HCC with age/sex groups), model 3 (selected 54 HCCs with age/sex groups), model 4 (bed-days of care plus model 3), and model 5 (medication-days plus model 3). We evaluated model performance using $R^2$ at individual level, predictive positive value (PPV) of the top 5% of high-cost patients, and predictive ratio (PR) within subgroups. Results: The suitability of the model, including prior use, bed-days, and medication-days, was better than other models. $R^2$ values were 8%, 39%, 37%, 43%, and 57% with model 1, 2, 3, 4, and 5, respectively. After being removed the extreme values, the corresponding $R^2$ values were slightly improved in all models. PPVs were 16.4%, 25.2%, 25.1%, 33.8%, and 53.8%. Total expenditure was underpredicted for the highest expenditure group and overpredicted for the four other groups. PR had a tendency to decrease from younger group to older group in both female and male. Conclusion: The risk adjustment models are important in plan payment, reimbursement, profiling, and research. Combined prior use and diagnostic data are more powerful to predict health costs and to identify high-cost patients.

• Health Policy and Management
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• v.16 no.3
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• pp.70-85
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• 2006

The purposes of this study were (1) to describe patients' behaviors to protect themselves from medical errors and their involvement in decision making on the diagnostic and treatment procedures (2) to examine whether patients' characteristics, such as age, sex, education, experience of hospitalization and/or surgery influence their self protect behaviors and involvement in decision making on the diagnostic and treatment procedures. A survey was conducted with 99 patients visited one university hospital in Seoul, Korea. A 20-item questionnaire, a 4-point Likert scale, was used to measure the degree of patients' active involvement in decision making; patients' self protect behaviors regarding medication, hospitalization, and surgery; and communication (Cronbach's alpha=0.801). SPSS 12.0 was used for the descriptive and correlation analysis. Only 6.1% of the participants were involved in the decision making process for the diagnostic tests and treatment. More patients did self-protect behaviors associated with the medication than other areas but widely varied from 18.2 to 94.3 % among various items. More people with age of 60 or older compared to people in younger age groups reported more protect behaviors particularly associated with medication. Patient education is needed to improve their active role in preventing medical errors and to promote patients' safety.

• Health Policy and Management
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• v.16 no.3
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• pp.19-36
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• 2006

The purpose of this study was to assess adequately equipped with convenience facilities for the disabled in 160 healthcare institutions in Jongno district, Seoul. Healthcare institutions were equipped an average of 3.7 facilities out of 10. General hospitals had an average of 5.0 facilities, which was higher than an average of 3.6 facilities for private clinics (p<0.05). Of 160 healthcare institutions, only 13 (8.1%) offered easy access to the outpatient setting from the entrance for wheelchair users, highlighting difficult wheelchair access within hospitals. To provide easy access to medical service for the disabled, more accessible designs need to be adopted as part of the effort to improve public facilities for the disabled. Also, universal designs could be applied for newly constructed roads, structures and transportation vehicles to maximize accessibility for the disabled. Increased accessibility for the disabled in the community will eventually increase the use of healthcare institutions.

• Health Policy and Management
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• v.19 no.3
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• pp.1-26
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• 2009

Objectives : To identify target areas and set priorities among those areas identified for national quality evaluation. Methods : Target areas were identified from: i) analysis of the national health insurance claims data, mortality and prevalence data ii) various group surveys, including representatives from 22 medical specialty associations, 19 physician associations, QI staffs in hospital, civil organizations, and commissioners of Health Insurance Review and Assessment Service(HIRA) ⅲ) literature reviews and RAM(RAND/UCLA appropriateness method). The priority areas for national quality evaluation represented the full spectrum of health care and the entire life span. The criteria for selecting the priority areas were impact, improvability, and measurability. The priority areas were divided into three categories : short-term, mid-term, long-term. Results: Based on the group surveys and the data analysis, 46 candidates were selected as quality evaluation priority areas. 13 areas were selected as having a short-term priority areas: tuberculosis, community acquired pneumonia, stroke, ischaemic heart disease, diabetes, hypertension, chronic lower respiratory disease(asthma, chronic obstructive pulmonary disease), intensive care unit, emergency room, nosocomial infection, use of antibiotics, multiple medication and renal failure. This results suggested that we need to enlarge the target priority areas to the chronic diseases in short-term. Conclusions: The priority areas identified from the study will assist healthcare quality associated institutions as well as HIRA in selecting quality evaluation areas. It is required to develope and implement strategies for improving the quality of care within the next 5 years.

• Health Policy and Management
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• v.13 no.2
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• pp.1-22
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• 2003

Since 1990s, the use of Complementary and Alternative Medicine(CAM) has been rising rapidly all of the world. In 1983, WHO recommended that the traditional medicine actively be utilized. At the end of 20th century, as chronic and intractable diseases increased in western countries, traditional medicine has attracted considerable attention. COWM shows possibilities of new approaches for these intractable diseases. Thus, we try to show our proper approach of COWM through the international comparative study. In order to fulfill the objectives, we applied the following methodology: 1) Literature review on previous study, 2) Local survey using self-administered questionnaire, and 3) FGI(Focus Group Interview) with local experts. The results were as follows : Three Asian countries, China, Korea and Taiwan, are very active in implementing COWM policy. Japan, however, has independent system of unified medicine. In regards to the combined care policy and system, China has the most advanced COWM system among four countries. In respect to combined care education, it is needed to increase the COWM education contents and the amount of cross educational curriculum. Based on the current COWM system, Chinese, Japanese and Taiwanese doctors can prescribe both oriental and western drugs. But, Korean medical law prohibits western doctors and oriental doctors from prescribing the counterpart´s medicine. So, the revision of current medical law is urgent for COWM in Korea. And when it comes to patient satisfaction, more than fifty percent responded positively in China, Korea and Taiwan. To achieve the goal of COWM ; 1) mutual understanding and recognition of COWM is essential. 2) institutional and legal support system for COWM is desperately urgent. 3) possible international collaboration and cooperation should be sought to untangle these complex cultural dilemmas.