• Health Policy and Management
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• v.26 no.3
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• pp.185-194
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• 2016

Background: The purpose of this study is to forecast changes in the prevalence of chronic diseases and health expenditure by age group. Methods: Based on the Future Elderly Model, this study projects the size of Korean population, the prevalence of chronic diseases, and health expenditure over the 2014-2040 period using two waves (2012, 2013) of the Korea Health Panel and National Health Insurance Service database. Results: First, the prevalence of chronic diseases increases by 2040. The population with hypertension increases 2.04 times; the diabetes increases 2.43 times; and the cancer increases 3.38 times. Second, health expenditure on chronic diseases increases as well. Health expenditure on hypertension increases 4.33 times (1,098,753 million won in 2014 to 4,760,811 million won in 2040); diabetes increases 5.34 times (792,444 million won in 2014 to 4,232,714 million won in 2040); and cancer increases 6.09 times (4,396,223 million won in 2014 to 26,776,724 million won in 2040). Third, men and women who belong to the early middle-aged group (44-55 years old) as of 2014, have the highest increase rate in health spending. Conclusion: Most Korean literature on health expenditure estimation employs a macro-simulation approach and does not fully take into account personal characteristics and behaviors. Thus, this study aims to benefit medical administrators and policy makers to frame effective and targeted health policies by analyzing personal-level data with a microsimulation model and providing health expenditure projections by age group.

• Health Policy and Management
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• v.26 no.3
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• pp.195-206
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• 2016

Background: Concentration of patients to large hospitals is serious problem in Korea. The purpose of this paper is to propose appropriate policy direction to relieve concentration of patients to large hospitals. It is focused on evaluation of the possibility of family doctor system as a policy alternative to relieve concentration of patients to large hospital by empirically analyzing the effect of usual source of care (USC) on large hospitals medical care use. Methods: Korea Health Panel conducted 2009, 2012, 2013 by KIHASA (Korea Institute for Health and Social Affairs) and NHIS (National Health Insurance Service) was used for analysis. For dependent variables, first, the ratio of the amount of using large hospital to total amount of using medical care, and second, the amount of using large hospital are estimated. Independent variables are having an USC and type of USC. Panel analysis was done with above variables. Results: Main results are as follows. First, having an USC increases using large hospital. Second, having a domestic clinic type USC decreases using large hospital and ratio of using large hospital. Third, the effect of domestic clinic type USC is greater in older group, less income group, worse health status group, not having private insurance group, and having chronic disease group. Conclusion: These results show that family doctor program can be a policy alternative to relieve concentration of patients to large hospital. Nonetheless, primary care system in Korea is unsatisfied. It is recommended to reinforce primary care system and family doctor system to relieve concentration of patients to large hospitals.

• Health Policy and Management
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• v.10 no.3
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• pp.1-18
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• 2000

This study was conducted to find medical care utilization pattern and to examine the affecting factors on medical facilities utilization using Andersen's medical care service behavioral model. Three hundreds and five public officials with detected disease through the health examination in 1998 were surveyed using self-administered questionnaire. And 230 data were available and analyzed. The results of this study were summarized as follows: Among variables of predisposing factors, knowledge for disease, confidence about periodic health examination program in health insurance, and the attitude toward medical utilization in the usual showed significant relations with the medical utilization. Other variables were not related with the medical utilization. Variables of enabling factors did not show significant relations with the medical utilization. Recognition of family members for detected disease had significant relations with the medical utilization. Among variables of need factors, absence caused by detected disease was significantly related with the medical utilization. The number of non-occupational diseases detected, but untreated people were 75(32.6%) of total subjects, mainly because detected diseases seemed insignificant to them. With multiple logistic regression analysis, the significant variables having an effect on the medical facilities utilization were 'knowledge for disease', 'attitude toward medical utilization in the usual', 'recognition of family members for detected disease' and 'experience of absence caused by detected disease'. On considerations of above findings, counselling for detected disease and its treatment, health education for individuals and program for family support promotion are needed for health management of public officials with diseases detected in health examination.

• Health Policy and Management
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• v.16 no.4
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• pp.24-47
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• 2006

Based on the findings of a study focused on medical institutions(Fama & French, 2002), this study determined possible causality between determinants of capital structure and liability level, while estimating targeted debt ratio. Moreover, it also examined hypotheses about the adjustment of targeted debt ratio and the of fundraising patterns, so that it verified the relative priority of trade-off theory and pecking order theory. First, profitability had positive(+) relationships with liability level, while investment opportunities had negative(-) relationships with liability level. This finding supported pecking order theory, and non-liability tax shield effects had negative(-) relationships with liability level as estimated in both trade-off theory and pecking order theory. Next, this study verified trade-off and pecking order theory at once by means of regression analysis about the variation of liability level in associations with disparity from targeted debt ratio and short-term fluctuation of profit and investment. As a result, it was noted that liability level became mean-reversed to targeted liability ratio but slowly, SO it was difficult to assert that such mean reverse may support trade-off theory. However, the finding that most of short-term fluctuations of profit and investment are absorbed into liabilities supported pecking order theory. On the other hand, it was found that the larger scale of medical institutions is more supportive of pecking order theory in the associations between liability level and profitability and the fundraising patterns than trade-off theory.

• Health Policy and Management
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• v.16 no.4
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• pp.68-85
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• 2006

With the competitive environment accelerating in healthcare industry, the hospital network system is considered as one of the strategies for clinical and managerial efficiency. This study was intended to offer a theoretical view on the hospital network system and to analyze the current network status of hospitals in Korea. Specifically, network types were classified based on the criteria modified from previous studies, and were used to describe and compare the scope and intensity of associated activities. The questionnaire survey was conducted with 237 hospitals during the period of December 27 2005 to January 25 2006. Above 90% of tertiary and secondary care hospitals were under the network system, while only 20% of primary care clinics were affiliated. In general, the scope and intensity of network activities was limited. Vertical and/or clinical integration was more common than horizontal and/or managerial integration. Three most frequent types of hospital network systems were clinical-vertical integration (Type A), clinical/managerial-vertical integration(Type B), and clinical/managerial-horizontal /vertical integration (Type C). Such network types differentiated significantly different features of affiliated hospitals and network systems. The affiliation duration to the network system was the only significant factor influencing on the network type. The strategic approach to the network system was emphasized for hospitals to increase the potential advantage of hospital network systems.

• Health Policy and Management
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• v.20 no.3
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• pp.73-103
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• 2010

This study aims to explore how the transformational leadership (consisting of three factors"charisma, individualized consideration, and intellectual stimulation) and the organizational culture (typified by developmental, rational, consensual, and hierarchical culture) are related to the organizational effectiveness (consisting of job satisfaction, organizational commitment, and intention to leave a job) of dental clinics. We found the following empirical results through a survey of 378 persons who work in dental clinics. Firstly, the respondents acknowledged charismatic leadership as the typical type of leadership ; as for organizational culture, a culture of consensus is recognized as the representative type. Secondly, transformational leadership has different effects according to the type of organizational culture: a positive influence in developmental and rational cultures, but a negative influence in consensual and hierarchical cultures. Thirdly, developmental culture has proven to be the most suitable for increasing job satisfaction and organizational commitment. The developmental, rational, and consensual cultures have all contributed to reducing intention to leave among clinic staff, whereas in the hierarchical culture, intention has been elevated. Fourthly, transformational leadership has a positive effect on the job satisfaction and organizational commitment; the intent to leave has been lessened under individualized consideration and charismatic leadership, but has been increased under leadership of intellectual stimulation. Fifthly, it is consideration and charisma that help to increase organizational effectiveness. These influences will become more effective through a developmental culture. Based on the above empirical results, we propose practical measures to improve the organizational effectiveness of clinics, in particular dental clinics. In order to build developmental culture, the doctor (manager) should produce an atmosphere in the clinic in which staff members are able to create and jointly own ideas and then promote awareness of staff participation. Additionally, in order to bring leadership of charisma and consideration into full play, the doctor should shape a relationship of mutual trust mainly by recognizing and praising the work of clinic staff. Finally, the doctor needs to acknowledge that organizational effectiveness can be significantly improved by increasing the transparency of the business.

• Health Policy and Management
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• v.20 no.3
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• pp.138-156
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• 2010

Objective : The purpose of this study is 1) to understand the information-searching behavior of health care consumers ; 2) to examine the relationship between the information-searching behavior of health-care consumers and regulatory variables such as socioeconomic factors, characteristics of medical utilization, and perceived risks ; and 3) to determine the factors that affect consumer satisfaction, especially with respect to information-searching behavior. Method : The data for this study were collected from 838 respondents in five university hospital located in three areas?Seoul, Gyeonggi province, and Chungchong province. As the first step of the study, we conducted a preliminary survey from September 23?26, 2008. At the second step, we conducted a survey on the effect of information-searching behavior on those individuals who had visited. Furthermore, personal interviews were conducted through a face-to-face survey between September 30 and October 17, 2008. Results : The major research findings that were obtained from the study were as follows : First, the age, educational level, and residential district were associated with information source utilization. Second, the level of information searching effort and quality of service had a significant effect on consumer satisfaction. Conclusion : These results show that it is essential for marketers to have in-depth knowledge about the young and educated people who actively search for information and about those who are in the prime of their life and rely on word-of-mouth communication from personal and experi in-al informers. Therefore, marketers should develop different marketing strategies to meet the needs of such consumers.

• Health Policy and Management
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• v.20 no.3
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• pp.36-57
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• 2010

The degree of income inequality deepened by health care expenditure was useful in assessing the health security level. This exploratory study was conducted to provide a basic evidence to prove the necessity of reinforcement the benefit coverage of South Korea's health security systems. Data from the Household Income and Expenditure Survey of Korea and Luxembourg Income Study were used. Income inequality indices before and after deduction of health care expenditure were computed, and the degree of the increase in the indices was compared among 13 countries. The degree of decrease against the effect of income inequality reduction policies by health care expenditure was determined. The relationships between the national characteristics and the increase in income inequality were examined. In South Korea, all income inequality indices increased after deducting health care expenditure, but the difference was not high compared to the mean of 13 countries. However, the degree of decrease against the effect of income inequality reduction policies by health care expenditure was high, compared to the mean of 13 countries. The proportion of public sector spending on health care proved to be statistically significant with the increase of income inequality indices (p<0.05). In the context of the continuous increase in health care expenditure, if benefit coverage of health security systems is not reinforced, income inequality will all the more increase due to health care expenditure. In the establishment of the policies for reinforcement of the benefit coverage, income inequality after deduction of health care expenditure should be continuously monitored.

• Health Policy and Management
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• v.22 no.2
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• pp.249-262
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• 2012

The purpose of this study is to investigate the determinants of intent to use the medical-application(M-APP) of smart phone of nurses working at the nursing department of two university hospitals in Korea. The independent variables used in the study are performance expectancy, effort expectancy, social influence, facilitating condition, attitude toward using technology, self efficacy, anxiety, ability to use a smart phone easily and socio-demographic characteristics. The sample used in the study consisted of 378 nurses selected from two university hospitals located in Seoul and Wonju, Korea. Data were collected with self-administered questionnaires and analyzed using multiple regression analysis. The results of this study revealed 5 independent variables of attitude toward using technology, self efficacy, anxiety, ability of using APP and interest in smart phone have the significant effect on the intent to use the M-APP. The results imply that the hospital administrators and nursing managers should try to give more chances to learn the skills of using M-APP, provide sufficient resources and establish the stable hospital information system in order for their employees to use the M-APP more easily at their working places.

• Health Policy and Management
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• v.22 no.1
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• pp.65-84
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• 2012

Because of the rising healthcare costs, there is a growing need for developing efficiency indicators for medical resources use and measuring efficiency of healthcare providers and healthcare systems using them. In this study, we aimed to develop efficiency indicators for medical resources use by means of Delphi technique. We systematically reviewed the existing measures of medical resource use. Thirty nine indicators were selected as a candidates across the six domains: medical personnel, medical equipment, medical facilities, ethical management, resource efficiency, and drug use. To develop efficiency indicators with professional consensus, a 2-round Delphi survey was conducted among 29 professional experts. The following indicators were selected based on the Delphi survey results: adjusted number of the patient per day and level of the nurse number medical personnel in medical personnel domain; the number of the scan a professional physician and the quality of the scan in medical equipment domain; bed utilization rate in medical facility domain; drug price reported pharmaceutical price by medical institutions, medical fee billing transparency, and medical care appropriateness in ethical management domain; costliness index in resource efficiency domain; and utilization of high cost drug and items per prescription in drug use domain. The efficiency indicators could provide valid information about efficiency of healthcare providers and healthcare systems with respect to their resources use and facilitate policies to improve their efficiency.