• Health Policy and Management
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• v.10 no.3
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• pp.108-128
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• 2000

The Korean government has implemented the policy for merging 141 health insurers into Korean Unified Health Insurer (KUHI) in July of 2000. The unification of multiple insurers will definitely effect the stability of financial management, equity of premium burdens and efficiency of administrative management. However, it is difficult to predict what forms the far-reaching effects of the unification would take. Thus, pursuing the unification may be express as a huge policy experiment. In order to lead the unification, which lies on a crossroad between success and failure, to the road of success, we need to infer the problems and obstacles predicted in the step-wise processes of merging organizations, finances and the systems of computing premium, and come up with the effective means to maintain the stability of financial management, to improve the equity of premium burdens and to increase the efficiency of administrative management. Thus, I first described the changes of the Korean medical insurance system, and analyzed the performances of self-employed medical insurance 1 year after the integration of societies in October of 1998. At the base of examining the stability of financial management, equity of premium burdens and efficiency of administrative management, I predicted the problems and obstacles that could occur after the unification of the multiple medical insurers, and proposed a few ways of leading the unification of the multiple medical insurers in Korea to success. The most worried factor is that insurance finance would become unstable since the expansion of premium revenues is not easy because raising the premium for all Koreans is to be difficult. In addition, the unification of insurance finance could weaken the insurer's efforts for declaring real incomes of the self-employed and increasing the collection rate of premiums from them. This weakening would be the decisive factor of lowering the equity of premium contributions between the self-employed and employees. And bureaucratization and rigidity that are unavoidable in a gigantic unified organization could lower the efficiency of administrative management. Furthermore, by having 3 labor unions in the unified organization, it is possible to experience frequent difficulties and discords among the unions and between the unions and organization. Thus, when smooth pursuing of the unification of multiple insurers gets difficult, the social expenses derived from the failure would eventually end up on all Koreans. The unification is to be performed after coming up with the ways to eradicate these worries, so that the unification of multiple insurers would step onto the road of success.

• Health Policy and Management
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• v.16 no.4
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• pp.48-67
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• 2006

The aim of the study was to examine levels of satisfaction with health care in North Korea and to identify factors associated with it using a convenience sample of North Korean refugees in China. Data from the 2004 Survey of Health Seeking Behavior of North Korean Households conducted by the Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health were used. The study subjects were 273 North Korean refugees whose length of stay in China was less than 3 months. Factor analysis was used to extract factor dimensions from the 12 satisfaction items. Bivariate (t test and ANOVA) and multiple regression analyses were used in examining factors associated with satisfaction with health care use in North Korea Overall, satisfaction level was low ($2.36{\pm}0.36$, score range: 1-5). Of the three-factor dimensions, physician skills scored the highest $(2.93{\pm}0.36)$, followed by drug availability $(2.51{\pm}0.07)$ and general cleanliness $(1.66{\pm}0.55)$. In the multiple regression analysis, having a usual source of care was significantly associated with patient satisfaction. Respondents who identified primary care (section) doctors as their usual source of care tended to be less satisfied than those with the city or county hospital as their usual source of care. County residents tended to report a lower degree of satisfaction with general cleanliness than city residents. Among socioeconomic characteristics, the number of household assets positively predicted satisfaction with drug availability. North Korean residents appear to be dissatisfied with their medical care. It may reflect some inadequacies in the North's universal health care system to meet the healthcare needs of its people.

• Health Policy and Management
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• v.22 no.2
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• pp.183-206
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• 2012

Changing social conditions have resulted in a situation where elderly patients are no longer cared for by family and where medical care hospitals play a more prominent role. In this study, the unique elements of the medical service required from a long term care hospital were identified using conventional and exploratory analysis, and the causal relationship between medical service quality, relationship quality, and Revist intent was confirmed. The intermediary role and the quantitative importance of relationship quality (including trust and commitment) were also characterized. This study identifies the key points and indicators that the administrators of a long term care hospital can use to effectively plan their medical service offering in order to secure the commitment of customers through relationship quality. The theoretical indications of this study are set out below. First, four factors are selected as being the key elements determining service quality: medics, administrative service, healthcare environment, and subsidiary facilities. Second, it seems that medics, administration service, and the healthcare environment have some effect on the evaluations made in relation to trust and satisfaction (subsidiary facilities are not considered to be a key element). Third, patient satisfaction has a positive impact on trust and commitment and can be regarded as a key element for establishing connections. Fourth, commitment is likely to be strengthened when trust is significant. Fifth, as trust and commitment increase, revist intent strengthens. Lastly, this study illustrates how the levels of trust and commitment play a modulating role between patient satisfaction and revist intention. There are many practical indications from the findings of this study. First, the influences of medics, the administrative service, and the healthcare environment on trust and satisfaction vary. Especially, the healthcare environment is likely to be more important than medics. Accordingly, it is essential to establish an elderly-friendly environment, to improve a hospital's structure, and to maintain a clean environment. Second, medics must show compassion to their patients and be patient when providing explanations to elderly patients who often lack powers of concentration. Third, in order to establish patient trust, it is essential that medics provide an excellent medical service. Ultimately, these elements of relationship quality may strengthen the revist intention of elderly patients.

• Health Policy and Management
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• v.29 no.4
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• pp.482-495
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• 2019

Background: An important function of the regional public hospital is to satisfy the basic medical needs of the community through the stable provision of high-quality medical services. The purpose of this study was to identify the relevance index (RI) of the regional public hospital and to identify the factors that affect the RI. Methods: Data were obtained from the 2017 regional public hospital operation evaluation report and 2017 medical monitoring report for vulnerable area. RI of the regional public hospital was a dependent variable, and multiple regression analysis was performed with observed variables of medical supply-demand condition, medical supply, and medical supply structure. Direct effects and indirect effects were confirmed by the analysis of structural equation models (SEM) to see if there were mediating effects. Results: The RI was 13.1%, and the average of all percentage refined diagnosis-related group (RDRG) was 29.4%. Factors affecting RI were medical supply-demand conditions, medical supply, and medical supply structure. As a result of multiple regression analysis, RI was higher when high percentage RDRG of the regional public hospital (t=4.117, p<0.05), the size of regional public hospital location (t=-2.554, p<0.05), and the population of regional public hospital location (t =-2.415, p<0.05) were smaller. The results of the SEM analysis show that the higher the medical supply-demand conditions, the more direct effect of decreasing the RI and the indirect effect of decreasing the effect of reduction through the medical supply (direct effect=-1.322, total effect=-0.573, p<0.01). The higher the medical supply structure, the more direct effect on the RI (direct effect=1.047, p<0.05) and the higher the medical supply, the more indirect effect of RI through the medical supply structure (total effect=direct effect=0.619, p<0.05). Conclusion: It has been confirmed that the provision of medical services can affect the RI the regional public hospital which should be considered in carrying out future policies.

• Health Policy and Management
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• v.10 no.1
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• pp.111-125
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• 2000

To compare the differences in the recognition on hospital utilization and satisfaction, 368 hospital employees and 485 patients were selected in four hospitals in Seoul and Kyung-gi do. The survey was done using a constructed form of checklist from Apr. 30 to May 10, 1999. And the results are as follows: l. Gaining knowledge of hospitals available among hospital employees differed from that of patients. When finding out about sources of information concerning hospitals, direct visit to the hospital was recognized to be the main factor for the hospital employees in contrast to the patients' recognition which were mass media, personal involvement of job related workplace and recommendations from other hospitals. There was no difference between university and general hospitals. 2. The factors that concern which hospital to choose there was a difference between hospital employees and patients. Hospital employees recommended their own hospital solely based on the reason that it was their work place. On the other hand, the patients made a choice based on the type of medical staff, transportation available and whether it was a university hospital or not. There was no difference between university and general hospitals. 3. The recognition of employees concerning hospital image of a hospital between hospital employees and patients was different. In university hospitals, the employees recognized the name value of university hospital and cooperation as most important, whereas the patients thought convenience, kindness were the main factors. Patients considered general hospitals to be more convenient. There was some difference between university and general hospitals. For university hospitals employees' recognition was higher and for the general hospital patients' recognition is higher on hospital image. 4. The recognition of employees was different from that of patients' on hospital satisfaction. The patients' satisfaction was higher than that of employees'. There was no difference between university and general hospitals. Based on the above findings, the employees' recognition on hospital utilization and satisfaction was different from that of the patients, but there was no difference between university and general hospitals. In both groups choice of hospital was associated with satisfaction. Results showing difference between employees' and patients' recognition can be applied to implement customer-oriented attitude and be used as a baseline data for internal-external marketing planning of hospital management. The study may be limited in that the results cannot be generalized due to its small sample size and not being able to reflect demographic variables and life style. Further studies to investigate the difference of hospital utilization and hospital satisfaction will be necessary to define demographic characteristics and recognition of employees which influences patients' hospital satisfaction.

• Health Policy and Management
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• v.3 no.1
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• pp.124-145
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• 1993

General practitioners, internists, pediatricians, and family physicians are classified as so-called primary care physicians in the United States. We carried out this study for the purpose of answering the following question; "Who are the primary care physicians in Korea\ulcorner" We analyzed the 663, 154 claims which were drawn from the health insurance processing file made during the period of one month, April 1992 on the basis of systemic random sampling technique. The 663, 154 cases were matched with the doctor's file registered at the National Federation Medical Insurance by using the indivisual physician code number and analyzed according to the kind of specialty. If we follow the Geyman's definition of primary care physician in the United States, this study shows that they can take care of 43.2% of the total private clinic's claims in Korea. Provided that general practitioners and family physicians are considered the same way as in the United Kingdom, they could with only 8.3% of the total claims in Korea. The most frequent diseases are those which rank first to 46th in the total private clinic's claims. The proportion of the most frequent diseases was highest for pediatricians(90.4%) and followed by internists(81.4%), otolaryngologists(78.7%) and family physicians(76.5%). The proportion of the most frequent diseases in the most common 46 diseases was highest for radiologists(80.4%) and the next was as follows : general practitioners(78.3%), family physicians(67.4%), and internists(67.4%). We classified the most common 20 diseases of each specialty into 17 categories of ICD-9 and compared it with those of general practitioners. The specialists who had managed a similar disease pattern to those of general practitioners were identified as anesthesiologists, family physicians, general surgeons, and internists. Some specialists practicing at private clinics managed the diseases which were not quite appropriate for their specialties. After we evaluated each specialty by the most common diseases, the most frequent diseases, and the most frequent 20 diseases of each specialty in terms of the 17 categories of ICD-9, a tentative assumption is made that the primary physicians in the Republic of Korea are general practitioners, anesthesiologists, family physicians, internists, and general surgeons. This study has concluded that the categories of the primary care physicians are so diverse that their roles and distributions are distorted accordingly. Vigorous health policy efforts in correcting the malcomposition need to be made for the better provision of primary health care in Korea. in Korea.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.4
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• pp.435-447
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• 2019

In order to prevent unnecessary re-admission, it is necessary to intensively manage the groups with high probability of re-admission. For this, it is necessary to develop a re-admission prediction model. Two - year discharge summary data of one university hospital were collected from 2016 to 2017 to develop a predictive model of re-admission. In this case, the re-admitted patients were defined as those who were discharged more than once during the study period. We conducted descriptive statistics and crosstab analysis to identify the characteristics of rehospitalized patients. The re-admission prediction model was developed using logistic regression, neural network, and decision tree. AUC (Area Under Curve) was used for model evaluation. The logistic regression model was selected as the final re-admission predictive model because the AUC was the best at 0.81. The main variables affecting the selected rehospitalization in the logistic regression model were Residental regions, Age, CCS, Charlson Index Score, Discharge Dept., Via ER, LOS, Operation, Sex, Total payment, and Insurance. The model developed in this study was limited to generalization because it was two years data of one hospital. It is necessary to develop a model that can collect and generalize long-term data from various hospitals in the future. Furthermore, it is necessary to develop a model that can predict the re-admission that was not planned.

• Journal of the Health Care and Life Science
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• v.9 no.1
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• pp.147-151
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• 2021

This study was conducted to investigate the variables affecting the quality of life according to the degree of obesity of male and female college students. The research data used the data of the 8th year (2019) of the National Health and Nutrition Survey. Among the survey data, 287 students enrolled in college were enrolled. As a result of the study, the body mass index according to sex was 23.71kg/m2 for male students, 21.31kg/m2 for female students, and male students were overweight, and female students showed normal weight. The quality of life score according to gender was 0.97 points for male students and 0.98 points for female students, indicating a high quality of life score for female students. In the results of a regression analysis conducted to investigate the effect of obesity on the quality of life of college students, boys had normal weight (β=0.053, p=0.003), overweight (β=0.041, p=0.030) and obese weight compared to underweight. The quality of life was significantly higher in (β=0.046, p=0.012). However, there was no significant relevance in female students. In the future, it is considered that the education program for obese body type and the education program for underweight should be combined with the university's health-related education program.

• Journal of dental hygiene science
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• v.9 no.1
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• pp.83-89
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• 2009

About 380 dental hygienists who were working in public health centers in 2004 joined this study with questionnaires about the evaluation of job training programs regarding oral health care. The findings are as follows. 1. As for the general characteristics of subjects including location, age and career, the dental hygienists in Public Health Subcenters outnumbered the dental hygienists in Public Health Centers, as the former accounted for 61.1 and the latter 35.3 percent. And the dental hygienists in their 36~40s made up the largest age group. The group in their 11~15 years career revealed 48.4, over 16 years career 35.7, under 10 years career group 15.9 percent, respectively. 2. The portion of certification in the respondents was 28.9 percent, as compared to the 71.1percent of non-certification. The major reasons of non-certification were not-applying(44.6%), participation rejected (29.3%). 3. Freqently requested curriculums were school based oral health program(4.42, the highest by Linkert 5 point scale), followed by oral health education(4.41), public oral health services for the toddler and for the elderly(4.04), for the disabled(3.92), oral health planning evaluation(3.85) and oral health survey& investigation(3.69). The gap between Dental hygienists at Public Health Center and Public Health Subcenter was statistically significant different(p < 0.001) in oral health survey& investigation and oral health planning evaluation.

• Health Policy and Management
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• v.34 no.2
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• pp.141-155
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• 2024

Background: This study aimed to identified the relationship between the risk of obstructive sleep apnea, subjective health, and health-related quality of life among the middle-aged and elderly population in Korea. Methods: Adults aged 40 or older were extracted from the total 22,559 respondents to the 2019-2020 Korea National Health and Nutrition Examination Survey VIII, and secondary analysis was conducted on a total of 6,659 middle-aged and elderly people with no missing values. Logistic regression analysis and multiple regression analysis were conducted to examine the relationship between obstructive sleep apnea risk factors and subjective health as well as quality of life. Results: The subjective health status decline in the high-risk group compared to the non-risk group for obstructive sleep apnea was statistically significantly higher, with an odds ratio of 1.84 (p<0.001). The health-related quality of life was also statistically significantly lower by 0.02 points (β, -0.02; p<0.001). As a result of subgroup analysis on specific variables, the association between the risk of obstructive sleep apnea and subjective health and health-related quality of life was statistically significant depending on gender, sleep time, presence of depression, household income, and number of household members. Based on the obstructive sleep apnea risk group, women had a higher correlation with low subjective health and lower health-related quality of life scores than men. Sleeping time of more than 8 hours or less than 6 hours was more associated with low subjective health and lower health-related quality of life score than sleeping time of 6-8 hours. Patients with depression were more likely to have low subjective health than those without depression. The lower the household income level and the smaller the number of household members, the higher the association with low subjective health and the lower the health-related quality of life score. Conclusion: It is essential to recognize that the risk of obstructive sleep apnea not only directly affects sleep disorders but also impacts individuals' subjective health and quality of life. Consequently, social support and education should be provided to raise awareness of this issue. Particularly, programs for preventing and managing obstructive sleep apnea should target vulnerable groups such as women, individuals in single-person households, low household income, and those with depression, aiming to improve their subjective health and quality of life.