• 보건행정학회지
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• 제13권3호
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• pp.52-70
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• 2003

The rate of conversion to Medical-juridical-persons' ownership of medical institutions has increased rapidly since its start in 1970s in Korea. The most sensitive issue to introduce for-profit medical institutions, ignited particularly by the WTO/DDA negotiations, has sparked considerable debate, stemming largely from conflicting views on the theoretical effects of ownership status on organizational behavior. This study surveyed health-related experts' opinions on allowing for for-profit-firms-owned medical institutions. Some fear that the obligation to maximize the share-holders' return on their investment will cause the medical institutions to eliminate necessary but less lucrative services. They may easily fall under more pressure to generate income, and respond more aggressively than not-for-profit medical institutions to financial pressures. Advocates of for-profit ownership of medical institutions argue that greater responsiveness to the demands of the marketplace will lead to larger investment, higher quality and lower costs to consumers. Referring to both foreign countries' experience and domestic experts' opinions, this study suggests for reform of the current Korean Medical-Juridical-Person(MJP) System. Introduction of so-called “Capital-investment” MJPs is recommended where the properties left in case of their dissolution can be distributed to original investors according to the procedures stipulated in their statutes. However, their annual profits are not allowed to be allocated to investors, but should be reinvested for their medical institutions, as is the case in current MJPs. Their legal aspects are also reviewed in this study.

• 보건행정학회지
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• 제13권3호
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• pp.104-128
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• 2003

Equity in health care has taken priority in the Korean government's policy agenda after the government-led national health insurance achieved universal coverage in 1989 along with the final inclusion of the self-employed as beneficiary. The purpose of this study is to examine the extent to which there exists difference or inequality in the utilization of health care, especially cancer inpatient services among income classes. We analysed the utilization of cancer inpatient services of residents in Jeju Island for a year of 2000, using the national health insurance data for qualification of beneficiaries and utilization of health care. The independent variable are 10 income classes based on the national health insurance fee imposed on each household for a year of 2000. The dependent variables of this study are an amount of cancer inpatient health care utilization measured by cancer admission days and cancer treatment costs. Also, cancer inpatient health care utilization is analysed by three categories divided into utilization in medical care institutions (1) within Jeju Island, (2) outside Jeju Island, and (3) all within and outside Jeju Island. We measured concentration index of cancer inpatient health care utilization. This analysis showed negative concentration index within Jeju Island and positive outside Jeju Island, and positive in all within and outside Jeju Island. This results suggest inequality against the relatively poor income groups in utilization of cancer inpatient health care services. Especially, inequity of cancer inpatient health care would be more serious in Jeju Island of Korea, considering that lower income groups reportedly have higher incidence rates in most of cancer and thus use more health services.

• 보건행정학회지
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• 제27권1호
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• pp.63-74
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• 2017

Background: This study aims to analyze quality of and satisfaction with Korea medical services and identify factors affecting medical service satisfaction, revisit, and recommendation intention among international patients. Methods: Secondary analysis of survey data conducted by Korea Health Industry Development Institute from June 10th to July 17th in 2013 was done using multiple regression and logistic regression analysis. The 191 international patients from 9 medical institutions in Seoul were enrolled. Results: The results showed that international patients were satisfied with 85.6 points out of 100.0 points. International patients appraised higher in staff service rather than other services. Factors influencing medical service satisfaction were gender, religion, medical specialty, length of stay, and quality of medical services. Quality of medical service explained 29.8% of medical service satisfaction and especially, 'doctor's care' and 'communication and patient respect' were significantly related to medical service satisfaction. Medical specialty had a significant influence on revisit intention. There were no statistically significant influencing factors of recommendation intention. Additionally, more satisfied patients were associated with higher revisit and recommendation intention. Conclusion: This study implies that quality of medical services is a critical factor for patient satisfaction and that satisfaction with medical services is an important factor for increasing revisit and recommendation intention among international patients. In addition, health care providers should consider cultural differences to enhance satisfaction with medical services for international patients. Therefore, multidimensional strategy is required to strengthen the cultural competency of healthcare providers.

• 보건행정학회지
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• 제27권4호
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• pp.315-323
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• 2017

Background: This study was purposed to analyze the effect of spatial accessibility to the psychiatry department in general hospital on the outpatient visit of mental patients. Methods: Data was provided from the Statistics Korea and Statistical Geographic Information Service, National Health Insurance Service, Health Insurance Review and Assessment Service, and Korea Transport Institute in 2015. The study regions were 103 administrative regions such as Si and Gu. The 103 regions had at least one general hospitals with a psychiatry department. The number of outpatient visit of mental patients in regions was used as the dependent variable. Spatial accessibility to mental general hospital was used as the independent variable. Control variables included such as demographic, economic, and health medical factors. This study used network analysis and multi-variate regression analysis. Network analysis by ArcGIS ver. 10.0 (ESRI, Redlands, CA, USA) was used to evaluate the average travel time and travel distance in Korea. Multi-variate regression analysis was conducted by SAS ver. 9.4 (SAS Institute Inc., Cary, NC, USA). Results: Travel distance and time had significant effects on the number of outpatient visits in mental patients in general hospital. Average travel time and travel distance had negative effects on the number of visits. Variables such as (number of total population, percentage of aged population over 65, and number of mental general hospital) had significant effects on the number of visit in mental patients. Conclusion: Health policy makers will need to consider the spatial accessibility to the mental healthcare organization in conducting regional health planning.

• 보건행정학회지
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• 제27권4호
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• pp.324-335
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• 2017

Background: The aim of this study is to analyze determinants of welfare attitudes toward healthcare services in South Korea, using three main theories: self-interest (positive welfare attitudes if the policy fulfills people's personal interests), symbolic attitudes (positive welfare attitudes if the person is politically progressive or egalitarian), and sociotropic perception (positive welfare attitudes if the person experienced positive aggregated collective experiences of societal events and trends regarding the policy). Although the definition of the welfare attitude is rather ambiguous in literatures, in this investigation, we operationalize the concept as the 'willingness to pay higher taxes to improve the level of health care services for all people in Korea' which shows individuals' actional propensity. Methods: We used the health module from the International Social Survey Program 2011 for the analysis (N= 1,391). Five logistic regression models were built successively using two variables for each theory to measure key concepts of self-interest, symbolic attitudes, and sociotropic perceptions as independent variables. Results: The result showed self-interest and symbolic attitudes factors to be strong determinants of welfare attitudes towards healthcare services in South Korea, whereas sociotropic perception factors have inconsistent effects. Conclusion: For a more politically elaborated healthcare reform in South Korea and elsewhere, there needs to be further research on various dimensions and determinants of welfare attitudes to understand popular basis of welfare expansion, especially in the era of inequality.

• 보건행정학회지
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• 제1권1호
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• pp.95-108
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• 1991

The World Health Organization and its member states, in 1978, declared that primary health care is a key to attain the goal of Health for All by the goal of Health for All by the yeas 2000. As a member state of WHO, the Republic of Korea has participated in the declaration of ALMA-ATA and committed to put national efforts for devedoping and implementing primary health care approach with the spirit and content of this Declaration. Since 1978, to translate the spirit of the Declaration into realization, Korean goverment has developed a new category of health manpower such as Community Health Practitioners serving people living in remote rural areas and Village Health Workers serving voluntarily their own village, strengthened the function of Health Centers and Health Subcenters through their reorientation and improved the infrastructure by their new construction or renovation. While primary health care is viewed as an essential health care in Korea, there are some circles who follow a narrow definition in referring to the health care at the periphey of a health system, which is erroneous. Considering the PHC is accepted as the best alternative approach to health care to solve problems that modern health systems are facing, we propose the followings as desirable health policy directions that modern health systems are facing, we propose the followings as desirable health policy directions which might translate the persopective into action at the national level after reviewing past and current PHC approach in Korea : 1. To improve the equity through the reduction of gaps between those who have access to health care and those who have not. 2. To reinforce multisectoral approach and intersectoral coordination through the re- establishment of the National Health Council or establishment of equivalent organization at the central level. 3. To stengthen community participation through lacal people's empowerment by leadership training, changing planning process from the top-down approach to bottom-up and giving the priority to human resources rater than technology, 4. To reinforce the Ministries of Health and Social Affairs through upgrading its role and function to Coordinate Ministries which involve human welfare policies, and creating a Division which is in charge of PHC in the Ministry.

• 보건행정학회지
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• 제3권2호
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• pp.130-158
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• 1993

This study was written to discover the changes that may exist in the contents of medical services after introduction of health insurance system, and to identify the net-effect of health insurance system on medical services. Uncomplicated nornmal delivery and appendectomy patients were divided into 4 groups, the non-insured in pre-NHI periods(group A), the insured of health insurance for employees in pre-NHI periods(group B), the insured of regional health insurance for city residents in post-NHI periods(group C) and the insured of health insurance for employees in post-NHI periods(group D). The mehtod of matching was applied to control for major demographic differences among these 4 groups of each disease. In pre-NHI period, the medical services and the variation of medical services of the non-insured were compared with those of the insured. The difference between the change of medical services from group A to those of group C, and the change of medical services from group B to those group D is defined as the net-effect of health insurance. The results are as follows. First, in length of stay after delivery or operation, total length of stay, some laboratory examination, amount of several drugs used in appendectomy patients, frequency of sitz bath in delivery patients, there was net-effect of health insurance in increasing direction. Second, length of stay after delivery or operation, total length of stay, some laboratory examination, amount of several drugs used in appendectomy patients and frequency of sitz bath in delivery patients were significantly more in the insured than in the non-insured group in pre-NHI period. Third, the variation of medical services of post-NHI period was not less then those of pre-NHI period. Fourth, antenatal care on which the third party does not pay and the patient pays for all, was diffrerent by socioeconomic and educational level of patients.

• 보건행정학회지
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• 제9권1호
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• pp.72-109
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• 1999

This study is conducted to investigate the current status on the utilization of health care and plan for solving this problem. The claims data of the fiscal tear 1995 obtained from the regional health insurance society are used for the study. The main findings of the study are summarized as follows. Indexes(The Extremal Quotient(EQ), coefficients of variance(CV's))which represent the regional difference in the admission rate of the tertiary medical diagnosis group report that there is difference in quantity and quality of utilization of health care. The admission rate is lower in the big city areas, Kyoungkido, Kangwondo and Chunlapukdo. Even after age-sex adjustment, the admission rate is still low in Kangwondo, Chunlapukdo and Kyoungsangpukdo. The big city areas tend to have higher rates in the expenses per claim, hospital days per claim, and daily expenses but the rates are still low in some area in Kangwondo, Chunlanamdo and Kyoungsangpukdo. This result remains as same after age-sex adjustment. There is a large regional difference in average utilization rate for the tertiary hospital of the tertiary medical diagnosis group: 57.2%(SD 11.53). The utilization rates for the tertiary hospital in their large catchment area are 96.34%, 83.19% and 73.22% in each Kyoungin, Kyoungnam and Kyoungpuk areas whereas it is lower in a Chungpuk and Chungnam areas. The regional differences of health care utilization of the tertiary medical diagnosis group gave some relationships with their geographical characteristics such as socio-economic characteristics and supply factors of medical services. It is important that many medical policies should be developed in order to minimize and balance out the regional differences of health care utilization. The service allocation policy should include the reconstruction of manpower policy, developing the resource allocating formula, finding the self-sufficient catchment area and reforcing of public health services. Moreover, in order to achieve the balanced development by region, they should investigate and consider each county's microscopic properties under the consistent macrocopic policy. The further studies to find causes of regional difference are needed.

• 보건행정학회지
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• 제23권1호
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• pp.66-77
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• 2013

The purpose of this empirical study is to investigate the factors of self-leadership depending on individual characteristics, job characteristics, and qualities of leader-member exchange. Additionally, this study aims to discover the effect of self-leadership's outcome factors on organizational citizenship behavior and innovative activities. In order to verify research model and hypothesis, questionnaires were collected from department members working at general hospitals, hospitals, and clinics in metropolitan area of Seoul, which were 85 departments and 344 respondents. Collected data were analyzed with SPSS ver. 19.0 and Amos ver. 18.0 statistical package using Structural Equation Model. The results of the analysis showed that both individual characteristics and job characteristics have significant positive effect on self-leadership. Also, self-leadership had significant positive relationship on innovative action and organizational citizenship behavior. The implications of this study are as follow. First, this study empirically explained how self-leadership is applied in healthcare organizations. Second, it verified the relationship between causal factors and outcome factors of self-leadership. Also, prior researches of self-leadership have been conducted on business companies, but this study explored self-leadership at healthcare organizations, which increased external validity. Nowadays, many people are interested in the effect of leadership in order to overcome issues coming from enlarged organizations and to improve performance. Self-leadership will contribute to maximizing voluntary efforts of human resources and performance in a rapidly changing healthcare industry.

• 보건행정학회지
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• 제9권2호
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• pp.77-94
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• 1999

The purpose of this study is to establish strategy by subdividing consumer market according to the lifestyle which influences the use of medical facilities. The subject of this study were 700 adults who were over 20 years of age and residing in Suwon and its vicinity. To collect data trained staff conducted person-to-person interviews with the assistance of structured questionnaires. The questionnaires cover the areas of life style pattern study. the characteristics of demographic sociology, decision-making process related to the use of medical service. The influencing factors were analyzed and as a result total 18 factors were singled out. Cluster analysis was performed to differentiate similar responses. Each group was named as 'health-unconcern type' 'passive health-concern type' 'regular health-concern type' and 'active health-concern type' according to the characteristics. Each group showed statistically significant difference in the characteristics of demographic sociology. Decision-making process regarding the use of medical service according to lifestyle was analyzed. As a result following items showed significant difference:whether the information was utilized, what was the criteria in selecting medical facilities for serious illness or complicated examination. who was the decision maker in selection medical facilities, and with whom one discussed in selecting medical facilities. The result of this study has its limitation in that it can not be applied directly to market subdivision. However, this will help medical facilities understand customers' lifestyle. which will eventually provide medical facilities with marketing tools in establishing effective PR strategy. In order to apply the lifestyle as a marketing tool of medical facilities, following tasks are to be carried out: the development of the questionnaire which can better analyze consumers' lifestyle related to the use of medical service. the examination of precise characteristics of subdivided market according to lifestyle. and the continuing study on the relationship between lifestyle and the process in selecting medical facilities.