• Health Policy and Management
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• v.3 no.2
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• pp.27-80
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• 1993

It is widely known that patients' utilization pattern for medical care facilities and the patientflow are influenced by multi-factors, such as demographic characteristics, structural characteristics of society, socio-psychological characteristics(value, attitude, norms, culture, health behavior, etc.), economic characteristics(income, medical price, relative price, physician induced demand, etc.), geographical accessibility, systematic characteristics(health care delivery system, payment methods for physician fees, form of health care security, etc.), and characteristics of medical facilities(reliability, quality of medical care, convenience, kindness, tec.). This study was conducted to research the mechanism of patient-flow according to changes of health care system(implementation of national health insurance, health care referral system and regionalization of health care utilization, etc.) and characteristics of medical facilities(ownership of hospital, characteristics of medical services, non-medical characteristics, etc.). In this study, the fact could be ascertained that the patient-flow had been influenced by changes of health care system and characteristics of medical facilities.

• Korea Journal of Hospital Management
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• v.27 no.1
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• pp.1-10
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• 2022

Background: This study aims to empirically compare and evaluate the current status of medical accessibility and health inequality between people with disabilities and without. We calculated the ACSC hospitalization rate, which is a medical accessibility index, for hypertension, a major risk factor for cardiovascular disease that accounts for more than 20% of deaths among people with disabilities using the 2016 National Health Insurance Big Data. Methods: The subjects of the study were a total of 601,520, including 64,018 people with disabilities and 537,501 people without. Logistic regression was performed to analyze the differences in hypertension hospitalization rates adjusted for demographic and sociological characteristics and disease characteristics using SAS 9.4 program. Results: Before adjusting for the characteristics, the hypertension hospitalization rate of people with disabilities was 1.55%, and the people without disabilities were 0.49%. After adjusting, it was found that people with disabilities were 2.11 times higher than people without disabilities, and it was statistically significant. Conclusion: The preventable hospitalization rate of people with disabilities is higher than that of people without, suggesting that the disabled have problems with access to medical care and health inequality. Therefore, the government's policy improvement is required to close the medical gap for the disabled.

• Research in Community and Public Health Nursing
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• v.26 no.1
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• pp.11-17
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• 2015

Purpose: This study was to ascertain whether there are differences in health care utilization and expenditure for Type I Medical Aid Beneficiaries before and after applying Copayment. Methods: This study was one-group pretest posttest design study using secondary data analysis. Data for pretest group were collected from claims data of the Korea National Health Insurance Corporation and data for posttest group were collected through door to-door interviews using a structured questionnaire. A total of 1,364 subjects were sampled systematically from medical aid beneficiaries who had applied for copayment during the period from December 12, 2007 to September 25, 2008. Results: There was no negative effect of copayment on accessibility to medical services, medication adherence (p=.94), and quality of life (p=.25). Some of the subjects' health behaviors even increased preferably after applying for copayment including flu prevention (p<.001), health care examination (p=.035), and cancer screening (p=.002). However, significant suppressive effects of copayment were found on outpatient hospital visiting days (p<.001) and outpatient medical expenditure (p<.001). Conclusion: Copayment does not seem to be a great influencing factor on beneficiaries' accessibility to medical services and their health behavior even though it has suppressive effects on outpatients' use of health care.

• Korea Journal of Hospital Management
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• v.25 no.1
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• pp.13-20
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• 2020

Purposes: This study has the purpose to the improvement of health promotion for local residents through delivery of high-quality medical service by improving imbalance of medical use and seeking an improvement plan for accessibility of effective medical service by understanding the pattern of medical use by region. Methodology: As for the method, this study derived results at the significance level of p<0.05 through chi square test(χ² test) and Generalized Estimating Equation(GEE) SAS 9.4 version by using the data of the 7th Korean Longitudinal Study of Ageing 2018. Findings: Study results show that local residents use medical service such as hospitalization care and outpatient visit more as compared to the residents in Gyeonggi-do/large or medium-sized cities. The more the number of chronic disease, the more they select hospitalization care rather than outpatient visit. Results also show that patients engaged in labour tend to select outpatient treatment rather than hospitalization treatment. Meanwhile, severity of disease turned out to be higher amongst medical care beneficiaries than that of national health insurance patients when comparing the types of medical security. Practical Implications: In stead of solving the problem of the difference in medical use by region from the aspect of income and economic level, an integrative solution shall be provided putting viewpoint on the social phenomenon suited to the changes of the times. This study suggests a plan for using a health and medical community care center that acts as a gate keeper of regional medical service.

• Journal of Technologic Dentistry
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• v.33 no.4
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• pp.413-425
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• 2011

Purpose: This study conducted a survey on the elderly with physical debilities, who are in a medically vulnerable social class, to examine closely their demo-sociological characteristics, unmet needs, dental states, and living qualities and satisfaction levels relating to oral health and social supports to them, and also to prepare the basis for effective public medical policies and health improvement programs aimed at improving the quality of life for the elderly with physical debilities. Methods: Twenty-two elderly care facilities within Jeju Special Self-Government Province participated in the survey. Between 11 January and 5 March 2010, a total of 250 elderly persons(65 and over) with physical debilities were interviewed and their dental health was checked. Results: The results of the survey are as follows. The need for social support for dental care of the elderly with physical debilities was high in the medical institution-supported service (49.6%). The unmet needs for physical care were high in bathing (49.6%) and using public transportation (71.6%). More than half of these surveyed had ten or fewer teeth. The survey found that 31.6% of the participants experienced problems eating, due to poor dental health. Concerning quality of life, 30.5% of those surveyed experienced physical pain. Conclusion: In summary, the ages of the survey participants directly relates to the degree of behavioral debility experienced. The more debility a participant exhibits, the greater is the need for social support and dental care. The dental health of a participant directly relates to a higher quality of life. Good dental health of a participant translate to better quality of life. In light of the fact that the elderly with physical debilities suffer from a lack of accessibility to medical care and worse oral health than do other elderly persons, it is essential to increase accessibility to medical institutions that can provide such services as door to door dental care. Current insurance policies, funding for denture insurance, and free denture and denture-upgrade programs desperately need to be expanded. Therefore, to improve effectively the quality of life for the elderly with physical debilities civil dental medical resources should be encouraged to provide inclusive and prevention-focused medical care. In the public domain, door to door dental care services and cooperation with civil dental care resources need to be improved to increase impartial accessibility to dental medical institutions.

• Health Policy and Management
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• v.15 no.3
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• pp.79-93
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• 2005

The purpose of the study is to identify Ambulatory Care Sensitive Conditions (ACSC) and their potential health insurance applicability in Korea, using the correlation and regression analysis with the empirical data provided by Korean Health Insurance Review Agency(KHIRA). Here, ACSC would be thought of as conditions that when timely and effectively treated in the outpatient medical services can help reduce the risk of hospitalizations. As for ACSC, reducing accessibility for outpatient visit results in increasing hospitalization. In this respect, the ACSC concept is popularly adopted as one of the performance indicators of the national health system. As one of main results, fortifying the accessibility to necessary health care in a way of sharing appropriately the role with private health insurance can lead to the efficiency of national health care delivery systems in view of total health care expense, in particular in a case of ACSC children. Lastly, we would like to strongly suggest that the disease treatment data set reported to KHIRA needs to be opened to private insurance companies only for illness experience investigation.

• Journal of Home Health Care Nursing
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• v.10 no.1
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• pp.5-14
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• 2003

Recently, there has been an increasing need for long-term care and comprehensive health care services in community settings. The Ministry of Health and Welfare introduced the Hospital-Based Home Nursing Care Program in 2000. Before this initiative, there was a Home Nursing Demonstration Center, affiliated with the Seoul Nurse Association, had offered home nursing services with the financial support from the local government. since 1993, the Center's nursing staff has been engaged in a general hospital in an effort to provide home nursing care services within Korea's health care system. The purpose of this study was to analyze and identify characteristics of community-based home nursing care supplied by a community-based home nursing team engaged in a general hospital. Also. visit nursing care services provided by public health centers were evaluated in terms of accessibility and supply versus demand, to enhance the accessibility of low-income patients living in Seoul to home nursing care services. Data were collected from home nursing insurance reimbursement claims submitted by the community-based home nursing care team from March 1 to October 30 in 2001 and a questionnaire survey on home-visit nursing services of 25 public health centers in Seoul. The subjects consisted of 197 patients and 12 public health centers. The result were as follows. First, medical institution's community-based home nursing care program was better in technical quality than health-center-based home-visit nursing care. In addition. the pattern of the subject patients was similar to that of hospital-based home nursing care program. Second, there was a high demand for community-based home nursing care while only a small number of home-visiting nurses served at public health centers in Seoul. As a result, many patients could not receive adequate care. Finally, we suggest that community-based home nursing care program should be introduced in the national health system to meet the at-home care needs of severely ill low-income patients. Furthermore, to better utilize home nursing and visit-nursing care resources and offer continued care for patients in community settings, an efficient referral network should be built among related institutions. This would require improvement of reimbursement system and amendment of the law related to health insurance system and community-based home nursing care services.

• Journal of Korean Society of Rural Planning
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• v.22 no.1
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• pp.93-100
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• 2016

Land price can be affected by convenience or psychological repulsion like PIMFY (Please In My Front Yard) or NIMBY (Not In My Back Yard) for various facilities. Services related to public establishment, welfare, medical attention, and amenities in rural areas are comparatively poorer than those in urban areas. The purpose of this study is to estimate the implications of the accessibility to community facilities in rural areas for land prices using a hedonic price model. The accessibility to facilities is estimated by real road distances and the land prices are applied for four types of land usages: field, rice paddy, building lots, and village halls. Community facilities are classified from public and community services view: education, safety, culture, transport, environment, health care, and finance. The results show that the accessibility to health care and transport can positively affect land prices and the accessibility to environment (waste facilities and junkyard) and unpleasant services (funeral hall and charnel house) can negatively affect land prices. Especially, the accessibility to hospital is the most positive influential factor for all types of land usages.

• Journal of Preventive Medicine and Public Health
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• v.31 no.3 s.62
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• pp.460-470
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• 1998

By expanding health insurance, customers will carry a smaller burden of medical costs. As a result, the number of visits to a physician increase and this result in the improvement of medical accessibility. But medical care utilization may be changed not only by insurance status but also by socio-demographic factor, economic status and other factors. The question thus remains, at which level of accessibility and what price of medical care service in health insurance will the customer and the medical care service be satisfied. The price of medical care service ls comprised of the customer's out-of-pocket money and the costs not covered by health insurance. If the price of medical care services in health insurance are appropriate, medical care utilization should not differ because of the difference in income status or the acuteness of illness. But If the price is not adequate, low income groups will receive relatively low medical care utilization, particularly in the case of chronic disease. The purpose of this study is to evaluate the differences in medical care utilization among the various income groups and those with varying acuteness of illness. The major hypotheses to test in this study are : (i) whether there are differences in medical care utilization among different income groups exist, (ii) whether differences in medical care utilization among different income groups exist with the hospital type. (iii) whether differences in medical care utilization among different income groups exist with the acuteness of illness and with age. The data was collected from the JongRo District Health Insurance Society in Seoul. A total of 118,336 persons were selected as the final sample for this study. The major findings of this study were as follows; 1. The volume of ambulatory utilization among users was statistically significant by income level. 2. Among different income groups, the volume of ambulatory utilization was statistically significant by the acuteness of illness. 3. Higher income groups with chronic diseases had a greater volume of ambulatory utilization than other groups.

• Journal of Korean Society of Rural Planning
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• v.24 no.4
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• pp.147-155
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• 2018

The purpose of this study was to identify vulnerable area of emergency medical care. In the existing method, the emergency medical vulnerable area is set as an area that can not reach the emergency room within 30 minutes. In this study, we set up an area that can not reach within 30 minutes including the accessibility of 119 emergency center. To accomplish this, we obtained information on emergency room and 119 emergency center through Open API and constructed road network using digital map to perform accessibility analysis. As a result, 509 emergency room are located nationwide, 78.0% of them are concentrated in the region, 1,820 emergency center are located, and 61.0% of them are located in rural areas. The average access time from the center of the village to the emergency room was analyzed as 15.3 minutes, and the average access time considering the 119 emergency center was 21.8 minutes, 6.5 minutes more. As a result of considering the accessibility of 119 emergency center, vulnerable areas increased by 2.5 times, vulnerable population increased by 2.0 times, and calculating emergency medical care vulnerable areas, which account for more than 30% of the urban unit population, it was analyzed that it increased from 17 to 34 cities As a further study, it will be necessary to continuously monitor and research the real-time traffic information, medical personnel, medical field, and ambulance information to reflect the reality and to diagnose emergency medical care in the future.