• Title/Summary/Keyword: Administrative

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Trend of Medical Care Utilization and Medical Expenditure of the Elderly Cohort (노인 코호트의 의료이용 및 입원진료비 변화 추이 -공.교 의료보험 대상자를 대상으로-)

  • Lee, Kyeong-Soo;Kang, Pock-Soo
    • Journal of Preventive Medicine and Public Health
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    • v.30 no.2 s.57
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    • pp.437-461
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    • 1997
  • Because of a significant improvement in the economic situation and development of scientific techniques in Korea during the last 30 years, the life expectancy of the Korean people has lengthened considerably and as a result, the number of the elderly has markedly increased. Such an increase of the number of aged population brought about many social, economic, and medical problems which were never seriously considered before. This study was conducted to assess the trend of medical care utilization and medical expenditure of the elderly. The data of each patient in the study were taken from computer database maintained for administrative purpose by the Korea Medical Insurance Corporation. The study population was 132,670 who were 60 years old or more and registered in Korean Medical Insurance Corporation from 1989 to 1993. The study subjects were predominantly female(56.3%) and 10,000-20,000 Won premium group(50.6%). The following are summaries of findings : The total increase of the number of inpatient cases was 40.5% from 1989 through 1993. The average annual increase was 3.7% in inpatient medical expenditures per case, 4.4% in inpatient medical expenditures per day and 0.08% in length of stay per case from 1989 through 1993. Cataract was the most prevalent disease of 10 leading frequent diseases in all ages from 1989 through 1993. The case mix in 1993 compared to 1989 revealed that cataract and ischemic cerebral disease were increased whereas essential hypertension and pulmonary tuberculosis were decreased . The average annual increase of medical expenditures was 3.8% in general hospitals, 6.3% in hospitals and 2.4% in clinics. From 1989 through 1993, medical expenditures used by high-cost patients accounted for about 14% to 20% of all expenditures for inpatient care, while they represented less than 2.5% of the elderly population. Time series analysis revealed that total medical expenditures and doctor's fee for inpatient will be progressively increased whereas drug expenditures for inpatient will be decreased. And there will be no change in length of stay. Based on the above results, the factors increasing medical cost and utilization should be identified and the method of cost containment for the elderly health care should be developed systematically.

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Analysis on Factors Influencing Welfare Spending of Local Authority : Implementing the Detailed Data Extracted from the Social Security Information System (지방자치단체 자체 복지사업 지출 영향요인 분석 : 사회보장정보시스템을 통한 접근)

  • Kim, Kyoung-June;Ham, Young-Jin;Lee, Ki-Dong
    • Journal of Intelligence and Information Systems
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    • v.19 no.2
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    • pp.141-156
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    • 2013
  • Researchers in welfare services of local government in Korea have rather been on isolated issues as disables, childcare, aging phenomenon, etc. (Kang, 2004; Jung et al., 2009). Lately, local officials, yet, realize that they need more comprehensive welfare services for all residents, not just for above-mentioned focused groups. Still cases dealt with focused group approach have been a main research stream due to various reason(Jung et al., 2009; Lee, 2009; Jang, 2011). Social Security Information System is an information system that comprehensively manages 292 welfare benefits provided by 17 ministries and 40 thousand welfare services provided by 230 local authorities in Korea. The purpose of the system is to improve efficiency of social welfare delivery process. The study of local government expenditure has been on the rise over the last few decades after the restarting the local autonomy, but these studies have limitations on data collection. Measurement of a local government's welfare efforts(spending) has been primarily on expenditures or budget for an individual, set aside for welfare. This practice of using monetary value for an individual as a "proxy value" for welfare effort(spending) is based on the assumption that expenditure is directly linked to welfare efforts(Lee et al., 2007). This expenditure/budget approach commonly uses total welfare amount or percentage figure as dependent variables (Wildavsky, 1985; Lee et al., 2007; Kang, 2000). However, current practice of using actual amount being used or percentage figure as a dependent variable may have some limitation; since budget or expenditure is greatly influenced by the total budget of a local government, relying on such monetary value may create inflate or deflate the true "welfare effort" (Jang, 2012). In addition, government budget usually contain a large amount of administrative cost, i.e., salary, for local officials, which is highly unrelated to the actual welfare expenditure (Jang, 2011). This paper used local government welfare service data from the detailed data sets linked to the Social Security Information System. The purpose of this paper is to analyze the factors that affect social welfare spending of 230 local authorities in 2012. The paper applied multiple regression based model to analyze the pooled financial data from the system. Based on the regression analysis, the following factors affecting self-funded welfare spending were identified. In our research model, we use the welfare budget/total budget(%) of a local government as a true measurement for a local government's welfare effort(spending). Doing so, we exclude central government subsidies or support being used for local welfare service. It is because central government welfare support does not truly reflect the welfare efforts(spending) of a local. The dependent variable of this paper is the volume of the welfare spending and the independent variables of the model are comprised of three categories, in terms of socio-demographic perspectives, the local economy and the financial capacity of local government. This paper categorized local authorities into 3 groups, districts, and cities and suburb areas. The model used a dummy variable as the control variable (local political factor). This paper demonstrated that the volume of the welfare spending for the welfare services is commonly influenced by the ratio of welfare budget to total local budget, the population of infants, self-reliance ratio and the level of unemployment factor. Interestingly, the influential factors are different by the size of local government. Analysis of determinants of local government self-welfare spending, we found a significant effect of local Gov. Finance characteristic in degree of the local government's financial independence, financial independence rate, rate of social welfare budget, and regional economic in opening-to-application ratio, and sociology of population in rate of infants. The result means that local authorities should have differentiated welfare strategies according to their conditions and circumstances. There is a meaning that this paper has successfully proven the significant factors influencing welfare spending of local government in Korea.

A Case Study on the Effective Liquid Manure Treatment System in Pig Farms (양돈농가의 돈분뇨 액비화 처리 우수사례 실태조사)

  • Kim, Soo-Ryang;Jeon, Sang-Joon;Hong, In-Gi;Kim, Dong-Kyun;Lee, Myung-Gyu
    • Journal of Animal Environmental Science
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    • v.18 no.2
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    • pp.99-110
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    • 2012
  • The purpose of the study is to collect basis data for to establish standard administrative processes of liquid fertilizer treatment. From this survey we could make out the key point of each step through a case of effective liquid manure treatment system in pig house. It is divided into six step; 1. piggery slurry management step, 2. Solid-liquid separation step, 3. liquid fertilizer treatment (aeration) step, 4. liquid fertilizer treatment (microorganism, recirculation and internal return) step, 5. liquid fertilizer treatment (completion) step, 6. land application step. From now on, standardization process of liquid manure treatment technologies need to be develop based on the six steps process.

A Study on Perception and Attitudes of Health Workers Towards the Organization and Activities of Urban Health Centers (도시보건소 직원의 보건소 업무에 대한 인식 및 견해)

  • Lee, Jae-Mu;Kang, Pock-Soo;Lee, Kyeong-Soo;Kim, Cheon-Tae
    • Journal of Yeungnam Medical Science
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    • v.12 no.2
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    • pp.347-365
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    • 1995
  • A survey was conducted to study perception and attitudes of health workers towards health center's activities and organization of health services, from August 15 to September 30, 1994. The study population was 310 health workers engaged in seven urban health centers in Taegu City area. A questionnaire method was used to collect data and response rate was 81.3 percent or 252 respondents. The following are summaries of findings: Profiles of study population: Health workers were predominantly female(62.3%); had college education(60.3%); and held medical and nursing positions(39.6%), technicians(30.6%) and public health/administrative positions(29.8%). Perceptions on health center's resources: Slightly more than a half(51.1%) of respondents expressed that physical facilities of the centers are inadequate; equipments needed are short(39.0%); human resource is inadequate(44.8%); and health budget allocated is insufficient(38.5%) to support the performance of health center's activities. Decentralization and health services: The majority revealed that the decentralization of government system would affect the future activities of health centers(51.9%) which may have to change. However, only one quarter of respondents(25.4%) seemed to view the decentralization positively as they expect that it would help perform health activities more effectively. The majority of the respondents(78.6%) insisted that the function and organization of the urban health centers should be changed. Target workload and job satisfaction: A large proportion (43.3%) of respondents felt that present target setting systems for various health activities are unrealistic in terms of community needs and health center's situation while only 11.1 percent responded it positively; the majority(57.5%) revealed that they need further training in professional fields to perform their job more effectively; more than one third(35.7%) expressed that they enjoy their professional autonomy in their job performance; and a considerable proportion (39.3%) said they are satisfied with their present work. Regarding the personnel management, more worker(47.3%) perceived it negatively than positive(11.5%) as most of workers seemed to think the personnel management practiced at the health centers is not fair or justly done. Health services rendered: Among health services rendered, health workers perceived the following services are most successfully delivered; they are, in order of importance, Tb control, curative services, and maternal and child health care. Such areas as health education, oral health, environmental sanitation, and integrated health services are needed to be strengthening. Regarding the community attitudes towards health workers, 41.3 percent of respondents think they are trusted by the community they serve. New areas of concern identified which must be included in future activities of health centers are, in order of priority, health care of elderly population, home health care, rehabilitation services, and such chronic diseases control programs as diabetes, hypertension, school health and mental health care. In conclusion, the study revealed that health workers seemed to have more negative perceptions and attitudes than positive ones towards organization and management of health services and activities performed by the urban health centers where they are engaged. More specifically, the majority of health workers studied revealed to have the following areas of health center's organization and management inadequate or insufficient to support effective performance of their health activities: Namely, physical facilities and equipments required are inadequate; human and financial resources are insufficient; personnel management is unsatisfactory; setting of service target system is unrealistic in terms of the community needs. However, respondents displayed a number of positive perceptions, particularly to those areas as further training needs and implementation of decentralization of government system which will bring more autonomy of local government as they perceived these change would bring the necessary changes to future activities of the health center. They also displayed positive perceptions in their job autonomy and have job satisfactions.

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Collision of New and Old Control Ideologies, Witnessed through the Moving of Jeong-regun (Tomb of Queen Sindeok) and Repair of Gwangtong-gyo (정릉(貞陵) 이장과 광통교(廣通橋) 개수를 통해 본 조선 초기 지배 이데올로기의 대립)

  • Nam, Hohyun
    • Korean Journal of Heritage: History & Science
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    • v.53 no.4
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    • pp.234-249
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    • 2020
  • The dispute involving the construction of the Tomb of Queen Sindeok (hereinafter "Jeongreung"), King Taejo's wife in Seoul, and the moving of that tomb, represents the most clearly demonstrated case for the collision of new and old ideologies between political powers in the early period of Joseon. Jeongreung, the tomb of Queen Sindeok from the Kang Clan, was built inside the capital fortress, but in 1409, King Taejong forced the tomb to be moved outside the capital, and the stone relics remaining at the original location were used to build the stone bridge, Gwangtong-gyo. In an unofficial story, King Taejong moved the tomb outside the capital and used the stone items there to make the Cheonggyecheon Gwang-gyo so that the people would step upon the area in order to curse Lady Kang. In the final year of King Taejo, Lady Kang and King Taejong were in a politically conflictual relationship, but they were close to being political partners until King Taejo became the king. Sillok records pertaining to the establishment of Jeongreung or Gwangtong-gyo in fact state things more plainly, indicating that the moving of Jeongreung was a result of following the sangeon (a written statement to the king) of Uijeongbu (the highest administrative agency in Joseon), which stated that having the tomb of a king or queen in the capital was inappropriate, and since it was close to the official quarter of envoys, it had to be moved. The assertion that it was aimed at degrading Jeongreung in order to repair Gwangtong-gyo thus does not reflect the factual relationship. This article presents the possibility that the use of stone items from Jeongreung to repair Gwangtong-gyo reflected an emerging need for efficient material procurement that accompanied a drastic increase in demand for materials required in civil works both in- and outside the capital. The cause for constructing Jeongreung within the capital and the cause of moving the tomb outside the capital would therefore be attributable to the heterogeneity of the ideological backgrounds of King Taejo and King Taejong. King Taejo was the ruler of the Confucius state, as he reigned through the Yeokseong Revolution, but he constructed the tomb and Hongcheon-sa, the temple in the capital for his wife Queen Sindeok. In this respect, it is considered that, with the power of Buddhism, there was an attempt to rally supporters and gather the force needed to establish the authority of Queen Sindeok. Yi Seong-gye, who was raised in the Dorugachi clan of Yuan, lived as a military man in the border area, and so he would not have had a high level of understanding in Confucian scholarship. Rather, he was a man of the old system with its 'Buddhist" tendency. On the other hand, King Taejong Yi Bang-won was an elite Confucian student who passed the national examination at the end of the Goryeo era, and he is also known to have held a profound understanding of Neo-Confucianism. To state it differently, it would be reasonable to say that the understanding of symbolic implications for the capital would be more profound in a Confucian state. Since the national system that was ruled by laws had been established following the Three-Kingdom era, the principle of burial outside of the capital that would have seen a grave constructed on the outskirts of the capital was not upheld, without exception. Jeongreung was built inside the capital due to the strong individual desire of King Taejo, but since he was a Confucian scholar prior to becoming king, it would not have been accepted as desirable. After taking the throne, King Taejong took the initiative to begin overhauling the capital in order to reflect his intent to clearly realize Confucian ideology emphasizing 'Yechi' ("ruling with good manners") with the scenic view of the Capital's Hanyang river. It would be reasonable to conclude accordingly that the moving of Jeongreung was undertaken in the context of such a historic background.

The Characteristics and Operation System of the Staff Officials at Jongbusi (Court of the Royal Clan) in the Late Joseon Period - Based on Jongbusi nangcheong seonsaengan (Register of Staff Officials at the Court of the Royal Clan) Kept at Jangseogak Archives (조선 후기 종부사(宗簿寺) 낭청(郎廳)의 실태 및 운영체계 - 장서각 소장 『종부사낭청선생안(宗簿寺郎廳先生案)』을 중심으로 -)

  • Kim, Dong-geun
    • (The)Study of the Eastern Classic
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    • no.69
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    • pp.83-114
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    • 2017
  • The purpose of this article is to analyze the standings of working-level officials belonging to Jongbusi (Court of the Royal Clan) holding the rank of "jeong" and below between the 18th and mid-19th Century. Jongbusi, which was headed by a Grade-3 official, was in charge of the compilation of royal genealogy and supervision of royal relatives. During the late Joseon Period, its officials were composed of its chief, jeong, jubu (Grade-6 official), and jikjang (Grade-7 official). By 1864, it was incorporated into Jongchinbu (Office of the Royal Relatives). Jongbusi nangcheong seonsaengan (Register of Staff Officials at the Court of the Royal Clan), which is preserved at the Jangseogak Archives of the Academy of Korean Studies, lists the officials who served at the office between 1794 and its incorporation into Jongchinbu in 1864. The register also includes the officials' ranks, names, DOBs, family clans, their ranks in the offices they were transferred from, their ranks in the office they were transferred to, etc. Those interested view it as a precious relic that provides valuable information on the officialdom of the dynasty. A majority of the officials who served at Jongbusi were those who passed the higher civil service examination. Many of them at the level of jikjang were those who passed the licentiate examination. Their designation as an official was part of the "muneum" system, which granted official posts to descendants of those who accomplished a distinguished service for the country or served as a high-ranking official. They were those transferred from equal or lower positions in another office. Many of jubu-level officials of Jongbusi were those transferred from honorable and important posts of other offices or local administrative offices. Many of jikjang-level officials of Jongbusi were those who previously served as dosa (assistant officials) at Uigeumbu (Bureau of Crime Investigation) headed by a Grade-1 official. The officials' transfer to an office with a lower position like Jongbusi appears to have been for the provision of placing them in working-level positions rather than letting them remain in positions only carrying an honorary title. As for the transfer of officials of Jongbusi to other offices, many of those with the rank of jeong were transferred to lower positions. Supposedly it was because not many Grade-3 positions were vacant. Many of them were transferred to honorable and important posts. Some of them were also transferred to positions at local government offices, supposedly to avoid an excess of personnel at the central government. Those at the level of jubu or jikjang of Jongbusi were transferred to equal or higher posts in other offices. Particularly, most of those holding the position of jikjang (Grade-7) were transferred to higher posts. The family clan that produced the largest number (10%) of Jongbusi officials was the Jeonju Yi Clan, which produced the largest number of those who passed the higher civil service examination. It was also found that the top 20 family clans produced about half of the entirety of Jongbusi officials. According to the aforesaid Jongbusi nangcheong seonsaengan, about 90% of the cases of promotion of Jongbusi officials occurred after the revision of Seonwon boryak (Royal Genealogy of the Joseon Dynasty). It is speculated that the supervision of royal family members, one of the two leading functions assigned to Jongbusi, was suspended in the late Joseon Period. The relevant function does not appear even in chronicles pertaining to the Joseon Dynasty. The reason being had something to do with the sharp decrease in the number of royal family members during the reign of King Injo (r. 1623-1649). Their number was decreased to the extent that royal ceremonies could not be adequately carried out. Naturally, the meaning of supervising royal family members faded. Witnessing such a sorry state of the royal family, Heungseon Daewongun, King Gojong's father who served as the regent, incorporated Jongbusi into Jongchinbu in an effort to enhance the status and authority of the royal family.

The Effect of the Quality of Education Service on the Performance of Education Service through Relationship Commitment in Franchise Beauty Academy: Moderating Effect of Trust Level (프랜차이즈 뷰티 아카데미의 교육서비스 품질이 관계 몰입을 통한 교육 서비스 성과에 미치는 영향 연구: 신뢰 수준의 조절효과)

  • Kim, Chang-Bong;Kim, Hee-Su
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.16 no.3
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    • pp.193-211
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    • 2021
  • Recently, interest in Korean Wave craze and K-beauty, led by K-pop, is increasing. In addition, the popularity and influence of the domestic beauty service industry has increased, and the economic and cultural ripple effects have been continuously expanding. The need to professional manpower training in response to the demand for manpower due to the growing development of domestic beauty services is emphasized, and the number of trainees who are actual consumers of beauty academy is increasing. Therefore, the purpose of our study is to examine the importance of quality factors of educational services to achieve educational purposes in the educational services provided by the Beauty Academy and the relationship between relationship commitment and educational service performance. Furthermore, it is to draw the importance of administrative support services, educational programs as well as educational service provision activities. However, the research for professional manpower training according to the provision of beauty services is insufficient compared to the development speed of the beauty industry. Therefore, at the present time when beauty service education is emphasized, our study will examine the relationship between relationship commitment and educational service performance based on the quality of education service by the students of domestic beauty academy. The measurement variables set for our study are program, instructor quality, tuition, external service, service fairness, relationship commitment, trust level, and educational service performance. The variables were analyzed and derived through the survey, and the following contents were derived from the empirical analysis. First, the quality of education service provided by the beauty academy, such as program, external service, service fairness, relationship commitment and trust level, had a significant effect on relationship commitment. Educational services provided by the institute, such as the systematicity and diversity of educational programs, enabled students to have a uniform relationship commitment. The quality of education service itself is to learn the expertise necessary for providing beauty service from the standpoint of the students and play an organic role in the relationship with the institute. Second, the moderating effect of trust level between academies and students was significant in the quality of education service and the relationship commitment. This means that students will feel higher level of service quality through the practical trust relationship of the students about the educational services provided by the institute. Based on the results of the empirical analysis, the implications of our study are to find ways to improve the students' ability and satisfaction represented by the results of educational services. This is because the quality of education services provided by the institute called Beauty Academy will have a great impact on the career choice of educational facilities and students. The characteristics of consistency, convenience, and knowledge orientation of education itself should be considered comprehensively, and a strong market position should be established through image formation through external service factors, which are external environments of academies.Furthermore, in terms of presenting differentiated strategies with competitors, the educational service quality factors play a significant role in the commitment to the relationship with the students, so the role of relationship marketing will be important for the psychological stability experienced by the students by grasping the demand accompanying the behavior of the students in advance.

Survey Studies on Serviceable Sericultural Communities in Korea (養蠶適地選定에 관한 調査硏究)

  • Choe, Byong-Hee;Gwon, Yeong-Ha;Mun, Jae-Yu;Baek, Hyeon-Jun;Lee, Geon-Yeong;Lee, Sang-Pung;Lee, Won-Ju;Im, Su-Ho;Jo, Dong-Ok;Kim, Seong-Ho;Hwang, Hong-Do;Kim, Gi-Seok;Kim, Su-Gyeong;Go, Nak-Yong;So, Byeong-Ju;Lee, Geon-U;Lee, Jae-Ok;Im, Dong-Rak;Jo, Jin-Gu
    • Journal of Sericultural and Entomological Science
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    • v.25 no.1
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    • pp.34-43
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    • 1983
  • These studies have been carried out to find better locations for sericultural service regardless of the international silk market fluctuation in Korea. In order to acieve the purpose, various investigations and analyses have been carried out for more than four hundred sericultural communities to find out the main factors which caused to decrease in cocoon production in spite of a gloomy past silk market. Now, we believe that we have set up some fundamental guide lines in developing sound serviceable sericultural communities in Korea in case the government accepts the written advices, and the results obtained are as follows: 1. The Korean sericulture has been very prosperous from the 60's to the 70's. In 1976 the cocoon production was at its peak, reaching 41,704M/T from which its decline took place with annual averages of 18.5% for total cocoon production and 16.4% for mulberry field. These figures represent a quantitative decrease to one-third of the total amount in 1976. Since then, the Korean sericulture had continuously suffered from a shortage of raw silk resulting in a slow development of sericulture. At present, a steady development through all possible measures is great importance. 2. The downfall of the korean sericulture resulted from two factors of such as the external, which led to the decline in the price of raw silk at the international market and restrain of import and, the internal, resulting in the little increase of cocoon price and a comparatively lower benefits from the sericulture than from other cash crops. 3. The already established sericultural zone collapsed and then reorganized with the outstanding regional specialization so the decline in total cocoon production in the country. Based on the agricultural regions, 1980 cocoon production was very stable in the mountaineaus area of the east-south which used with intercropping. In this area there was small decline of 33% compare with that of the 1979, and with 70% decline in the dry field farming area of Kangwon Do. In an administrative districtwise, six counties beginning with Sanchnung county of Kyungsang Nam Do, showed less than 20% decline of cocoon production, sixteen counties beginning with Samchuck county of Kangwon Do marked above 80% decrease of cocoon production. In the smaller unit area-wise, there was a big difference among them. twenty-five myons rather increased and a hundrd fourty-three myons decreased above 80% of it. 4. The cocoon production was positively correlated with the decreasing percentage of cocoon production per household. It was also affected by the ratio of the mulberry field area to the total cultivated area per household and cocoon productivity per 10a. 5. Four hundred sixty-four villages in the seventeen counties were surveyed on the basis of farm management and techniques concerned ('80/'79), and then the results were evaluated by using of computer. These results are summarized as foolows: (1) Cocoon production per household There was no difference among the agricultural regions in cocoon production. The cocoon production per household in the comparatively stable villages increased from 100.8kg in 1979 to 122kg in 1981. Cocoon yield in the stable villages decreased by 20% of '81/'79. The cocoon production per house hold in while that of the unstable villages decreased by more than 40% from 102.9kg in 1979 to 82kg in 1981. (2) Cocoon yield per 10a mulberry field The cocoon yield per 10a was higher in the plain area than in the mountaineous area. The stable villages had an average of 73.4kg cocoon yield/10a while the unstabe ones had only an average of 55kg. (3) Adoption the mulberry branch rearing method The branch rearing method was more popular in the plain area than in the mountainous area. In the stable vilages adopted 24.2% in spring and 16.7% in autumn of 1979. In 1981 it shwed increases of 34.3% and 10.1% in the two seasons respectivly. However, the unstable villages showed 13.3% and 126% in both seasons, respectively. (4) The patterns of the combined management system in the sericultural farming The popular management system in the sericultural from was combined with rice and other cash crops, showing 55% of the total households surveyed. Fourteen percent of the households combined the management system with rice and other cash crops and 14% of the households combined with rice only. The villages wich earned less than 20% of the total income from the sericulture reached 81% of the total houscholds indicating that they were still far beyond a complete combination system. (5) Damage by agricultural chemicals The damage caused by agricultural chemicals was mainly due to the protection of rice against insectpests and diseases in the plain areas and took place mostly in the autumn season. The chemicals applied was 65% of Iiquid and 35% of powder forms and 35% of damage was from granulat form of the chemicals. The use of the granular chemicals was low because of high cost.

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Comparative Analysis of Community Health Practitioner's Activities and Primary Health Post Management Before and After Officialization of Community Health practitioner (보건진료원의 정규직화 전과 후의 보건진료원 활동 및 보건진료소 관리운영체계의 비교 분석)

  • Yun, Suk-Ok;Jung, Moon-Sook
    • Journal of agricultural medicine and community health
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    • v.19 no.2
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    • pp.141-158
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    • 1994
  • To provide better health care services to the rural population, the government has made the Community Health Practitioner(CHP) a regular government official from April 1, 1992. This study was carried out to study the impact of officialization of CHP on the activities and management system of Primary Health Post(PHP). Fifty PHPs were selected by two stage sampling, cluster and simple random, from 595 PHPs in Kyungnam and Kyungpook provinces. Data were collected by a personal interview with CHPs and review of records and reports kept in the PHPs. The study was done for the periods of January 1-March 31, 1992 (before officialization) and January 1-March 31, 1993 (after officialization). Ninety-six percent of the CHPs wanted to become a regular government official in the hope of better job security and higher salary. The proportion of CHPs who were proud of their iob was increased from 24% to 46% after officialization. Those CHPs who felt insecure for their job decreased from 30% to 10%. Monthly salary was increased by 34% from 802,600 Won to 1,076,000 Won and 90% of the CHPs were satisfied with their salary, also more CHPs responded that they have autonomy in their work planning, implementation of plan, management of the post, and evaluation of their activity. There were no appreciable changes in such CHPs' activities as assessment of local health resources, drawing map for the catchment area, utilization of community organization, grasping the current population structure in the catchment area, keeping the family health records, individual and group health education, and school health service. However, the number of home visits was increased from 13.6 times on the average per month per CHP to 27.5 times. More mothers and children were referred to other medical facilities for the immunization and family planning services. Average number of patients of hypertension, cancer, and diabetes in three months period was decreased from 12.7 to 11.6, from 1.5 to 1.2, and 4.3 to 3.4, respectively. Records for the patient care, drug management, and equipment were well kept but not for other records. The level of record keeping was not changed after officialization. The proportion of PHPs which had support from the health center was increased for drug supply from 14.0% to 30.0%, for consumable commodities from 22.0% to 52.0%, for maintenance of PHP from 54.0% to 68.0%, for supply of health education materials from 34.0% to 44.0%, and supply of equipment from 54.0% to 58.0%. Total monthly revenue of a PHP was increased by about 50,000 Won; increased by 22,000 Won in patient care and 34,700 Won in the government subsidy but decreased in the membership due and donation. However, there was no remarkable changes in the expenditure. The proportion of PHPs which had received official notes from the health center for the purpose of guidance and supervision of the CHPs was increased from 20% to 38% during three months period and the average number of telephone call for supervision from the health center per PHP was increased from 1.8 to 2.1 times(p<0.01). However, the proportion of PHPs that had supervisory visit and conference was reduced from 79% to 62%, and from 88% to 74%, respectively. The proportion of CHPs who maintained a cooperative relationship with Myun Health Workers was reduced from 42% to 36%, that with the director of health center from 46% to 24%, that with the chief of public health administration section from 56% to 36%, and that with the chairman of PHP management council from 62% to 38%. Most of the CHPs (92% before and 82% after officialization) stated that the PHP management council is not helpful for the PHP. CHPs who considered the PHP management council unnecessary increased from 4% to 16%(p<0.05). Suggestions made by the CHPs for the improvement of CHP program included emphasis on health education, assurance of autonomy for PHP management, increase of the kind of drugs that can be dispensed by CHPs, and appointment of an experienced CHP in the health center as the supervisor of CHPs. The results of this study revealed that the role and function of CHPs as reflected in their activities have not been changed after officialization. However, satisfaction in job security and salary was improved as well as the autonomy. Support of health center to the PHP was improved but more official notes were sent to the PHPs which required the CHPs more paper works. Number of telephone calls for supervision was increased but there was little administrative and technical guidance for the CHP activities.

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The Location of Medical Facilities and Its Inhabitants' Efficient Utilization in Kwangju City (광주시(光州市) 의료시설(醫療施設)의 입지(立地)와 주민(住民)의 효율적(效率的) 이용(利用))

  • Jeon, Kyung-Sook
    • Journal of the Korean association of regional geographers
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    • v.3 no.2
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    • pp.163-193
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    • 1997
  • Medical services are a fundamental and essential service in all urban areas. The location and accessibility of medical service facilities and institutions are critical to the diagnosis, control and prevention of illness and disease. The purpose of this paper is to present the results of a study on the location of medical facilities in Kwangju and the utilization of these facilities by the inhabitants. The following information is a summary of the findings: (1) Korea, like many countries, is now witnessing an increase in the age of its population as a result of higher living standards and better medical services. Korea is also experiencing a rapid increase in health care costs. To ensure easy access to medical consultation, diagnosis and treatment by individuals, the hierarchical efficient location of medical facilities, low medical costs, equalized medical services, preventive medical care is important. (2) In Korea, the quality of medical services has improved significantly as evident by the increased number of medical facilities and medical personnel. However, there is still a need for not only quantitative improvements but also for a more equitable distribution of and location of medical services. (3) There are 503 medical facilities in Kwangju each with a need to service 2,556 people. This is below the national average of 1,498 inhabitants per facility. The higher locational quotient and satisfactory population per medical facility showed at the civic center. On the other hand, problem regions such as the traditional residential area in Buk-Gu, Moo-deung mountain area and the outer areas of west Kwangju still maintain rural characteristics. (4) In the study area there are 86 general medicine clinics which provide basic medical services. i. e. one clinic per every 14,949 residents. As a basic service, its higher locational quotient showed in the residential area. The lower population concentration per clinic was found in the civic center and in the former town center, Songjeong-dong. In recently build residential areas and in the civic center, the lack of general medicine clinics is not a serious medical services issue because of the surplus of medical specialists in Korea. People are inclined to seek a consultation with a specialist in specific fields rather than consult a general practitioner. As a result of this phenomenon, there are 81 internal medicine facilities. Of these, 32.1% provide services to people who are not referred by a primary care physician but who self-diagnose then choose a medical facility specializing in what they believe to be their health problem. Areas in the city, called dongs, without any internal facilities make up 50% of the total 101 dongs. (5) There are 78 surgical facilities within the area, and there is little difference at the locational appearance from internal medicine facilities. There are also 71 pediatric health clinics for people under 15 years of age in this area, represents one clinic per 5,063 people. On the quantitative aspect, this is a positive situation. Accessibility is the most important facility choice factor, so it should be evenly located in proportion to demander distribution. However, 61% of 102 dongs have no pediatric clinics because of the uneven location. (6) There are 43 obstetrical and gynecological clinics in Kwangju, and the number of residents being served per clinic is 15,063. These services need to be given regularly so it should increase the numbers. There are 37 ENT clinics in the study area with the lower concentration in Dong-gu (32.4%) making no locational differences by dong. There are 23 dermatology clinics with the largest concentration in Dong-Gu. There are 17 ophthalmic clinics concentrated in the residential area because of the primary function of this type of specialization. (7) The use of general medicine clinics, internal medicine clinics, pediatric clinics, ENT clinics by the inhabitants indicate a trend toward primary or routine medical services. Obstetrics and gynecology clinics are used on a regular basis. In choosing a general medicine clinic, internal medicine clinic, pediatric clinic, and a ENT clinic, accessibility is the key factor while choice of a general hospital, surgery clinic, or an obstetrics and gynecology clinic, thes faith and trust in the medical practitioner is the priority consideration. (8) I considered the efficient use of medical facilities in the aspect of locational and management and suggest the following: First, primary care facilities should be evenly distributed in every area. In Kwangju, the number of medical facilities is the lowest among the six largest cities in Korea. Moreover, they are concentrated in Dong-gu and in newly developed areas. The desired number of medical facilities should be within 30 minutes of each person's home. For regional development there is a need to develop a plan to balance, for example, taxes and funds supporting personnel, equipment and facilities. Secondly, medical services should be co-ordinated to ensure consistent, appropriate, quality services. Primary medical facilities should take charge of out-patient activities, and every effort should be made to standardize and equalize equipment and facility resources and to ensure ongoing development and training in the primary services field. A few specialty medical facilities and general hospitals should establish a priority service for incurable and terminally ill patients. (9) The management scheme for the inhabitants' efficient use of medical service is as follows: The first task is to efficiently manage medical facilities and related services. Higher quality of medical services can be accomplished within the rapidly changing medical environment. A network of social, administrative and medical organizations within an area should be established to promote information gathering and sharing strategies to better assist the community. Statistics and trends on the rate or occurrence of diseases, births, deaths, medical and environment conditions of the poor or estranged people should be maintained and monitored. The second task is to increase resources in the area of disease prevention and health promotion. Currently the focus is on the treatment and care of individuals with illness or disease. A strong emphasis should also be placed on promoting prevention of illness and injury within the community through not only public health offices but also via medical service facilities. Home medical care should be established and medical testing centers should be located as an ordinary service level. Also, reduced medical costs for the physically handicapped, cardiac patients, and mentally ill or handicapped patients should be considered.

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