• Journal of Preventive Medicine and Public Health
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• v.24 no.4 s.36
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• pp.485-495
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• 1991

This study examined the effects of referral requirements for insurance patients which have been enforced since July 1, 1989 when medical insurance coverage was extended to the whole population except beneficiaries of medical assistance program. The requirements are mainly aimed at discouraging the use of tertiary care hospitals by imposing restrictions on the patient's choice of a medical service facility. The expectation is that such change in the pattern of medical care utilization would produce several desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities. In this study, these effects were assessed by the change in the number of out-patient visits and bed-days per illness episode and the share of each type of facility in the volume of services and the amount of expenditures after the implementation of the new referral system. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for the patients treated during the first six months of 1989, prior to the enforcement of referral requirements, and those of the patients treated during the first six months of 1990, after the enforcement. The 1989 sample included 299,824 claims (3.6% of total) and the 1990 sample included 332,131 (3.7% of total). The data were processed to make the unit of analysis an illness episode instead of an insurance claim. The facilities and types of care utilized for a given illness episode are defined to make up the pathway of medical care utilization. This pathway was conceived of as a Markov Chain process for further analysis. The conclusion emerged from the analysis is that the enforcement of referral requirements resulted in less use of tertiary care hospitals, and thereby decreased the volume of services and the amount of insurance expenses per illness episode. However, there are a few points that have to be taken into account in relation to the conclusion. The new referral system is likely to increase the use of medical services not covered by insurance, so that its impact on national health expenditures would be different from that on insurance expenditures. The extension of insurance coverage must have inereased patient load for all types of medical service organizations, and this increase may be partly responsible for producing the effects attributed to the new referral system. For example, excessive patient load for tertiary care hospitals may lead to the transfer of their patients to other types of facilities. Another point is that the data for this study correspond to very early phase of the new system. But both patients and medical care providers would adapt themselves to the new system to avoid or overcome its disadvantages for them, so as that its effects could change over time. Therefore, it is still necessary to closely monitor the impact of the referral requirements.

• Journal of Society of Preventive Korean Medicine
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• v.13 no.2
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• pp.129-146
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• 2009

Background and Objectives: The purpose of the study was to explore the attitude of workers toward a system of collaborative hospital practice between western and traditional Korean medicine, to identify factors influencing this attitude, and discuss the reasons socioeconomic groups' differences. Method: The data were collected with a questionnaire for this study from 14 April 2009 to 1 May 2009. Data were analyzed mainly via non-parametric statistics and logistic regressions utilising SPSS 17.0 (Statistical Package for the Social Sciences) to determine the workers' attitude about the hospital system and to predict factors contributing to positive attitudes. Results: A total of 1,260 workers working for large factories in Gwangju Metropolitan City. Findings confirmed that more than 40% of the workers show interest in the system and about 44% of the workers also express positive attitudes. Factors found to influence the workers' response included marital status, income level, health status, experience in complementary medicine services, the number of health care facilities' visit. Conclusions: The prospects to establish the system of collaborative hospital practice as reflected by the workers' view about the Korean health care service delivery system. Their attitudes toward the system differed among socioeconomic groups. Government and health care providers should identify the socioeconomic subgroups' demands and opinions in order to find and develop measures of integrating western and traditional Korean medicine in health care facilities.

• Journal of Korean Academy of Nursing Administration
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• v.17 no.2
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• pp.226-237
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• 2011

Purpose: This study was done to identify the experience of health care services by foreign residents in Korea. Method: Participants were 12 foreigners from China, North America, and Japan. Qualitative data were collected using three focus group interviews and analyzed with qualitative content analysis. Results: The participants' experience of health services was categorized as 21 sub-categories, 11 categories and three main categories. The main categories were 'Quality of health care', 'Health care personnel', and 'Health care system and infrastructure'. The main category of 'Quality of health care' included three categories, 'Health care personnel' included another four categories, and 'Health care system and infrastructure' included the remaining four categories. The participants reported positive experiences such as favorable feelings and satisfaction particularly, with the high quality of health care but also negative experiences such as apprehension, distrust, difficulties, and inconvenience in the health care service in Korea. Conclusions: The results of this study can be helpful in the development of strategies to improve health care services for foreigners by providing fundamental information about the foreign residents' experience of health care services in Korea from their perspectives.

• The Korean Journal of Health Service Management
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• v.2 no.1
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• pp.125-136
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• 2008

Government came to enforce long-term care insurance system in preparation for the rapid aging society. Whether this system is successful or not depends on the professionalism of long-term care-givers who are professional population in charge of care service. Currently in the early stage of enforcement, such problems as a race cutting fee resulted from numerical increase of educational facilities, insolvent operation, degradation of education level resulted from unprofessional instructor, are pointed out. As a mean of manpower-training on long-term care insurance system, this study is to research public-private-university network model of the Academy of Continuing Education attached to Ko Sin University which is the case of Yong Do Gu Busan city. Networking between the vision and development strategy of Yong Do Gu on continuing education city, education system on community manpower-training supported by Ko Sin University, and service field of welfare for the elderly can not only contribute to the professionalism of long-term care-givers but also play an ideal role in manpower-utilization and arrangement of community. Through this networking, high quality of education level and circumstance, using the existing infra, manpower-training and utilization for continuing education of Yong Do Gu can be accomplished. Additionally, the connection with facilities related with welfare for the elderly can contribute to professionalism and accountability of manpower-networking.

• Health Policy and Management
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• v.29 no.3
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• pp.342-356
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• 2019

Background: The objectives of the study are to find out the effect of the implementing reform in three Central Asian countries, identify its impact on health status and health care delivery systems. This study address to identify strong and weak points of the health systems and provide a recommendation for further health care organization. Methods: A comparative analysis was conducted to evaluate the effects of implemented policy on health care system efficiency and equity. Secondary data were collected on selected health indicators using information from the World Health Organization Global Health Expenditure Database, European Health Information Platform, and World Bank Open Data. Results: In terms of population status, countries achieved relatively good results. Infant mortality and under-5 mortality rate decreased in all countries; also, life expectancy increased, and it was more than 70 years. Regulations of the health systems are still highly centralized, and the Ministry of Health is the main organ responsible for national health policy developing and implementation. Among the three countries, only Kyrgyzstan was successful in introducing a national health system. Distribution of health expenditure between public expenditure and out-of-pocket payments was decreased, and out-of-pocket payments were less the 50% of total health expenditure in all countries, in 2014. Conclusion: After independent, all three countries implemented a certain number of the policy reform, mostly it was directed to move away from the old the Soviet system. Subsequent reform should be focused on evidence-based decision making and strengthening of primary health care in terms of new public health concepts.

• Research in Community and Public Health Nursing
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• v.15 no.3
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• pp.450-459
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• 2004

Purpose: The purpose of this study is to grasp the welfare service for the demented people staying at home and the service that caregivers want to use. Therefore, we are going to develop a Korean senile dementia-care management model. Method; It analyzed the data of 185 demented people and caregivers, who registered in 16 public dementia care centers in B city since June 2002. Results: 1) The types of services used by the aged people with dementia staying at home were, in the order of frequency of use, the day-care center(26.5%), and home-help service (21.6%). 2). The types of services according to the degree of dementia were as follows; mild cases: home care service (5.4%), moderate cases: day-care service (40.0%) and severe cases: day-care service (26.0%). 3). The caregivers who want to use senile welfare institutions accounted for 23.3%, and the major reason they could not use the institutions was due to their economic situation. 4) The Korean senile dementia care management system must be excuted, considering caregivers' economic state and severity of dementia. Since the system was actively operated, many small sized welfare service institutions showed development. Conclusion: The welfare services appropriate to the severity of dementia should be provided. With the model developed in this study, the dementia management requires sufficient care and should be achieved to reduce the caregivers burden.

• Research in Community and Public Health Nursing
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• v.15 no.3
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• pp.365-375
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• 2004

Purpose: This study intends to make a database for hypertensive patients and middle-aged women who are visiting the Yeojoo County Health Center. While building up the database, the study reviewed the current assessment tools used in the health center, developed appropriate health care programs, and designed a computerized health care system. Method: The modeling of a database for the system was constructed by MS-Access for DBMS (Database Management System) and Visual Basic. The system is to be used only in the health center by being designed as a client server method, making it possible for many public employees to be interconnected, and enables them to retrieve and search data from the database simultaneously. Results: The health management system systematically follows nursing processes including assessment, diagnosis, intervention and evaluation. Diagnosis. once it is done according to the self determined criteria, saves time and provides appropriate health information for the members. Also, the health education program was developed to follow up on the health status of the members on a continuous basis. Conclusion: Based on these results, it is required to evaluate health care programs provided for the members by using the database system and to develop more practical health care programs. It is also necessary to connect the system to other databases. which contain information about members.

• Health Policy and Management
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• v.22 no.4
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• pp.522-537
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• 2012

The purpose of this study was to analyze the level of the cognitive function and activities of daily living of the beneficiary older adults at home based on Korean Long-term Care Insurance System. A cross-sectional descriptive survey was conducted from November 2010 to May 2011, the final respondents were 1,026 beneficiary older adults taking home visit care covered in Korean long-term care insurance system. The questionnaire included general characteristics of subjects, cognitive function, ADL(Activity of daily living). The data was analyzed using the SPSS 20.0 version. There was significant difference in cognitive function and ADL between 1st Grade, 2nd Grade and 3rd Grade of long-term care classification. The correlated factors of cognitive function were ADL, long-term care grade, disability of arm and leg, limitation of joint, bed sore and tube feeding. The correlated factors of ADL were cognitive function, long-term care grade, disability of arm and leg, bed sore and tube feeding. This study suggests that cognitive functions have to be mainly considered in long-term care grade. It is necessary to make an effort to develop long-term care grade in Korean long-term care insurance system an cognitive function improvement program for the beneficiary older adults. Above all things government will be seriously contemplating of revise contents for long-term care grade to provide quality of care for the older adults.

• The Korean Journal of Health Service Management
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• v.10 no.3
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• pp.159-171
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• 2016

Objectives : This study was performed to investigate the characteristics and ADL(Activities of Daily Living) associated factors of elderly inpatients in long-term care hospitals. Methods : Data were collected from the nationwide data of 'Survey of Patients (2013-2014)' administerd by the Ministry of Health & Welfare. The data included in this study consisted of 27,606 cases of elderly inpatients in long-term care hospitals. Results : The survey scores for the elderly inpatients were as follows: 57.6% 'Needed much and total help' with ADL, followed by 26.6% who 'Needed much help', and 15.8% who 'needed minimal supervision' in long-term care hospitals. The ADL score was high in the following categories: women, old age, referred visit, health insurance type, not-recovered & death, transferred, corporate hospitals, small hospital size, low number of physicians per 100 beds, and high number of nursing staff per 100 beds. The inpatients with 'diseases of the nervous system', 'diseases of the circulatory system' and 'diseases of the genitourinary system' were more likely to have high ADL scores. Conclusions : The results of this study suggest that long-term care hospitals should provide active and proper care for patients with high ADL scores and improve medical personnel training as well provide more medical care.

• Research in Community and Public Health Nursing
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• v.13 no.3
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• pp.444-455
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• 2002

Purpose: This study was performed to develop the case management program that can provide the qualitative health care service to satisfy the increasing needs for health care elderly and prevent the increase in medical cost cased by prolonged and repetitive hospitalization. Method: The survey was completed as follows. First, 290 elderly patients who would be soon discharged in 4 hospitals are participated in the survey on needs of nursing care and case management programs. Second, 70 professionals working at 5 hospitals including doctors, nurses, social workers and so on are participated in the survey on the case management team operation. Result: Level of needs to Nursing care and case management programs showed so high. Professionals suggested on the case management team operation. Finally, based on the survey and literature review, the case management program was developed. Conclusion: In this study, the specific models for the five case management services were suggested. It is thought that the service provision by the case management team based on the multi-disciplinary case management program model suggested in this study would be suggested as a constituent of the effective health care delivery system for the hospitalized elderly patients.