• Journal of Preventive Medicine and Public Health
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• 제48권4호
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• pp.195-202
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• 2015

Objectives: Receiving proper dental care plays a significant role in maintaining good oral health. We investigated the relationship between regional deprivation and dental care utilization. Methods: Multilevel logistic regression was used to identify the relationship between the regional deprivation level and dental care utilization purpose, adjusting for individual-level variables, in adults aged 19+ in the 2008 Korean Community Health Survey (n=220 258). Results: Among Korean adults, 12.8% used dental care to undergo examination and 21.0% visited a dentist for other reasons. In the final model, regional deprivation level was associated with significant variations in dental care utilization for examination (p<0.001). However, this relationship was not shown with dental care utilization for other reasons in the final model. Conclusions: This study's findings suggest that policy interventions should be considered to reduce regional variations in rates of dental care utilization for examination.

• 지역사회간호학회지
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• 제12권3호
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• pp.589-599
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• 2001

The purpose of this study was to analyze the relation amongst health status, health care costs. health service utilization among the low income elderly who were 60 years of age or older, earning a half of the average Korean family income. The cross-sectional descriptive survey research we conducted used families randomly sampled nationwide. The data were collected from July 12 to August 7, 1999 and the total sample was 1.259 household members (421 households). These were the major findings. 1. As for the health status. 72.4% of respondents fell ill in the last 1 month; 54% of respondents had chronic disease. 2. As for the health care cost. the cost of hospitalization and the medical treatment were 1.069,000 won and 226.000won. respectively. 59.3% of respondents experienced a burden from the monthly health care expenses. 3. As for the health service utilization for the last 3months. 28.5% of respondents didn't utilize the health service. In addition, 22.2% of respondents gave up a medical treatment because of economic situation (88.8%). 4. The statistically significant determinants of health service utilization are old age, female, living with a spouse, unemployed state, medicare, and more days sick. 5. It is shown conclusively that equity and efficacy of the health care policy are to be considered for lower income older adult.

• 농촌의학ㆍ지역보건
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• 제19권2호
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• pp.97-106
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• 1994

In order to estimate the utilization pattern of a rural health subcenter, and to identify the recognition for it among the inhabitants in Kogsung district, a questionnaire survey was carried out for objects of 708 population. The results observed were as follows; 1. The annual utilization rate of a rural health subcenter for a basic health service unit was 27.5 per 100 persons, and annual mean visiting times was 1.43 times. 2. The most frequent disease by, annual health subcenter utilization illness was respiratory disease(26.5%), and the next was musculoskeletal disease(23.9%), gastrointestinal disease(15.9%) by order. 3. Favorite reasons for community health subcenter utilization were lower medical cost(23.4%), near distance from living place(20.7%) and lower disease severity(19.5%) by order. But disfavorite reasons for it were non effective treatment(26.2%), insufficient equipment(25.4%) and absence of specialist(17.4%) by order. 4. Insufficient items about community health subcenter utilization were restriction of treatment limit(47.1%), lower reliance(22.4%) and not punctral(21.8%) by order. 5. The results of logistic regression analysis suggested that statistically significant factors in health subcenter utilization were age, educational level and the nearest medical facility class. 6. There was no difference between recognition for a community health subcenter's work and actual utilizing service, and desirable works for it were disease preventing service, disease control of elderly and sanitation control by order. These results suggested that to increase the utilization of rural health subcenter and to promote the accessibility of rural residents to primary health care, there must be considered public relation about health subcenter, expansion of health equipment and recognition about access time.

• 농촌의학ㆍ지역보건
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• 제21권2호
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• pp.243-251
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• 1996

Authors surveyed the inhabitants in Ulnung Island to assess the patterns of medical utilization. One hundred eighty six population(65 male and 121 female) were surveyed with formed questionnaire from Aug. 16 to Aug. 19 in 1994. Results are as follows. 1. The prevalence rate of acute diseases was 19.3%. 2. The prevalence rate of chronic diseases was 35.0%. In classification of chronic disease, the disease of musculoscletal system was the highest(33.9%) and that of digestive system in next order. 3. The first-visit medical facility when disease developed was community health center mainly. The admission care was taken in 37.6%. The 80.0% among location of medical facility for admission care was out of island. The surgical operative care were taken in 19.9%. The 86.5% among location of medical facility for surgical operative care was out of island. 4. Among the contents of dissatisfaction for medical service within island, 'Insufficient equipment' was the highest(35.8%), and 'Insufficient traffic networks' in next order. The results of this study suggest that public health facilities and medical personnel be strengthened and emergency transfer system be secured in Ulnung Island.

• 지역사회간호학회지
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• 제25권3호
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• pp.159-169
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• 2014

Purpose: The purpose of this study was to evaluate the effectiveness of case management for patients with hypertension on their health status and medical service utilization. Methods: This study was a secondary analysis of data collected for a larger study of chronic disease management in 2008 using the National Health Insurance Corporation database. A total of 12,944 patients who received case management for hypertension were included in this analysis. The subjects of case management were classified into subgroups, namely, over-use, under-use, and non-use groups according to the amount of medical service utilization. To compare the medical service utilization, a control group was selected randomly. The data were analyzed through descriptive statistics, McNemar test, and ANOVA. Results: All the subgroups displayed significant differences in blood pressure, self-management, social support, and their characteristics of medical service utilization. The total medical expense of the under-use and non-use groups increased after case management. However, there was no decrease in the medical expense of the over-use group. Conclusion: This finding suggests that there is a need to re-examine why patients overuse medical services and to supplement specific strategies for encouraging appropriate medical service utilization, and enhancing case management efforts for the over-use group.

• 한국농촌간호학회지
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• 제4권2호
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• pp.110-119
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• 2009

Purpose: This study was done to identify Community Health Practitioner's (CHP's) perception of barriers to research utilization Method: Participants were 153 CHPs working in Chungbuk Province. Modified Barriers Scale was utilized in the research, and 4 sub-scales were nurse factor, organization factor, research factor and communication factor. Data was analyzed by using SPSS/WIN12.0. Results: Research factor showed the highest barrier score among four sub-scales, and nurse factor was the lowest. CHPs with membership in any nursing academic society showed lower scores on the four sub-scales. Those who had taken a course related to research were less likely to see the research factor or communication as barriers. Barriers to research utilization were not associated with work experience years or to demographics. Conclusion: It is highly recommended that CHPs be trained in research methods and evidence-based practice and that research articles be written more clearly.

• 한국사회복지학
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• 제56권4호
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• pp.123-147
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• 2004

본 연구에서는 노인요양보험제도의 도입을 앞두고 재가 요보호 노인 가족의 재가복지 및 재가보건서비스의 이용의향을 유형별로 알아보고, 이에 관련된 요인을 행동주의모델을 이용하여 검토함과 동시에 서비스를 이용하지 않는 이유를 분석하는 것을 목표로 하였다. 각 서비스 이용의향에 관련된 요인을 로지스틱 회귀분석을 통해 분석한 결과, 선행요인으로는 재가복지와 재가보건 서비스 모두 연령이 낮은 사람이 이용의향이 높았다. 서비스 이용촉진 및 저해요인 중에는 경제적인 여유가 있거나 부부양자가 있는 사람, 혹은 부양과 관련된 정보를 제공해 줄 사람이 있어, 물적 자원이 있거나 비공식적 지원을 받고 있는 사람이 재가복지와 재가보건 서비스에 대한 이용의향이 모두 높게 나타났다. 욕구요인에서는 예상과는 달리, 노인의 증상이 심각하거나 거동불편 정도가 심한 사람, 혹은 요보호 노인 외에도 요보호 가족이 있어 서비스에 대한 이용 욕구가 높은 집단이 오히려 이용의향이 낮게 나타났는데, 서비스의 유료화를 위해서는 경제적 자원과 같은 촉진요인을 가지고 있지 않으면 서비스에 대한 욕구(필요도)가 높아도 서비스 이용으로 연결되지 못할 위험이 있는 것으로 해석된다. 한편 서비스를 이용하지 않는 이유로는 경제적인 부담 이외에 '가족이 돌봐야 한다'. '노인이 싫어한다'와 같은 전통적인 부양의식이 차지하는 비율이 높았다. 요보호 노인의 증가로 서비스에 대한 이용 의향이 이전에 비해 높아지고 있지만, 서비스에 대한 욕구가 높음에도 불구하고 서비스 이용의향이 없는 사람이 적지 않았다. 본 연구를 통해 재가복지 서비스에 대한 이용의향과 재가보건 서비스에 대한 이용의향을 나타낸 집단의 특성이 유사한 것이 확인되었고, 향후 클라이언트 위주의 서비스 제공을 위해서는 보건복지 서비스의 연계를 통한 서비스 제공의 필요성이 재확인되었다.

• 한국사회복지학
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• 제53권
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• pp.105-128
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• 2003

본 연구는 65세 이상 노인을 모시고 있는 가족부양자를 대상으로 재가복지서비스에 대한 이용의사와 이에 영향을 미치는 요인을 분석함으로써 향후 노인부양의 사회적 지원방안을 보다 효과적으로 마련하는데 연구의 목적이 있다. 서비스 이용의사에 영향을 미치는 요인을 선행요인, 가능태 요인, 욕구요인으로 구분하여 이용행위를 분석한 Anderson-Newman 모델을 기반으로, 총 230명의 가족부양자가 분석에 포함되었다. SAS 6.12를 이용하여 빈도분석, 교차분석과 함께, 서비스 이용의사에 있어 다양성이 포함될 수 있도록 다중명목 로지스틱 분석(Multinominal logistic analysis)을 실시하였다. 연구결과, 재가복지서비스를 이용하겠다는 의향은 85.9%로 나타났으며 시설보호서비스도 비슷한 수준인 86.9%이었다. 그러나 재가복지서비스는 무료 또는 유료라도 사용하겠다는 의사가 각각 50%씩 나타난 반면, 시설보호서비스는 유료라도 사용하겠다는 의사가 91.1%로 상대적으로 높게 나타났다. 또한 장기요양 발생시 대처방안에 있어서도 가족이 전담하기보다는 장기요양보험제도나 사회적 고용지원제도와 연결시키려는 욕구가 높았다. 재가복지서비스 이용의사에 영양을 미치는 요인을 분석해보면, 서비스를 이용할 의사여부는 연령, 부양자와 노인간의 우애관계, 노인부양 가치관과 같은 선행요인(predisposing factors)이나, 노인부양의 경제적 혹은 심리적 부담, 가족내 추가로 돌봐야 할 가족원 유무 등과 같은 서비스 이용의 직접적인 욕구와 연결된 요인(need factors)들이 주요한 영향력을 보이고 있다. 반면 서비스를 이용하겠다는 사람들 중 무료 옥은 유료 이용의사를 주요하게 구분하는 것은 가능태 요인(enabling factors)으로, 소득수준이 높을수록, 주부양자를 대체할 부부양자가 없을수록 유료라도 사용하겠다는 의향이 높은 것으로 나타났다. 이와 같은 연구결과에 기초하여 향후 노인부양을 위한 사회적 서비스의 지원 방향성과 대책이 제시되었다.

• 대한간호학회지
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• 제42권7호
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• pp.928-935
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• 2012

Purpose: The current study was done to identify individual- and group-level factors associated with health care service utilization among Korean medical aid beneficiaries by applying multilevel modeling. Methods: Secondary data analysis was performed using data on health care service reimbursement and medical aid case management progress from 15,948 beneficiaries, and data from 229 regions were included in the analysis. Results: Results of multilevel analysis showed an estimated intraclass correlation coefficient (ICC) of 18.1%, indicating that the group level accounted for 18.1% of the total variance in health care service utilization, and that beneficiaries within the region are more likely to share common features with regard to health care service utilization. At the individual level, existence of disability and types of medical aid beneficiaries showed a significant association, while, at the group level, social deprivation index, and the number of beneficiaries and case managers within the region showed a significant association with health care service utilization. Conclusion: The significant influence of group level variables in health care service utilization found in this study indicate a need for group level approaches, such as policy change and/or promotion of community awareness.

• Journal of Preventive Medicine and Public Health
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• 제21권2호
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• pp.419-430
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• 1988

This study was performed in a rural community, Kanghwa county which was introduced to a regional medical insurance pilot program in 1982. The purposes of this study were, firstly, to observe the changes in ambulatory care utilization in the three years 1982, 1983 and 1987 : secondly, to analyse factors which convert perceived medical care needs to effective medical care demand. During the three periods, a serial interview survey was performed to determine the changes in medical utilization before and after the regional medical insurance program implementation. The number of subjects was 3,356 persons in the year 1982, 3,705 in 1983 and 2,745 in 1987. The results of the study were as follows : 1. Total ambulatory care utilization rates per 100 persons during a 2-week period were 23.6 in the year 1982, 21.8 in 1983, and 29.3 in 1987; and physician visit rates were 6.1 in 1982, 11.7 in 1983, and 14.9 in 1987. Thus, compared to the total utilization rate there was a definite increase in physician visit, and during the study periods there was a decrease in drug store visits whereas an increase in hospital or clinic visits was noticed. 2. The rates of effective demand for medical care need were 70.7% in 1982, 70.5% in 1983 and 75.9% in 1987 : and the rates of patients who visited physicians were 20.2% in 1982, 42.8% in 1983 and 35.6% in 1987. Thus, physician visits increased sharply by introducing the medical insurance program, but after the latent medical care demands were fulfilled, there was a slight decrease in the physician visits. 3. The number of acute symptoms and the number of chronic symptoms were common determinants of total ambulatory care utilization and physician visits. Besides the medical care need factors, age in 1982, sex and accessibility in 1983, and accessibility in 1987 were statistically significant determinants of the total utilization ; sex and accessibility in 1983, and education in 1987 were also statistically significant determinants of the physician visit. 4. For persons with perceived acute symptoms during the 2-week periods, accessibility in total utilization and age in physician visits were common discriminating factors of ambulatory care utilization in the three years, and education and income were also statistically significant variables. For persons with perceived chronic symptoms, occupation and income were statistically significant discriminating variables commonly observed in total utilization and physician visits.