• Title/Summary/Keyword: Economic Design

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A Conceptual Review of the Transaction Costs within a Distribution Channel (유통경로내의 거래비용에 대한 개념적 고찰)

  • Kwon, Young-Sik;Mun, Jang-Sil
    • Journal of Distribution Science
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    • v.10 no.2
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    • pp.29-41
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    • 2012
  • This paper undertakes a conceptual review of transaction cost to broaden the understanding of the transaction cost analysis (TCA) approach. More than 40 years have passed since Coase's fundamental insight that transaction, coordination, and contracting costs must be considered explicitly in explaining the extent of vertical integration. Coase (1937) forced economists to identify previously neglected constraints on the trading process to foster efficient intrafirm, rather than interfirm, transactions. The transaction cost approach to economic organization study regards transactions as the basic units of analysis and holds that understanding transaction cost economy is central to organizational study. The approach applies to determining efficient boundaries, as between firms and markets, and to internal transaction organization, including employment relations design. TCA, developed principally by Oliver Williamson (1975,1979,1981a) blends institutional economics, organizational theory, and contract law. Further progress in transaction costs research awaits the identification of critical dimensions in which transaction costs differ and an examination of the economizing properties of alternative institutional modes for organizing transactions. The crucial investment distinction is: To what degree are transaction-specific (non-marketable) expenses incurred? Unspecialized items pose few hazards, since buyers can turn toalternative sources, and suppliers can sell output intended for one order to other buyers. Non-marketability problems arise when specific parties' identities have important cost-bearing consequences. Transactions of this kind are labeled idiosyncratic. The summarized results of the review are as follows. First, firms' distribution decisions often prompt examination of the make-or-buy question: Should a marketing activity be performed within the organization by company employees or contracted to an external agent? Second, manufacturers introducing an industrial product to a foreign market face a difficult decision. Should the product be marketed primarily by captive agents (the company sales force and distribution division) or independent intermediaries (outside sales agents and distribution)? Third, the authors develop a theoretical extension to the basic transaction cost model by combining insights from various theories with the TCA approach. Fourth, other such extensions are likely required for the general model to be applied to different channel situations. It is naive to assume the basic model appliesacross markedly different channel contexts without modifications and extensions. Although this study contributes to scholastic research, it is limited by several factors. First, the theoretical perspective of TCA has attracted considerable recent interest in the area of marketing channels. The analysis aims to match the properties of efficient governance structures with the attributes of the transaction. Second, empirical evidence about TCA's basic propositions is sketchy. Apart from Anderson's (1985) study of the vertical integration of the selling function and John's (1984) study of opportunism by franchised dealers, virtually no marketing studies involving the constructs implicated in the analysis have been reported. We hope, therefore, that further research will clarify distinctions between the different aspects of specific assets. Another important line of future research is the integration of efficiency-oriented TCA with organizational approaches that emphasize specific assets' conceptual definition and industry structure. Finally, research of transaction costs, uncertainty, opportunism, and switching costs is critical to future study.

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Development and application of prediction model of hyperlipidemia using SVM and meta-learning algorithm (SVM과 meta-learning algorithm을 이용한 고지혈증 유병 예측모형 개발과 활용)

  • Lee, Seulki;Shin, Taeksoo
    • Journal of Intelligence and Information Systems
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    • v.24 no.2
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    • pp.111-124
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    • 2018
  • This study aims to develop a classification model for predicting the occurrence of hyperlipidemia, one of the chronic diseases. Prior studies applying data mining techniques for predicting disease can be classified into a model design study for predicting cardiovascular disease and a study comparing disease prediction research results. In the case of foreign literatures, studies predicting cardiovascular disease were predominant in predicting disease using data mining techniques. Although domestic studies were not much different from those of foreign countries, studies focusing on hypertension and diabetes were mainly conducted. Since hypertension and diabetes as well as chronic diseases, hyperlipidemia, are also of high importance, this study selected hyperlipidemia as the disease to be analyzed. We also developed a model for predicting hyperlipidemia using SVM and meta learning algorithms, which are already known to have excellent predictive power. In order to achieve the purpose of this study, we used data set from Korea Health Panel 2012. The Korean Health Panel produces basic data on the level of health expenditure, health level and health behavior, and has conducted an annual survey since 2008. In this study, 1,088 patients with hyperlipidemia were randomly selected from the hospitalized, outpatient, emergency, and chronic disease data of the Korean Health Panel in 2012, and 1,088 nonpatients were also randomly extracted. A total of 2,176 people were selected for the study. Three methods were used to select input variables for predicting hyperlipidemia. First, stepwise method was performed using logistic regression. Among the 17 variables, the categorical variables(except for length of smoking) are expressed as dummy variables, which are assumed to be separate variables on the basis of the reference group, and these variables were analyzed. Six variables (age, BMI, education level, marital status, smoking status, gender) excluding income level and smoking period were selected based on significance level 0.1. Second, C4.5 as a decision tree algorithm is used. The significant input variables were age, smoking status, and education level. Finally, C4.5 as a decision tree algorithm is used. In SVM, the input variables selected by genetic algorithms consisted of 6 variables such as age, marital status, education level, economic activity, smoking period, and physical activity status, and the input variables selected by genetic algorithms in artificial neural network consist of 3 variables such as age, marital status, and education level. Based on the selected parameters, we compared SVM, meta learning algorithm and other prediction models for hyperlipidemia patients, and compared the classification performances using TP rate and precision. The main results of the analysis are as follows. First, the accuracy of the SVM was 88.4% and the accuracy of the artificial neural network was 86.7%. Second, the accuracy of classification models using the selected input variables through stepwise method was slightly higher than that of classification models using the whole variables. Third, the precision of artificial neural network was higher than that of SVM when only three variables as input variables were selected by decision trees. As a result of classification models based on the input variables selected through the genetic algorithm, classification accuracy of SVM was 88.5% and that of artificial neural network was 87.9%. Finally, this study indicated that stacking as the meta learning algorithm proposed in this study, has the best performance when it uses the predicted outputs of SVM and MLP as input variables of SVM, which is a meta classifier. The purpose of this study was to predict hyperlipidemia, one of the representative chronic diseases. To do this, we used SVM and meta-learning algorithms, which is known to have high accuracy. As a result, the accuracy of classification of hyperlipidemia in the stacking as a meta learner was higher than other meta-learning algorithms. However, the predictive performance of the meta-learning algorithm proposed in this study is the same as that of SVM with the best performance (88.6%) among the single models. The limitations of this study are as follows. First, various variable selection methods were tried, but most variables used in the study were categorical dummy variables. In the case with a large number of categorical variables, the results may be different if continuous variables are used because the model can be better suited to categorical variables such as decision trees than general models such as neural networks. Despite these limitations, this study has significance in predicting hyperlipidemia with hybrid models such as met learning algorithms which have not been studied previously. It can be said that the result of improving the model accuracy by applying various variable selection techniques is meaningful. In addition, it is expected that our proposed model will be effective for the prevention and management of hyperlipidemia.

A Study on Modern People's Consciousness and Wearing Practice of Korean Costumes (우리나라 옷에 대한 현대인(現代人)의 의식(意識)과 춘용실태(春用實態)에 관(關)한 연구(硏究) - 서울 지역(地域)을 중심(中心)으로 -)

  • Hwang, Chun-Sub
    • Journal of the Korean Society of Costume
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    • v.1
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    • pp.119-129
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    • 1977
  • It is significant for developing the future for us to know our present age. In order to preserve our Korean costume as a fola clothes retaining our distinguished independent characterisitics and to help design the tomorrow of our Korean costume playing a role as a racial to develop the world clothing culture, a survey was conducted to investigate modern people's conscious-ness and wearing practumes of Korean costume by questionaire and interviewing methods. The results of the survey were analyzed as follows: (1) At present, Korean costumes were purchased as customtailored(64.0%) and as ready-made(17.8%) and most of them were not made at individual homes. The laundry and ironing of them were carried out at laundry shops(68.8%). Considering our present economic, social and cultural aspects, sowing, laundryand ironing will not be carried out at homes again in the future and ready made costumes seen to be produced in a large scale in the future. Garment makers and laundry shop operators should be trained how to make our Korean costumes retain our traditional beauty in the course of their production and laundry and the makers of ready-made costumes must make research how to efficiently produce ideal ready-made costumes by adopting the synchro system in their wrk odisivion. (2) The age group wearing Korean costumes most frequently was the aged people over 60 (their wearing rate; 45%-50%) and the group wearing them most frequently next io the aged people over 60, was housewives(their wearing rate; 15%-20%). Excludign aged people and housewives, other respondentsdid not wear Korean costumes very frequently. Men's wearing rate was lower their wearing rate was the younger their ages were and the less their monthly incomes were. Korean costumes were used for holiday and festival(60%), wedding and funeral ceremonies (52%), visiting and working(22%), casual wear(12.8%) and home wear(9.2%). The use of Korean costumes as casual and home wears, was lower than the use for holday, festival, visiting and working, Under our present circumstances in which our Korean people use both Western style clothes and Korean costumer, our Korean costume has lostits position as a basic and necessary requiement in Korean people's daily life and become a ceremonical and fancy costume. It is natural that the times and life change everything in our daily life. Our costume has to be made as good ceremonial and fancy clothes satisfying modern sensibility according to its new role. In order for us to get close with our clothes, a keen study must be carried out to cleat the color, material, style, function and harmony of the Korean costume matching the of the times. (3) The 47.8% of the respondents answered that they were proud of our Korean costume as our folk clothes, 47.6% replied that thought them just common and 1.1% responded that they were ashamed of it. Most of them were affirmative in feeling pride with our Korean costume. (4) Considering the functional aspect of Korean costumes, their strong points were symetric beauty, rhythmical beauty, unity feeling, harmonical beauty and detailed decorations. Their common shortcomings were lack of individuality and inadequateness for active life. The shortcomings of woman costumes were suppressing breast, making resperation difficult and in adequnteness in summer time. The main reason not to wear our Korean costumes, was due to the fact that they are incomvenient for active life. As a measure to eliminate such shortcomings, 1) the suspension system of skirt to remove the suppression of breast should be generally adopted. 2) they should be simplified in their structure to make them convenient for active life and adepuate in wearing them in hot weather in an extent to which the traditional beauty of the costume may not be lostand 3) a new technique must be explored for showing individuality by wearing method and new arrangment of colors and decorations. (5) The reasons desiring to wear Korean costumes were classifide as follows: A. Korean costumes are our traditional clothes(43.4%). B. Korean costumes are noble and beautiful(26.8%). C. They are accustomed to wear Korean costumes by habit(19.5%). D. Korean costumes are necessary for attending ceremoneis(9.5%). E. Miscellaneous reasons(0.8%). Classifying these reasons into age groups, the high age group over 40 wore them because they were easy to wear by habit and the low age group of 10-30 never thought that they were east to wear by habit. Considering that even those who were accustomed to wear Korean costumes showed a low wearing rate and that the young generation were accustomed to wear Western style clothes rather than Korean costumes, the wearing rate of Korean costumes will be reduced in the future if such trend continues. It is urgent for us to make our best efforts in order to enhance the interest of young generation in Korean costumes and not to make them lose the strong points of Korean costume in the future. (6) Conicering the plan of the respondents on what kind of clothes they were going to wear in the future, among the age group over 50, those who wanted to wear only Korean costumes were 24.8%(men) and 35.1%(women), those who wanted to wear 49.7%(men) and 47.4(women), those who wanted to wear chiefly Western style clothes were 20.7% (men) and 14.4%(women) and those who wanted to wear only Western style clothes, were 2.4% (men) and 2.1%(women). This shows that the general tendency to wear only or chiefly Korean costumes is more prevalent than that to wear only Western style. Among the age group under 50, the tendency to wear Western style clothes was conspicuous and most of the respondent answered that they would wear chiefly Western style clothes and Korean costumes occasionally. Only 5.4% of the respondent answered that they would wear only Western style clothes and this shows that meny respondents still wonted to wear Korean costumes. Those who wanted their descendants to wear what they desire, were 50.1%(men) and 68.8% (women) and those who wanted their descendants to wear Koran costumes occasionally, were 85.8%(men) and 86.3%(women). This shows that most of respondents wanted their descendants to wear Korean costumes. In order to realize, it is necessory for us to make ourdescendants recognize the preciousness of our traditional culture and modify our Korean costumes according to their taste so that they may like wearing them.

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Analyzing the User Intention of Booth Recommender System in Smart Exhibition Environment (스마트 전시환경에서 부스 추천시스템의 사용자 의도에 관한 조사연구)

  • Choi, Jae Ho;Xiang, Jun-Yong;Moon, Hyun Sil;Choi, Il Young;Kim, Jae Kyeong
    • Journal of Intelligence and Information Systems
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    • v.18 no.3
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    • pp.153-169
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    • 2012
  • Exhibitions have played a key role of effective marketing activity which directly informs services and products to current and potential customers. Through participating in exhibitions, exhibitors have got the opportunity to make face-to-face contact so that they can secure the market share and improve their corporate images. According to this economic importance of exhibitions, show organizers try to adopt a new IT technology for improving their performance, and researchers have also studied services which can improve the satisfaction of visitors through analyzing visit patterns of visitors. Especially, as smart technologies make them monitor activities of visitors in real-time, they have considered booth recommender systems which infer preference of visitors and recommender proper service to them like on-line environment. However, while there are many studies which can improve their performance in the side of new technological development, they have not considered the choice factor of visitors for booth recommender systems. That is, studies for factors which can influence the development direction and effective diffusion of these systems are insufficient. Most of prior studies for the acceptance of new technologies and the continuous intention of use have adopted Technology Acceptance Model (TAM) and Extended Technology Acceptance Model (ETAM). Booth recommender systems may not be new technology because they are similar with commercial recommender systems such as book recommender systems, in the smart exhibition environment, they can be considered new technology. However, for considering the smart exhibition environment beyond TAM, measurements for the intention of reuse should focus on how booth recommender systems can provide correct information to visitors. In this study, through literature reviews, we draw factors which can influence the satisfaction and reuse intention of visitors for booth recommender systems, and design a model to forecast adaptation of visitors for booth recommendation in the exhibition environment. For these purposes, we conduct a survey for visitors who attended DMC Culture Open in November 2011 and experienced booth recommender systems using own smart phone, and examine hypothesis by regression analysis. As a result, factors which can influence the satisfaction of visitors for booth recommender systems are the effectiveness, perceived ease of use, argument quality, serendipity, and so on. Moreover, the satisfaction for booth recommender systems has a positive relationship with the development of reuse intention. For these results, we have some insights for booth recommender systems in the smart exhibition environment. First, this study gives shape to important factors which are considered when they establish strategies which induce visitors to consistently use booth recommender systems. Recently, although show organizers try to improve their performances using new IT technologies, their visitors have not felt the satisfaction from these efforts. At this point, this study can help them to provide services which can improve the satisfaction of visitors and make them last relationship with visitors. On the other hands, this study suggests that they managers along the using time of booth recommender systems. For example, in the early stage of the adoption, they should focus on the argument quality, perceived ease of use, and serendipity, so that improve the acceptance of booth recommender systems. After these stages, they should bridge the differences between expectation and perception for booth recommender systems, and lead continuous uses of visitors. However, this study has some limitations. We only use four factors which can influence the satisfaction of visitors. Therefore, we should development our model to consider important additional factors. And the exhibition in our experiments has small number of booths so that visitors may not need to booth recommender systems. In the future study, we will conduct experiments in the exhibition environment which has a larger scale.

An Ontology Model for Public Service Export Platform (공공 서비스 수출 플랫폼을 위한 온톨로지 모형)

  • Lee, Gang-Won;Park, Sei-Kwon;Ryu, Seung-Wan;Shin, Dong-Cheon
    • Journal of Intelligence and Information Systems
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    • v.20 no.1
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    • pp.149-161
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    • 2014
  • The export of domestic public services to overseas markets contains many potential obstacles, stemming from different export procedures, the target services, and socio-economic environments. In order to alleviate these problems, the business incubation platform as an open business ecosystem can be a powerful instrument to support the decisions taken by participants and stakeholders. In this paper, we propose an ontology model and its implementation processes for the business incubation platform with an open and pervasive architecture to support public service exports. For the conceptual model of platform ontology, export case studies are used for requirements analysis. The conceptual model shows the basic structure, with vocabulary and its meaning, the relationship between ontologies, and key attributes. For the implementation and test of the ontology model, the logical structure is edited using Prot$\acute{e}$g$\acute{e}$ editor. The core engine of the business incubation platform is the simulator module, where the various contexts of export businesses should be captured, defined, and shared with other modules through ontologies. It is well-known that an ontology, with which concepts and their relationships are represented using a shared vocabulary, is an efficient and effective tool for organizing meta-information to develop structural frameworks in a particular domain. The proposed model consists of five ontologies derived from a requirements survey of major stakeholders and their operational scenarios: service, requirements, environment, enterprise, and county. The service ontology contains several components that can find and categorize public services through a case analysis of the public service export. Key attributes of the service ontology are composed of categories including objective, requirements, activity, and service. The objective category, which has sub-attributes including operational body (organization) and user, acts as a reference to search and classify public services. The requirements category relates to the functional needs at a particular phase of system (service) design or operation. Sub-attributes of requirements are user, application, platform, architecture, and social overhead. The activity category represents business processes during the operation and maintenance phase. The activity category also has sub-attributes including facility, software, and project unit. The service category, with sub-attributes such as target, time, and place, acts as a reference to sort and classify the public services. The requirements ontology is derived from the basic and common components of public services and target countries. The key attributes of the requirements ontology are business, technology, and constraints. Business requirements represent the needs of processes and activities for public service export; technology represents the technological requirements for the operation of public services; and constraints represent the business law, regulations, or cultural characteristics of the target country. The environment ontology is derived from case studies of target countries for public service operation. Key attributes of the environment ontology are user, requirements, and activity. A user includes stakeholders in public services, from citizens to operators and managers; the requirements attribute represents the managerial and physical needs during operation; the activity attribute represents business processes in detail. The enterprise ontology is introduced from a previous study, and its attributes are activity, organization, strategy, marketing, and time. The country ontology is derived from the demographic and geopolitical analysis of the target country, and its key attributes are economy, social infrastructure, law, regulation, customs, population, location, and development strategies. The priority list for target services for a certain country and/or the priority list for target countries for a certain public services are generated by a matching algorithm. These lists are used as input seeds to simulate the consortium partners, and government's policies and programs. In the simulation, the environmental differences between Korea and the target country can be customized through a gap analysis and work-flow optimization process. When the process gap between Korea and the target country is too large for a single corporation to cover, a consortium is considered an alternative choice, and various alternatives are derived from the capability index of enterprises. For financial packages, a mix of various foreign aid funds can be simulated during this stage. It is expected that the proposed ontology model and the business incubation platform can be used by various participants in the public service export market. It could be especially beneficial to small and medium businesses that have relatively fewer resources and experience with public service export. We also expect that the open and pervasive service architecture in a digital business ecosystem will help stakeholders find new opportunities through information sharing and collaboration on business processes.

'Yongyudam of Hamyang', the Significance and Value as a Traditional Scenic Place ('함양 용유담(咸陽 龍遊潭)', 전래명승으로서의 의의와 가치 구명)

  • Rho, Jae-hyun
    • Korean Journal of Heritage: History & Science
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    • v.47 no.1
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    • pp.82-101
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    • 2014
  • The purpose of this study was to survey and analyze the origin story and the legends associated with Yongyudam(龍遊潭, Dragon Creek), its scenic and spatial description in Climbing Writings(遊山記: Yusangi Notes), its geographical and geological features, its surrounding remains and letters chiseled on the rocks through the field study and the study on literatures associated with it so to identify its significance and value and then to ensure justification on preservation of Yongyudam scenic site. Conclusions of this study are as follow. As the traditional scenic place 'Geumdae-Jiri(金臺智異)' representing Hamyang-gun(咸陽郡) depicts Mount Cheonwangbong and 'Yongyudong Village(龍遊洞)', ancient maps and literatures have positioned Yongyudam as the center of Eomcheon-river Creek as well as the representing scenic site of Yongyudong Village. Core images in the spatial awareness of Yongyudam described in our ancestors' Climbing Writings Notes on Jirisan Mount are 'geographical and scenic peculiarity associated with swimming dragons', 'potholes in various shapes and sizes scattered on rocks', 'loud sound generated by swirling from shoals' and 'the scenic metaphor from the dragon legend', which have led scenic features of Yongyudam scenic site. In addition, significant scenic metaphors from legends such as 'Nine Dragons and Ascetic Majeog' and 'Kasaya Fish' as well as 'the Holy Place of Dragon God', the rain calling magic god have descended not only as the very nature of Yongyudam scenic site but also the catalyst deepening its mystic and place nature. On the other hand, Jangguso Place(杖?所, Place of Scholars) in the vicinity of Yongyudam was the place of resting and amusement for scholars from Yeongnam Province, to name a few, Kim Il-son, Cho Sik, Jung Yeo-chang and Kang Dae-su, where they experienced and recognized Jirisan Mount as the scenic living place. Letters Carved on the rocks at Jangguso Place are memorial tributes and monumental signs. Around Yongyudam, there are 3 stairs, letters chiseled on the rocks and the water rock artificially built to collect clean water, which are traditional scenic remains detectable of territoriality as the ritual place. In addition, The letters on the rock at Yongyudong-mun(龍遊洞門) discovered for the first time by this study are the sign promoting Yongyudam as the place of splendid landscape. The laconism, 'It is the Greatest Water in Jirisan Mount(方丈第一山水)' on a rock expresses the pride of Yongyudam as the representing scenic place of Mount Jirisan. Other than those, standing rocks such as Simjindae Rock, Yeong-gwidae Rock and Ganghwadae Rock show the sign that they are used as amusement and gathering places for ancestor scholars, which add significance to Yongyudam. By this study, it was possible to verify that Yongyudam in Mount Jirisan is not simply 'the scenic place in the tangible reality' but also has seamlessly inherited as the traditional scenic attraction spiritualized by overlapped historical and cultural values. Yongyudam, as the combined heritage by itself, shows that it is the product of the place nature as well as unique ensemble of cultural scenic attraction inherited through long history based on natural scenery. It is certain that not only the place value but also geographical, geological, historical and cultural values of Yongyudam are the essence of traditional scenic attraction, which should not be disparaged or damaged by whatever political or economic interests and logics.

A Study on the Seawater Filtration Characteristics of Single and Dual-filter Layer Well by Field Test (현장실증시험에 의한 단일 및 이중필터층 우물의 해수 여과 특성 연구)

  • Song, Jae-Yong;Lee, Sang-Moo;Kang, Byeong-Cheon;Lee, Geun-Chun;Jeong, Gyo-Cheol
    • The Journal of Engineering Geology
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    • v.29 no.1
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    • pp.51-68
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    • 2019
  • This study performs to evaluate adaptability of seashore filtering type seawater-intake which adapts dua1 filter well alternative for direct seawater-intake. This study varies filter condition of seashore free surface aquifer which is composed of sand layer then installs real size dual filter well and single filter well to evaluate water permeability and proper pumping amount according to filter condition. According to result of step aquifer test, it is analysed that 110.3% synergy effect of water permeability coefficient is happened compare to single filter since dual filter well has better improvement. dual filter has higher water permeability coefficient compare to same pumping amount, this means dual filter has more improved water permeability than single filter. According to analysis result of continuous aquifer test, it is evaluated that dual filter well (SD1200) has higher water permeability than single filter well (SS800) by analysis of water permeability coefficient using monitoring well and gauging well, it is also analysed dual filter has 110.7% synergy effect of water permeability coefficient. As a evaluation result of pumping amount according to analysis of water level dropping rate, it is analysed that dual filter well increased 122.8% pumping amount compare to single filter well when water level dropping is 2.0 m. As a result of calculating proper pumping amount using water level dropping rate, it is analysed that dual filter well shows 136.0% higher pumping amount compare to single filter well. It is evaluated that proper pumping amount has 122.8~160% improvement compare to single filter, pumping amount improvement rate is 139.6% compare to averaged single filter. In other words, about 40% water intake efficiency can be improved by just installation of dual filter compare to normal well. Proper pumping amount of dual filter well using inflection point is 2843.3 L/min and it is evaluated that daily seawater intake amount is about $4,100m^3/day$ (${\fallingdotseq}4094.3m^3/day$) in one hole of dual filter well. Since it is possible to intake plenty of water in one hole, higher adaptability is anticipated. In case of intaking seawater using dual filter well, no worries regarding damages on facilities caused by natural disaster such as severe weather or typhoon, improvement of pollution is anticipated due to seashore sand layer acts like filter. Therefore, It can be alternative of environmental issue for existing seawater intake technique, can save maintenance expenses related to installation fee or damages and has excellent adaptability in economic aspect. The result of this study will be utilized as a basic data of site demonstration test for adaptation of riverside filtered water of upcoming dual filter well and this study is also anticipated to present standard of well design and construction related to riverside filter and seashore filter technique.

An Intervention Study on Integration of Family Planning and Maternal/Infant Care Services in Rural Korea (가족계획과 모자보건 통합을 위한 조산원의 투입효과 분석 -서산지역의 개입연구 평가보고-)

  • Bang, Sook;Han, Seung-Hyun;Lee, Chung-Ja;Ahn, Moon-Young;Lee, In-Sook;Kim, Eun-Shil;Kim, Chong-Ho
    • Journal of Preventive Medicine and Public Health
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    • v.20 no.1 s.21
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    • pp.165-203
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    • 1987
  • This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

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