• Journal of Home Health Care Nursing
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• v.26 no.3
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• pp.253-264
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• 2019

The aim of this review is to present a German system of an outpatient care center under the German Health Insurance Act and home care (integration of medical care, basic care, bathing) under the Long-Term Care Insurance Act. This idea of a German integrated home care system should contribute to the development of a Korean home care model. Prior the introduction of long-term care insurance (1995), and with the of the health insurance law (1989), German outpatient care centers already provided medical and basic care services for patients with acute and chronic symptoms. Since 1995, patients with acute symptoms and rehabilitation periods under the Health Insurance Act have been eligible for home care. The Long-Term Care Insurance Act is intended for all citizens who are unable to carry out their daily activities for more than six months. In 2017, 13,657 (97%) of 14,050 outpatient care centers provided home care services after long-term care and health insurance. In other words, patients in Germany can use home care in both the acute and chronic phase at the same home care center, or 'integrated home-care center'.

• Journal of Preventive Medicine and Public Health
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• v.46 no.3
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• pp.127-133
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• 2013

This study investigated the German experience in the transition to a unified health care system and suggests the following implications for Korea. First, Germany could have made use of the unification process better if there had been a good road map. Therefore Korea must develop a well prepared road map that considers all possible situations. Second, Germany saw an opportunity for the improvement of the health care system in the early stage of unification but could not take advantage of it because the situation changed dramatically and they had not sufficiently prepared for it. Korea should take into account the opportunity for improvement of the present health care system, such as the roles of public health and traditional medicine. Thirdly, the conditions f North Korea seem to be far worse than those of former East Germany and also worse than even those of other transition countries. Therefore Korea should design a long-term road map taking as many variables into account as possible, including the different rigid way of thinking and the interrelationship among the social sectors. Fourthly, during the German reunification unexpected factors changed the direction of the events. Korea should have a separate plan for the unexpected factors.

• Journal of Home Health Care Nursing
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• v.23 no.2
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• pp.243-252
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• 2016

Purpose: This study aims to classify multiple forms of home care services from a service user's perspective. By comparing the German system to the Korean one, this study seeks to find better ways of enhancing client-centered care. Methods: The data of 121 home care users were collected from six home care centers that had under the management of nursing managers for more than five years. The researcher used a German instrument to estimate the level of care. Results: High correlation was found between German and Korean assessment criteria (r=0.81, p<.001). However, compared to their German counterparts, Korean home care providers allocated more time towards provision of domestic help per daily visit. German home care providers allocated more time towards services relating to provision of support for physical activities, including personal hygiene. It was confirmed that the level of care in Korea does not correlate with either the categories of home care services and duration. Conclusion: Therefore, care services should be offered according to long-term care needs. This study suggests a need for systematic care aimed at strengthening the client's autonomy which should be properly planned, implemented, and managed.

• Safety and Health at Work
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• v.9 no.2
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• pp.140-143
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• 2018

Background: The Occupational Safety and Health Monitoring and Assessment Tool (OSH-MAT) is a practical instrument that is currently used in the German woodworking and metalworking industries to monitor safety conditions at workplaces. The 12-item scoring system has three subscales rating technical, organizational, and personnel-related conditions in a company. Each item has a rating value ranging from 1 to 9, with higher values indicating higher standard of safety conditions. Methods: The reliability of this instrument was evaluated in a cross-sectional survey among 128 companies and its validity among 30,514 companies. The inter-rater reliability of the instrument was examined independently and simultaneously by two well-trained safety engineers. Agreement between the double ratings was quantified by the intraclass correlation coefficient and absolute agreement of the rating values. The content validity of the OSH-MAT was evaluated by quantifying the association between OSH-MAT values and 5-year average injury rates by Poisson regression analysis adjusted for the size of the companies and industrial sectors. The construct validity of OSH-MAT was examined by principle component factor analysis. Results: Our analysis indicated good to very good inter-rater reliability (intraclass correlation coefficient = 0.64-0.74) of OSH-MAT values with an absolute agreement of between 72% and 81%. Factor analysis identified three component subscales that met exactly the structure theory of this instrument. The Poisson regression analysis demonstrated a statistically significant exposure-response relationship between OSH-MAT values and the 5-year average injury rates. Conclusion: These analyses indicate that OSH-MAT is a valid and reliable instrument that can be used effectively to monitor safety conditions at workplaces.

• Development and Reproduction
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• v.25 no.2
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• pp.113-121
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• 2021

This article aims to introduce German discussion on the approval of the non-invasive prenatal diagnosis (NIPD), which started with the development of PrenaTest^® by LifeCodexx AG. The discussion started with the concern that the non-invasive nature of NIPD, such as PrenaTest^®, may rapidly expand the use and scope of similar tests, thus leading to a new era of eugenics. Based on this concern, the need for clear clinical guidelines on specific indications for NIPD has been suggested. Along the same line, it was discussed whether PrenaTest^® is against the Basic Law prohibiting discrimination on grounds of disability and whether the test is outside the scope of the purpose of gene testing limited by Genetic Diagnosis Act. Through such discussion, the Federal Ministry of Health of Germany established the preconditions for inclusion of NIPD in the German public health insurance system. For this, the German motherhood guideline was amended and the information for the insured persons provided to pregnant women was included in the amended guideline. Such discussion made in Germany provides insight on which points should be considered when various gene testings are accepted in Korea, in which genetic communication has not been systematized yet. In particular, German counseling system for pregnant women will provide valuable insights for Korea where the direction for regulations on abortion has not been established even after the ruling by the Constitutional Court that charges for abortion are against the constitution.

• Journal of Society of Preventive Korean Medicine
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• v.22 no.3
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• pp.45-60
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• 2018

Background : There have been a variety of healthcare systems related to CAM practitioners developed in each country. However, the European cases have not been widely introduced in Korea so far. In the case of Germany, CAM practices have been developed in the frame of "Heilpraktiker" system. Objectives : The objectives of this study were to review the historical development and current situation of German Heilpraktiker system and its conflicting relationship with Western medical doctors, in order to utilize it as basic data for the conflict resolution between Western- and KM doctors in Korea. Methods : The historical development, current regulations and education system of Heilpraktiker were assessed. Research articles, reports, government publications and websites dealing with this issue were searched for and analyzed. Results : Heilpraktiker system was developed within German historical and cultural situation where naturopathic traditions were reilluminated in connection with modernization process of the state under the influence of romanticism formulating German nationalism. Between the concept of "Kurierverbot"(prohibition on medical treatment by non-physicians) and "Kurierfreiheit"(freedom of medical treatment), Heilpraktiker achieved a limited but legitimated right to conduct non-biomedical treatments from the state in the process of the formulation of modern German medical system. In this process, the conflicts between medical doctors and heilpraktikers have been also growing up to now. Conclusions : Heilpraktiker system, officially recognized with the legislation of Heilpraktiker law in 1939, stands at a crossroads between the continual development through strengthening its professionality, and abolition of the system due to its lack of quality control and medical evidence mostly argued by Western medical doctors, which has considerable implications for Korean situations in terms of the conflicting relationship between KM- and Western medical doctors. In this regard, it is necessary to discuss the debates on the concept "Kurierfreiheit"(freedom of medical treatment) developed within German tradition of medical pluralism.

• Journal of Society of Preventive Korean Medicine
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• v.23 no.3
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• pp.109-119
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• 2019

Background : Germany is the first country in the world to introduce modern systems of public health insurance, and the country which most widely uses complementary alternative medicine(CAM) in Europe. In early 21^st century, a large evaluation studies were conducted to include acupuncture in health insurance payments, which were eventually decided. Objectives : This study is to investigate and analyze the process of public policy determination on insurance coverage for acupuncture in German health insurance system. Methods : We collected the data and information through the literature search and from the websites of German government departments and health insurance organizations. To obtain contextual information, German experts of health insurance and acupuncture clinical study were interviewed. Results : As use of acupuncture had been growing, German public health insurers wanted to evaluate the validity of acupuncture coverage and sponsored three evaluation projects for clinical effectiveness of acupuncture using randomized clinical trials, systematic reviews, and pragmatic trials from 2001 to 2005. For some pain condition, acupuncture was founded not to be effective than sham acupuncture, but more effective than standard care. The federal joint committee of health insurance decided to cover acupuncture for chronic pain of lumbar spine and chronic pain in at least one knee joint due to gonarthrosis. Conclusions : Considering the controversial subject matter in the process of acupuncture's health insurance coverage in Germany, expanding the benefits of Korean medicine in Korea needs to come up with ways to overcome the difficulties of placebo effect, standardization and lack of literature evidence.

• Journal of the Korean Society of Safety
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• v.28 no.1
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• pp.151-157
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• 2013

This paper is a comparative study on risk assessment policy between Asian countries such as Japan, Korea, Singapore and EU countries, German, UK. Risk assessment is a tool adopted currently in many countries in order to reduce occupational risk in workplace because it help employers to identify their hazard arousing in their working conditions then to settle the issues. This paper compares institutional framework posed in EU and Asian countries. As a result of comparative study, EU countries have more concrete legal system for risk assessment than Asian countries. But Asian countries are now interested in risk assessment such as Japan, Korea and Singapore. The author also suggests successful ways to settle down the risk assessment policy in a country. These findings help to understand occupational health and safety policy on risk assessment in Asian countries.

• The Korean Society of Law and Medicine
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• v.21 no.2
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• pp.3-33
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• 2020

Until recently the German and the South Korean medical associations reacted cautiously to the introduction of telemedicine between doctor and patient which is exclusively on the platform conducted. But the General Assembly of German Physicians voted to lift the ban on remote treatment with the amendment to Section 7 (4) MBO-Ä(Medical Association's Professional Code of Conduct) in 2018 and the situation has been fundamentally changed in Germany. From then until now 16 of 17 rural medical associations have changed their professional code to allow telemedicine. In addition the legislature started to prepare the basis for the introduction of the electronic health card (eGK) and the telematics infrastructure. So far, various laws such as Medicinal Products Act, Drug Advertisement Act and Social Code have been changed to support legalization of telemedicine and digitalization of health care. Unlike in Germany, the social circumstances such as excessive centralization of the big hospitals in Seoul and the resulting concern of small medical practices for profitability are the main obstacles to the introduction of telemedicine. However the German approach how to legalise the telemedicine and to prepare for legal and technical infrastructure is also interesting in South Korea. The discussions for and against the changes in the law and the telematics infrastructure attempted by the German government for several years indicate that not only lifting the ban on remote treatment, but also harmonization of all the related legal system could guarantee successful implementation of telemedicine.

• Safety and Health at Work
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• v.6 no.3
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• pp.206-210
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• 2015

Background: Fatigue has a strong impact on workers' performance and safety, but expedient methods for assessing fatigue on the job are not yet available. Studies discuss posturography as an indicator of fatigue, but further evidence for its use in the workplace is needed. The purpose of the study is to examine whether posturography is a suitable indicator of fatigue in clerical workers. Methods: Thirty-six employees (${\emptyset}$ 34.8 years, standard deviation = 12.5) participated in postural tasks (eyes open, eyes closed, arm swinging, and dual task) in the morning and afternoon. Position of their center of pressure (COP) was registered using a Nintendo Wii Balance Board and commercial software. From registered COP time series, we calculated the following parameters: path length (mm), velocity (mm/s), anterior-posterior variance (mm), mediolateral variance (mm), and confidence area ($mm^2$). These parameters were reduced to two orthogonal factors in a factor analysis with varimax rotation. Results: Statistical analysis of the first factor (path length and velocity) showed a significant effect of time of day: COP moved along a shorter path at a lower velocity in the afternoon compared with that in the morning. There also was a significant effect of task, but no significant interaction. Conclusion: Data suggest that postural stability of clerical workers was comparable in the morning and afternoon, but COP movement was greater in the morning. Within the framework of dynamic systems theory, this could indicate that the postural system explored the state space in more detail, and thus was more ready to respond to unexpected perturbations in the morning.