• The Korean Journal of Health Service Management
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• v.3 no.1
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• pp.14-24
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• 2009

This study aims at deriving any useful information necessary to strengthen the competitiveness for growth through empirical analyses on general hospital located in a province in order to countermeasure the opening and competition of medical markets. The characteristics of user were identified on the basis of disease groups under KCD in the research method. In addition, the analysis on the expenses of diagnosis and treatment was divided into the treatment progress and degree of hospital resource utilization And the regression was carried out to identify the impacts of characteristics of inpatient users on the degree of hospital resource utilization. As a result of major research, the inpatient users of the general hospital located in the provincial area in consideration of inpatient users were formed around the inpatient disease groups representative for Korea(diseases of the respiratory system, injury and poisoning & certain other consequences of external causes). And it was understood that most of residents within a distance of 40 minute by the public transportation were using. And mostly were under the age of 9 or over 60, and the provision of medical features such as the degree of consultation and operational functions were inadequate. When we classify inpatient treatment cost for each resource application as the medical cost being the center of patient care function, the equipment and human resource application sector are constituted over half. Accordingly, the following suggestions are made as plans to strengthen the competitiveness for the growth of general hospitals located in the provincial areas on the basis of analytical results. First, it is necessary to have the characterization matching to the age and disease groups with a high frequency. Second, it is necessary to increase the degree of hospital resource utilization according to the characterization. Third, it is necessary to concentrate on public relations. The above suggestion, as a method for securing image improvement and competitive power as a general hospital, and through expansion of social function that a regional general hospital needs to secure not only as an individual institution but also as a general hospital, it can be seen that a general improvement of image as a regional general hospital is possible.

• Journal of Preventive Medicine and Public Health
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• v.5 no.1
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• pp.57-95
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• 1972

This study was conducted to assess the effectiveness of service by maternity aids concerning maternal and child health in improving simultaneously infant mortality, contraception and vital registration among expectant mothers in rural Korea, where there is less apportunity for maternal and child health care. It is unrealistic to expect to solve this problem in rural Korea through professional persons considering the situation of medical facilities and the socioeconomic condition of residents. So, we intended to adopt a system of services by maternity aids who were educated formally among indigenous women. After the women were trained in maternal and child health, contraception, and registration for a short period, they were assigned as a maternity aids to each village to help with various activities concerning maternal and child health, for example, registration of pregnant women, home visiting to check for complications, supplying of delivery kits, attendance at delivery, persuasion of contraception, and invitation for registration and so on. Mean-while, four researchers called on the maternity aids to collect materials concerning vital events, maternal child health, contraception and registration, and to give further instruction and supervision as the program proceeded. A. Changes of women's attitude by services of maternity aid. Now, we examined to what extent' such a service system to expectant mothers affected a change in attitude of women residing in the study area as compared to women of the control area. 1) In the birth and death places, there were no changes between last and present infants, in study or control area. 2) In regard to attendants at delivery, there were no changes except for a small percentage of attendance (8%) by maternity aid in study area. But, I expect that more maternity sids could be used as attendants at delivery if they would be trained further and if there was more explanation to the residents about such a service. 3) Considering the rate of utilization of sterilized delivery kit, I am sure that more than 90 percent would be used if the delivery kit were supplied in the proper time. There were significant differences in rates between the study and the control areas. 4) Taking into consideration the utilization rate of the clinic for prenatal care and well baby care, if suck facilities were installed, it would probably be well utilized. 5) In the contraception, the rate of approval was as high as 89 percent in study area as compared to 82 percent in the control area. 6) Considering the rate of pre-and post-partum acceptance on contraception were as much as 70 percent or more, if motivation to use contraception was given to them adequately, the government could reach the goals for family planning as planned. 7) In the vital registration, the rate of birth registration in the study area was some what improved compared to that of the control area, while the rate of death registration was not changed at all. Taking into account the fact that the rate of confirmation of vital events by maternity aids was remarkably high, if the registration system changed to a 'notification' system instead of formal registration ststem, it would be improved significantly compared to present system. B. Effect of the project Thus, with changes in the residents' attitude, was there a reduction in the infant death rate? 1) It is very difficult problem to compare the mortality of infants between last and present infants, because many women don't want to answer accurately about their dead children especially the infants that died within a few days after birth. In this study the data of present death comes from the maternity aides who followed up every pregnancy they had recorded to see what had happened. They seem to have very reliable information on what happened in first few weeks with follow up visitits to check out later changes. From these calculaton, when we compared the rate of infant death between last and present infant, there was remarkable reduction of death rate for present infant compare to that of last children, namely, the former was 30, while the latter 42. The figure is the lowest rate that I have ever heard. As the quality of data we could assess by comparing the causes of death. In the current death rate by communicable disease was much lower compare to the last child especially, tetanus cases and pneumonia. 2) Next, how many respondents used contraception after birth because of frequent contact with the maternity aid. In the registered cases, the respondents showed a tendency to practice contraception at an earlier age and with a small number of children. In a comparison of the rate of contraception between the study and the control area, the rate in the former was significantly higher than that of the latter. What is more, the proportion favoring smaller numbers of children and younger women rose in the study area as compared to the control area. 3) Regarding vital registration, though the rate of registration was gradually improved by efforts of maternity aid, it would be better to change the registration system. 4) In the crude birth rate, the rate in the study area was 22.2 while in the control area was 26.5. Natural increase rate showed 15.4 in the study area, while control area was 19.1. 5) In assessment of the efficiency of the maternity aids judging by the cost-effect viewpoint, the workers in the Medium area seemed to be more efficiency than those of other areas.

• Journal of Society of Preventive Korean Medicine
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• v.4 no.2
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• pp.1-24
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• 2000

This study was conducted to examine utilization patterns and determinants of oriental medical services. Data were collected from 545 residents in Taegu city The results of this study are summarized as follows 1) 37.8% of subjects used oriental medical services in the past year. Especially, the female, the ages of 50 and 60 over, the single. low-educated. high-income class, white-collar class, medical insured tended to use more oriental medical services than another groups. 2) 46.7% of users of oriental medical services reported that number of visits in the past year was 2 - 5 times 37 1% of them was 1 times, and 4.5% over 10 times. 3) According to the reasons to choose the oriental medical facilities, most was 'on their own judgement'(48.8%) and 'by the advice of relatives and friends'(42.0%) Regarding to the objectives of using oriental medicine, 68.3% was 'treatment', 31.7% 'health counselling and promotion'. And among diseases of users, diseases of musculo-skeletal system was the highest(54.5%). 4) 57.9% of oriental medical services users had experience of utilizing western medicine on the same diseases. Among peoples with experiencing western medicine on the same diseases. 54.4% received oriental medical services 'in addition to western medicine', 45.6%'in place of western medicine 'And 41.2% of using both services reported that they had difficulty in deciding to choose the type of services -oriental medical services or western medicine-for their diseases. 37.3% of them answered that 'providing relevant information' was the most desirable measure to solve this problem, 27.3% 'establishment of effective referral system between oriental and western medical facilities '23.6% 'cooperative medical treatment systems in the same facilities', 11.8%'integration of oriental medicine into western medicine 5) According to the satisfaction level with each items of oriental medical services, the respondents had positive views on efficacy, kindness, and side-effects. They, however, had negative view on the cost of oriental medical services. 6) In regarding to the priority of improvement of oriental medical system,'expansion of insurance benefit package 'ranked first. 'expansion of insurance benefit Package 'ranked second, 'improvement of scientific methods and diagnostic technique 'third, and 'safety of herbal medicine' fourth in order. 7) The significant factors influencing the utilization of oriental medical services were kindness of oriental medical practitioners, efficacy , travel time, age To be brief, utilization rate of oriental medical services in urban area generally tends to be high. There, however, have been various barriers to limit oriental medical services, such as incomplete benefit package of oriental medical insurance and lack of coordination and referral system between oriental and western medical services, lack of scientific diagnostic procedures, high price etc . For the development of oriental medical services, Much attention to remove these limiting factors should be placed. In addition, kindness of oriental medical practitioners , which is expected to be more important factor in the consumer - focused health care environment than ever, should be kept high consistently. Since this study was conducted for specific residents of an urban city. further research including more sampling in different urban areas should be required to generalize the results of the study.

• Journal of agricultural medicine and community health
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• v.24 no.1
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• pp.35-47
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• 1999

Medication non-compliance among the elderly results in medical problems and substantial cost to the health care system. This study investigate predicted variable related to the medication task ability among elderly. This study was done in the selected 4 villages in Kimchun County of Kyungbuk Province from July to August, 1996. The subject was the resident that 202 adults above 60 years of age. The questionnaire of interview included medication task ability, socio-demographic data, COOP/WONCA chart, family ABGAR score. BDI(Beck depression inventory), ADL(activities of daily living), IADL(instrumental activities of daily living), and MMSE-K(minimental state examination-Korean version). The results were as followed : 1. Approximately 49% of study population was taking drug medication currently. We found that 93% of study population was successful at the medication task all alone, 6% was failure at the medication task all alone, so need help partly or completely. 2. Significant variables between group of medication task ability were age, educational attainment, IADL, and MMSE-K in univariate analysis. And significant correlated variables with medication task ability were ADL, IADL, MMSE-K, and BDI in correlation analysis. 3. Major predictors to medication task ability on multiple logistic regression were IADL and sex finally. Findings suggest that IADL is related to medication task ability than other test battery of health status, so IADL could be used to necessary for medication management and add information to conventional methods of assessing mental status.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.8
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• pp.162-170
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• 2017

This study analyzed the current situation of medium and small-sized hospital nursing staff and related policies, and identified the factors that affect staffing level to provide evidence for planning and adopting policy. By analyzing the statistical data published by public institutions such as the Ministry of Health and Welfare and Health Insurance Review and Assessment Service, the result was viewed based on the understanding of various internal and external health care environments. The number of active nurses was less than 50% of the number of licensed nurses and has decreased every year. This means that the cost-effectiveness of increases in nursing college enrollment should be reconsidered. Inpatient nursing fees by staffing grades has caused nurses to move from medium and small-sized hospitals, where there is a severe lack of staff, to more advanced general hospitals. As a result, the lack of nursing staff in medium and small-sized hospitals has worsened. In conclusion, reexamination is needed to improve effectiveness of inpatient nursing fees by staffing grades as a policy to secure the workforce of medium and small-sized hospitals. Furthermore, the tracking management system of licensed nurses must be able to solve the imbalance between demand and supply of nursing staff.

• Tuberculosis and Respiratory Diseases
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• v.82 no.1
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• pp.27-34
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• 2019

Background: Understanding the burden of disease is important to establish cost-effective treatment strategies and to allocate healthcare resources appropriately. However, little reliable information is available regarding the overall economic burden imposed by chronic obstructive pulmonary disease (COPD) in Korea. Methods: This study is a multicenter observational research on the COPD burden in Korea. Total COPD costs were comprised of three categories: direct medical, direct non-medical, and indirect costs. For direct medical costs, institutional investigation was performed at 13 medical facilities mainly based on the claims data. For direct non-medical and indirect costs, site-based surveys were administered to the COPD patients during routine visits. Total costs were estimated using the COPD population defined in the recent report. Results: The estimated total costs were approximately 1,245 million US dollar (1,408 billion Korean won). Direct medical costs comprised approximately 20% of the total estimated costs. Of these, formal medical costs held more than 80%. As direct non-medical costs, nursing costs made up the largest percentage (39%) of the total estimated costs. Costs for COPD-related loss of productivity formed four fifths of indirect costs, and accounted for up to 33% of the total costs. Conclusion: This study shows for the first time the direct and indirect costs of COPD in Korea. The total costs were enormous, and the costs of nursing and lost productivity comprised approximately 70% of total costs. The results provide insight for an effective allocation of healthcare resources and to inform establishment of strategies to reduce national burden of COPD.

• Health Policy and Management
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• v.4 no.1
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• pp.49-76
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• 1994

Small area variations in health care utilization have long been studied as an important issue related to boto cost containment and quality assurance. This study was conducted to investigate if variations in hospital services across small geographic areas in Korea existed. The claims data of the fiscal year 1992 obtained from the regional health insurance societies were used for the study. Main findings of the research can be summarized as follows : 1. Extremal Quotients(EQ) of hospital expenditure per capita and hospital days per capita varied among diagnosis types. The EQ ranged from 2.05(cataract) to 41.67(pneumonia) in hospital expenditure per capita and from 1.86(cataract) to 45.89(pneumonia) in hospital days per capita. The diagnosis groups which showed high variation were pneumonia, cephalo-pelvic disproportion, gastritis and duodenitis, fracture of rib, and acute bronchitis. Those which showed low variation were acute appendicitis and cataract. 2. The EQ level of admission rate was different in terms of diagnosis types, ranging from 2.57(catarct) to 44.45(pneumonia). The variations were high in medical disorders such as pneumonia, oephalo-pelvic disproportion, gastritis and duodenitis and acute bronchitis, while relatively low in surgical conditions such as acute appendicitis and cataract. 3. As an indicator of service intensity, the EQ of expenditure per admission ranged from 1.67(acute appendicitis) to 31.27(essential hypertension). The diagnoses which had high variation were essential hypertension, gastric ulcer, whereas those which had low variation were cephalopelvic disproportion and acute appendicitis. With regard to hospital days per admission, the EQ ranged from 1.55(acute appendicitis) to 28.13(gastric ulcer) by diagnosis types. The diagnosis groups with showed high variation were gastric ulcer, essential hypertension, and acute bronchitis, whereas those with low variation were cephalo-pelvic disproportion, intervertebral disc disorders, and acute appendicitis. Both the expenditure and hospital days per admission showed lewwer variations than the expenditure per capita, hospital days per capita and admission rate. 4. Comparing patterns of variation in utilization indices, diagnoses such as essential hypertension, gastric ulcer, fracture of rib showed higher variations in expenditure per admission than in admission rates, whereas diagnoses such as pneumonia, cephalo-pelvic disproportion and gastric ulcer showed higher variations in admission rate than expenditure per admission. These findings suggest that wide variations existed in several diagnoses groups across small areas in Korea. Further research should be performed to investigate factors related to small area variations including provider behavior.

• Journal of agricultural medicine and community health
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• v.24 no.1
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• pp.65-77
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• 1999

In order to estimate the utilization pattern of a rural health subcenter, and to identify the recognition for it among the farmhouse members in a suburban area, a questionnaire survey was carried out for objects of 696 population. The results observed were as follows: The annual utilization rate of rural health subcenter for a basic health service unit was 25.0 per 100 persons, and annual mean visiting times was 0.22 times. And the most frequent disease by annual health subcenter utilization illness was musculoskeletal disease(30.6%), and the next was respiratory disease(14.1%), gastrointestinal disease(13.9%) by order. Favorite reason for community health subcenter utilization were near distance from living place(49.6%), lower disease severity(18.9%) and lower medical cost(18.1%) by order. But disfavoring reasons for it were absence of specialist(20.2%), non effective treatment(19.2%) and insufficient equipment(14.7%) by order. And insufficient items about community health subcenter utilization were restriction of treatment limit(40.7%), lower reliance(22.5%) and difficulty in traffic(13.4%) by order. The results of logistic regression analysis suggested that statistically significant factors in health subcenter utilization was educational level. The desirable works for the health subcenter in a suburban area were disease control of elderly and disease preventing service. These results suggested that to increase the utilization of rural health subcenter in a suburban area and to promote the accessibility of rural residents to primary health care, there must be considered public relation about health subcenter, improvement of medical quality and change of priority about health subcenter's works.

• The Korean Nurse
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• v.35 no.2
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• pp.71-91
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• 1996

The objectives of thes study were to identify the need for equipment development in nursing, and to determine the priorities for that development. The study was descriptive study done between March 2 and May 30, 1995, in which the subjects, including 421 patients, 223 family members, and 198 nurses from neurosurgery, orthopedic, rehabilitation medicine, internal medicine and intensive care units of nine general hospitals in Seoul, completed a questionnarie developed by the research team. The questionnaire consisted of 35 open and closed questions. Data was analyzed using frequencies and percentages. The results ware summarized as follows: 1) The average age of the nurses was 27.9 years, 48% of the patients were between 20 and 40 years of age, and 17% were over 60. The average lingth of experience for the nurse subjects was four years five months with 36.9%. having over five years experience. The most frequent diagnoses of patients were spinal disc(35.9%), internal medicine disease(26.0%), cerebral vascular accident(16.6%) and spinal cord injury(10%) 2) Many of the nurses(96.4%) reported deficiencies with existing equipment and 96.5% of the nurses, but only 79.8% of the patients, nurses' time. Further, 82.3% of the nurses and 75.8% of the patients felt that the development of new equipment would lead to a decrease in the cost of nursing care. 3) Nurses felt that the greatest areas of inconvenience were patient feeding(71.7%), hygiene(71.2%), caring for a patient confined to bed(70.7%), patient clothing(67.2%), mobility transfers(63.5%) and urinary elimination(52.0%). However, patients and family members listed the following as being the most inconvenient: urinary elimination(58.7%), Hygiene(50.5), feeding(48.4%), mobility transfers(47.1%) and bed care(45.2%). 4) Generally the nurses listed more inconveniences and patients and family members listed more demands for the development of equipment. These included utensils with large handles, and regulators for tube feedings; mattresses that provide for automatic position change and massage, which have patient controlled levers and a place for bed pan insertion; automatic lifts or transfer from bed to wheelchair; equipment to facilitate washing and oral hygiene as well as equipment that will allow patients with spinal cord injuries easy access to showers; a bed pan/urinal for women that is comfortable and effective from which urine can be measured and disposed of easily; disposable dressing sets and tracheostomy care sets and a convenient way of measuring changes in wound size; a safe delivery system for oxygen, a variety of mask sizes and better control of humidity, tracheal material than at present, as well as a communication system for patients with tracheostomies; clothing that will allow access to various parts of the body for treament or assessment without patients having to remove all of their clothing; and finally a system that will allow the patient to control lighting, telephones and pagers. Priority areas for equipment development reported by the nurses were, urinary elimination(58. 7%), hygiene(50.5%), feeding(48.4%), mobility transfers(47..1%), bowel elimination(40.8%). Those reported by the patients family members were feeding(71.7%), hygiene(70.0%), bedcare(70.7%), clothing(67.2%), mobility transfers(63.6%), urinary elimination(52.9%) and bowel elimination(50.5%) Altogether, nurses, patients and family members listed the following as priorities; clothing (178), bed care(144), urinary elimination(92), environment(81), hygiene(70). Further, a health professional forum listed urinary elimination, oxygen delivery, medication delivery, mobility transfers, bed care and hygiene in that order as priority areas. From this study it can be concluded that the first need is to develop equipment that will address the problems of urinary elimination. To do (l)This nurses who are interested in equipment development should organize an equipment development team to provide a forum for discussion and production of equipment for nursing.

• The Journal of Korean Medicine
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• v.43 no.2
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• pp.51-60
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• 2022

Objectives: Currently, Korea's medical services are divided into Western medicine and Korean medicine, and people who are not satisfied with the existing treatments are looking for complementary and alternative medicine(CAM). Therefore, this study attempted to confirm patients' perception of the ongoing collaborative treatment and integrated medical service that added CAM to collaborative treatment based on tertiary hospital users. So that we can confirm the expected advantage and disadvantage of integrated medical service system and the necessity of supporting medical expenses for it. Methods: The survey was conducted on 100 people who experienced tertiary hospital treatment and other 100 people who experienced both tertiary hospital treatment and Korean medicine treatment at the same period. The survey was conducted until the number of respondents in both group reached 100. The survey was conducted through e-mail and was conducted from September 27, 2021 to October 8, 2021. Results: For the advantages of collaborative treatment 'increased in psychological stability,' and for disadvantages 'longer time spent for treatment' were the most common. If integrated medical services are implemented in the future, expected advantages include 'consideration of various treatments.' and expected disadvantages include 'increased medical cost.' The needs to expand support for health insurance for integrated medical services were 75.5% among responders. Conclusions: We were able to find out the (expected) advantages and disadvantages of the collaborative medical care and the integrated medical system that medical users experienced or expected, also confirmed positive answers to the expansion of health insurance support for the integrated medical system.