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

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

• Quality Improvement in Health Care
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• v.10 no.1
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• pp.42-56
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• 2003

Background : The purpose of this study is to investigate the influencing factors on the length of emergency department stay of patients with acute myocardial infraction. Methods : we reviewed medical records of all patients who were Hospitalized with acute myocardial infraction from March 1, 2002 to February 28, 2003. Results : The average length of stay in the emergency room of the subjects was 182.74 minutes. After the emergency room treatment, 48.1% of the subjects were transferred to intensive care unit. The hospitalization through emergency room mostly took place in the office hours. There were more patients on Monday. The influencing factors on the length of stay in the emergency room of patients with acute myocardial infraction were emergency room arrival time which was classified in seasons, treatment hours of specialized doctors, medical care insurance and required time of radiologic examination. Conclusion : In order to reduce the length of emergency room stay, it might be an available solution secure enough spaces, facility, and staff of the radiologic test only for the patients of the emergency room. And the effective use of emergency facility and space, establishment of standardized treatment guideline, and provision of emergency treatment support system are also needed.

• Journal of Home Health Care Nursing
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• v.19 no.1
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• pp.5-10
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• 2012

Background: The purpose of this study is to investigate the needs for wound care services in the elderly care institutions by analyzing hospital-based home care nursing in select facilities in Korea. Methods: A total of 92 staffs at the elderly care institutions, located throughout the country, completed self-report questionnaires between February 1 and November 31, 2009. SPSS ver. 17.0 was used for data analysis, regarding frequency and chi square. The 5% level of significance was the critical level for acceptance of the study's hypotheses. Results: Results were as follows; group A and group B were rated as 'high' and 'very high', respectively, in care of simple pressure ulcer, care of complicated pressure ulcer, stitch out, care of simple surgical wound, ostomy care, complicated ostomy care, simple dressing and complicated dressing. Conclusion: Political decisions intended to promote visits by hospital- based home care nurses to the elderly care institutions would be a prudent course.

• Journal of Preventive Medicine and Public Health
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• v.31 no.3 s.62
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• pp.564-578
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• 1998

Most extended care facilities have admitted both the healthy and unhealthy elderly, among which members' average caring demand vary. The Aged Welfare Law, however, currently provides no reasonable basis on the staffing policy for extended care facilities. It just reflects the admitted number of the elderly rather than differences in members' average caring demand among facilities. This study is designed to estimate the need for caring staff on the basis of the correlation between the individual health status measured by various tools including Activities of Daily Living and caring demand by actual service time for each one. The sample included all of the admitted elderly(187 persons) in 4 extended care facilities, two in Seoul and the other two in Kangwon-Do over the survey period October 5 through October 20, 1996. The survey process consisted of 3 stages. (1) The current staffing information was collected through self-completed written questionnaires left for head of official in each facility. (2) Six graduate students at School of Public Health interviewed all residents to collect information on their health status and sociodemographics. The response rate for the interview was relatively high(85%). (3) Information on direct and indirect caring time consumed for each residents came from self-completed written questionnaires given to nurses and helpers in each target facilities. Analysis of the data was made using Pearson's correlation and multiple regression technique through SAS program. Based on this procedure, the following was found. 1. No facility meet the staffing standard in the Aged Welfare Law completely. 2. It is actual service time that is most correlated with ADL(Activities of daily living). 3. When all of the elderly are divided by four groups based on the level of ADL, the mean values of needed caring time in each group are 15, 21, 36 and 88 minutes respectively. 4. There is no significant difference among facilities in distribution of elderly person by group. 5. No facility meets the estimated number of nurses and helpers which reflects health status of the admitted elderly. Therefore, it is required that severity of the admitted elderly be considered in establishing staffing standard for extended care facility.

• The Journal of the Korea institute of electronic communication sciences
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• v.9 no.2
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• pp.211-217
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• 2014

This study is of elderly care facilities in Seoul oral health care providers survey of recognition and affecting factors. The subjects were selected 92 people who care providers, data were collected using a questionnaire. Multiple regression analysis, duration of carrer and experience of oral care education significantly affected in the presence of factors. As a result, in order to improve the oral health of the elderly nursing staff to promote oral health education and training programs are urgently needed.

• Journal of Korean Academy of Nursing
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• v.39 no.3
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• pp.409-421
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• 2009

Purpose: In this research multi-level analysis was done to identify factors related to quality of services. Patient characteristics and organizational factors were considered. Methods: The data were collected from the Health Insurance Review and Assessment Service(HIRA) data base. The sample was selected from 17,234 patients who had been admitted between January 2007 and May 2008 to one of 253 long-term care hospitals located in Seoul, six other metropolitan cities or nine provinces The data were analyzed with SAS 9.1 using multi-level analysis. Results: The results indicated that individual level variables related to quality of service were age, cognitive ability, patient classification, and initial quality scores. The organizational level variables related to quality of service were ownership, number of beds, and turnover rate. The explanatory power of variables related to organizational level variances in quality of service was 23.72%. Conclusion: The results of this study indicate that differences in the quality of services were related to organizational factors. It is necessary to consider not only individual factors but also higher-level organizational factors such as nurse' welfare and facility standards if quality of service in long term care hospitals is to be improved.

• Korean Institute of Interior Design Journal
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• v.14 no.2 s.49
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• pp.142-152
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• 2005

It is estimated that the need to build health facilities for the elderly will grow in the near future as the Korean society is aging. Thus the study on the spatial composition of 22 facilities as well as on the cases of health facilities for the elderly in Japan, where public health and medicare for aged people are well taken care of, was conducted and the following are the results: 1. As of 2000, there was one facility for every 8,000 and 1,100 aged citizen under long-term care, and these facilities secured beds enough for $8\%$ of those who need long-term care. 2. The spatial composition was categorized into general living space, long-term care, management, provision, and home assistance, and housing was provided. Moreover, the space was divided according to their nature of use, the arrangement, the form of entrance into the building, moving line inside, the relationship with the health facilities and their characteristics are analyzed based on different users, managers, moving line including that of provision of food, the relationship between different spaces with different functions as well as on the relationship between locations of each space. 3. The total capacity, building area and actual area of the welfare facilities for the elderly are analyzed, and area per person, detailed area for each space, percentage of each living space for long-term care patients and characteristics of recuperation room are suggested.

• Journal of Korean Dental Hygiene Science
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• v.4 no.2
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• pp.1-7
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• 2021

Background: To identify the factors that affect the current status and satisfaction of people with disabilities at community oral care centers. Methods: A structured self-administered survey, including five questions on facility environment, five on usage procedure, four on medical skill, four on care cost, three on friendliness, and three on satisfaction, was administered to 218 residents of the G-disabled community care center. It comprised a Likert 5-point scale (strongly agree, 5 points; agree, 4 points; moderate, 3 points; disagree, 2 points; not at all, 1 point). The reliability of the measurement tool was 0.932 for Cronbach's α. Results: The evaluation of community oral care centers for the disabled showed that the environment was hygienic (4.42±0.73), reservation system was well maintained (4.18±0.95), and the dentist-in-charge was satisfied with the treatment (4.37±0.62). The participants agreed that the details were sufficiently explained (4.29±0.71). However, in terms of medical expenses, the score of "have fully heard the explanation of medical expenses and reductions" was 3.88±0.92. The factors affecting satisfaction were sex, final educational background in the facility environment, usage procedure, and medical skill. Conclusion: To increase the satisfaction of people with disabilities at community oral care centers, it is necessary to establish a facility environment and service according to the patients' need and increase the reduction or exemption benefits between different treatment cost categories. Oral health management policies for the disabled should be developed based on these factors, so that the oral care of vulnerable groups in blind spots can be maintained.

• Korea Journal of Hospital Management
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• v.20 no.4
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• pp.50-61
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• 2015

Advances in healthcare technology and rapid economic growth lead to the increased life expectancy and consequently the size of elderly population. Korea is one of the countries that are rapidly aging. Thus, it is particularly important to prepare for the aging society. Recently, the number of healthcare institutions for the elderly citizens has increased. The purpose of selecting a hospital for the elderly is, in general, maintenance of health rather than improvement of health receiving proper treatment. Unlike choosing a hospital for treatment, customers of a long term care hospital have a different set of factors to consider. Especially, when choosing a long term care hospital, the influence of patient's family is greater than the patient. This study examines the factors they consider for long term care hospital. A total of 198 questionnaires were collected from the families of actual patients of long term care hospitals. Twelve questionnaires were found to be non-usable because of missing and unsatisfactory responses. Consequently, 186 questionnaires were used for the analyses. Findings of this study are as follows. First, seven factors have been identified to consider when choosing a long term care hospital for the elderly. They include convenience of facilities, costs variety of facility programs, service hours, reputation, accessibility, quality of medical staff, medical facilities, and facility size. Second, This study measured both importance and satisfaction with these attributes and analyzed the difference between them. Satisfaction was lower than importance in the categories of convenience of facilities, costs, and programs, and accessibility. On the other hand, satisfaction was higher in terms of service hours, reputation, and quality of medical staff. Finally, the current study found positive impact of accessibility and quality of medical staff on reuse intention of a long term care hospital.

• Journal of Korean society of Dental Hygiene
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• v.22 no.1
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• pp.63-72
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• 2022

Objectives: This study was conducted to prepare basic data to propose the necessity and utilization of oral welfare products in the welfare services of the long-term care insurance system, focusing on facility workers working in elderly facilities. Methods: The analysis was conducted on 144 workers working at some local elderly facilities. The questionnaire was constructed by classifying the use of oral welfare tools into 6 questions and the necessity and demand for oral welfare devices into 13 questions. Frequency analysis and technical analysis were performed for data analysis, and one-way ANOVA was performed for differences in the necessity and demand for oral welfare equipment. The statistical significance level was p<0.05. Results: As a result of examining the awareness of the necessity and demand for oral welfare equipment among workers in elderly facilities, the awareness of the necessity of including oral welfare equipment in the items of welfare equipment in the current long-term care insurance system was high at 4.15 points. As a result of analyzing the correlation between awareness of care products and the need and demand for oral welfare equipment, it was confirmed that there was a statistically significant positive correlation (p<0.01). Conclusions: In the long-term care insurance system for the elderly, oral welfare products need to be considered for welfare equipment services. The provision of oral welfare products within the long-term care insurance system for the elderly can provide opportunities and services to select various self-care tools. In addition, it is expected that it will be possible to promote changes in the long-term care insurance system for the elderly and to improve the system in a variety of positive ways.