• Journal of Korean Academy of Nursing Administration
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• v.14 no.3
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• pp.229-240
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• 2008

Purpose: To develop the patient classification system based on the resource utilization for reimbursement of long-term care hospitals in Korea. Method: Health Insurance Review & Assessment Service (HIRA) conducted a survey in July 2006 that included 2,899 patients from 35 long-term care hospitals. To calculate resource utilization, we measured care time of direct care staff (physicians, nursing personnel, physical and occupational therapists, social workers). The survey of patient characteristics included ADL, cognitive and behavioral status, diseases and treatments. Major category criteria was developed by modified delphi method from 9 experts. Each category was divided into 2-3 groups by ADL using tree regression. Relative resource use was expressed as a case mix index (CMI) calculated as a proportion of mean resource use. Result: This patient classification system composed of 6 major categories (ultra high medical care, high medical care, medium medical care, behavioral problem, impaired cognition and reduced physical function) and 11 subgroups by ADL score. The differences of CMI between groups were statistically significant (p<.0001). Homogeneity of groups was examined by total coefficient of variation (CV) of CMI. The range of CV was 29.68-40.77%. Conclusions: This patient classification system is feasible for reimbursement of long-term care hospitals.

• Health Policy and Management
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• v.27 no.2
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• pp.139-148
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• 2017

Background: The purpose of this study is to investigate family caregivers' opinions about out-of-pocket payment for long-term care (LTC) facilities, and find the differences in the opinions for family caregivers of all different levels of income. Methods: We used the data of the study on out-of-pocket payment in national long-term care insurance, including 1,552 family caregivers with the elderly in long-term care facilities. Results: The average out-of-pocket payment per month was 511,635 Korean won and distributed from 230,750 to 1,365,570 Korean won. The amount of out-of-pocket payment might be affected by not co-payment but the cost of non-covered service. There were differences in them for family caregivers of all different levels of income. Opinions were surveyed about 5 issues. By levels of income, there were differences in their opinions about 3 issues, the financial burden on LTC, the necessity of reducing out-of-pocket payments, and to be willing to pay more for a high quality service. But there were not different opinions about the interruption of LTC service and staying with LTC facilities. Conclusion: These findings suggest that the range of out-of-pocket payment for LTC facility is wide and it can be a burden to lower income group. It should be to prepare the policies to ease the financial burden and support the appropriate LTC use.

• Journal of Korean Academy of Rural Health Nursing
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• v.8 no.1
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• pp.5-12
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• 2013

Purpose: This research was a survey to ascertain whether there are differences in opinion about designated doctors and hospitals, type of health care service utilized and health behavior between people who have applied to be Medical Aid Beneficiaries, but not using the Designated Doctor System. Method: The participants were from three groups, application for two years, one year and non-appliers. Data collection was done by Medical Care Client Managers through in-depth interviews using a structured questionnaire. Results: The participants expressed no negative effect of the designated doctor system in relation to designated doctor, hospital or health behavior but there was a significant effect in type of health care service utilized. Conclusion: In the future, the commitment of Medical Care Client Managers is important, but the role of health care providers will be emphasized in order to sustain the effectiveness of the health care system under the Designated Doctor System.

• Research in Community and Public Health Nursing
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• v.22 no.3
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• pp.333-341
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• 2011

Purpose: The purpose of this study was to analyze married immigrant women's utilization of health care and their demand for public health care services. Methods: This study was conducted through descriptive survey with 102 married immigrant women in 2 cities, and survey was done from November, 2010 to May, 2011. Results: The results were as follows. Of respondents, 70% were using medical services in Korea and only 38.2% of them were satisfied with services. Major difficulties in using health care services were 'access problem' (35.7%), 'communication problem' (27.7%), and 'medical cost' (19.8%). The respondents' main sources of health information were family (56%), health care center (15%). The types of health information and education demanded by respondents were children's health care (22.1%), pregnancy and delivery (21.1%), and common disease care (20.0%). The most wanted services from public health care institutions were vaccination (24.5%), health promotion (21.5%), and leisure activity programs (20.6%). There was a statistically significant difference in period of immigration and public health care demands. Conclusion: For married female immigrants, it is recommended to provide tailored public health care services such as outreach service and visiting nursing care service, and to set up different language signs for common disease patients.

• Health Policy and Management
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• v.22 no.4
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• pp.497-521
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• 2012

Objectives This study aimed to investigate the effect of social capital, health risk behavior and health status on medical care utilization by the elderly. The data and Research method Data were obtained from the 4th wave survey of the Korea Welfare Panel Study. 4,087 household members aged 65 years and over were subject to analysis. Descriptive statistics are used to describe the basic features of the data in a study. we performed a structural equation modeling(SEM) analysis to evaluate the effect of social capital and mediating effect of health risk behavior and health status. Results Results showed that factors related to medical care utilization of the elderly were different depending on types of service (inpatient and outpatient service) except health status. Age, higher social capital, more health-risk behavior and poorer health status were associated with increased use of inpatient service. Social capital was found to have a positive direct effect on it. Also, social capital had an indirect effect on reducing use of inpatient services by improving health status. On the other hand, lower age and higher household income tended to increase use of outpatient service, while higher social capital and higher health status were inversely related. Social capital had a direct effect and an indirect effect on reducing use of outpatient service and, at that time, health status played a mediating role. Conclusions Social capital may contribute to improve health status and indirectly reduce medical care utilization of the elderly by enhancing their health status. These results provide evidence that more policy and strategy considerations should be needed for the elderly to strengthen their social capital in order to enhance their levels of health and more efficient utilization of medical care.

• International Journal of Contents
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• v.5 no.4
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• pp.62-68
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• 2009

This paper presents a novel method to design and implement mobile u-health system by defining the essential elements of mobile healthcare services. We choose common service elements for the proposed u-healthcare scheme and design the service platform. Especially we focus on automatic feces or urine sensing u-care scheme to prove the effectiveness of our platform. We construct the system with sensing part with a manikin and a diaper wireless communication part with feces or urine sensing data, and coordinator system based on the u-health platform defined in this paper. Experimental results show that our scheme is useful in the area of u-care service for the handicapped, the elderly, and patients who can hardly move by themselves. In addition the designed scheme offers a realized u-care scheme with the purpose of advanced developing tools for application or service developers.

• Journal of Home Health Care Nursing
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• v.10 no.1
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• pp.73-84
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• 2003

This study was done to examine the home care service provided by home care nurses and the level of client satisfaction. Data were collected from 110 clients who received the home care service at the P-hospital in Pusan from 23th April, 2001 to 30th November, 2002. The tool for measurement of satisfaction was composed of 16 items and was 4 score scale. Data was analyzed by using SPSS/WIN 10.5 program, the results of this study are summarized as follows; 1) 77.3% among 110 clients were over sixty years old. By the disease pattern. subjects were distributed into cancer(52.7%), cerebro-vascular disease(22.7%) and the others. 36.4% of clients were received home visits from 10 to 20 times by home care nurse. 2) The total number of home care services was 20,828. And most of the clients received the health education and training. 3) The mean score of satisfaction on provided home care services was $3.36\pm0.45$, out of 4. among 16 items. 'The home care nurses were kind enough' was highest ($3.59\pm0.49$), the total level of satisfaction of home care services was very high. with total mean score $53.84\pm7.16$. As mentioned above. the satisfaction level of home care services was very high. so we can except that the prospect of home care services is very challengeable. Therefore. we should try to expand the service recipients with promotional education to the home care clients under the cooperation with medical staff and make more efforts to develop the management system about clients' information. to improve the quality of the service, to assure close ties with the public health centers for the continuous home care service linking.

• Health Policy and Management
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• v.9 no.4
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• pp.140-156
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• 1999

The purpose of this article was to review the basic concept of the SERVQUAL scale and to evaluate its usefulness in health care settings. The SERVQUAL scale was developed by Parasuraman et al. in 1988. Its purpose was to provide an instrument for measuring the quality of service that would apply across a broad range of services with minor modifications in the scale. The SERVQUAL scale is based on gap theory, which indicates the difference between consumers' expectations and their assessment of the actual performance of a specific firm. It has five dimensions to define service quality. These dimensions include: (1) tangibles' (2) reliability' (3) responsiveness' (4) assurance' (5) empathy. While the SERVQUAL scale has been tested in a number of health care settings. the findings have been mixed. So. health care marketers should be cautious in their use of the SERVQUAL scale. However, it is rare to find instruments that are as well validated as SERVQUAL appears to be. As well the SERVQUAL scale provides valuable information about the quality of health care service.

• Journal of Society of Preventive Korean Medicine
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• v.19 no.2
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• pp.51-56
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• 2015

Objective : We analyzed present condition of cooperative medical care using claims data of HEALTH INSURANCE REVIEW & ASSESSMENT SERVICE form patients treated by Korean-Western cooperative medicine. The study aimed to offer guidelines in selecting disease-related research in developing Korean-Western convergence technology. Method : Based on the patients using Korean medical service, we analyzed claims data of patients using Korean medical service and western medical service from January 2012 to December 2013. We were assigned to the server remotely. With the concept of 'episode of care', we rebuilt claims data and analyzed present condition of cooperative medical usage. Results : We analyzed present condition of cooperative medical care per episode of care. Among outpatients, Low back pain, lumbar region(M5456) was the highest number. Among inpatients, Sciatica due to intervertebral disc disorder(M511) was the highest number. Conclusion : Based on the claims data provided by HEALTH INSURANCE REVIEW & ASSESSMENT SERVICE, we have derived a list of multy frequently disease frequently treated by cooperative medical care by analyzing present condition.

• Research in Community and Public Health Nursing
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• v.15 no.4
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• pp.551-565
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• 2004

Purpose: The purpose of this study is to develop a day care center model focused on public health institutions for the elderly residing in their homes. Method: Research design for this study was a mult-level research, which consisted of a related literature review, an Internet search for knowledge of the current situation at home and abroad, on-site interviews, questionnaires collected from a sample of residents in a rural area, and a key-informants approach. Results: 1) The subjects of service - Generalized service should be provided to the elderly, 65 years and older, regardless of their assets. 2) The contents of service - Providing pre-health oriented and post-social welfare service that can integrate and satisfy a wide variety of public health and welfare needs of the elderly would strengthen the health care service of a day care center for the elderly. 3) Delivery system - Basic-level local self-governments should become a central operating body, and establishing a properly adjusted delivery system to a rural area after considering the efficiency and the access of vulnerable rural areas is needed based on modification of 'a Special Law for Agricultural and Fishery Areas' (rural public health center>rural health sub-center ${\rightarrow}$ unified health sub-center ${\rightarrow}$ public health hospital (public health center) ${\rightarrow}$ public welfare office). 4) Facility - Public health facilities such as public health centers and sub-centers should be located in areas that can easily access the facilities. 5) Funding - For day care center for the elderly in local self-government, the central government should modify a relevant implementation of subsidy in and provide some facilities and service regardless of the degree of self reliance of local self-government. 6) Human resources - It is needed to guarantee the period of workers of a day care center for the elderly, at least 3 to 5 years, with considering their specialty on aged care and avoiding circulation based positions. Furthermore, appropriate specially trained personnel such as medical workers and social workers should be placed to take care of both health service and welfare through strengthening of 'rules of law of elderly welfare,' Conclusion: future research is needed to test the model through a demonstration study using a model which may be developed in the future and to standardize the appraisal criteria of people hoping to enter a day care center for the elderly.