• Journal of Preventive Medicine and Public Health
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• v.43 no.3
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• pp.245-256
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• 2010

Objectives: This study aims to compare quality indicators for the hemodialysis services between patients with health insurance and those with medical aid. Methods: This study used data from sampled hospitals that provided a hemodialysis service. A total of 2287 patients were selected, and the information for hemodialysis service has been granted from medical record reviews. A multi-level regression analysis was used to examine the differences in process and outcome indicators for hemodialysis between patients with health insurance and those with medical aid. Process indicators were defined as: frequency of hemodialysis, hemodialysis time, erythropoietin (EPO) use, measurement of hemodialysis dose at least once a month, measurement of phosphate at least once every three months, and measurement of albumin at least once every three months. Outcome indicators were defined as: hemodialysis adequacy, anemia management, blood pressure management, and calcium, phosphate and nutrition management. The total scores for outcome indicators ranged from 0 (worst) to 4 (best). Results: There was a significant difference in the measurement of hemodialysis dose at least once a month between patients with health insurance and those with medical aid (OR 0.66, 95% CI = 0.43 - 0.99). However, frequency of hemodialysis, hemodialysis time, EPO use, measurement of phosphate at least once every three months, measurement of albumin at least once every three months, hemodialysis adequacy management, Hb${\geq}$11 g/dL, blood pressure within the range of 100-140 /60-90 mmHg, calcium x phosphate${\leq}$55 $g^2/dL^2$ and albumin${\geq}$4 g/dL were not significantly different between the groups. Conclusions: There were no significant differences in outcome indicators for hemodialysis between the groups. Further studies are warranted into the mechanism that results in no differences in the outcome indicators for hemodialysis.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.14 no.2
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• pp.111-120
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• 2018

The need for oral health rights for people with disabilities is very high, and current oral health care system does not fully reflect these demands. Efforts to promote oral health of people with disabilities are urgently needed. In order for the disabled to have oral health rights, access to oral health services for people with disabilities should be improved and barriers to access should be resolved. In this study, we propose oral health service delivery system to guarantee oral health rights for the disabled. In addition, before applying the proposed oral medical delivery system, the external effects of the system application were predicted and the expert verification was conducted to find out the solution. There are some controversies about the development of the service delivery system proposed in this study. As a result of the expert verification, there were disagreements about the suitability of the service provider, the suitability of the service recipient, the appropriateness of the service content and scope, and the appropriateness of the cost and the revenue source. Subsequent Delphi surveys require the development of structured questionnaires for discussions that require consensus. It is expected that a reasonable consensus of expert opinions will be derived.

• Korean Journal of Health Education and Promotion
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• v.28 no.1
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• pp.81-92
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• 2011

Objectives: The purpose of this study is to evaluate the influence of depression symptom on the self-rated health status(SRHS), the outpatient health service utilization and quality of life(QOL) also the relationship depression symptom with socio-demographic and health related factors. Methods: We selected 9,550 participants without chronic diseases from a total of 18,104 in the '2009 community health survey in Gyeongnam. They were assessed by using a Korean version of the Center for Epidemiological Studies-Depression Scale(CES-D). Those with CES-D scores of 21 or greater were defined as having probable depression. Results: A probable depression were associated in bivariate analysis with gender, age, educational status, monthly household income, marital status, current smoking status, drinking habit, physical activities and body mass index. After adjustment for covariates, probable depression groups predicted a lower status in SRHS. Likewise probable depression groups predicted a higher utilization in outpatient health service. Also probable depression groups predicted a lower score in QOL. Conclusions: Probable depression influence SRHS, outpatient health service utilization and QOL even after adjusting for the socio-demographic, health related factors and chronic medical illness. Programs for prevention and management of depression will be helpful to promote health and QOL.

• Health Policy and Management
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• v.23 no.4
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• pp.343-348
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• 2013

Background: Price control alone may not successfully restrain growth in health expenditures. This study aimed to propose fee adjustment model suitable for Korea reflecting health service volume and to clarify applicability of the model by comparing actual conversion factor with estimated conversion factor from simulation of this model. Methods: Fee adjustment model was developed based on Alberta's fee adjustment formula in Canada and 7 alternatives were assessed according to diversely applied parameters of the model. Results: Estimated conversion factors of the tertiary care hospital and the hospital were lower than actual conversion factors, since the utilization of heath service has been increased. However, there was no big difference between estimated conversion factors and actual conversion factors of the general hospital and the clinic. Eventually this fee adjustment model could estimate proper conversion factor reflecting health service volume. Conclusion: This model may be applicable to the mechanism as determining conversion factor between insurer and provider via negotiation and controling growth in health expenditures.

• Korean Circulation Journal
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• v.52 no.4
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• pp.265-279
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• 2022

Digital health is rapidly growing worldwide and its area is expanding from wellness to treatment due to digital therapeutics (DTx). This study compared DTx in the Korean context with other countries to better understand its political and practical implications. DTx is generally the same internationally, often categorized as software as a medical device. It provides evidence-based therapeutic interventions for medical disabilities and diseases. Abroad, DTx support entailed state subsidies and fundraising and national health insurance coverage. In the case of national health insurance coverage, most cases were applied to mental diseases. Moreover, in Japan, DTx related to hypertension will possibly be under discussion for national health insurance coverage in 2022. In overseas countries, coverage was decided only when the clinical effects were equivalent to those provided by existing technology, and in the UK, real usage data for DTx and associated evaluations were reflected by national health coverage determination. Prices were either determined through closed negotiations with health insurance operating agencies and manufacturers or established based on existing technology. Concerning the current situation, DTx dealing with various diseases including hypertension are expected to be developed near in the future, and the demand for use and compensation will likely increase. Therefore, it is urgent to define and prepare for DTx, relevant support systems, and health insurance coverage listings. Several support systems must be considered, including government subsidies, science/technology funds, and health insurance.

• The Korean Journal of Health Service Management
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• v.10 no.1
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• pp.1-11
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• 2016

Objectives : Medical service specialization could have positive effects on their profits and medical service quality. This study was to examine the relationship between medical service specializations and operational performance in hospitals. Methods : We used the National Inpatient Sample data provided by the Health Insurance Review and Assessment Service from 2010 to 2013. The hospital operational performance was determined by measuring the specialization level of the hospital based on DRGs. Results : The information theory index was 2.38 in 2010, 2.38 in 2011, 2.37 in 2012, and 2.37 in 2013. A multiple regression model was constructed which showed that if the specialization level becomes higher, it decreases the length of stay per case with an increase in medical expense. Conclusions : Differentiation and concentrated medical service specialization strategy have had a positive effect on the operational performance of hospitals.

• Journal of Preventive Medicine and Public Health
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• v.35 no.3
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• pp.236-244
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• 2002

Objective : To empirically investigate the relationship of internal and external customer satisfactions, service quality, and customer loyalty in medical services. Methods : This essay proposes an integrated model to explain the causality of internal and external customer satisfactions, service quality, and customer loyalty. To this end, a structural model was developed, consisting of the following factors: internal and external customer satisfactions, service quality, and customer loyalty. The study included 214 sets of data, with 107 sets being collected for both out-patients and in-patients. The data were analyzed using AMOS 4.0. Results : We found the greater the internal customer satisfaction, the greater the out-patient quality of service quality. Secondly, the greater the service quality, the greater the external customer satisfaction of both in- and out-patients. The service quality of doctors, compared to that of the nurses, had a greater effect on external customer satisfaction. Thirdly, the service quality of doctors and nurses affected both internal and external customer satisfactions, which ultimately affected the customer loyalty. Finally the greater the external customer satisfaction, the greater the customer loyalty. Conclusion : This Study confirms the positive relationship among the internal and external customer satisfactions, service quality, and customer loyalty, which proves the doctors quality of service is the primary factor for external satisfaction, and customer loyalty relating to medical services.

• Health Policy and Management
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• v.30 no.2
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• pp.178-184
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• 2020

Background: Korea set up a new diagnosis-related group as a demonstration project in 2009. The new diagnosis-related group was reformed in 2016. The main purpose of the study is to identify the effect of reform on coverage of national health insurance. Methods: This study collected inpatient data from a hospital that contains medical information and cost from 2015 July to 2016 June. The dependent variable was the coverage of national health insurance. The dependent variable was divided by total, internal medicine partition, surgical partition, and psychiatric partition. To analyze the effect of the reform, this study conducted an interrupted time series analysis. The final sample included 23,695. Results: The health insurance coverage of internal medicine has the highest, followed by surgery and psychiatry. The health insurance coverage of bundle payment is higher than that of unbundled payment. The proportion of bundled payment and non-benefit decreased and the proportion of unbundled payment increased. The coverage of national health insurance significantly increased after policy reform in internal medicine partition (p-value=0.0356). Conclusion: The results of the study imply that policy reform enhanced the coverage of national health insurance in internal medicine. The government needs to monitor side effects such as an increase of unbundled payment.

• Child Health Nursing Research
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• v.6 no.1
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• pp.103-111
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• 2000

The aim of the study is to analyze and evaluate the Child Health Management Service that was promoted as a part of Mother-Child Health Guidance Project by the Public Health Center of BukCheju-gun in 1999, to reflect the problems needed to be improved, and, thus, to present the integral program model for the Child Health Management Service that guides childhood health, regarded as the foundation of that of the adulthood period, to the optimum level. The common results of the evaluation of the Child Health Management Service of BukCheju-gun public health center are as below: 1. In the aspect of public information, the existing simple material and method of public information was not effective. 2. The opportunities for the necessary training and education to develop the persons concerned and their ability for the Child Health Management were not enough.3. The environment under which the service, aimed to promote Child's health, was carried out was not clearly divided from that of the services related with the prevention and treatment of disease. And the service environment for the child health was threatening to the clients.4. Still, the actual result was pursued more than the quality management, while carrying out the project. With the reflection of the above result, the research has presented the program model of Child Health Management Program for the next. The main concept of the model is, through the establishment of the network for information offerings and effective convergence of a variety of opinions for the community around the Public Health Center and for the correct evaluation of the project and the reflection of the result from it, to achieve the ultimate goal of the optimal growth and development of the childhood by expanding the support necessary for carrying out Child Health Management Program more effectively.

• Annals of Occupational and Environmental Medicine
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• v.34
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• pp.29.1-29.14
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• 2022

Background: Hotel housekeepers are one of the most important occupational group within tourism hotel sector; various health problems related to their job have been described, above all musculoskeletal disorders. The objective of this study is to understand the experiences and perceptions of hotel housekeepers and key informants from the Balearic Islands (Spain) regarding occupational health conditions and the strategies employed to mitigate them. Methods: A qualitative study was carried out. Six focus groups with hotel housekeepers and 10 semi-structured interviews with key informants were conducted. Next, we carried out a content analysis. Results: Hotel housekeepers reported musculoskeletal disorders, anxiety and stress as main occupational health problems; health professionals underscored the physical problems. Hotel housekeepers perceived that their work (physically demanding and with repetitive movements) caused their health conditions. To solve health issues, they used medication (anti-inflammatory agents, painkillers, sedatives and anxiolytics), which allowed them to continue working; health public services, generally rated as satisfactory; individual protective equipment; ergonomics (with difficulties due to high work pace and hotel facilities) and physical activity. Two contrasting attitudes were identified regarding sick leave: HHs who refused to accept a doctor-prescribed sick leave (due to fear of being fired, sense of responsibility, ...), and those who accepted it (because they could not continue working, they prioritised health before work). Conclusions: Our results might contribute to plan improvement strategies and programs to address health problems among hotel housekeepers. These programs should include interventions, such as coping strategies for the work-related risk factors (i.e., stress) and strategies to reduce medicine consumption. Additionally, hotel facilities should adopt policies focused on making workplaces more ergonomic (i.e., furniture) and to diminish the work pace.