• Health Policy and Management
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• v.3 no.2
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• pp.130-158
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• 1993

This study was written to discover the changes that may exist in the contents of medical services after introduction of health insurance system, and to identify the net-effect of health insurance system on medical services. Uncomplicated nornmal delivery and appendectomy patients were divided into 4 groups, the non-insured in pre-NHI periods(group A), the insured of health insurance for employees in pre-NHI periods(group B), the insured of regional health insurance for city residents in post-NHI periods(group C) and the insured of health insurance for employees in post-NHI periods(group D). The mehtod of matching was applied to control for major demographic differences among these 4 groups of each disease. In pre-NHI period, the medical services and the variation of medical services of the non-insured were compared with those of the insured. The difference between the change of medical services from group A to those of group C, and the change of medical services from group B to those group D is defined as the net-effect of health insurance. The results are as follows. First, in length of stay after delivery or operation, total length of stay, some laboratory examination, amount of several drugs used in appendectomy patients, frequency of sitz bath in delivery patients, there was net-effect of health insurance in increasing direction. Second, length of stay after delivery or operation, total length of stay, some laboratory examination, amount of several drugs used in appendectomy patients and frequency of sitz bath in delivery patients were significantly more in the insured than in the non-insured group in pre-NHI period. Third, the variation of medical services of post-NHI period was not less then those of pre-NHI period. Fourth, antenatal care on which the third party does not pay and the patient pays for all, was diffrerent by socioeconomic and educational level of patients.

• Quality Improvement in Health Care
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• v.3 no.1
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• pp.144-152
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• 1996

Background : Because of introduction of nationwide health care system in 1989 and the improvement of socioeconomic status of population the number of outpatient visiting university hospital has good facilities and manpower has increased. So the waiting time for medical service at university hospital are lengthened. Particularly outpatients complain that waiting for prescribed drugs at pharmacy depart are long. Reducing waiting time at pharmacy depart door-to-door delivery system that the patients applying for door-to-door delivery receive prescribed drug at home without waiting at pharmacy depart were studied. The objective of this study is to analysis the opinion of outpatients for door-to-door delivery system, to study the appropriateness of adopting the system and to produce ideal model for the system. Method : Outpatients waiting drug at pharmacy depart were questioned about door-to-door delivery system. to find the factors affect utilizing the system the logistic regression was used. Result : 83.3% of the patients want to utilize the system without charging, and 72.9% of the patients want to utilized system with charging. 68.3% of patients with charging want to use this system because of long waiting time at pharmacy depart. 50% of patients who do not want to use door-to-door do not use this system because of incorrect delivery. The affecting factors to utilize the system were sex, waiting time, fee. Conclusion : The model for door to door delivery system. 1. door-to-door personnel reside in hospital and the patient want to utilize the system apply for the delivery with charging. 2. The applied drugs dispense at spare time. 3. Delivery company gathers drug at appointed time and delivers. 4. The delivery fee is 2,000-3,000 won. 5. To prevent from loss and changing the drug the name of patient on packet are printed and drug packet are sealed. 6. The company submit the confirm sheet which are written that the patient received drug correctly to hospital. 7. The delivery time of drug is reserved for the convenience of receiving.

• Journal of Preventive Medicine and Public Health
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• v.18 no.1
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• pp.41-50
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• 1985

To find out the differences in medical practice according to the environment of patient care and managerial situation of the medical care institutions, normal spontaneous vaginal delivery and acute appendicitis were selected, which is suitable for comparison because of their high comparability. A total of 473 cases of normal spontaneous vaginal delivery and 408 cases of acute appendicitis was sampled from the claims to Korea Medical Insurance Cooperations during January to June 1984. Complicated cases were excluded from population and sampling was restricted from 40 to 60 percentile for total charges by the type of medical care facility in order to rule out the influence originating from case mix. Important items representing type and quantity of medical care service were compared by type of facility. Major findings are as follows : 1. University hospital shows the highest in charges per case and decrease in order of general hospital, and clinic. 2. In case of normal spontaneous vaginal delivery, average length of stay shows statistically significant difference by type of facility. 3. Charge amount for each service item affected by practice pattern shows statistically significant difference mostly by type of facility. It is suggested that medical practice pattern is different by type of facility for medical services. 4. Difference in total medical expenditure by type of facility is affected more with charges for materials, consumables and drugs than with fee for service activity. 5. In administering drugs to patients, hospital and clinic show higher injection rate than university and general hospital. 6. Clinical Laboratory tests were common in order of uninalysis, hemoglobin, hematocrit, white blood cell count, urine microscopic examination in cases of normal spontaneous vaginal delivery; white blood cell count, urinalysis, hemoglobin, hematocrit, urine microscopic examination, white blood cell differential count, in cases of acute appendicitis. 7. The result for Laboratory test and Radiologic study shows extreme difference by type of facility. Test rate is lowest in clinic and increase hospital, general hospital, and university hospital in order, both in type and frequency.

• Women's Health Nursing
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• v.18 no.3
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• pp.200-208
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• 2012

Purpose: This study was aimed to examine the gap between predicted cesarean section rate and real cesarean section rate and it's determining factors of 44 tertiary hospitals. Method: This study is a cross-sectional analysis using the data of 25,623 deliveries in 2009 drawn from homepage of Health Insurance Review and Assessment Service. Data were analyzed with t-test, F-test, Scheff$\acute{e}$ test, and logistic regression. Result: There were statistically significant differences in the gap of cesarean section rate (more gap indicates higher quality of delivery) by grade of nurse staffing and delivery cases. Hospitals with nurse staffing grade 1 to 2 had more possibility to be classified into higher grade in quality of delivery (OR 5.67, 95% CI 1.07-30.08). Also hospitals with over 500 delivery cases had more possibility be classified into higher grade in quality of delivery (OR 4.92, 95% CI 1.14-21.23, respectively). Conclusion: The finding suggests that grade of nurse staffing may influence the real cesarean section rate because nurses do a vital role to prevent unnecessary cesarean section. Further study is required to provide evidence that nurse staffing influence on patient outcome and cost-effectiveness in order to obtain adequate number of nursing staffs.

• Women's Health Nursing
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• v.15 no.4
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• pp.353-361
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• 2009

Purpose: This study aimed to provide fundamental information about childbirth and antenatal care for pregnancy women and to find differences in mother's antenatal care and delivery service satisfaction between vaginal delivery and cesarean section. Methods: This study was conducted in 4 residential areas and a study sample of 184 postpartum mothers who agreed to collect data. Data was collected from September 1 to October 20 2007 and a structured questionnaire were recruited by the survey. The data was analyzed by t-test and chi-squire test using SPSS/WIN 12.0. Results: There was a significant difference in delivery place between vaginal delivery and cesarean delivery. Only 10.7% of vaginal delivery group delivered in general hospitals, however 24.5% of the cesarean section group delivered in general hospitals. Early antenatal care also showed statistical difference in mode of delivery. 43.5% of vaginal delivery mothers visited hospitals for the detection of pregnancy but 28.3% of cesarean section mothers did that. Vaginal delivery mothers more satisfied with her own delivery method and suggested a vaginal delivery to others. Conclusion: These results suggest that cesarean section mother's sensitivity of early antenatal care was less than vaginal delivery mother. Satisfaction related to delivery care services were higher in the vaginal delivery group.

• The Korean Nurse
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• v.9 no.3 s.47
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• pp.36-40
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• 1970

The development of public health nursing in this country is delayed due to such factors as the pattern of delivery of medical care which was strictly clinically oriented, comprehensive family health service was over-shadowed by the over-emphasis of contro

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.22 no.1
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• pp.22-37
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• 2015

Purpose: This study aimed to compare the health service delivery level and educational needs by work experiences and types of public health center among the nurses who work as visiting health services workers at public health centers. Methods: Data collected from 484 nursing staff for 2 weeks, was analyzed using the SPSS program t-test, ANOVA, and Spearman Rank-Order Correlation. Nurses with more than 2 years experience were 79.1%; and 43.6% of the subjects worked within Gun type public health centers. Results: The health service performance frequency of metropolitan city type public health centers was significantly high in the areas of education, behavior pattern, chronic disease, pregnant women & infants, and multi-cultural family. The health service performance frequency of Gun type public health centers was significantly high in the areas of type of test, fundamental nursing, and basic rehabilitation. In addition, the correlation between the performance frequency and educational needs was positively correlated, and the subjects with greater educational needs performed more. Conclusion: Educational programs should be designed according to the types of public health centers rather than work experiences, especially in systematic training for frequently performed items after reviewing the practice precisely.

• Journal of Korean Academy of Nursing
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• v.39 no.4
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• pp.574-583
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• 2009

Purpose: This paper analyzed alternative methods of calculating the conversion factor for nurse-midwife's delivery services in the national health insurance and estimated the optimal reimbursement level for the services. Methods: A cost accounting model and Sustainable Growth Rate (SGR) model were developed to estimate the conversion factor of Resource-Based Relative Value Scale (RBRVS) for nurse-midwife's services, depending on the scope of revenue considered in financial analysis. The data and sources from the government and the financial statements from nurse-midwife clinics were used in analysis. Results: The cost accounting model and SGR model showed a 17.6-37.9% increase and 19.0-23.6% increase, respectively, in nurse-midwife fee for delivery services in the national health insurance. The SGR model measured an overall trend of medical expenditures rather than an individual financial status of nurse-midwife clinics, and the cost analysis properly estimated the level of reimbursement for nurse-midwife's services. Conclusion: Normal vaginal delivery in nurse-midwife clinics is considered cost-effective in terms of insurance financing. Upon a declining share of health expenditures on midwife clinics, designing a reimbursement strategy for midwife's services could be an opportunity as well as a challenge when it comes to efficient resource allocation.

• Journal of Korean Academy of Nursing Administration
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• v.22 no.2
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• pp.129-136
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• 2016

Purpose: The aim of this study was to identify nurses' role in the delivery of health guidance service within the annual health guidance membership service. Methods: Dynamic job analysis process was applied with vertical job analysis and horizontal job analysis through a focus group workshop and expert survey. Results: As a result of this study, job description was established with 4 duties, 11 tasks, 60 task elements. Major duties consisted of 'professional nurse practice', 'coordination and cooperation', 'education and consultation', and 'administrative work and improvement'. A job process map was also framed. Conclusion: The results can be used to establish nurses' role in providing health care service. Ongoing research on nurse's role as a health guider will be a fundamental base for health care service development and will contribute to expansion of common health management services.

• Journal of the Korean Dietetic Association
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• v.18 no.4
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• pp.372-384
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• 2012

The purpose of this study was to provide a basic resource for establishment of hygienic management standards for meal delivery from the central kitchen to schools. Flow diagrams for delivery of food were analyzed, and time-temperature conditions of the food and environment were measured. Four different foods samples including Mexican salad, radish salad, stir-fried pork and vegetables, and stir-fried chicken and vegetables were collected after production and before service. Microbiological analysis was performed for aerobic plate counts (APC), Enterobacteriaceae, coliforms, E. coli, Salmonella spp., S. aureus, B. cereus, C. perfringens, and L. monocytogenes. After completion of production of cooked foods 2~3 hours were taken for the cooked foods to reach the temperature danger zone. Food temperatures at the meal service did not meet the recommended temperatures ($10/57^{\circ}C$) for conventional school food service systems. The highest APC counts were observed in radish salad (5.70 log CFU/g), followed by Mexican salad (5.18 log CFU/g). Enterobacteriaceae and coliform counts were within acceptable levels of those recommended by the UK Public Health Laboratory Service. No E. coli or pathogens were found. These results provide useful information for determination of microbiological hazards in school food service systems, and suggest that time-temperature control during delivery is necessary for the safety of cooked foods.