• 한국보건간호학회지
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• 제24권2호
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• pp.211-225
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• 2010

Purpose: This comparative study analyzed information systems including manpower, contents of service, clients, and costs among four nations. Methods: A literature review of relevant publications from Korea, United States, Japan, and Germany supported the use of several plans to activate home nursing care services under the long-term care insurance system in Korea. Results: Korean home nursing care services require quality improvements. The results indicated that a rule is necessary that rations simple visiting service and home nursing care services under the long-term care insurance system, that an integrated management system for elderly care is required, and that the revised delivery of services needs to establish and reflect on various factors to estimate the value in a home visiting nursing care cost system. Conclusion: The data should be valuable in establishment of home nursing care services under the long-term insurance system in Korea.

• 농촌의학ㆍ지역보건
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• 제44권1호
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• pp.28-38
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• 2019

본 연구에서는 우리나라 보건소 방문건강관리사업과 노인장기요양보험의 방문간호, 의료기관의 가정간호사업 등 가정방문간호사업 현황을 살펴보고, 향후 발전과정을 모색하고자 수행되었다. 본 연구를 위하여 각 가정방문간호사업의 관련 법령, 통계자료, 지침과 안내서, 연구논문과 학술대회 자료집 등을 검색하여 관련 문헌을 고찰하였다. 연구결과 보건소 방문건강관리사업은 지역보건법에 근거하여 주로 취약계층을 대상으로 간호사에게 의해 비용부담 없이 제공되고 있으며, 2017년 12월을 기준으로 1,261,208명 등록 관리되는 것으로 나타났다. 보건소 방문건강관리사업 등록 대상자는 흡연율, 걷기 실천율, 혈압조절율, 혈당조절률 등이 향상되는 것으로 나타나, 건강행위와 질병관리 측면에서 긍정적인 효과가 있고, 비용-편익이 있다고 보고되었다. 노인장기요양보험에서의 방문간호는 노인장기요양보험법에 근거하여 간호사 또는 간호조무사에 의해 재가장기요양기관에서 방문간호를 제공하고 있으며, 시간당 정해진 수가에 따라 비용을 받고 있는데, 2017년에 전체 요양급여비의 0.2%만이 방문간호로 이용하는 것으로 나타났다. 재가장기요양보험 방문간호 이용자는 비이용자에 비해 의료비도 더 적게 쓰고, 입원일도 적다고 보고되었다. 의료기관 가정간호는 의료법에 근거하여 2명 이상의 가정간호사(가정전문간호사)를 고용한 의료기관에서 의사의 처방 하에 가정간호서비스를 제공하는데, 2017년 460명의 가정간호사가 가정간호서비스를 제공하고, 전체 의료비의 0.038%가 가정간호비용으로 지불된 것으로 나타났다. 우리나라 가정방문간호 유형은 관련법이나 인력, 사업 대상이 다르지만, 서비스 이용자의 건강관리에 효과가 있고, 비용-편익이 상당히 높은 것으로 나타났다. 우리나라 가정방문간호를 발전과 활성화를 위해 세 개 유형의 가정방문간호 서비스가 통합적으로 제공될 수 있는 방안을 모색하고, 근로 조건의 개선, 가정방문간호서비스 제공인력기준이나 방문간호수가 체계의 개선과 같은 법령의 개정 등을 고려할 필요가 있다고 본다.

• 근관절건강학회지
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• 제3권1호
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• pp.4-22
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• 1996

Purposes of this study were to identify a hospital-based home care model and to improve the physical, emotional and economical effectiveness of arthritic patients through medical and nursing team approach. The design in nonequivalent control group pretest-posttest design with matched samples in terms of age, sex and disease severity. Fifty two patients in each group were assigned in Seoul, Kyunggi, Kangwon and Kwangju. Before and after 6-month period of home care, level of pain, duration of morning stiffness, Richie Index, ADL, self efficacy, depression, cost expenditure were measured. Nine patients were excluded from the control group in the period of study because of denial of participation. Contents of home care provided to the experimental group include mainly distribution of prescribed drugs, 'assessment of patients' condition and side-reactions of drug. All of the information related to the home care patient were reported to the physician. On the bases of these data, the physician prescribe the specific drugs to each patient. Each patient visited the physician every 2 or 3 month for laboratory test. Patients assigned to the control group visited the outpatient clinic once a month as usual. Null hypotheses were selected because physicians concerned about the ineffective change of patients' conditions due to indirect communication with patients through nurses. Level of pain, Richie index, ADL, self-efficacy, depression, duration of morning stiffness and direct medical cost were the home care provided to them. If a family member accompany in a home care group can save 10,676 Won/month in Seoul, 34,000 Won/month in other districts. Other in-direct cost for transportation and meal can also be saved. In conclusion, those patients with low level of ADL, high level of pain and Richie index, living in the remote area definitely need the home care.

• 농촌의학ㆍ지역보건
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• 제24권1호
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• pp.91-101
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• 1999

장 노년층 인구증가에 따른 건강문제의 다양화, 주민의 건강 요구증가에 부응하기 위해서는 기존의 의료기관 중심의 진료서비스 만으로는 새로운 건강문제를 충분히 해결할 수 없으므로 새로운 보건의료 제공 체계가 도입 되기에 이르렀다. 이미 선진국에서는 오랜 역사를 갖고 있는 가정간호사제도가 우리 나라에서도 입법화되어 1994년부터 병원중심의 가정간호사업이 시범적으로 운영되고 있다. 본 연구는 농촌지역의 중소병원에서 실시하고있는 가정간호사업소에 등록되어 있는 환자의 방문비용을 분석하는 것을 목적으로 실시되었으며, 1996년 5월 - 1997년 4월(1년간)까지 등록된 102명의 진료기록부를 분석하였다. 자료 분석 방법은 수준을 파악하기 위하여 평균과 분포로 분석하였으며 변수간의 차이점 등은 t - test와 ANOVA로 분석하였다. 분석 결과는 다음과 같다. 첫째, 등록환자의 일반적 특성은 남자가 44.1%, 여자가 55.9%로서 여자가 높았으며 연령은 60세 이상이 73.5%로서 노인 환자가 많았다. 둘째, 골다공증이 등록환자의 35.3%로서 제일 높았으며 각종 암이 21.6%, 뇌졸중이 14.7%로 나타나 연령과 관계가 깊은 것으로 나타났다. 질환특성은 복합질환, 즉 한가지 이상의 증상, 혹은 질환을 함께 갖고있는 경우가 73.5%로서 단순질환 26.5% 보다 높았다. 셋째, 남자 환자의 방문당 평균비용이 47,764원으로서 여자 환자의 46,078원 보다 높았다. 연령별로는 연령이 높아질수록 방문당 평균비용이 높은 것으로 나타났다. 성별과 연령별 비용은 통계학적으로 유의한 차이가 있는 것으로 나타났다. 넷째, 질환 특성별 비용은 단순질환이 복합 질환보다 방문당비용이 약간 높았으나 통계학적으로 유의한 차이가 없었으며, 질환별로는 COPD, 각종 암, 당뇨, 골다공증의 순으로 방문비용이 높게 나타났다. 다섯째, 가정간호의 방문비용이 질환으로 병원에서 치료받을 경우 보다 적게 나타나 비용효율이 있는 것으로 나타났다. 본 연구 결과는 제한된 자료를 분석한 것이므로 결과를 일반화시키는데 신중을 기할 필요가 있다. 그러나 가정간호사제도가 향후 정착되기 위해서는 가정간호 대상질환의 선정, 서비스내용 및 질, 비용효율 및 효과에 대한 평가가 계속 실시될 것을 제안한다.

• 지역사회간호학회지
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• 제21권3호
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• pp.362-373
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• 2010

Purpose: The purpose of this study is to evaluate the costs and benefits of individual home visiting health care using secondary data and literature review. Methods: The total number of subjects was 1,008,837. A specific program was classified into disease management, care of infant, child and women, or elderly care. The costs and effects of a program were identified from a societal perspective, and the effects were converted into monetary terms or benefits. The total cost was calculated in the way that medical expenses, travel costs and productivity losses were offset by the decrease in benefits and thus only the program budget was included in the total cost. Results: The total program cost was 47.6 billion won per year and the total annual benefit was estimated at 435.6 billion won. The benefits of arthritis management were the biggest among disease management programs. The net benefit was 388.0 billion won per year and the benefit/cost ratio was 9.16. Conclusion: Home visiting health care was validated to be economically effective. It made a positive contribution to improving the health status of vulnerable populations and reducing medical expenses. These results suggest that home visiting care should be extended more broadly to vulnerable populations.

• 가정∙방문간호학회지
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• 제3권
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• pp.98-110
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• 1996

As the health of people is a integral element of the public well-being, the government adopted and put the home visiting nurse system into practice from Jan. 1990, so that the public might get the necessary health service at the low cost and at home. Thus, it resulted in a rapid increase of the public need for the quality of life. The increasing demand for home care created a necessity for an increased man-power like home care nurse. Since the demand of the publics‘ home care has increased, Seoul Nurses’ Association, one of the branches of Korean Nurses Association has developed for the project team of Home Visiting Nurses Activities. The purpose of this study will analyzed and classified home nursing care activities of home visiting nurse according to the criteria of nursing diagnosis Korean Nurses‘ Association. The subject of the study was 54 patients in 1993 and 148 patients in 1994. All patients received home care at home from visiting nurses were living in Seoul city. The results of the study were as follows; 1) With regard to the nursing diagnosis, 24 items were classified. 2) The patients and families wanted to increase the number of time for home visiting. 3) Main sources of request to visit the patients at home were mainly from the families through nurses or doctors who cared for the patients. 4) In comparison of the characteristics visiting activities between 1993 and 1994, the number of the classification of nursing diagnosis and the number of visiting activities in 1994 were relatively increased than the outcomes in 1993.

• 가정∙방문간호학회지
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• 제26권1호
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• pp.81-90
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• 2019

Purpose: In accordance with changes in the healthcare environment, it is necessary to understand managerial cost accounting for nurses. This study aimed to develop educational components of managerial cost accounting for nurses. Methods: This study is comprised of a comprehensive literature review, nominal group technique using focus group interview, audit by an expert group, and priority analysis. Results: The comprehensive literature review identified 15 educational components of managerial cost accounting. In the nominal group technique, the participants finally agreed on eight educational components of managerial cost accounting for nurses. The average content validity index of these components was 0.99. "Activity-based costing" scored the highest for relative importance (15.7%). Conclusions: These results can be used to develop an education program to strengthen nurses' managerial cost accounting competencies. Furthermore, it will be helpful to use a basis for the development of cost management curricula for nursing students and on-the-job training courses of nurse managers and executives.

• 간호행정학회지
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• 제14권2호
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• pp.118-130
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• 2008

Purpose: The purpose of this study was to estimate of home-visiting nursing costs for low-income elderly with chronic disease in a metropolitan city using the severity classification and ABC(active-based costing). Methods: First, the HHC activity pool was established. The performance time of each nursing activity were estimated. Second, nursing resources(labor costs, operating costs, and traffic expenses) were analyzed and nursing cost per minute was calculated. And then the cost of each activity was estimated. Third, 202 visiting cases were classified into three group by their severity. And then nursing cost per visit according to their severity was estimated. Results: 59 nursing activities were included in HHC activity pool. The average working time of 59 nursing activity was 6.7minutes and nursing cost per minute was 489 won. According severity, nursing cost per visit were in class I, 54,296 (won), class II 83,124(won), and class III 93,455(won).

• 가정∙방문간호학회지
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• 제12권2호
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• pp.63-86
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• 2005

Purpose: This study is a descriptive research which is designed to investigate hospitalized patients' intent to use home care nursing according to the types of medical security. Method: This researcher surveyed 236 patients who were hospitalized at B medical center located in Busan,. Data were collected from Sep. 1 to Nov. 30, 2005 using a questionnaire survey, medical records, face-to-face interviews and observations. Collected data were analyzed in terms of frequency, percentage, mean and standard deviation through $x^2$-test and t-test under SPSS WIN 10.0 Program. Result: Out of the total subjects, 59.3% were medical aid clients and the remaining 40.7%, health insurance ones. The hospitalized period and frequency of the former group were 38.0 days and 4.0 times, respectively, while those of the latter, 37.7 and 3.4. When home care nursing clients were examined using a given classification device, it was found that out of the total 236 subjects, 205(86.9%) were needed to receive home care nursing, 121, medical aid and the other 84, health insurance. 24.0% of medical aid clients heard about home care nursing ever before, lower than 39.3% of health insurance clients. 43.8% of the former clients said cost for home care nursing was high while, 47.6% of the latter group responded expense for the nursing intervention was low. 30.6% of medical aid clients had intent to use home care nursing, lower than 47.6% of health insurance clients. 71.7% of those patients whose monthly income was 99 million won or below had no intent to use home care nursing, higher than 62.5% of those who were 100 million or over in monthly income(p<.05). 76.4% of those clients who had no nursing provider intented to use home care nursing, higher than those who had nursing provider(p<.05). Concerning contents of home care nursing, 85.1% of medical aid clients needed education, training and counseling while, 77.4% of health insurance aids wanted medication and injection. Conclusion: In conclusion, the use of home care nursing by medical aid clients should be promoted through improving conditions for home care nursing in terms of expense, family and residence and making public relations about activities and contents of the home care nursing.

• 가정∙방문간호학회지
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• 제15권2호
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• pp.82-90
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• 2008

Recent shortening of hospitalization has partly led to the transition of health care services from hospitals to communities in cardiovascular (CVD) care. Home healthcare nursing is an alternative modality of care for chronically ill CVD patients. Cardiac rehabilitation (CR) has been redefined as a "secondary prevention center", consisting of: patient assessment; nutritional counseling; blood pressure and diabetes management; tobacco cessation; psychosocial management; and physical activity counseling. Improvement in health-related quality of life (HRQOL) is a major goal of the CR that integrates physical, psychological and social dimensions of care. The review of evidence on effects of CR on HRQOL may allow home healthcare nurses to provide better comprehensive care for CVD patients. There is evidence on beneficial effects of CR on HRQOL in patients with myocardial infarction (MI) as well as patients with chronic heart failure. Specifically, home-based CR, which is more cost-effective than hospital-based CR, has been reported to produce comparable improvements in HRQOL with hospital-based CR in MI patients. In conclusion, a newly-designed, home-based CR may be required to be applied to Korean home healthcare nursing system for improving HRQOL.