• Journal of Preventive Medicine and Public Health
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• v.22 no.4 s.28
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• pp.555-577
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• 1989

This study was conducted to compare the delivery management including laboratory tests, medication and surgical procedures for the delivery in various medical facilities. Two university hospitals, two general hospitals, three hospitals, two private obstetric clinics, and two midwifery clinics in a large city were selected as they permitted the investigators to abstract the required data from the medical and accounting records. The total number of deliveries occurred at these 11 facilities between 15 January and 15 February, 1989 was 789 among which 606(76.8%) were vaginal deliveries and 183 (23.3%) were C-sections. For the normal vaginal deliveries, CBC, Hb/Hct level, blood typing, VDRL, hepatitis B antigen and antibody, and urinalysis were routinely done except the private clinics and midwifery clinics which did not test for hepatitis B and Hb/Hct level at all. In one university hospital ultrasonography was performed in 71.4% of the mothers and in one general hospital liver function test was done in 76.7% of the mothers. For the C-section, chest X-ray, bleeding/clotting time and liver function test were routinely done in addition to the routine tests for the normal vaginal deliveries. Episiotomy was performed in 97.2% of the vaginal deliveries. The type and duration of fluid infused and antibiotics administered showed a wide variation among the medical facilities. In one university hospital antibiotics was not administered after C-section at all while in the general hospitals and hospitals one or two antibiotics were administered for one week on the average. In one private clinic one pint of whole blood was transfused routinely. A wide variation was observed among the medical facilities in the use of vitamin, hemostatics, oxytocics, antipyreptics, analgesics, anti-inflammatory agents. sedatives. digestives. stool softeners. antihistamines. and diuretics. Mean hospital day for the normal vaginal deliveries of primipara was 2.6 days with little variation except one hospital with 3.5 days. Mean hospital day for the C-section of primipara was 7.5 days and that of multipara was 7.6 days and it ranged between 6.5 days and 9.4 days. Average hospital fee for a normal vaginal delivery without the medical insurance coverage was 182,100 Won for the primipara and 167,300 Won for the multipara. In case of the primipara covered by the medical insurance a mother paid 82,400 Won and a multiparous mother paid 75,600 Won. Average hospital fee for a C-section without the medical insurance was 946,500 Won for the primipara and 753,800 Won for the multipara. In case of the primipara covered by the medical insurance a mother paid 256,200 Won and a multiparous mother paid 253,700 Won. Average hospital fee for a normal vaginal delivery in the university hospitals showed a remarkable difference, 268,000 Won vs 350,000 Won, as well as for the C-section. A wide variation in the laboratory tests performed for a normal vaginal delivery and a C-section as well as in the medication and hospital days brought about a big difference in the hospital fee and some hospitals were practicing the case payment system. Thus, standardization of the medical care to a certain level is warranted for the provision of adequate medical care for delivery.

• Health Policy and Management
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• v.4 no.2
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• pp.1-26
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• 1994

As the hospital environment is changing rapidly, management is therefore obligated to use new ways to provide better service to patients. For example information system is introduced to some hospitals in Korea. Information system has several benefits such a soperational efficiency by on-line delivery and processing of data, accurate and rapid information production, continuous monitoring of performance and feedback, improvement of work process and better service quality. Still, many hospitals cannot be sure that information system is useful for improving organization performance. Because only one or two area of hospital information system were considered for development and with limited development hospital information system cannot be used effectively. The purpose of this study is to suggest the model of information system utilizaton and to analyze the hospital in formation system in Korea. The results are following; 1. In Korea, proportion of operating system of comuter is 31% of UNIX, 11% of IBM OS and 10% of PC LAN. 2. As we expect, scope of application software and amounts of heardware and software invest ments are affected by concern of CEO. 3. Many CIO(chief information officer) say that the biggest problems are lack of after-service and obsolescence of computer equipments in terms of hardware and shortage of application software for hospital in terms of software. 4. Personnel of information system department is so small that hospital information system can't be improved. 5. During the development of information system, full-time participation of end user is only 20% hospital with almost less than 12 person-month. This study was accomplished by survey through mail questionnaires. Response to the survey was only 55% and it was hard to generalize all the result obtained from this survey. However, We hope that this study would be helpful for helth care organization to acknowlege hospital information system in korea and to design the future architecture and frame of information system.

• Journal of agricultural medicine and community health
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• v.29 no.2
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• pp.287-301
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• 2004

Objectives: The development of internet programs for smoking cessation was motivated to quit smoking in the large group of smokers. This personalized program consisted of tailored message to consider the smokers characteristics, and contain the informations on the outcomes of smoking cessation and the skills to be used in the quit attempts. The purpose of this study was to develop the internet management program and information push-delivery system for smoking cessation to encourage the personal intention to quit smoking. Methods: We conducted in 3 steps as developing push service to encourage intention of smoking cessation, analyzing problems of smoking cessation program through the pilot test and suggesting improvements by implication stages. Results: This program is delivered for 30 days. if the participants do not fail to quit smoking. The contents consisted of 13 stages which were divided on starting period. practical period, maintenance period and success period. And push service afforded the tailored message to participants using their e-mail. According to the evaluation of pilot test, the problems of internet information push-delivery service for smoking cessation were the over-tasks per visiting time, recording style of participants, difficulty of terms and sentences, lack of visual effects, absence of follow-up module and unsuitable link with main homepage. Improvements were divided on 3 stages by implication period. The first stage included the immediate improvements as improving link with homepage, modifying menu of smoking information and upload file of notice part. The second stage included the short term improvements as alleviating condition of withdrawal, coordinating start stage of retrial, modifying errors of information push-delivery service and addition of educational materials. The third stage included the long term improvements as development of follow-up module, cost-effectiveness evaluation, reducing contents quantity, introduction of checking style, compensation of graphics effect and review for SMS utilization. Conclusions: This program contribute to improving smoking cessation rate. Therefore this program should be tested in a community to evaluate the effectiveness. To promote the effectiveness, this program should be developed the contents and the strategies for various targets, and established the follow-up system for ex-smokers.

• The Journal of the Korean dental association
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• v.21 no.12 s.175
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• pp.997-1003
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• 1983

The author studied the quality and change of the effective demand for dental treatment of the cutpatients of the Wonkwang dental clinic from the March of 1982 to the August of 1983. The results were compared with the previous reports to find any changes that might come from the effect of dental insurance system. After discussing the results, the author concluded as follows: 1. The twenties were the most in the age groups, but it is desirable that age groups of mixed dentition be the most to enhance the dental health status of community. 2. The effective demand for dental treatment increased especially in the areas such as intraoral radiograph taking, amalgam filling, temporary filling, endodontic treatments, and drug application on the soft tissue, but decreased in the areas such as prosthodontic treatments, and there were no demand for the orthodontic treatment. 3. As compared with the absolute needs, the effective demand was relatively high for teeth extraction and amalgam filling, but it was generally very low. 4. So, the present extent of dental insurance system should be expanded, and the dental care delivery system should be established within the community. Finally, the economic and social status of Iri community should be enhance by political and educational plannings.

• The Korean Nurse
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• v.35 no.2
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• pp.71-91
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• 1996

The objectives of thes study were to identify the need for equipment development in nursing, and to determine the priorities for that development. The study was descriptive study done between March 2 and May 30, 1995, in which the subjects, including 421 patients, 223 family members, and 198 nurses from neurosurgery, orthopedic, rehabilitation medicine, internal medicine and intensive care units of nine general hospitals in Seoul, completed a questionnarie developed by the research team. The questionnaire consisted of 35 open and closed questions. Data was analyzed using frequencies and percentages. The results ware summarized as follows: 1) The average age of the nurses was 27.9 years, 48% of the patients were between 20 and 40 years of age, and 17% were over 60. The average lingth of experience for the nurse subjects was four years five months with 36.9%. having over five years experience. The most frequent diagnoses of patients were spinal disc(35.9%), internal medicine disease(26.0%), cerebral vascular accident(16.6%) and spinal cord injury(10%) 2) Many of the nurses(96.4%) reported deficiencies with existing equipment and 96.5% of the nurses, but only 79.8% of the patients, nurses' time. Further, 82.3% of the nurses and 75.8% of the patients felt that the development of new equipment would lead to a decrease in the cost of nursing care. 3) Nurses felt that the greatest areas of inconvenience were patient feeding(71.7%), hygiene(71.2%), caring for a patient confined to bed(70.7%), patient clothing(67.2%), mobility transfers(63.5%) and urinary elimination(52.0%). However, patients and family members listed the following as being the most inconvenient: urinary elimination(58.7%), Hygiene(50.5), feeding(48.4%), mobility transfers(47.1%) and bed care(45.2%). 4) Generally the nurses listed more inconveniences and patients and family members listed more demands for the development of equipment. These included utensils with large handles, and regulators for tube feedings; mattresses that provide for automatic position change and massage, which have patient controlled levers and a place for bed pan insertion; automatic lifts or transfer from bed to wheelchair; equipment to facilitate washing and oral hygiene as well as equipment that will allow patients with spinal cord injuries easy access to showers; a bed pan/urinal for women that is comfortable and effective from which urine can be measured and disposed of easily; disposable dressing sets and tracheostomy care sets and a convenient way of measuring changes in wound size; a safe delivery system for oxygen, a variety of mask sizes and better control of humidity, tracheal material than at present, as well as a communication system for patients with tracheostomies; clothing that will allow access to various parts of the body for treament or assessment without patients having to remove all of their clothing; and finally a system that will allow the patient to control lighting, telephones and pagers. Priority areas for equipment development reported by the nurses were, urinary elimination(58. 7%), hygiene(50.5%), feeding(48.4%), mobility transfers(47..1%), bowel elimination(40.8%). Those reported by the patients family members were feeding(71.7%), hygiene(70.0%), bedcare(70.7%), clothing(67.2%), mobility transfers(63.6%), urinary elimination(52.9%) and bowel elimination(50.5%) Altogether, nurses, patients and family members listed the following as priorities; clothing (178), bed care(144), urinary elimination(92), environment(81), hygiene(70). Further, a health professional forum listed urinary elimination, oxygen delivery, medication delivery, mobility transfers, bed care and hygiene in that order as priority areas. From this study it can be concluded that the first need is to develop equipment that will address the problems of urinary elimination. To do (l)This nurses who are interested in equipment development should organize an equipment development team to provide a forum for discussion and production of equipment for nursing.

• Research in Community and Public Health Nursing
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• v.7 no.2
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• pp.384-399
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• 1996

The concept of parish nursing began in the late 1960s in the United States when increasing numbers of churches employed registered nurses (RNs) to provide holistic, preventive health care to the members of their congregations. Parish nursing role was developed in 1983 by Lutheran chaplain Granger Westberg, and provides care to a variety of church congregation of various denominations. The parish nurse functions as health educator, counselor, group facilitator, client advocate, and liaison to community resources. Since these activities are complementary to the population-focused practice of community health' CNSs, parish nurses either have a strong public health background or work directly with both baccalaureate-prepared public health nurses and CNSs. In a Midwest community in U.S.A., the Healthy People 2000(1991) objectives are being addressed in health ministries through a coalition between public health nurses and parish nurses. Parish nursing is in the beginning state in Korea and up untill now, there has been no research was conducted on concrete role of korean parish nurses. The main purpose of this study was to identify, classify and analyze activities of parish nurses. The other important objective of this study was to establish an effective approach and direction for parish nursing and provide a database for korean parish nursing model through analysis and' classification of the content of the nursing record which included nursing activities. This study was a descriptive survey research. The parish nurses were working in churches where the demonstration project developed on parish nursing. The study was done on all nursing records which were working in churches where the demonstration project developed on parish nursing. The study was done on all nursing records which were documented by parish nurses in three churches from March, 1995 to February, 1996. Namsan, Taegu Jeei and Nedang presbyterian churches in Taegu and Keimyung nursing college incooperated together for the parish nursing demonstration project. The data analysis procedure was as follows: First, a record analysis tool was developed and second, the data was collected, coded and analyzed, the classification for nursing activities was developed through a literature review, from which the basic analysis tool was produced and cotent validity review was also done. The classification of the activities of parish nurses showed 7 activitity categories. 7 activity categories consisted of visitation nursing, health check-ups, health education, referring, attending staff meetings, attending inservices and seminar, volunteers coordinating. The percentage of activities were as follows: Visitation nursing(A: 51.6%, B: 55%, C: 42.6%) Health check-ups(A: 13.5%, B: 12.1%, C: 22.3%) Health education(A: 13.5%, B: 13.2%, C: 18.2%) Referring(A: 1.4%, B: 4.2%, C: 2.4%) Attending staff meeting(A: 18.8%, B: 13.0%, C: 12.2%) Attending inservices and seminar(A: 1.5%, B: 2.2%, C: 2.1%) Volunteers coordinating(A: 0.3%, B: 0.4%, C: 0.0%) To establish and develope parish nursing delivery network in Korea, parish nurses role, activities and boundaries of practice should be continuously monitored and refined every 2 years. Also, It is needed to develope effective nursing recording system based on the need assessment research data of various congregation members. role, activities and boundaries of practice and arrangement of the working structure, continuing education, cooperation with community resources and structuring and organizing parish nursing delivery network. Also, It is needed to develope effective nursing recording system based on the need assessment research data of various congregation members.

• Health Policy and Management
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• v.4 no.2
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• pp.77-110
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• 1994

This study is an empiriacl analysis of effects of government intervention on the health care delivery system in Korea. The purposes of this study are to find out the effects of government intervention on the per capita national health expenditure(per capita NHE), crude mortality rate(CMR), and institutional efficiency. Here, the institutional efficiency is defined as a formula shown below: log$\frac{100-curde mortality rate }{per capita NHE}$$\times$100. The formula indicates that the instiutional efficiency increases if the CMR and/or per capita NHE goes down. In the meantime the government intervention is measured by six independent variables: I) the degree of social developments, ii) the numberr of physicians per 100, 000 population, iii) the proportion of specialists among the total physicians, iv) the proportion of public expenditure among the NHE, v) the proportion of public beds to the total number of beds, vi) the proportion of physicians working at the public sector to the total number of physicians. In the above six independent variables iv), v) and vi) are the ones that reflect the degree of government intervention. In actual calculation, the two independent variables v) and vi) are integrated into a new variable based on one to one correspondence. The materials used are the time-series data from 1970 through 1990 in Korea. A path analysis and the time-series regression analysis were adopted to estimate and examine the causal relationship between variables involved. And decomposition of the effect of causal relationship is made to find net effect, direct and indirect effect. The major findings are as follows; 1. The effect of public expenditure, number of physicians per 100, 000 population, the proportion of specialists among the total physicians and social development shows a positive relationship with per capita NHE. Only if the government intervention would be counted, the effects of the number of physicians and the proportion of specialists succeed in containing per capita NHE. 2. In additionn to the above four variables, one additional variable, per capita NHE, was also responsible for the reduction of CMR. The factor of social development found to be the most potent predictor of the CMR reduction. However, the CMR reduction due to government intervention was negligible. 3. Meanwhile, the above four variables were found to was have negative effects on the institutional efficiency. The reverse is true when the government intervention is counted. For example, the number of physicians and the proportion of specialists have played a positive role in raising institutional efficiency via goverment intervention. This comes from the factual effect that the increment of institutional efficiency via the reduction of per capita NHE is bigger than via the reduction of CMR.

• Health Policy and Management
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• v.28 no.1
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• pp.48-52
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• 2018

Background: The current study evaluated the hospital utilization and characteristics of patients who received health care services for acute cerebral infarction outside their own residential area. Methods: Using the 2014 national patient survey data, information on 2,982 patients diagnosed with acute cerebral infarction through emergency department were retrieved for the analyses. Multiple logistic regression was performed to investigate the characteristics associated with using hospitals outside residential area among patients diagnosed with acute cerebral infarction. Results: Fifteen point nine percent of patients admitted for acute cerebral infarction utilized hospitals outside their residential area. Patients residing in a province were 7.7 times more likely to utilize hospitals located outside their residential areas compared to those living in Seoul metropolitan city. Patients living in Gangwon and Jeolla were 0.26 times and 0.48 times more likely to go to hospitals in different geographical areas. Also, patients within the age group of 80 years and over were 0.65 times less likely to be admitted to hospitals outside their residential area compared to those in their 40s-50s. Conclusion: The use of hospitals outside patient's residential area is shown to be substantial, given that the acute cerebral infarction requires immediate recognition and treatment. The findings on the geographical differences in the hospital utilization suggest further investigation.

• Research in Community and Public Health Nursing
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• v.10 no.1
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• pp.70-79
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• 1999

This study attempts to encourage the development of a rehabilitation delivery system as a substitute service for hospitalization such as a community based intermediate facility or home health care. We need substitute services for hospitalization to curtail the length of stay for inpatients due to car accidents. It focused on developing an estimation for early discharge based on a detailed statement of treatment from medical records of 109 inpatients who were hospitalized at General Hospital in 1997. This study has three specific purposes: First, to find the mean length of stay and mean medical expenditure. Second, to estimate the mean of early discharge from the mean length of stay. Third, to analyize the income effect per bed from early discharge. In order to analyze the length of stay and medical expenditure of inpatients the author conducted a micro and macro-analysis with medical expenditure records. To estimate the early discharge we examined with a group of 4 experts decreases in the amount of treatment after surgery, in treatments, in tests, in drug methods. We also looked their vital signs, the start of ROM exercise, the time removel, a patient's visitations, and possible stable conditions. In addition to identifing the income effect due to an early discharge, the data was analyzed by an SPSS-PC for windows and Excell program with a regression analysis model. The research findings are as follows: First, the mean length of stay was 47.56 days, but the mean length of stay due to early discharge was 32.26 days. The estimation of early discharge days was shown to depend on the length of stay. The longer the length of stay, the longer the length before discharge. For example, if the patient stayed under 14 days the mean length of stay was 7.09 while an early discharge was 6.39, whereas if the mean length of stay was 155.73, the early discharge time was 107.43. The mean medical expenditure per day of car accident patients was found to be 169,085 Won, whereas the mean medical expenditure per day was shown to be in a negative linear form according to the length of stay. That is the mean expenditure for under 14 days of stay was 303,015 Won and the period of the hospitalization of 15 days to 29 days was 170,338 Won and those of 30 days to 59 days was 113,333 Won. The estimation of the income effect due to being discharged 16 days was around 2,350,000 Won with a regression analysis model. However, this does not show the real benefits from an early discharge, but only the income increasing amount without considering prime medical cost at a general hospital. Therefore, we need further analysis on cost containments and benefits incending turn over rates and medical prime costs. From these research findings, the following suggestions have been drawn, we need to develop strategies on a rehabilitation delivery system focused on consumers for the 21st century. Varions intermediate facilities and home health care should be developed in the community as a substitute for shortening the length of stay in hospitals. In home health care cases, patients who want rehabilitation services as a substitute for hospitalization in cooperation with private health insurance companies might be available immediately.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.28 no.3
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• pp.291-301
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• 2024

This systematic review and meta-analysis aimed to evaluate the impact of prospective payment systems (PPSs) on cholecystectomy. A comprehensive literature review was conducted, examining studies published until December 2023. The review process focused on identifying research across major databases that reported critical outcomes such as length of stay (LOS), mortality, complications, admissions, readmissions, and costs following PPS for cholecystectomy. The studies were specifically selected for their relevance to the impact of PPS or the transition from fee-for-service (FFS) to PPS. The study analyzed six papers, with three eligible for meta-analysis, to assess the impact of the shift from FFS to PPS in laparoscopic and open cholecystectomy procedures. Our findings indicated no significant changes in LOS and mortality rates following the transition from FFS to PPS. Complication rates varied and were influenced by the diagnosis-related group categorization and surgeon cost profiles under episode-based payment. There was a slight increase in admissions and readmissions, and mixed effects on hospital costs and financial margins, suggesting varied responses to PPS for cholecystectomy procedures. The impact of PPS on cholecystectomy is nuanced and varies across different aspects of healthcare delivery. Our findings indicate a need for adaptable, patient-centered PPS models that balance economic efficiency with high-quality patient care. The study emphasizes the importance of considering specific surgical procedures and patient demographics in healthcare payment reforms.