• Korea Journal of Hospital Management
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• v.29 no.2
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• pp.37-47
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• 2024

Purpose: This study aimed to determine the effect of adjusted out-of-pocket maximum rules in the 'differential co-payment ceiling', which means having a higher burden of co-payment, that expanded to the entire ceiling level in long-stay admission patients in long-term care hospitals(LTCH). Methodology: We used health insurance claim data between January 1, 2022, and December 31, 2022 received from the National Health Insurance Service. The study populations were inpatients in long-term care hospitals more than 1 days during the study period. We performed the difference in characteristics of the LTCH patient of the differential and general ceiling by the chi-square test. We estimated the change of the population, cost, and co-payments per person under the assumption of restructuring. Finding: Based on adjusted out-of-pocket maximum rules in 2023, it was expected that the number of benefits decreases at the high-income level while increasing at the low-income level. The burden of health expenditure after reimbursement of co-payment ceiling, is expected to increase by 65.1% in the highest medical necessity, whereas the low medical necessity would decreases compared to 2022. Practical Implications: The results demonstrate that the current out-of-pocket maximum rules do not reflect the needs of medical necessity. This study suggested the need to reflect the medical necessity in LTCH on the out-of-pocket maximum rules in the future.

• Tuberculosis and Respiratory Diseases
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• v.87 no.1
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• pp.100-114
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• 2024

Background: Long-term oxygen therapy (LTOT) improves the survival of patients with hypoxemia due to chronic respiratory diseases. The clinical outcomes of LTOT are strongly associated with patient adherence. To improve the adherence of patients, physicians have focused on the efficacy of LTOT. However, poor adherence may stem from patients' perceptions of LTOT. Herein we evaluated patients' perceptions of LTOT affecting adherence. Methods: We conducted a cross-sectional survey study using descriptive, open, and closed-ended questionnaire. Patients using oxygen therapy (OT) or requiring it but avoiding OT responded to the questionnaires at three university hospitals. Results: Seventy-nine patients responded to the questionnaires. The number of patients using home and portable OT was 69 (93%) and 37 (46.3%), respectively. Patients with good adherence were 22 (30.1%). Among patients with good adherence, 90.9% used oxygen according to physicians' prescriptions whereas only 37.3% of those with poor adherence followed physicians' prescriptions (p<0.01). The reasons for avoiding using home OT were fear of permanent use (50%), unwanted attention (40%), and lack of symptoms (40%). They avoided portable OT because of unwanted attention (39%), heaviness (31.7%), and lack of symptoms (21.6%). Conclusion: Patients on LTOT had the perception of the misunderstanding the effects of OT and of psychosocial barriers to initiate or use LTOT. Considering these findings, health professionals need to provide effective education on the purpose of LTOT to improve patient adherence to OT and provide sufficient support for the management of psychosocial barriers in patients using LTOT.

• The Korean Journal of Health Service Management
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• v.12 no.1
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• pp.81-93
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• 2018

Objectives : This cross-sectional study aims to investigate the differences in general health status (GHS) and physical care burdens (PCB) of inpatient groups in long-term care hospitals (LTCH). Methods : The data of 228 patients were analyzed by integrating the electronic medical record (EMR) data of 2016, recorded by the nurses of hospitalized patients in the hospital. Results : There was a statistically significant difference in the GHS between the high-medical demand group and the other groups, but there was no difference in the GHS among other groups. The overall PCB was higher in the high-medical demand group than in the middle-medical demand, and cognitive impairment groups, but not in the problem behavioral group. Conclusions : The current classification of patient groups has shown limitations in terms of the basis of differential benefits of the groups. In particular, the PCB of the problem behavior group was not different from that of any group; hence, it should be adjusted through further study. To control the surge of medical care costs, it is necessary to improve the irrationality of the LTCH pay system in terms of the integration and continuity for elderly care.

• Journal of Korean Academy of Rural Health Nursing
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• v.19 no.1
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• pp.44-54
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• 2024

Purpose: This study identifies the factors influencing unplanned readmissions among participants of the medical aid community care pilot program. Methods: This descriptive study analyzed data from 1,013 participants in a medical aid community care pilot program. Data were analyzed using multiple logistic regression analysis. Results: The presence of mental illness, injury-related conditions, long-term care grades, and activities of daily living scores are key factors influencing the likelihood of readmission. In particular, the presence of a mental disorder or an injury-related condition increased the probability of readmission, whereas individuals with long-term care grades 1~2 showed a decreased likelihood of readmission. Conclusion: This study emphasizes the importance of enhancing the management of mental and injury-related conditions, effective utilization of long-term care services, and improvement of ADL scores to reduce readmission. These findings offer crucial insights for enhancing the efficiency of home medical care benefit programs and sustainable expansion of services.

• The Korean Journal of Health Service Management
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• v.8 no.4
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• pp.95-107
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• 2014

This study is a descriptive research to investigate the actual conditions under which nurses working in long-term care hospitals are sexually harassed and situations in which sexual harassment occurs and to determine victims' coping methods after being sexually harassed. The period of data collection was from May 13, 2013 to June 14 and the research subjects were 113 nurses working in 10 long-term care hospitals in Busan assigned by convenience sampling. The results showed that sexual harassment of nurses mostly occurred as follows: visual harassment, which involved the perpetrators looking inappropriately at nurses; physical harassment, which involved intentional touching or leaning into the body; and verbal harassment, which involved making sexual jokes and remarks. The development of a prevention program for sexual harassment targeting patients and nurses in long-term care hospitals should be required to enable victims to perceive and efficiently cope with sexual harassment.

• Journal of East-West Nursing Research
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• v.25 no.1
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• pp.81-89
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• 2019

Purpose: This study aimed to investigate influencing factors on nursing competency of nurses in long-term care hospitals. Methods: A descriptive research design was used with a convenience sample of 150 nurses. Data were collected from Feb 15 to Mar 8, 2017 using self-reported questionnaires and analyzed by descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and multiple regression analysis using the SPSS/WIN 18.0 program. Results: The mean scores of self-efficacy, organizational citizenship behavior and nursing competency were 3.84 out of 5, 3.77 out of 5 and 3.80 out of 5, respectively. Nursing competency was positively correlated with self-efficacy (r=.63, p<.001) and organizational citizenship behavior (r=.64, p<.001). Factors influencing on nursing competency were self-efficacy (${\beta}=.38$, p<.001), organizational citizenship behavior (${\beta}=.37$, p<.001) and Clinical career(${\beta}=.14$, p=.011), which explained 51% of the variance. Conclusion: Based on the finding of this study, it is necessary to develop education and intervention programs in order to increase the nursing competency for nurses in long-term care hospitals.

• Korean Journal of Adult Nursing
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• v.24 no.4
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• pp.390-397
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• 2012

Background: Few nurses are trained in palliative care for long-term care in Korea. The End-of-Life Nursing Education Consortium (ELNEC)-Geriatric training program improves nurses' ability to promote palliative care for the elderly. Purpose: The aim of this study was to evaluate nurses' satisfaction and knowledge following the attendance at the ELNEC-Geriatric curriculum on nurses' knowledge of palliative care. Methods: Nine ELNEC-Geriatric modules were presented to 203 interdisciplinary professionals on July 1 and 3, 2010, in Seoul, South Korea. The Palliative care quiz for nursing (PCQN) was used to evaluate nurses' knowledge. Of all the participants, 128 nurses were completed the questionnaire. Of these nurses, 45.2% were staff nurses and 73.4% were hospital nurses. Results: Approximately eight nine percent of the nurses reported previous experience in caring for dying patients and attending various hospice palliative care training programs. Overall program satisfaction of the participants was 4.03 on a 5-point scale, and their mean of the total PCQN score was 12.75 out of 20 after participating in ELNEC-Geriatric course, which was a significant improvement (p=.022) from the pretest. Conclusion: The results of this study demonstrate that ELNEC-Geriatric curriculum was successfully implemented and significantly contributed to increasing the nurses' knowledge for palliative care in long-term care in Korea.

• The Korean Journal of Health Service Management
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• v.5 no.1
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• pp.147-158
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• 2011

This study compares the degree of satisfaction and the causes of selecting facilities for stroke patients in the senior specialized hospitals and other senior care facilities. The research results are followed. First, The patients who held the level of senior long-term care used senior specialized hospitals, while the patients who had the level of 2 or 3 degree used senior care facilities. The patients helped by cooperative care service used senior care facilities, and the patients helped by private service or family service used senior specialized hospitals. Second, The patients in senior specialized hospitals had affirmative attitude for their service system, while the patients in senior care facilities preferred their various service systems. In the satisfaction of the facilities, the patients in senior care facilities felt more satisfaction to staff, environment, service, and other factors than the patients in hospitals did. Third, in the result of logistic analysis, the patients had an affirmative attitude in case that they had spouse, experience of senior specialized hospitals or senior care facilities, without senior long-term care insurance. They also valued the service standard and the staff quality. As this study points out, the overall preference is higher in the senior care facilities. So, the stroke patients recognized the new role between the hospitals and the facilities after the establishment of long-term senior medicare system. This research had some limitation for the research areas and numbers. So the data analysis for the types of facility and the responses may not be generalized. However, the standard of choosing facility and satisfaction will be a guideline for establishing a new future role between hospitals and facilities. This result will be used as a basic data for the renovation of long-term senior medicare insurance.

• Health Policy and Management
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• v.32 no.4
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• pp.368-379
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• 2022

Background: This study aimed to establish a strategy to improve the poor working environment and working conditions among long-term healthcare workers in Korea. Methods: A total of 600 questionnaires with which long-term health care workers participated in the targeted base areas of each city and province nationwide were distributed directly and 525 responses were collected and 506 responses were analyzed. Surveys, on-site field visits, and in-depth interviews were also conducted to understand the working environment as well as conditions and establish a strategy for improving the working environment among long-term healthcare workers to understand the demands of working conditions and working conditions. Results: Korean long-term care workers firstly and mostly enumerated their risk factors for ill-health when lifting or moving elderly recipients directly by hand (69.9%), followed by increased physical workload with old beds, tools, and facilities (42.3%) in the workplaces, shortage of manpower (32%), and source of infection (30%). To improve the working environment as well as conditions, Korean long-term care workers considered improving low-wage structures, ergonomic improvements to solve excessive physical loads, and increasing various bonus payments as well as implementing the salary system, positive social awareness, and increasing resting time. Of 506 responses, 92.3% replied that the long-term care insurance system for the elderly should be developed to expand publicization at the national level. Conclusion: This study proposes to improve the low-wage structure of Korean long-term care workers, automation and improvement of facilities, equipment, and tools to eliminate excessive physical loads (beneficiary elderly lifting), and reduction of night labor.

• Research in Community and Public Health Nursing
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• v.33 no.4
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• pp.357-371
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• 2022

Purpose: This study aims to investigate factors related to long-term length of stay (LOS) of patients with chronic diseases in Korean veterans hospitals. Methods: The subjects were 196 elderly patients with chronic disease staying in the hospital for more than 10 days, Data were collected by the survey of patients with structured questionnaires and medical records review by nurses from July 15 to August 10, 2019. Collected data were analyzed using t-test, ANOVA, Pearson's correlation coefficient and stepwise multiple regression. Results: The present and desired LOS were 37.78±32.66 days and 60.87±45.95 days, respectively. Factors affecting hospital LOS were found to be main disease (genitourinary) (p<.001), assistance in activities of daily living (p<.001), area of hospital (p<.001), payment of medical fees (p=.026), hospital satisfaction (p=.036) and the explanatory power of these variables was 26.4%. The most common health problems that need to be solved after discharge were symptom alleviation and health promotion. These problems can be solved using community-based facility services or visiting medical-welfare services (especially home care nursing). Conclusion: In order to reduce hospital LOS, the following measures are required: personalized self-management education, provision of transportation services for dialysis therapy of inactive patients, linking patients with visiting medical-welfare services including home care nursing and mobile healthcare services, operation of the case management system including the notice of the discharge date at admission, interim check of patient status, and connecting the patient with community resources or transferring the patient to long-term care facilities at discharge.