• The Journal of the Korea Contents Association
• /
• v.17 no.4
• /
• pp.585-595
• /
• 2017

The purpose of this study is to analyze the difference of medical care between medical assistance and health insurance patients to evaluate the increase of medical care costs due to the moral hazard of medical care patients and to provide a basis for rational medical care policy decision. For this purpose, we compared health insurance benefit data for Seoul citizens by gender, age, and type of medical institutions. The results of the analysis are as follows. First, all of the hospitalized and outpatient use of the advanced general Hospitals, medical assistance patients were less than those of the health insurance patients, so that the medical assistance patients could not use the high cost medical services. Second, in general hospitals, patients with health insurance are often hospitalized. On the other hand, medical assistance patients use a lot of outpatient services because they are less burdened. Third, in hospitals and clinics, medical benefits patients often use inpatient and outpatient services. Therefore, medical assistance patients are likely to use unnecessary medical care of outpatient and hospitalization clinics and hospitals, outpatient of general hospitals. But, in hospitalization and outpatient use in advanced general hospitals and medical assistance patients can not use due to excessive medical burden. Therefore, the policy to reduce the burden of medical expenses for patients with severe illness will continue, and the medical care patients using clinics and hospitals should be careful not to use unnecessary medical services.

• Quality Improvement in Health Care
• /
• v.2 no.2
• /
• pp.112-129
• /
• 1996

Background : A small number of high cost patients usually spend a larger proportion of scarce health resources. Aged, long-term care and readmitted patients usually belong to these high cost patient group. Among others, long length of stay and readmission can be reduced by checking its cause, and these are the areas needed most of quality improvement activity. Characteristics of high cost medical users between health insurance program and medical assistance program were reviewed. Methods : The inpatient claims of health insurance and medical assistance program were analyzed. Patients were divided by 6 groups; long-term, mid-term, short-term, readmitted, cancer and aged. We defined high cost patients as those who had spent one and half million won and over per 6 months. Characteristics of high cost patients for each group were reviewed. Results : medical assistance patients used much more resources than the insured members in the average hospital cost per case but less in daily hospital cost. The former had a longer length of stay and had much heavier diseases. Major diseases of both group were cancer, diseases of circulatory system and chronic degenerative diseases. Gallstone and schizophrenia were more in the insured program. However, pulmonary tuberculosis, asthma were more common among the medical assistance patients. Early readmission before 2 weeks were 28-30% of the total readmission. Readmission rate in the malignat neoplasm and renal failure were 80% and more. Q.A program should be installed to prevent unnecessary readmissions. Conclusion : Almost 30% of early readmissions and admissions due to complications and long length of stay should be reviewed carefully to keep cost down and to enhance the quality of hospital care.

• Journal of dental hygiene science
• /
• v.21 no.1
• /
• pp.70-78
• /
• 2021

Background: The aim of this study was to analyze the public demand for information about the job of dental hygienists by mining text data collected from the online Q & A section on an Internet portal site. Methods: Text data were collected from inquiries that were posted on the Naver Q & A section from January 2003 to July 2020 using "dental hygienist job recognition," "role recognition," "medical assistance," and "scaling" as search keywords. Text mining techniques were used to identify significant Korean words and their frequency of occurrence. In addition, the association between words was analyzed. Results: A total of 10,753 Korean words related to the job of dental hygienists were extracted from the text data. "Chi-lyo (treatment)," "chigwa (dental clinic)," "ske-illing (scaling)," "itmom (gum)," and "chia (tooth)" were the five most frequently used words. The words were classified into the following areas of job of the dental hygienist: periodontal disease treatment and prevention, medical assistance, patient care and consultation, and others. Among these areas, the number of words related to medical assistance was the largest, with sixty-six association rules found between the words, and "chi-lyo," "chigwa," and "ske-illing" as core words. Conclusion: The public demand for information about the job of dental hygienists was mainly related to "chi-lyo," "chigwa," and "ske-illing" as core words, demonstrating that scaling is recognized by the public as the job of a dental hygienist. However, the high demand for information related to treatment and medical assistance in the context of dental hygienists indicates that the job of dental hygienists is recognized by the public as being more focused on medical assistance than preventive dental care that are provided with job autonomy.

• The Journal of the Korea Contents Association
• /
• v.17 no.5
• /
• pp.366-375
• /
• 2017

The purpose of this study is to analyze the use of hospital, hospitalization, medical service, discharge and power of medical care patients who are concerned about moral hazard. We conducted focus group interview with 3 medical care patients and their families and 5 workers who had worked for more than 4 years in a nursing hospital. The main results and implications are as follows. First, admission to nursing hospitals was mostly based on the linkage between the medical institutions and the competition to attract the patients rather than the choice of the patients. Second, the main cause of the long-term hospitalization of medical assistance patients was the lack of social protection measures such as absences of residence and care giver, although there are factors that cause moral hazard such as low self-pay. Third, most of the patients were in need of treatment, but they were admitted to the hospital even though their needs were not higher than those of the health insurance patients. Fourth, the rehabilitation service is the mainstay of the medical service of the nursing hospital, and the roles of nursing staff and care givers are important. Fifth, medical care patients are paying medical expenses for nursing hospitals due to cost of living and family support, but they are exempted from the hospital expenses or the burden of their own expenses in the hospital. Sixth, public institutions and social welfare institutions have not managed continuously since commissioning patients to nursing hospitals and have neglected the connection with community services after discharge.

• Journal of Korean Public Health Nursing
• /
• v.5 no.1
• /
• pp.70-95
• /
• 1991

The ageing problem of the population has been emerging in Korea since 1970's so that it is expecting the elderly 65 years and over among the total population from $4.5\%$ in 1988 to be $6.3\%$ in year 2000. This study was conducted to provide secure policy development in coming years for the aged on medical and health care aspects based on the examining current status of the aged problems and health care policies and systems. The study divided into four parts; The first part examined the medical insurance program and public assistance program of the health services in relation to the aged. The second part emphasized on reduction of medical care cost for the aged. The third part studied the regular health check-up program and health education for the aged. The fourth part examined the chronic disease management programs for the aged and strategies of the health care service quality improvement and specialized programs. The following recommendations made as the results of the study. 1. At present, the medical insurance program and public assistance program for the medically indigent is not appropriate to the elderly because it is a part of general medical insurance program so that Health Security Law for the Aged is proposed. 2. Medical cost will be increased due to the high occupancy rate of hospital beds and long stay of the elderly so that it is recommended to develop an early discharge program, home health care program, Health hospice and an althernative programs. 3. At present, a regular health check-ups for the elderly is not included in medical insurance program so that it is recommended to be included in the insurance program and at the same time health education program thoroughly developed for the aged. 4. To make proper medical and nursing services on chronic diseases for the elderly, it is recommended manpower development, specialized clinics or hospitals, nursing homes and an equivalent long term care facilitices should be established on the community based and a research institutions also to be related to supper the care programs.

• The Korean Society of Law and Medicine
• /
• v.15 no.2
• /
• pp.195-223
• /
• 2014

Nurses are medical care providers most closely associated with the national health. Their works are subdivided and specialized, and it is such a factor making nurse's role more important, and with the appearance of specialized nurses, they have secured a position as an independent medical care provider. As the domain of nurse's service becomes broader, there are more accidents and disputes related to nurses. However, there are not many studies conducted on such problems, and even when medical disputes take place related to nurses, the court does not make consistent judgments as a matter of fact. Besides, as the ambiguity of nurse's range of service and the lack of nursing workforce work as a factor causing nurse's medical malpractice, more legal discussions and studies are required to seek proper solutions to such problems. Thus, as a plan to clarify legal issues likely to occur due to nurse's medical practice, this study classified nurse's work into medical assistance practice and other jobs based on their own independent judgments, and proposed establishing concrete regulations on the range of their work, while reviewing common problems extracted from precedents related nurse's medical malpractice. Moreover, while examining Japanese precedents related to the Act of Medical Service Personnel, Nurses and Midwives, which is the sole act of nurses in Japan, this study reviewed the necessity of revising the present nurse-related regulations in Medical Service Act, or enacting a sole act of nurses.

• Research in Community and Public Health Nursing
• /
• v.8 no.1
• /
• pp.116-132
• /
• 1997

The purpose of the study is to find out how laws related to the nursing profession can be improved by analyzing the rules and regulations concerning nursing. Furthermore, to help settle legal matters in the process of doing nursing work. The data used for the study are the Health and Medical Act, the Maternal and Child Health Act, the School Health Act, the Special Act for Health and Medical Service in Rural Areas, the Industrial Health & Safety Act and the Notice on Nursing Professional Courses analyzed by age and content. The results of the study are as follows : First, basic nursing practice includes 'nursing care for recuperation and assistance in medical treatment and in special areas including the pre-vention of disease, maintenance of health, control of environment, and other therapeutic activities. It is suggested that the phrase 'assistance in medical treatment' should be eliminated as it limits the basic nursing practice to the assistance of the medical treatment. Second, Article 56 of the Health & Medical Act prescribes a special nurse but it does not prescribe a specific job. Accordingly, the new provison concerning the specific jobs of a special nurse should be added or a job guide should be inseated. Third, it is prescribed that those who have completed the training course after obtaining a license are qualified to be a midwife, a special nurse and a nurse practitioner working in special areas. However, school nurses, occupational health nurses and maternal and health workers are required to obtain a nurse license, but not to take an additional training course. Nurses working in special areas should be legally recognized as nurse specialists. The regulations to control various qualification standards consistently should be established. Fourth, the qualifications and types of nurses by area prescribed by Article 54 of the Health and Medical Act are not consistent with those of special nurses as recognized by affiliated organizations of the Korean Nurse Association and some hospitals. Accordingly, the qualifications and types of special nurses should be adjusted in consideration of special nurses. Fifth, as Article 16, Paragraph 2 of the Health and Medical Act does not prescribe the type and scope of first - aid treatment that nurses can provide, the first-aid treatment of nurses might be considered as an unlicensed practice. The specific regulations regarding these matters should be established. Sixth, the contents of the nursing record, which are prescribed by Article 21 of the Health and Medical Act as a duty, include 1) matters concerning body temperature, pulse, breath and blood pressure 2) matters concerning drug prescription 3) matters concerning input and output 4) matters concerning the treatment and nursing care (Article 17 of the Enforcement Regulations, Health and Medical Act). However, these matters are limited to basic nursing care and assistance in medical treatment. The new recording methods on nursing process are suggested to be adopted legally. Seventh, the prescription right entrusted to nurses which are prescribed by the School Health Act, the Special Act on Health and Medical Service for Rural Areas, and the Industrial Health and Safety Act are not consistent with the rights of nurses as prescribed by the Health and Medical Act. New regulations prescribing the partial right for medical treatment entrusted to nurses in consideration of the restraint of time and place in emergency situations should be established.

• Journal of Korean society of Dental Hygiene
• /
• v.19 no.6
• /
• pp.875-890
• /
• 2019

Objectives: This study aims to establish the concept of "dental assistance" within the dental field and to identify the scope of dental assistance, which can be utilized in order to distinguish the scope of work between jobs. Methods: The literature on dental hygienist work and dental assistance was reviewed, and the laws and precedents related to dental assistance were examined. Results: The criteria for judging the legitimacy of dental assistance included the following: whether the performance was conducted under the guidance and supervision of a doctor; whether there was a possibility of an aftereffect or side effects of the procedure; whether education was conducted within the curriculum; and whether it was evaluated in the national licensing examination. In addition, the work of the assistant in dental surgery and treatment is judged comprehensively by considering the type of dental surgery and treatment, invasive degree, necessity of expertise, and work proficiency of the dental hygienist. Therefore, it is suggested that dental hygienists may be of assistance for dental treatment/surgery because they meet the requirements of dental professionals, such as dental hygiene curriculum, national licensing examination, duties in the field of dentistry, and work proficiency. Conclusions: Dental assistance (including assistance in dental surgery) for dental treatment, dental/medical history taking, taking vital signs, and blood glucose monitoring should be permitted within the realm of dental hygienist work. Therefore, the actual expertise of dental hygienists should be reflected legally and the work of dental hygienists should be realized.

• The Korean Society of Law and Medicine
• /
• v.21 no.1
• /
• pp.69-105
• /
• 2020

In the health care system, medical fee payment is a very important and basic factor. The National Health Insurance Act adopted a contract system, and the content of the contract is to be determined the unit price per relative value scale. Accordingly, in the National Health Insurance system, the costs of health care benefits are adjusted each year according to inflation or changes in economic conditions. On the other hand, in the Medical Care Assistance system, the Medical Care Assistance Act does not prescribe the method of determining the medical payment, and all matters are delegated to the Minister of Health and Welfare. Accordingly, the Minister has adopted a fixed-payment system for hemodialysis treatment since 2001. A constitutional petition was filed in 2017 against this fixed-payment system, and the Constitutional Court rejected the petition in 2020. In this study, we examine the meaning and content of the medical fee payment system, focusing on the above constitutional petition case, and present three principles as constitutional limits on the system. The first of its principles is the principle of legality, the second is the principle of prohibition of comprehensive delegation, and the third is the principle of proportionality. From that point of view, There are many unconstitutional elements in the fixed-payment system on hemodialysis.

• Korea journal of population studies
• /
• v.5 no.1
• /
• pp.167-186
• /
• 1982

Financial barrier is well known as a determinant of the perceived need for and utilization of medical care in urban areas. This study aims to; a) estimate the levels of the perceived need for and utilization of medical care, b) analyze the reasons for not receiving medical care, and c) determine factors affecting the levels of need and utilization, and major reasons for not receiving medical care. The data of household interview survey in urban areas collected for a National Survey on Reorganization of Nationwide Health Care Delivery Network is used. An interview was conducted with a total of 2, 538 households in urban areas during a 28 day period of October through November, 1981, giving an overall response rate of 99 percent. The results show a factor of third-party payer is most influential to utilization (physician visits by patient), and living standard is a determinant to explain the variance of major reasons for not receiving medical care. Therefore, financial burden is still a major determent in utilization of medical care in urban areas. Improved level of living standard and expanded coverage of the third-party payer such as health insurance and public medical assistance will increase both an overall levels of utilization of and the need for medical care in urban areas in the future. The major statistics are as follows; a) rate of the need for medical care during a 15 day period per 100 persons was 33 percent: the differential rates appeared in sex, age, living standard, and third- party payer variables, b) percent of treatment employed per 100 persons who are wanting medical care was 82: the percents were high in young ages, high levels of living standard and education, and persons covered by third-party payer, and c) economic reasons for not receiving medical care per 100 persons who are wanting medical care were occupied with 60 percent: the rates are high in old ages, low levels of living standard and persons not covered by third-party payer.