• Journal of agricultural medicine and community health
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• v.4 no.1
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• pp.20-30
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• 1979

To investigate the status of morbidity and medicare utilization during last 8 months from 1 st Oct. 1977 to 31th May, 1978 in the area under Sam-Wha Medicare Insurance Union, a study was carried out through analyzing the medicare records of patients who are enrolled. For the study, 3 doctors and one nurse were mobilized and the results are as follows: 1) The total number of the Medicare insurance Union members in the study area were 5,735 composed of 3,000 males(52.3%) and 2,735 females(47.7%). 2) The total number of patients were 1,405 composed of 783 males (55. 0%) and 622 females(45. 0%) and the incidence rate per 1,000 population was 245.0 of total(261.0 in males and 227.4 in females). 3) Five major diseases with 52, 7% of total patients were acute upper respiratory infection(20.7%), peptic ulcer(12.2%), bronchitis(5.5%), injuries(5.2%) and dental problems(5.1%). 4) The order of the incidence rate of age group per 1,000 population was the year group on 0-4(342.6), 25-44(312.7), 45-64(307.0), 65 and over(240.3), 15-24(178.8) and 5-14(164.8). 5) Of the 1,405 total patients, the out-patients were 1,661(96.9%) and the in-patients were 44(3.1%) and the ratio wae 30.9 : 1.0. 6) Among the out-patients 96.7% of them were cared in primary medicare facilities, 1.0,% in secondary care, and 2.3% in tertiary care. And among the in-patients 50. 5% of them were cared in primary medicare facilities, 4. 5% in secondary care, 45. 5% in tertiary care. 7) Duration of medicare was concentrated within a week in 84. 3% of total patients.

• Health Policy and Management
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• v.4 no.1
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• pp.49-76
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• 1994

Small area variations in health care utilization have long been studied as an important issue related to boto cost containment and quality assurance. This study was conducted to investigate if variations in hospital services across small geographic areas in Korea existed. The claims data of the fiscal year 1992 obtained from the regional health insurance societies were used for the study. Main findings of the research can be summarized as follows : 1. Extremal Quotients(EQ) of hospital expenditure per capita and hospital days per capita varied among diagnosis types. The EQ ranged from 2.05(cataract) to 41.67(pneumonia) in hospital expenditure per capita and from 1.86(cataract) to 45.89(pneumonia) in hospital days per capita. The diagnosis groups which showed high variation were pneumonia, cephalo-pelvic disproportion, gastritis and duodenitis, fracture of rib, and acute bronchitis. Those which showed low variation were acute appendicitis and cataract. 2. The EQ level of admission rate was different in terms of diagnosis types, ranging from 2.57(catarct) to 44.45(pneumonia). The variations were high in medical disorders such as pneumonia, oephalo-pelvic disproportion, gastritis and duodenitis and acute bronchitis, while relatively low in surgical conditions such as acute appendicitis and cataract. 3. As an indicator of service intensity, the EQ of expenditure per admission ranged from 1.67(acute appendicitis) to 31.27(essential hypertension). The diagnoses which had high variation were essential hypertension, gastric ulcer, whereas those which had low variation were cephalopelvic disproportion and acute appendicitis. With regard to hospital days per admission, the EQ ranged from 1.55(acute appendicitis) to 28.13(gastric ulcer) by diagnosis types. The diagnosis groups with showed high variation were gastric ulcer, essential hypertension, and acute bronchitis, whereas those with low variation were cephalo-pelvic disproportion, intervertebral disc disorders, and acute appendicitis. Both the expenditure and hospital days per admission showed lewwer variations than the expenditure per capita, hospital days per capita and admission rate. 4. Comparing patterns of variation in utilization indices, diagnoses such as essential hypertension, gastric ulcer, fracture of rib showed higher variations in expenditure per admission than in admission rates, whereas diagnoses such as pneumonia, cephalo-pelvic disproportion and gastric ulcer showed higher variations in admission rate than expenditure per admission. These findings suggest that wide variations existed in several diagnoses groups across small areas in Korea. Further research should be performed to investigate factors related to small area variations including provider behavior.

• Journal of Preventive Medicine and Public Health
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• v.10 no.1
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• pp.86-93
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• 1977

An epidemiological study was conducted, from April 28 to June 3, 1975, to investigate source and course of infection of typhoid fever occurred in Munhyeon Dong, Nam Gu, Busan. The obtained results were as follows: 1. The entity of unknown febrile disease was identified as Salmonella typhi, D group and it's symptoms were abdominal pain, diarrhea, hepatomegaly, nausea and vomiting, aplenomegaly, rose spots, tenderness of ileocecal region etc., in that order. 2. The average duration from onset to recovery was 25.2 days and incidence rate was 39.5 per 1,000 population. 3. The source of infection was presumed a charity patient. 4. By the duration of report on the cases from onset, 10-19 days group was the highest. 5. The positive rate of initial stool culture was 38.9% and secondary was 5.6%. 6. Distribution of the cases by age and sex showed that 5-9 years old group was the highest as 30.5%, and male was higher than female. 7. Distribution of the cases by education level, under primary school as 66.6% was the highest. By the living standard, the highest was low income earner group as 77.8%. 8. Utilization rate of medical facilites was drug store (41.7%), herbal drug (8.3%), clinic (5.6%) in that order.

• Clinical and Experimental Emergency Medicine
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• v.5 no.4
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• pp.256-263
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• 2018

Objective We conducted a study to validate the effectiveness of the Korean criteria for trauma team activation (TTA) and compared its results with a two-tiered system. Methods This observational study was based on data from the Korean Trauma Data Bank. Within the study period, 1,628 trauma patients visited our emergency department, and 739 satisfied the criteria for TTA. The rates of overtriage and undertriage in the Korean one-tiered system were compared with the two-tiered system recommended by the American College of Surgery-Committee on Trauma. Results Most of the patient's physiologic factors reflected trauma severity levels, but anatomical factors and mechanism of injury did not show consistent results. In addition, while the rate of overtriage (64.4%) was above the recommended range according to the Korean criteria, the rate of undertriage (4.0%) was within the recommended range. In the simulated two-tiered system, the rate of overtriage was reduced by 5.5%, while undertriage was increased by 1.8% compared to the Korean activation system. Conclusion The Korean criteria for TTA showed higher rates of overtriage and similar undertriage rates compared to the simulated two-tier system. Modification of the current criteria to a twotier system with special considerations would be more effective for providing optimum patient care and medical resource utilization.

• Journal of Industrial Convergence
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• v.22 no.2
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• pp.135-141
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• 2024

This study aimed to analyze the characteristics of health check-up recipients in their 20s and 30s in Korea and identify factors influencing the participation rate in order to enhance the rate of health check-ups. The study population and methods utilized data from the 8th year of the Korea National Health and Nutrition Examination Survey, specifically the 2nd year (2020), and targeted 1,453 Korean residents aged between 20 and 30. The factors affecting health check-up participation were divided into sociodemographic factors, health behavior factors, mental health factors, and medical utilization factors, and both simple logistic regression analysis and multiple logistic regression analysis were conducted. The analysis results showed that educational level, marital status, type of health insurance, employment status, and subjective level of health were the factors influencing health check-up participation among Korean individuals in their 20s and 30s. These research findings can serve as foundational data for improving the health check-up participation rate among individuals in their 20s and 30s.

• Journal of Preventive Medicine and Public Health
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• v.22 no.4 s.28
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• pp.578-590
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• 1989

This study was conducted to assess the equity in the regional insurance scheme through analysis of the computerized data from one regional insurance society and National Federation of Medical Insurance. We analysed the insurance contribution and benefit by the classes based on total and income-related contribution per household. The major findings of this study are as follows : 1. The average proportion of income-related contribution among the total was 39.2% and the upper classes show higher proportion of the income-related contribution. 2. The upper classes show higher health care utilization rate than the lower classes. It suggests that the lower classes have relatively large unmet medical needs. 3. The analysis through the Lorenz curve reveals that there exists transference of contributions from the upper to lower classes. But the cumulative percentage of insurance benefit is smaller than that of the number of the insured. It implies that regional medical insurance scheme in Korea has still some inequity in the context of social security principles.

• Journal of Preventive Medicine and Public Health
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• v.16 no.1
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• pp.135-152
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• 1983

Emergency medical service is an important part of the health care delivery system, and the optimal allocation of resources and their efficient utilization are essentially demanded. Since these conditions are the prerequisite to prompt treatment which, in turn, will be crucial for life saving and in reducing the undesirable sequelae of the event. This study, taking the hyperbaric chamber for carbon monoxide poisoning as an example, is to develop a stochastic approach for solving the problems of optimal allocation of such emergency medical facility in Korea. The hyperbaric chamber, in Korea, is used almost exclusively for the treatment of acute carbon monoxide poisoning, most of which occur at home, since the coal briquette is used as domestic fuel by 69.6 per cent of the Korean population. The annual incidence rate of the comatous and fatal carbon monoxide poisoning is estimated at 45.5 per 10,000 of coal briquette-using population. It offers a serious public health problem and occupies a large portion of the emergency outpatients, especially in the winter season. The requirement of hyperbaric chambers can be calculated by setting the level of the annual queueing rate, which is here defined as the proportion of the annual number of the queued patients among the annual number of the total patients. The rate is determined by the size of the coal briquette-using population which generate a certain number of carbon monoxide poisoning patients in terms of the annual incidence rate, and the number of hyperbaric chambers per hospital to which the patients are sent, assuming that there is no referral of the patients among hospitals. The queueing occurs due to the conflicting events of the 'arrival' of the patients and the 'service' of the hyperbaric chambers. Here, we can assume that the length of the service time of hyperbaric chambers is fixed at sixty minutes, and the service discipline is based on 'first come, first served'. The arrival pattern of the carbon monoxide poisoning is relatively unique, because it usually occurs while the people are in bed. Diurnal variation of the carbon monoxide poisoning can hardly be formulated mathematically, so empirical cumulative distribution of the probability of the hourly arrival of the patients was used for Monte Carlo simulation to calculate the probability of queueing by the number of the patients per day, for the cases of one, two or three hyperbaric chambers assumed to be available per hospital. Incidence of the carbon monoxide poisoning also has strong seasonal variation, because of the four distinctive seasons in Korea. So the number of the patients per day could not be assumed to be distributed according to the Poisson distribution. Testing the fitness of various distributions of rare event, it turned out to be that the daily distribution of the carbon monoxide poisoning fits well to the Polya-Eggenberger distribution. With this model, we could forecast the number of the poisonings per day by the size of the coal-briquette using population. By combining the probability of queueing by the number of patients per day, and the probability of the number of patients per day in a year, we can estimate the number of the queued patients and the number of the patients in a year by the number of hyperbaric chamber per hospital and by the size of coal briquette-using population. Setting 5 per cent as the annual queueing rate, the required number of hyperbaric chambers was calculated for each province and for the whole country, in the cases of 25, 50, 75 and 100 per cent of the treatment rate which stand for the rate of the patients treated by hyperbaric chamber among the patients who are to be treated. Findings of the study were as follows. 1. Probability of the number of patients per day follows Polya-Eggenberger distribution. $$P(X=\gamma)=\frac{\Pi\limits_{k=1}^\gamma[m+(K-1)\times10.86]}{\gamma!}\times11.86^{-{(\frac{m}{10.86}+\gamma)}}$$ when$${\gamma}=1,2,...,n$$$$P(X=0)=11.86^{-(m/10.86)}$$ when $${\gamma}=0$$ Hourly arrival pattern of the patients turned out to be bimodal, the large peak was observed in $7 : 00{\sim}8 : 00$ a.m., and the small peak in $11 : 00{\sim}12 : 00$ p.m. 2. In the cases of only one or two hyperbaric chambers installed per hospital, the annual queueing rate will be at the level of more than 5 per cent. Only in case of three chambers, however, the rate will reach 5 per cent when the average number of the patients per day is 0.481. 3. According to the results above, a hospital equipped with three hyperbaric chambers will be able to serve 166,485, 83,242, 55,495 and 41,620 of population, when the treatmet rate are 25, 50, 75 and 100 per cent. 4. The required number of hyperbaric chambers are estimated at 483, 963, 1,441 and 1,923 when the treatment rate are taken as 25, 50, 75 and 100 per cent. Therefore, the shortage are respectively turned out to be 312, 791. 1,270 and 1,752. The author believes that the methodology developed in this study will also be applicable to the problems of resource allocation for the other kinds of the emergency medical facilities.

• Radiation Oncology Journal
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• v.36 no.3
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• pp.182-191
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• 2018

Purpose: To investigate the clinical outcome of proton therapy (PT) in patients with chordoma. Materials and Methods: Fifty-eight patients with chordoma treated with PT between June 2007 and December 2015 at the National Cancer Center, Korea, were retrospectively analyzed. The median total dose was 69.6 cobalt gray equivalent (CGE; range, 64.8 to 79.2 CGE). Local progression-free survival (LPFS), distant metastasis-free survival (DMFS), overall survival (OS), and disease-specific survival (DSS) rates were calculated by the Kaplan-Meier method. Results: With the median follow-up of 42.8 months (range, 4 to 174 months), the 5-year LPFS, DMFS, OS, and DSS rates were 87.9%, 86.7%, 88.3%, and 92.9%, respectively. The tumor location was associated with the patterns of failure: the LPFS rates were lower for cervical tumors (57.1%) than for non-cervical tumors (93.1%) (p = 0.02), and the DMFS rates were lower for sacral tumors (53.5%) than for non-sacral tumors (100%) (p = 0.001). The total dose was associated with both the LPFS rate and DMFS rate. The initial tumor size was associated with the DMFS rate, but was not associated with the LPFS rate. Three patients had grade 3 late toxicity with none ≥grade 4. Conclusion: PT is an effective and safe treatment in patients with chordomas. The tumor location was associated with the patterns of failure: local failure was common in cervical tumors, and distant failure was common in sacral tumors. Further refinement of PT, such as the utilization of intensity modulated PT for cervical tumors, is warranted to improve the outcome.

• Journal of Preventive Medicine and Public Health
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• v.31 no.2 s.61
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• pp.323-334
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• 1998

To investigate determinants of health care utilization of the physically disabled over 20 years old in age living in Taegu city, a self-administered questionnaire survey was carried out for 337 disabled persons with chronic illness from April to July, 1997. Health care utilization .ate was 81.9%(69.1% for hospital or clinic and 12.8% for pharmacy). Marital status, job, health concern, and response to illness showed statistically significant relationship with health care utilization(p<0.05). By path analysis, job, economic status, medical security type and response to illness had a significant direct effect on health care utilization(p<0.05), however, health concern and regular source of care had an indirect effect. The reasons of no health utilization were due to economic problem(31.1%), no symptom(18.0%), inconvenience to seek care or no accompanying persons to be helped(14.8%), unseriousness of the severity of the illness(14.8%), too busy to be treated or no free time(8.2%), hopeless prognosis to be treated(6.6%) in order. In conclusion, it is recommended that the program for expanding medicaid, improving socioeconomic status by getting a job and health education to increase the health concern toward physically disabled should be implemented to increase health care utilization rate.

• Journal of East-West Nursing Research
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• v.10 no.1
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• pp.11-26
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• 2004

The purpose of this study is to investigate the present conditions of nursing investment contents, its conversion process, and output in Oriental University Medical Center, Korea to get good qualified Oriental nursing result which is the ultimate purpose of the Oriental nursing management, and to develope a matrix of Oriental nursing management system on the basis of that project. The subjects for nursing investment and output contents were eighteen nursing directors in eleven Oriental University Medical Center and two hundred thirty-nine nurses with three years and over experience in Oriental medical center. The subjects for Oriental nursing organization, human affair management, and control function were nineteen Oriental medical center in Oriental University Medical Center, Korea. Data were collected from November, 2002 to February, 2003 with questionnaire. Data analysis was done by SPSS PC+ 12 program. Frequency, percentage, and minimum/maximum values were used for investment contents, and frequency and percentage were used for conversion process and output contents. 1. The input factors of oriental nursing management system The objective's western hospital career was over five years of one hundred and seventy-five(73.2%) persons. Nursing in-service education was performed in fourteen hospitals(77.8%). Two hundreds(83.7%) were pro to oriental nurse system. Only four hospitals(22.2%) had independent budget in nursing division. Nursing staff allocation to the bed was from 2.8:1 to 9.06:1 respectively, with a big gap of the rate following the hospitals. 2. The conversion factors of oriental nursing system 1) Oriental nursing system Oriental hospital nursing system was organized independently in ten hospitals among eighteen hospitals. The recruitment of nurses which was a vital role of the nursing division of the hospital was mostly(79%) opened. The education to develope nursing personnels was through in-service one in 97.4%. Education for oriental nursing and management was performed in 42.1%(eight hospitals) and that for reserves was done in 36.8%(seven hospitals). Administration for nursing education by nursing division was 68.5%(thirteen hospitals). The post education evaluation was performed by report submission in 36.8%(seven hospitals), by written examination in 26.3%, by questionnaires in 21.1%, and by lecture presentation in 15.8% subsequently. The directorial meeting for the nursing directors was attended by 84.2%(sixteen hospitals), and the meeting type was the medical executive and support division executive meeting in 55.6%(ten hospitals) and the personnel management in 39.6%(seven hospitals). 2) The actual conditions of oriental nursing personnel management The reason of working in oriental hospital was by voluntary in 67.1%(a hundred and sixty persons), by nursing department order in 28.0%(sixty-seven persons), and by others in 5.0%(twelve persons) respectively. The shift form was a three-shifts one in 94.7%(eighteen hospitals), a two-shift one in only one hospital. Duty assignment was functional in 52.6%(ten hospitals), team and functional in 26.3%(five hospitals) and no team alone. Promotion manual was present at 68.4%(thirteen hospitals) and the competency essentials comprised of performance evaluation in 79%, interview, written examination, training result, study result subsequently. No labor union existed in 79%(fifteen hospitals) 3) Oriental nursing preceptor system There were five oriental hospitals(27.7%) administering the preceptor utilization model, which showed lower rate than the twenty-two medical university hospitals in Seoul in which fifteen hospitals (72.7%) were having the system. To the question of necessity of oriental nurse system asked to the objectives of two hundred and thirty-nine with more than three year-experience in oriental hospital, two hundred persons(83.7%) answered positively. 4) The control of oriental nursing The evaluation results from the target hospitals were mostly not opened in 89.4% of oriental hospitals. Thirteen hospitals(68.3%) had evaluation system of direct managers and the next were three hospitals(15.8%) of direct managers and selves. There was one hospital(5.3% each) where fellows and superiors, fellows, and inferiors' evaluation was performed and no hospital where superiors, fellows, inferiors and selves, and superiors, fellows and selves' evaluation was performed. The QI activity of nursing was 42.1%(eight hospitals) for nursing service evaluation, 36.8% for survey of ECSI, 26.3% for survey of ICSI, 15.8% for medical visit rate, 10% for hospital standardization inspection in sequence. 3. The output factors of oriental nursing management system The job satisfaction appeared good in general, indicating very good in thirty-seven persons (15.7%), good in one hundred and fourteen persons (48.3%) and fair in eighty-five persons(36.0%).