• 한국산학기술학회논문지
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• 제14권5호
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• pp.2293-2303
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• 2013

목적: 본 연구의 목적은 국내 환자안전지표 산출 가능성을 확인하는 것이다. 조사방법: 환자안전지표의 정의는 OECD에서 AHRQ에 근거하여 작성한 보건기술문서 19의 기준을 이용하였고, 이에 따라 2004-2008년 퇴원손상심층조사 875,622건에서 환자안전지표(PSIs)를 산출하였다. 로지스틱 회귀분석을 이용하여 환자안전지표별 비율의 변이요인을 확인하였다. 분석결과: 2004-2008년간 약 80만 건의 퇴원 중에서 8개의 환자안전지표에 해당하는 위해사건은 3,084건이었다. 욕창(PSI3, 4.88), 시술 중 이물질 체내 잔류(PSI5, 0.05), 수술 후 패혈증(PSI13, 1.32), 출생손상-신생아(PSI17, 7.92), 산과적 외상-도구를 이용한 질식 분만(PSI18, 32.81)의 퇴원 1,000건당 비율은 모두 OECD 환자안전지표 비율의 최소-최대 범위 내에 포함되었다. 그러나 내과적 치료에 의한 감염(PSI7, 0.22), 수술 후 폐색전증 또는 심부정맥혈전증(PSI12, 0.90), 우발적 천공 또는 열상(PSI15, 0.71)의 퇴원 1,000건당 비율은 OECD 환자안전지표 최소값에 못 미쳤다. PSI 18을 제외한 7개의 지표값 모두 부진단명의 개수와 유의한 상관관계가 있는 것으로 나타났다. 또한 환자안전지표 비율은 환자특성을 보정했을 때, 병상규모 및 병원소재지 등 병원특성에 따른 유의한 차이를 보였다. 결론: 본 연구는 국가적인 행정자료를 이용하여 위해사고를 스크리닝 하는 환자안전지표를 산출한 최초의 실증적 연구이다. 본 연구의 결과는 자료의 질, 임상 관련 변수 등의 결과에 영향을 미치는 요소가 여전히 있지만, 환자안전에 대한 국가적인 통계를 추계하는 기초자료를 제공하였다는데 의의가 있다. 향후 본 연구결과를 바탕으로 위해사건으로 인한 사망 규모 산출 등의 결과연구가 필요하다.

• 대한방사선기술학회지:방사선기술과학
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• 제29권3호
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• pp.185-195
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• 2006

목 적: 방사선 관련종사자들의 1995년 1월 6일 "진단용 방사선 발생장치의 안전관리에 관한 규칙"을 제정한 이후 방사선 노출로 인한 개인피폭선량의 실태를 조사 분석하여, 해당 의료기관과 방사선 관련종사자들에게 방사선피폭에 대한 경각심을 고취시키고, 안전관리에 도움을 주고자 한다. 조사대상 및 방법: 2000년 1월 1일부터 2004년 12월 31일까지 5년 동안 전국에 있는 검사기관, 교육기관, 군부대, 병원, 보건소, 산업체, 연구기관, 의원에서 근무하였거나 근무하고 있는 방사선종사자들의 개인 피폭선량 측정결과 판독기관에 등재(登載)된 대상자 57,136명에 대한 분기별 피폭선량 자료 149,205건을 대상으로 하여 판독수행기관에 직접 방문 하거나, 전화를 통하여 책임자에게 연구의 목적을 설명하고 긴밀한 협조를 얻어 수집하였다. 자료를 분석하는데 있어 SPSS ver 12.0을 이용하였으며, 분석방법으로는 연도별 분기별 성별 연령별 직종별 근무부서별 업종별로 심부선량과 표면선량으로 나누어 분석하였다. 빈도분석 one-way ANOVA two-way ANOVA를 시행하였다. 결 과: 5년간의 평균 피폭선량에서 심부선량과 표면선량의 평균값이 해마다 낮아지는 것으로 조사되었고, 성별 평균 피폭선량은 심부선량과 표면선량에서 남자가 여자보다 높게 나타났으며 연령별 평균 피폭선량에서 심부선량과 표면선량은 높은 연령군보다 낮은 연령군에서 높게 나타났고, 직종별 평균 피폭선량은 심부선량과 표면선량 모두에서 방사선사가 가장 높게 나타났으며 근무 부서별 평균 피폭선량은 심부선량과 표면선량에서 핵의학과가 가장 높게 나타났고, 업종별 평균 피폭선량은 심부선량과 표면선량에서 병 의원이 높게 나타난 것으로 조사되었다. 결 론: 이상의 결과에서 볼 때 최근 5년간 전국 지역에 있는 병원 의원 기타 등에서 근무하는 방사선 종사자들의 방사선 평균 피폭선량은 국제방사선방어위원회(ICRP)에서 권고하는 허용선량 기준치(20 mSv/년)를 초과하지 않는 범위의 피폭을 받고 있는 것으로 나타났다. 그러나 그것은 평균적인 수치이지 개인적으로 피폭선량에 있어 그 범위의 피폭을 초과하는 종사자들이 있는 것으로 나타나 상당히 우려가 되고 있는 실정이다. 따라서 방사선 관련종사자들이 각자가 개인별 관리에 더욱더 철저를 기하고 방사선으로 인한 피폭을 최소화 시키는데 있어 체계적인 교육 및 안전 불감증에 대한 지도가 지속적으로 유지되어야 할 것이다.

• Journal of Preventive Medicine and Public Health
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• 제12권1호
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• pp.13-23
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• 1979

A study was carried out from October 1977 to September 1978 in order to develope health care delively system which will meet to rural area in Korea. For the study objective a model of health care delivery system of Myun (township) area was developed which is adopted the net-work of village health voluntary worker who will play the role of bridge for communication related with health and illness between families or village people and health subcenter, and :he model health care delivery system net-work was set in the area of Soodong Myun, Yangju Gun. which is the rural health demonstration area of Ewha Womans University since 1972. The activities and attitude of 22 village health voluntary workers were observed and analized. during the study period. The results are as follows; 1. For the field activities of village health voluntary workers. a guide line which is described with specific behavioral objectives was developed and used for not only training of the workers but also evaluation of their field activities. 2. During the study period, the number of 971 village people were served primary health care service by village health voluntary worker and the service was classified largely into symptomatic medications (92%) and preventive measures (8%). 3. Comparative percentage of the number of 894 symptomatic cases cared by village health voluntary workers to 5,695 cases of patient treated by Soodong Health Subcenter during the same period was 15.7%. 4. Annual utility rate of village health voluntary worker by Myun total people was 16.1% but utility rate by Rie was varied from 38.2% to 2.8% which shown there were considerable differences in each Rie. In order to settle the village health care service, the obstructive factors of utility should be detected and their counter measure must be taken. 5. As the health need of village people increases, it is expected that the supplement of drug excluding present sit basic drugs is inevitable, but considering the ability of village health voluntary worker, the selection of additional drugs and education, plan should be carefully studied. 6. It is desirable that a financial resource for supplementary purchase of first aid kit, drugs and materials whould be alloted from village public fund like Saemaeul Women's Club fund, which has already practiced in a few villages in the study area. 7. As pointed out by village health voluntary workers, in order to improve the village health, village leaders should be in the center of it and the cooperation of whole village people is a core of healthful village development, and it is reasonable that the health subcenter backs up these voluntary health activities by village people in techniques. 8. It seems effective that a supplementary education for village health voluntary worker be accomplished by a planned education through regular meetings like worker's monthly meeting and irregular post guide when Myun Health Workers can handle the problems found during the round trip of villages. 9. It is desirable that village health voluntary workers, who are recommended by a civil voluntary organization like Saemael Woman's Club, are charged by natural villagc unit, are given a function of village health care service and used through basic education at health subcenter. 10. It is advisable that the village health voluntary worker's service is compensated not by a form of money, but by other way such as an exemption of medical fee of worker herself or her families in health subcenter can be one method. 11. Daily health activities of each village health voluntary worker should be reported to health subcenter by biweekly or monthly in order to get not only for basic data of the program but also for evaluation the program. It is recomandable that the report form should be simple and clear enough for village health voluntary worker to fill it effectively. 12. Village health care service should be developed into a Saemaeul Movement in which village people actively participate. For this, the appointed function of village health voluntary worker should be absorbed into those of living Environment Betterment Section or Family Planning Section of Saemaeul Women's Club or it is desirable that establish a new section, Village Health Promoting Section and make it involve the appointed functions of those sections mentioned above.

• 농촌의학ㆍ지역보건
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• 제24권2호
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• pp.331-350
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• 1999

본 연구는 보건진료원의 성격특성과 직무만족도와의 관계를 파악하여 효율적인 업무수행에 도움을 주고 직무만족을 향상시킬수 있는 방안을 모색하기 위해 시도되었다. 연구의 대상은 광주, 전남지역 보건진료원 348명 중 200명으로 하였고, 1999년 2월 18일부터 3월 5일까지 설문지를 우편으로 대상자에게 발송하여 작성하게 한 후 응답지를 수집하였다. 연구도구로 성격특성 측정도구는 김(김기석, 1990)의 "일반성격검사"를 사용하였고 직무만족도 측정도구는 Salvitt의 도구를 석(석민현, 1992)이 수정 보완한 것을 사용하였다. 자료분석은 SPSS Program에 의해 백분율, 평균, 표준편차, Pearson's correlation coefficient, ANOVA, Logistic regression analysis 등으로 분석하였다. 본 연구의 결과는 다음과 같다. 1. 대상자의 특성 중 인구사회학적 특성과 직무만족도와의 관계에서 통계적으로 유의한 차이를 나타낸 것은 종교와 보수이다(P=.028). 2. 직업의식은 계속교육여부와 필수적 직무(P=.000), 자율성(P=.000), 보건진료원 선택동기와 필수적 직무(P=.007), 직업긍지(P=.007), 보건진료원 종사예정기간과 필수적 직무(P=.023), 직업적 긍지(P=.000), 현직에 대한 만족여부와 보수(P=.001), 필수적 직무(P=.016), 직업긍지(P=.000), 상호작용(P=.011), 자율성(P=.002), 조직요구(p=.001)가 직무만족과 통계적으로 유의한 차이를 나타냈다. 3. 근무지 여건과 직무만족도 관계를 보면 직급과 자율성(p=.038), 보건진료원 이전 분야별 경력과 상호작용(P=.059), 자율성(P.059), 진료소위치와 자율성(P=.021), 월가정방문수와 상호작용(P=.001), 월상담 교육건수와 보수(P=.044), 직업긍지(P=.021), 보건진료소 연수입과 필수적 직무(P=.013)가 통계적으로 유의한 차이를 나타냈다. 4. 보건진료원의 성격특성 중 자신감(80.1)과 책임성(82.6)이 다른 성격요인에 비해 높은 것으로 나타냈다. 5. 보건진료원의 직무만족도는 평균 3.16으로 보통수준으로 나타났으며, 직업적 긍지 점수가 4.09로 가장 높게 나타났다. 6. 성격특성과 직무만족도의 상관관계를 보면 지배성은 자율성(r=.24, P=.001)과 책임성은 직업긍지(r=.26, P=.000), 정서적 안정성은 필수적 직무(r=.25, P=.000), 사회성은 필수적 직무(r=.26, P=.000), 자신감은 필수적 직무(r=.34, P=.000)와 자율성(r=.31, P=.000)과 가장 관계가 있는 것으로 나타났다. 7. 보건진료원의 제요인과 성격특성 중 종교, 진료소위치, 환자진료, 교육기회 여부, 지배성, 자신감, 보건진료원 종사 예정기간, 현직에 대한 만족여부, 보건진료원 이전 근무 분야, 행정업무 등이 직무만족에 영향을 미치는 가장 중요한 요소로 나타났다.

• 한국보건간호학회지
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• 제12권2호
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• pp.27-47
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• 1998

The Purpose of this study is to offer basic data when the new printed media for sex education are developed, by grasping the problem through analyzing the data of the printed media for sex education that are produced by the government and composed of relatively inclusive contents. The subjects of analyzed data were 10 printed media books connected with sex education. This study focused on analysis for the printed media. therefore the method of analysis used effectively for the study of the mass media was used. The SAS program was used for analyzing the frequency of data and processing with percentage. The result of this study is as follows. 1. The subject of sex education that the printed media intend for was classfied the data for students and for teachers and the general. 2. According to the result of analyzing the writers of the printed media for sex education, classified by occupation, research workers accounted for $30.2\%$ as 23 persons, and the rest were distributed as 19 professors $(25\%)$, 13 teachers $(17.2\%)$, 10 workers in related institutions of various kinds $(13.1\%)$, 6 doctors $(10.6\%)$ and 3 writers $(3.9\%)$. Examing the organization of writers of the printed media for sex education for students, it was composed of sequence as research workers $30.5\%$. workers in related institutions of various kinds $19.6\%$, teachers $19.5\%$, professors $13\%$, doctors $10.8\%$ and writers $6.5\%$. And that of writers of the printed media for sex education for teachers and the general was shown as professors $43.2\%$ (13 persons), research workers $30.1\%$ (9 persons), teachers $13.2\%$ (4 persons) and doctors $10.2\%$ (3 persons). 3. Seeing the result of analyzing for the printed media, classified by themes, it was shown as 314.1 pages $(28.5\%)$ in a field of development of men, 195.9 pages $(17.6\%)$ in a field of sex-health, 141.7 pages $(12.9\%)$ in a field of relationship. 74.1 pages $(6.7\%)$ in a field of a sex act. 51.7 pages $(4.6\%)$ in a field of a personnal technology and 313.4 pages $(28.4\%)$ in the others. As are suit of the analysis classified by themes about the printed media for sex education for students, it was distributed as the content about sexual abuse $12.3\%$ (60.2 pages), the anatomical physiology of reproduction $12.1\%$ (59.3 pages). a friendship $8.5\%$ (41.6 pages). the reproduction $7.2\%$ (35.5 pages). a sexual disease $6.8\%$ (33.2 pages) and the puberty $4.3\%$ (20.9 pages). Examing the result of the analysis about contents classified by themes of the printed media for sex education for teachers and the general. it was indicated as 67.1 pages $(10.9\%)$ on the 'puberty', 37.9 pages $(6.2\%)$ on the anatomical physiology of reproduction, 36.6 pages ($6.0\%$ on a sexual disease, 23.2 pages $(3.8\%)$ on dating, 21.7 pages $(3.5\%)$ on a human sexual reaction. 21.0 pages $(3.4\%)$ on a sexual role. 20.1 pages $(3.3\%)$ of the reproduction. The suggestion according to the upper result is as follows. 1. It is needed to expand the range of analysis into the data. besides the printed media. into the data for sex education using such media as a video. a slide, a CD-ROM, on internet, etc. 2. It is necessary to develop the ideal program for sex education of teenagers and analyze the effect. on the basis of analyzing data about data sex education. 3. It is needed that practice workers for nursing or teachers for nursing as well as workers in educational field or medical experts participate in producing data for sex education.

• Asia pacific journal of information systems
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• 제19권3호
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• pp.99-124
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• 2009

Many firms in Korea have adopted and used advanced information technology in an effort to boost efficiency. The process of adapting to the new technology, at the same time, can vary from one firm to another. As such, this research focuses on several relevant factors, especially the roles of social interaction as a key variable that influences the technology adaptation process and the outcomes. Thus far, how a firm goes through the adaptation process to the new technology has not been yet fully explored. Previous studies on changes undergone by a firm or an organization due to information technology have been pursued from various theoretical points of views, evolved from technological and institutional views to an integrated social technology views. The technology adaptation process has been understood to be something that evolves over time and has been regarded as cycles between misalignments and alignments, gradually approaching the stable aligned state. The adaptation process of the new technology was defined as "appropriation" process according to Poole and DeSanctis (1994). They suggested that this process is not automatically determined by the technology design itself. Rather, people actively select how technology structures should be used; accordingly, adoption practices vary. But concepts of the appropriation process in these studies are not accurate while suggested propositions are not clear enough to apply in practice. Furthermore, these studies do not substantially suggest which factors are changed during the appropriation process and what should be done to bring about effective outcomes. Therefore, research objectives of this study lie in finding causes for the difference in ways in which advanced information technology has been used and adopted among organizations. The study also aims to explore how a firm's interaction with social as well as technological factors affects differently in resulting organizational changes. Detail objectives of this study are as follows. First, this paper primarily focuses on the appropriation process of advanced information technology in the long run, and we look into reasons for the diverse types of the usage. Second, this study is to categorize each phases in the appropriation process and make clear what changes occur and how they are evolved during each phase. Third, this study is to suggest the guidelines to determine which strategies are needed in an individual, group and organizational level. For this, a substantially grounded theory that can be applied to organizational practice has been developed from a longitudinal comparative case study. For these objectives, the technology appropriation process was explored based on Structuration Theory by Giddens (1984), Orlikoski and Robey (1991) and Adaptive Structuration Theory by Poole and DeSanctis (1994), which are examples of social technology views on organizational change by technology. Data have been obtained from interviews, observations of medical treatment task, and questionnaires administered to group members who use the technology. Data coding was executed in three steps following the grounded theory approach. First of all, concepts and categories were developed from interviews and observation data in open coding. Next, in axial coding, we related categories to subcategorize along the lines of their properties and dimensions through the paradigm model. Finally, the grounded theory about the appropriation process was developed through the conditional/consequential matrix in selective coding. In this study eight hypotheses about the adaptation process have been clearly articulated. Also, we found that the appropriation process involves through three phases, namely, "direct appropriation," "cooperate with related structures," and "interpret and make judgments." The higher phases of appropriation move, the more users represent various types of instrumental use and attitude. Moreover, the previous structures like "knowledge and experience," "belief that other members know and accept the use of technology," "horizontal communication," and "embodiment of opinion collection process" are evolved to higher degrees in their dimensions of property. Furthermore, users continuously create new spirits and structures, while removing some of the previous ones at the same time. Thus, from longitudinal view, faithful and unfaithful appropriation methods appear recursively, but gradually faithful appropriation takes over the other. In other words, the concept of spirits and structures has been changed in the adaptation process over time for the purpose of alignment between the task and other structures. These findings call for a revised or extended model of structural adaptation in IS (Information Systems) literature now that the vague adaptation process in previous studies has been clarified through the in-depth qualitative study, identifying each phrase with accuracy. In addition, based on these results some guidelines can be set up to help determine which strategies are needed in an individual, group, and organizational level for the purpose of effective technology appropriation. In practice, managers can focus on the changes of spirits and elevation of the structural dimension to achieve effective technology use.

• Journal of Preventive Medicine and Public Health
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• 제25권4호
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• pp.374-385
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• 1992

교대근무자들이 호소하는 생체리듬의 부조화로 인한 일련의 증상들은 개인특성, 작업환경, 교대형태의 영향을 많이 받는다. 따라서 본 연구에서는 개인특성과 작업환경의 영향을 고려하여 교대주기에 따른 근로자들의 자각증상의 차이를 보고자, 작업환경이 같고 교대주기에 있어 2일, 7일인 두 회사의 3교대근로자 182명과 86명을 대상으로 개인 특성 및 자각증상을 설문조사하였다. 결과를 요약하면 다음과 같다. 1. 수면장해증상 6문항 중 '근무 중 피로감을 느낀다', '예민하다'의 두 항목에서 7일주기의 교대근무자에서 증상호소의 빈도가 통계적으로 유의하게 높았으며(P<0.05), 점수화하여 두 군간의 평균을 비교한 결과 7일주기인 군에서 증상점수가 높았다(P<0.01). 2. 1일 평균 6시간의 수면을 기준으로 할 때, 수면시간에 있어서는 두 군간에 유의한 차이가 없었으며, 2일주기인 군에서는 수면시간이 증가함에 따라 장해증상에 현저히 줄었으나 (P<0.05), 7일주기인 군에서는 수면시간에 따른 장해증상의 차이가 없었다. 3. 소화기장해증상 10문항에서는, 7일주기인 군에서 '자주 그렇다'고 호소하는 빈도가 높았으나 통계적인 유의성은 없었으며, 점수화하여 두 군간의 평균을 비교한 결과 역시 7일 주기인 군이 평균점수가 높았으나 통계적으로 유의한 차이는 아니었다. 4. 피로자각증상은 육체적, 정신적 피로 호소율이 7일주기의 교대근무자들에게 현저히 높았으며(P<0.01), 신경감각적 피로 역시 유의한 차이가 있었다(P<0.05). 5. 공분산분석 (ANCOVA)을 통해 개인특성의 영향을 고려한 결과, 교대주기에 파라 수면장해 증상, 육체적, 정신적 피로에 통계적으로 유의한 차이를 보였다(P<0.01). 이상의 결과를 종합해 볼때, 2일주기의 교대근무자들보다 7일주기 교대근무자들이 피로와 수면장해증상 호소가 더 많았다. 따라서 향후 자각증상 뿐 아니라 객관적인 검사를 병행하여 현재 가장 많이 시행되고 있는 7일주기의 교대제에 대한 검토가 필요할 것으로 사료된다.

• 혜화의학회지
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• 제22권2호
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• pp.13-21
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• 2014

Subject : Kim hong-kyung(金洪卿)'s view of eight extra meridians Object : Kim hong-kyung has not only deeply studied Saam acupuncture but also the function and characteristics of extra meridian at the same time. Especially, he has tried the study to connect yin yang wei qiao mai(陰陽維蹻脈) with Lee je-ma(李濟馬)'s four trigram constitution theory, therefore the author felt the need to make public the theory and started reserch on the theory. Method : I researched the physiological properties of extra meridians through the past eastern medical literature, I reported on the types of people to show well the properties of extra meridians gathering Kum-oh's verbal explanation when I had classes from him. Result : Kum-oh Kim hong-kyung defined meridians as passways of consciousness and feeling, he interpreted 12 meridians and extra meridians with the view of mind, which has very important meanings in the history of acupuncture in the point of first trial to interpret meridians from this view. He explained Ren mai(任脈) and Du mai(督脈) are meridians which show clearly properties of yin-yang to appear trusts of affirmation and distrusts of denial in the mind, as Ren(任) means entrusting and Du(督) means supervising in English. He explained Chong mai(衝脈) is the meridian representing impulsive man that has a meaning of impulse as being suggested the name of Chong mai, because Chong mai is borrowed from Foot shao yin kidney meridian(足少陰腎經). Dai mai(帶脈) is the meridian representing the characteristics of woman that has a meaning of binding as being suggested from the name of Dai mai which acts when people have something on their flank or they are pregnant, because Dai mai borrowed from Foot shao yang gall bladder meridian. He thought that four trigram divided from yin and yang is innate trigram, so Yang wei mai(陽維脈), Yin wei mai(陰維脈), Yang qiao mai(陽蹻脈), Yin qiao mai(陰蹻脈) among extra meridians have connections with Tai-yang ren(太陽人), Tai-yin ren(太陰人), Shao-yin ren(少陰人), Shao-yang ren(少陽人) of Four trigram constitution theory respectively which was created by Lee je-ma. He explained yang means opponents and wei(維) means binding. Yang wei mai is the meridian to be active when opponents bind or intervene in you, also the meridian is well active to the people who easily criticize others who are rude, to the people who well refuse restraints from organization. Because he explained yin means me and wei(維) means binding. Yin wei mai is the meridian to be active when I bind and intervene in opponents. He also state that the meridian is easily active to the people who have a tendency to gather people and make party apparatus by nature. He explained Yang qiao mai is the meridian to be active in the situation that people are waiting for others to bridge gap because yang means opponents and qiao(蹻) which has a meaning of standing on one's tiptoes means bridging gap between people. He also state the meridian is easily active to Shao yin ren who has a tendency to be passive, to easily settle down and not to move by nature. He explained Yin qiao mai is the meridian to be active in the situation that I bridge gap between me and others to make friends, because yin means me and qiao(蹻) which has a meaning of standing on one's tiptoes means bridging gap between me and others. He also state the meridian is easily active to Shao yang ren who is active in every business and who has remarkable ability to make friends. Conclusion : Kim hong-kyung stated the physiological properties of extra meridians as below. Ren mai is the meridian representing positive confidence which is easily active when people have a mind to trust others, Du mai is the meridian representing negative distrust which is easily active when people have doubts. Chong mai is the meridian representing the characteristics of man that has impulsive characteristics. Dai mai is the meridian representing the characteristics of woman to be easily active when she is pregnant. Yang wei mai has close connections with Tai-yang ren who has a tendency to refuse restraints from others and to criticize on opponent's remarks and behaviors that are wrong. Yin wei mai has close connections with Tai-yin ren, as the meridian is active in the situation that people enjoy restraining and intervening in others. Yang qiao mai has close connections with Shao yin ren, as the meridian is active to the people who are negative and passive by nature. Yin qiao mai has close connections with Shao yang yin who has a strong tendency to make friends easily by nature.

• 보건교육건강증진학회지
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• 제6권2호
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• pp.23-39
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• 1989

There have been a lot of considerable. discussion and debate surrounding the management model in the health insurance management system and opinions regarding the management operating cost. It is a well known fact that there have always been dissenting opinions and debates surrounding the issue. The management operating cost varies according to the scale of the management organization and component members characteristics of the insurance carrier. Therefore, it is necessary to examine and compare the management operating cost to the simulated management models developed to cover those eligible for the health insurance scheme in this country. Since the management operating cost can vary according to the different models of management, four alternative management models have been established based on the critical evaluation of existing theories concerned, as well as on the basis of the survey results and simulation attempts. The first alternative model is the Unique Insurance Carrier Model(Ⅰ) ; desigened to cover all of the people with no classification of insurance qualifications and finances from the source of contribution of the insured, nationwide. The second is the Management Model of Large-scale District Insurance Carrier(Ⅱ) ; this means the Korean society would be divided into 21 large districts; each having its own insurance carrier that would cover the people in that particular district with no classification of insurance qualifications arid finances as in Model I. The third is the Management Model of Insurance Carrier Divided by Area and Classified with Occupation if Largescale (Ⅲ) ; to serve the self-employed in the 21 districts divided as in Model Ⅱ. It would serve the employees and their dependents by separate insurance carriers in large-scale similar to the area of the district-scale for the self-employed, so that the insurance qualifications and finances would be classified with each of the insurance carriers: The last is the Management Model of the Multi - insurance Carrier (Ⅳ) based on the Si. Gun. Gu area which will cover their own self- employed people in the area with more than 150 additional insurance carriers covering the employees and their dependents. The manpower necessary to provide services to all of the people according to the four models is calculated through simulation trials. It indicates that the Management Model of Large-scale District Insurance Carrier requires the most manpower among the four alternative models. The unit management operating costs per the insured individuals and covered persons are leveled with several intervals based on the insurance recipients. in their characteristics. The interval levels derived from the regression analysis reveal that the larger the scale of the insurance carriers is in the number of those insured and covered. the more the unit management operating cost decreases. significantly. Moreover. the result of the quadratic functional formula also shows the U-shape significantly. The management operating costs derived from the simulated calculation. on the basis of the average salary and related cost per staff- member of the Health Insurance Societies for Occupational Labours and Korean Medical Insurance Corporation for the Official Servants and Private School Teachers in 1987 fiscal year. show that the Model of Multi-insurance Carrier warrants the highest management operating cost. Meanwhile the least expensive management operating cost is the Management Model of Unique Insurance Carrier. Insurance Carrier Divided by Area and Classified with Occupation in Large-scale. and Large-scale District Insurance Carrier. in order. Therefore. it is feasible to select the Unique Insurance Carrier Model among the four alternatives from the viewpoint of the management operating cost and in the sense of the flexibility in promoting the productivity of manpower in the human services field. However. the choice of the management model for health insurance systems and its application should be examined further utilizing the operation research analysis for such areas as the administrative efficiency and factors related to computer cost etc.

• Asia pacific journal of information systems
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• 제19권2호
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• pp.95-116
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• 2009

Increasingly the institutional theory has been an important theoretical view of decision making process and IT adoption in many academic researches. This study used the institutional theory as a lens through which we can understand the factors that enable the effective appropriation of advanced information technology. It posits that mimetic, coercive, and normative pressures existing in an institutionalized environment could influence the participation of top managers or decision makers and the involvement of users toward an effective use of IT in their tasks. Since the introduction of IT, organizational members have been using IT in their daily tasks, creating and recreating rules and resources according to their own methods and needs. That is to say, the adaptation process of the IT and outcomes are different among organizations. The previous studies on a diverse use of IT refer to the appropriation of technology from the social technology view. Users appropriate IT through not only technology itself, but also in terms of how they use it or how they make the social practice in their use of it. In this study, the concepts of institutional pressure, appropriation, participation of decision makers, and involvement of users toward the appropriation are explored in the context of the appropriation of the mobile electronic medical record system (M-EMRS) in particularly a hospital setting. Based on the conceptual definition of institutional pressure, participation and involvement, operational measures are reconstructed. Furthermore, the concept of appropriation is measured in the aspect of three sub-constructs-consensus on appropriation, faithful appropriation, and attitude of use. Grounded in the relevant theories to appropriation of IT, we developed a research framework in which the effects of institutional pressure, participation and involvement on the appropriation of IT are analyzed. Within this theoretical framework, we formulated several hypotheses. We developed a second order institutional pressure and appropriation construct. After establishing its validity and reliability, we tested the hypotheses with empirical data from 101 users in 3 hospitals which had adopted and used the M-EMRS. We examined the mediating effect of the participation of decision makers and the involvement of users on the appropriation and empirically validated their relationships. The results show that the mimetic, coercive, and normative institutional pressure has an effect on the participation of decision makers and the involvement of users in the appropriation of IT while the participation of decision makers and the involvement of users have an effect on the appropriation of IT. The results also suggest that the institutional pressure and the participation of decision makers influence the involvement of users toward an appropriation of IT. Our results emphasize the mediating effect of the institutional pressure on the appropriation of IT. Namely, the higher degree of the participation of decision makers and the involvement of users, the more effective appropriation users will represent. These results provide strong support for institutional-based variables as predictors of appropriation. These findings also indicate that organizations should focus on the role of participation of decision makers and the involvement of users for the purpose of effective appropriation, and these are the practical implications of our study. The theoretical contribution of this study is lies in the integrated model of the effect of institutional pressure on the appropriation of IT. The results are consistent with the institutional theory and support previous studies on adaptive structuration theory.