• 간호행정학회지
• /
• 제7권2호
• /
• pp.205-221
• /
• 2001

It will become more and more popular to use the long-term care facilities and home health care services with the chronic disease increasing. It depends on how much the consumers would pay and purchase the services. They might get more benefits from that kind of services than from ordinary hospitalization. So far, the study of determining the medical service price has focused most often on the efforts from the providers' view. But it must be reasonable to include the consumers' value for the service. This study was performed to assess WTP(Willingness to Pay) for home health care service in order to apply to the determination of nursing price in a reasonable manner. In this study, respondents were asked if they would pay for the service's intangible benefits under the four different types(open-ended minimum WTP, open-ended maximum WTP, bidding WTP, referendum WTP). The contingent valuation method is a potentially useful tool in understanding how people value the benefits of the service. As a result, average open-ended minimum WTP was W16,015 per day among 65 respondents. Average open-ended maximum WTP was W29,154 per day among 65 respondents. Average bidding WTP was W26,300 per day among 65 respondents. Average referendum WTP was W22,200 per day among 70 respondents. The results of regression analyses were also consistent with theoretical prediction, e.g., increasing WTP with consumers' value for the service, state of patients, and household income. This study demonstrated that it was more reasonable to consider the consumers' value in determining the services' price. In addition, a further study is needed to test the validity of this CV method and to determine a proper nursing price based on the consumers' view.

• Asia pacific journal of information systems
• /
• 제21권3호
• /
• pp.71-96
• /
• 2011

Within the traditional medical delivery system, patients residing in medically vulnerable areas, those with body movement difficulties, and nursing facility residents have had limited access to good healthcare services. However, Information and Communication Technology (ICT) provides us with a convenient and useful means of overcoming distance and time constraints. ICT is integrated with biomedical science and technology in a way that offers a new high-quality medical service. As a result, rapid technological advancement is expected to play a pivotal role bringing about innovation in a wide range of medical service areas, such as medical management, testing, diagnosis, and treatment; offering new and improved healthcare services; and effecting dramatic changes in current medical services. The increase in aging population and chronic diseases has caused an increase in medical expenses. In response to the increasing demand for efficient healthcare services, a telehealth service based on ICT is being emphasized on a global level. Telehealth services have been implemented especially in pilot projects and system development and technological research. With the service about to be implemented in earnest, it is necessary to study its overall acceptance by consumers, which is expected to contribute to the development and activation of a variety of services. In this sense, the study aims at positively examining the structural relationship among the acceptance factors for telehealth services based on the Technology Acceptance Model (TAM). Data were collected by showing audiovisual material on telehealth services to online panels and requesting them to respond to a structured questionnaire sheet, which is known as the information acceleration method. Among the 1,165 adult respondents, 608 valid samples were finally chosen, while the remaining were excluded because of incomplete answers or allotted time overrun. In order to test the reliability and validity of the assessment scale items, we carried out reliability and factor analyses, and in order to explore the causal relation among potential variables, we conducted a structural equation modeling analysis using AMOS 7.0 and SPSS 17.0. The research outcomes are as follows. First, service quality, innovativeness of medical technology, and social influence were shown to affect perceived ease of use and perceived usefulness of the telehealth service, which was statistically significant, and the two factors had a positive impact on willingness to accept the telehealth service. In addition, social influence had a direct, significant effect on intention to use, which is paralleled by the TAM used in previous research on technology acceptance. This shows that the research model proposed in the study effectively explains the acceptance of the telehealth service. Second, the research model reveals that information privacy concerns had a insignificant impact on perceived ease of use of the telehealth service. From this, it can be gathered that the concerns over information protection and security are reduced further due to advancements in information technology compared to the initial period in the information technology industry, and thus the improvement in quality of medical services appeared to ensure that information privacy concerns did not act as a prohibiting factor in the acceptance of the telehealth service. Thus, if other factors have an enormous impact on ease of use and usefulness, concerns over these results in the initial period of technology acceptance may become irrelevant. However, it is clear that users' information privacy concerns, as other studies have revealed, is a major factor affecting technology acceptance. Thus, caution must be exercised while interpreting the result, and further study is required on the issue. Numerous information technologies with outstanding performance and innovativeness often attract few consumers. A revised bill for those urgently in need of telehealth services is about to be approved in the national assembly. As telemedicine is implemented between doctors and patients, a wide range of systems that will improve the quality of healthcare services will be designed. In this sense, the study on the consumer acceptance of telehealth services is meaningful and offers strong academic evidence. Based on the implications, it can be expected to contribute to the activation of telehealth services. Further study is needed to assess the acceptance factors for telehealth services, such as motivation to remain healthy, health care involvement, knowledge on health, and control of health-related behavior, in order to develop unique services according to the categorization of customers based on health factors. In addition, further study may focus on various theoretical cognitive behavior models other than the TAM, such as the health belief model.

• 융합정보논문지
• /
• 제11권10호
• /
• pp.194-204
• /
• 2021

본 연구는 생애주기별 민간의료보험 가입 현황 및 가입 요인을 알아보고, 민간의료보험 가입에 따라 생애주기별 의료이용 행태 차이를 파악하고자 시행하였다. 한국복지패널 12차-15차(2016-2019년) 자료를 SPSS 26 프로그램을 사용하여 58,223명의 인구사회학적 및 건강 특성에 따른 민간의료보험의 가입 현황 차이는 Chi-square, 가입 영향 요인은 다항 로지스틱 분석, 의료이용 행태는 평균분석하였다. 분석결과 민간의료보험의 가장 큰 가입요인은 가구소득이었으며, 성장기의 민간의료보험 가입이 생애주기 중 가장 높았고, 가구소득에 의해 복수 가입되었다. 청장년기는 가구소득과 유배우자, 장애가 없는 경우, 중년기는 가구소득과 경제활동, 유배우자, 건강수준이 큰 영향요인으로 나타났다. 노년기의 민간의료보험 가입률이 가장 낮았고, 저소득가구, 낮은 건강수준, 장애가 있는 경우에서 낮았다. 민간의료보험 가입자들의 의료이용 증가도 성장기와 청장년기에 나타났다. 국민건강보험의 보장성 강화와 이를 보충하기 위한 민간의료보험의 역할을 생애주기에 맞춰 정립하여 상호보완적으로 작용하게 하여 의료보장의 사각지대를 없애고, 국민의 건강과 후생을 최대화하여야 할 것이다.

• Asian Pacific Journal of Cancer Prevention
• /
• 제13권11호
• /
• pp.5525-5528
• /
• 2012

Introduction: Breast cancer is the most common cancer in women. Improvements of early diagnosis modalities have led to longer survival rates. This study aimed to determine the 5, 10 and 15 year mortality rates of breast cancer patients compared to the normal female population. Materials and Methods: The follow up data of a cohort of 615 breast cancer patients referred to Iranian Breast Cancer Research Center (BCRC) from 1986 to 1996 was considered as reference breast cancer dataset. The dataset was divided into 5 year age groups and the 5, 10 and 15 year probability of death for each group was estimated. The annual mortality rate of Iranian women was obtained from the Death Registry system. Standardized mortality ratios (SMRs) of breast cancer patients were calculated using the ratio of the mortality rate in breast cancer patients over the general female population. Results: The mean age of breast cancer patients at diagnosis time was 45.9 (${\pm}10.5$) years ranging from 24-74. A total of 73, 32 and 2 deaths were recorded at 5, 10 and 15 years, respectively, after diagnosis. The SMRs for breast cancer patients at 5, 10 and 15 year intervals after diagnosis were 6.74 (95% CI, 5.5-8.2), 6.55 (95%CI, 5-8.1) and 1.26 (95%CI, 0.65-2.9), respectively. Conclusion: Results showed that the observed mortality rate of breast cancer patients after 15 years from diagnosis was very similar to expected rates in general female population. This finding would be useful for clinicians and health policy makers to adopt a beneficial strategy to improve breast cancer survival. Further follow-up time with larger sample size and a pooled analysis of survival rates of different centres may shed more light on mortality patterns of breast cancer.

• 보건교육건강증진학회지
• /
• 제21권2호
• /
• pp.55-85
• /
• 2004

The problems of health in poor peoples are various and difficult things to solve it. They are highly susceptible to chronic disease because of bad environment and It is hard to access to medical services because of their Socio-demographic status. Therefore, it is important to address the problem of prevention of chronic disease and health promotion aspect. The purpose of this study was to determine the relationships among the health status, health behaviors and health practices of poor people in urban slum area. The subject of this study were 298 poor peoples who live in poor area in Daegu metropolitan city and they were asked to answer the survey questionnaires modified for Korean from behavioral risk factor surveillance system of Centers for Disease Control and Prevention USA. The result of the study were as follows； (1) There were significant relationships between health status (prevalence of chronic disease and perceived general health) and socio-demographic factor such as occupation, existence of spouse, number of family educational level, type of medical security. (2) There were some relationships between health risk behaviors such as smoking, drinking and obesity and health status of subject especially in female obesity.(3) There were relationships among health concern activity, prevalence of chronic disease and some social factor such as educational level and occupation. (4) There were relationships among health practice, health concern activity, health status and socio-demographic factors of subject. This study suggest that health status, socio-demographic status, health concerns and health promotion activity of study populations were associated and It is very important things supporting the poor people in the level of community and nation to practice healthy behaviors themselves.

• 한국병원경영학회지
• /
• 제24권3호
• /
• pp.1-10
• /
• 2019

Purpose: The purpose of this study was to investigate determinants of purchasing indemnity private health insurance and its impact on the healthcare utilization among outpatients with chronic disease. Methods: The study analyzed 4,997 chronic ill patients using 2015 Korean Health Panel data. Logistic regression analysis was conducted to analyze the factors affecting the purchase of indemnity private health insurance and multiple regression analysis was conducted to analyze the effect of private health insurance on the number of outpatient visits and outpatient expenditures. Findings: The age, education level, and number of chronic diseases were significant factors affecting the purchasing of indemnity private health insurance among chronic patients. As a result of analyzing the impact of indemnity private health insurance on healthcare utilization, the number of outpatient visits for those who enrolled in the indemnity private health insurance was higher than the number of outpatient visits for those who did not. But there was no statistically significant difference in outpatient medical expenses. Practical Implications: The results of this study shows that indemnity private health insurance may cause inequality in the healthcare utilization of the socially vulnerable. It is necessary to seek ways to strengthen the health security of chronic disease patients and high-risk elderly people who need more healthcare.

• 성인간호학회지
• /
• 제12권2호
• /
• pp.184-195
• /
• 2000

It has been believed that cancer is an omnious factor threatening the future and life itself. Patients having the disease experience anxiety, fear, feeling of weakness, depression and feelings of uncertainty and hopelessness. Most cancer patients, however, have expectations of possible recovery and a better future, very different from the patients who feel hopeless. Therefore. hope allows people to respond effectively to the fatal disease they have and prevents them from detoriorating physically and spiritually, positively influencing their survival, response to treatment and sense of security. Studies previously performed showed that hope is positively correlated with social and family supports, self-esteem, spiritual well-being, responsive action, health promotion behavior and quality of life. Thus, the study attempted to provide basic information on nursing cancer patients by investigating their levels of hope and determining predictive factors which influence hope. For the study 200 cancer patients in two university hospitals located in Pusan were sampled as subjects. Data were collected for twenty nine days from Feburary 1, 1999 to March 1. Instrumets for the study included 10 items from the self-esteem scale by Rosenberg (1965), 39 hope measurements by Kim and Lee(1965), 16 of the social support scale by Tae(1986) and 16 of the general characteristics scale, all of which totaled 81 items. The data were analyzed using the SPSS program. General characteristics of the investigated based on numbers and percentage. Hope, self-esteem and social support were analyzed using means, minimum, maximum and standard deviation. Relations among the foregoing three factors were analyzed using Pearson' correlation coefficient. Levels of hope in cancer patients were determined using t-test, ANOVA and Scheffe test. Predictive factors influencing hope were investigated using multiple stepwise regression analysis. Results of the study are summarized as follows: 1. An average level of hope was $185.55{\pm}23.39$ points(96 min. and 234 max.) 2. Levels of hope showed a significant difference among them according to sex (t=-3.69, P=.000), age(F=4.714, P=.000), job(F=3.247, P=.008), monthly income (F=6.113, P=.003), treatment charge (F=3.796, P=.011), supportive resources (F=10.554, P=.000), diagnosis(F=2.287, P=.029), perceived health status(F=22.184, P=.000), level of pain(F=3.334, P=.021), religion (F=4.911, P=.001) and religion's effect in life (F=11.706, P=.000), 3. For the subjects, self-esteem and social support were $38.32{\pm}7.21$(13 min, and 50 max.) and $52.97{\pm}8.49$points(28 min, 80 max.). Concerning social support, average levels of family support and medical support were found $35.95{\pm}6.05$(18 min, and 40 max) and $27.02{\pm}4.99$ points(20 min and 40 max). The hope the cancer patients showed significant correlations with self-esteem (r=.588, P=.000), family support(r=.224, p=.001) and medical support(r=.221, P=.002). 4. The five variables related to hope (self-esteem, religion's effect in life, perceived health status, social support and age) accounted for 54.2 percent of the hope level; especially, self-esteem was the highest at 34.6%. As shown in the above results, predictive factors which most influence hope in cancer patients were self-esteem and religion's effect of life. Therefore, nursing interventions to increase self-esteem should be developed. Regarding religion's effects, studies on spiritual aspects should be carried out in a way that contributes to promotion of hope.

• 농촌지도와개발
• /
• 제20권4호
• /
• pp.953-987
• /
• 2013

이 연구의 목적은 농촌 다문화가족의 자립인식 수준과, 자립을 위한 지원요구를 분석하는 것이다. 이 연구에서 밝혀진 주요결과는 다음과 같다. 첫째, 농촌 다문화가족의 자립인식 수준은 정보화영역에서 가장 낮았고, 사회심리관계영역에서 가장 높았다. 둘째, 사회보장 수혜 등 생활특성에 따라 농촌 다문화가족의 경제적 자립지원 요구를 카이자승검증한 결과, 의료보장을 받거나 또는 자녀교육 및 노후준비를 하지 않는 가족은 생활비 보조에 대한 요구가 유의미하게 더 높았다. 반면 의료보장을 받지 않거나 자녀교육 및 노후준비를 하는 가족은 농산물 판매교육, 농업기술교육, 창업지원에 대한 요구가 유의미하게 더 높았다. 셋째, 농촌 다문화가족의 PC보유율은 도시가족 보다 낮으며, 사회보장 수혜 등 생활특성에 따른 PC보유율의 차이는 유의미하지 않았다. 넷째, 사회보장 수혜 등 생활특성에 따른 다문화가족 자녀교육 또는 사회적 지원 요구의 차이는 통계적으로 유의하지 않았는데, 이러한 것들에 대한 요구가 다문화가족 전반을 포괄하는 보편성을 지님을 시사한다. 이상의 결과를 종합하여 볼 때 농촌 다문화가족에 대한 자립지원은 생활특성별, 영역별로 차별적이거나 통합적으로 접근되어야 할 것이다. 이 연구의 결과는 농촌 다문화가족의 자립을 지원하는 방안을 모색하는데 기초자료로 활용되어 질 것이다.

• Asian Pacific Journal of Cancer Prevention
• /
• 제16권14호
• /
• pp.6055-6059
• /
• 2015

Background: Medication policy development in Thailand is continually promoting rational drug use. Letrozole, an endocrine therapy drug, is usually prescribed for post-menopausal status early and advanced stage breast cancer. After Ministry of Public Health announced Letrozole as compulsory licensed drug in 2009, more breast cancer patients can access to this drug at low cost especially those within universal coverage schemes. To ensure that Letrozole is rationally prescribed, the drug utilization study was conducted. Objectives: The aim of this study was to describe the appropriate use of Letrozole in breast cancer and the relationship between appropriate use and health benefit schemes. Materials and Methods: A retrospective study to evaluate use of Letrozole in breast cancer patients was performed for six months between January - June 2010 in seven regional cancer hospitals, Thailand. All prescriptions of Letrozole were identified from pharmacy dispensing databases and prescription papers. A medical record review was also performed to evaluate appropriate use referring to the drug use evaluation criteria. The approved criterion of this study was referred from the guideline of Thai National Formulary version 2010. Results: There were 681 prescriptions of Letrozole for 254 breast cancer patients with an average age of $58.6{\pm}10.0years$. The patients in universal coverage scheme (UCS), civil servant medication benefit scheme (CSMBS) and social security scheme (SSS) were 77.7%, 18.5% and 8.7% respectively. 10.6% were prescribed Letrozole for the first time. Letrozole were prescribed by oncologists (82.8%). The average number of tablets per prescription was $58{\pm}10$. Calcium supplements were prescribed concomitant with Letrozole for 19.4%. To assess drug use evaluation criteria, 45 prescriptions were excluded because of uncompleted clinical data, 636 prescriptions were evaluated. The study showed 86 prescriptions (13.5%) with inappropriate use including 6 (0.9%) not prescribed for estrogen receptor (ER) and/or progesterone receptor (PR) positive, 31 (4.9%) not prescribed for post-menopausal and 49 (7.7%) not prescribed for an appropriate duration. Appropriate use percentages in different health benefit schemes were similar, 85.7% of CSMBS, 86.4% of SSS and 86.7% of UCS. The relationship between health benefit scheme and appropriate use of Letrozole was not significantly different, ${\chi}^2$ (2, N = 636) = 0.081, p > 0.05. Conclusions: The study showed inappropriate use in breast cancer patients because of non-compliance with duration, menopausal status and hormone receptor requirements. To prescribe appropriate indication did not referred to the appropriate practice along the treatment. Drug use evaluation proved very useful for detecting the sign of inappropriate use and allows immediate feedback to the stakeholder for developing medication policy in the future. Importantly, there was no significantly difference in appropriate use of Letrozole across health benefit schemes.

• 한국사회정책
• /
• 제25권1호
• /
• pp.195-229
• /
• 2018

본 연구는 한국현대사에 가장 논쟁적인 시기를 지나오면서 복지체제가 어떻게 변화해왔는지를 관찰했다. 복지체제는 수출주도형 경제성장의 필요에 조응하는 방식으로 변화했다. 1960년대 중반부터 시작된 경공업중심의 산업화는 농촌에 존재하고 있던 광범위한 유휴노동력을 흡수해 그들을 상품화시킴으로써 한국사회가 절대빈곤에서 벗어나는 계기를 마련했다. 하지만 노동력의 상품화에 조응하는 공적 탈상품화, 즉 사회보장제도는 매우 제한적인 영역과 대상에 국한해 제도화되었다. 실제로 탈상품화 제도는 노동력 재생산과 직접적 연관이 있는 영역에 국한되었고, 이마저도 농촌의 대체 가능한 유휴노동력이 풍부한 상황에서 그 대상은 매우 제한적이었다. 강제적 의료보험은 기업 부담을 이유로 거부되었고, 대규모 사업장을 중심으로 산재보험이 도입되었다. 1970년대에 들어서면서 한국 경제의 중심이 경공업에서 중화학공업으로 이동하기 시작하자 상품화된 노동력도 저숙련 여성노동력에서 숙련된 남성 노동력으로 변화했다. 수출중심의 대기업에 고용된 노동자들과 내수중심의 중소기업에 고용된 노동자들 간에 이중구조가 만들어지기 시작한 것도 바로 이 시기이다. 이에 따라 사회적 위험에 대응해 노동력 재생산을 지원하는 공적 탈상품화 제도도 대규모 사업장을 중심으로 제도화되었다.