• Health Policy and Management
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• v.5 no.1
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• pp.31-58
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• 1995

The Korean government achieved the universal coverage of health insurance in July 1989, and concomitantly introduced a new measure of regulated health care delivery system in using medical care. There are three reasons why the government took the new health care delivery system. Firstly, there was ample room for improving the allocative efficiency in the use of medical facilities. And the second one was to constrain the dramatic increase of medical demand under health insurance. Thirdly, and the most important reason was to alleviate the patient crowdedness in big general hospitals, particularly tertiary hospitals. There are essentially two different ways to control the use of health care : one is to cut the demand for health care, and the other to regulate behaviors of providers through the use of incentives/disincentives, demand-side approach or supply-side approach. The objective of this study is to examine whether or not medical care utilization behaviors under health insurance scheme have been changed among medical facilities such as clinic, hospital, general hospital and tertiary hospital in comparison with those before and after the introduction, particularly whether the patient crowdedness in tertiary hospitals has been alleviated or not. In order to conduct this study, the insurance claim data during the period of January 1989 and July 1992 were analyzed by focusing on diagnosis of both inpatients and outpatients, and especially the fifteen most frequent diseases in ambulatory care and the seven most frequent diseases in hospitalizatio. In addition, the same analyses were made on the changes in medical care utilization by specialty department. This was because the five departments, such as family medicine, ENT, eye, dermatology and rehabilitation, were exempted from applying the regulated health care delivery system in tertiary hospitals. The study revealed that a remarkable alleviation effect in the crowdness was noted for tertiary hospitals. This effect was most conspicuous for the most frequent mild diseases of both inpatient and outpatient care. For example, the fifteen most frequent OPD care at tertiary facilities have decreased as much as by 40%, of which 34% belonged to the cut in initial visits. Meanwhile, the proportion of those who used general hospitals and private practitioner's clinics have increased due to the shift of patients. The cases from the five special departments were also decreased, but not so much as other departments. A problem was noted that, as time passed by, the decreasing tendencies of crowdness at tertiary hospitals due to the regulated system became slightly smaller. Therefore, through complementary remedies are needed for the future implementation.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.5 no.1
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• pp.33-38
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• 2002

Purpose: The incidence of shigellosis had been decreased due to the use of antibiotics and the improvement of environmental sanitation but recently increases again. Shigellosis occurrs in mass outbreak through unsanitized meal preperation refered from welfare facility and school. We observed epidemic aspect and clinical coarse of childhood shigellosis. Methods: from December 2001 to January 2002, 22 inpatients with shigellosis in Dongbu Municipal Hospital were observed epidemiologically, clinically and microbiologically. Results: 1. The sexual ratio was 1:1 and mean age was $5.5{\pm}1.4$ years (14 months to 11 years). 2. The clinical manifestations were following: diarrhea (95.5%), high feve (10%) and asymptomatic (4.5%). The mean duration was $3.9{\pm}2.1$ days (1 to 12 days). All patients had no complication and normal serologic test. 3. S. sonnei was cultured in rectal swab, and was resistant to TMP/SMX and ampicillin, but susceptible to ampicillin/sulbactam and the 3rd generation cephalosporins. 4. The patients were treated by antibiotics with conservative treatment including electrolytes and fluid therapy for 5 days, resulting in improvement confirmed by negative reaction on stool culture. 5. These cases were all occurred in mass outbreak in day care center and were suspected to be secondary infection by members of family. Conclusion: This shigellosis occurred in day care center was secondary infection due to S. sonnei and had mild clinical coarse and improvement after antibiotic treatment.

• Journal of the Korean Institute of Landscape Architecture
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• v.43 no.1
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• pp.82-95
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• 2015

This study is intended to obtain a guideline for creating a therapeutic garden soundscape in a psychiatric hospital by analyzing the psychological and physiological effects of auditory components on mental patients. The subjects were 27 inpatients at a psychiatric institute located in Jeollabuk-do. They were recommended by their doctors and had been diagnosed with mild cases of schizophrenia. The survey was carried out in October 2011. With regard to the study, the subjects listened to single sounds(the sound of flowing water, birdsong, wind chimes and music) and 4 sounds composed of some of these, and then Electroencephalography(EEG) and psychological effects were measured. The moving water sound was perceived as pleasing and revitalizing and the birdsong as sonorous and delightful. When designing a healing garden in a psychiatric hospital, the vitality of sound should be considered. In comparison to other single sounds, water sounds were highly preferred and had greater effects on psychological vitality. Music sounds had a significant effect on enhancing tranquility while water sounds affected on both psychological vitality and tranquillity. When comparing single sounds with combined sounds, single sounds such as running water for vitality and music for tranquility had a greater psychological effect than combined sounds. In terms of combined sound preferences, the combination of water and bird sounds had higher preference rates. Generally, combined sounds including water tended to have higher preference rates. The physiological effects of single sounds showed that music had a greater therapeutic effect than natural sounds such as water sounds and birdsong in promoting tranquility. As for combined sounds adopted to enhance physiological tranquility, it is most appropriate to combine music and birdsong or music and water sounds. However, a single music sound is more effective than combined sounds. Overall, analyses of both psychological and physiological reactions showed music and water sounds to be most calming while water sounds promoted the greatest vitality.