• Health Policy and Management
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• v.23 no.1
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• pp.3-18
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• 2013

This paper investigates the possibility of expanding pay-for-performance (P4P) program as a provider payment system, in terms of financial, economical, and political sustainability. In order to expand the sustainable P4P, P4P should have usefulness in terms of economic value as well as efficiency in the financial aspects of health care. More importantly, the P4P would be politically sustainable only when both providers and consumers can accept. Korea's healthcare system seems to have logical ground for the P4P program financially and economically. However, how well the P4P can work remains to be proven in its implementation. After 43 tertiary hospitals applied the P4P program for acute myocardial infarction (AMI) and C-section in 2007, the number of hospitals adopting the P4P program for AMI and C-section has increased to 316 in 2011, and an incentive for hospitals applying the P4P has risen to 2% from 1% of health insurance benefits. This shows that the P4P program introduced by Health Insurance Review and Assessment Service is quite successful. In addition, people are aware of the need for improved P4P program and policy alternatives have been already made. Therefore, it is very important to come up with politically supportable strategies that can make providers and consumers accept the P4P program while maintaining the governance of the existing health insurance policy. To this end, there are some tasks to be considered. First, the expansion of the P4P program should be placed on the agenda of the Health Insurance Policy Review Committee, the highest decision-making body, and a separate agency for P4P planning should be established. Second, for more efficient P4P program, the processes of review and assessment, currently carried out separately, should be integrated into a single process. Third, infrastructure to measure the quality of medical services should be sharply expanded. Fourth, the current paradigm for the assessment should be changed. Lastly, a P4P program for consumers should be considered. Given that the consumers in Korea can use medical services freely, the National Health Insurance Corporation could initiate the P4P program for consumers as a means of controlling excessive use of medical services and adjusting consumer's moral hazard.

• Korean Journal of Social Welfare
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• v.59 no.1
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• pp.87-116
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• 2007

The purpose of this study is to identify the adaptation experience of foster children. This qualitative research was conducted through in-depth interview of 8 foster children in and over 4th grade. In data analysis of this qualitative study, the grounded theory suggested by Strauss and Corbin(1998) was used. The raw data collected from in-depth interview with the participants were analyzed in open coding, through theoretically sensitive and constant comparisons method. As a result, total 11 categories, 30 subcategories and 96 concepts were generated. In summary, the casual condition that caused the core phenomenon was 'family stability collapse'. The core phenomenon that foster children experience during the process of adaptation was 'marginalization'. The contextual condition that affected the outcome was 'cultural shock' and 'loyalty conflict.' The intervening condition that promote or restrain the action/interaction on core phenomenon were, 'support system', 'resilience menifestation', 'negative predestination'. The action/interaction strategy on core phenomenon were 'will to power' and 'pursuing moral superiority'. As a result, two concepts, 'mechanical adaptation to foster care environment' and 'active formation' of foster care environment' were assumed.

• Cross-Cultural Studies
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• v.52
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• pp.53-78
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• 2018

In the moral culture of the West, love and justice are two commands with roots in ancient times. One is the heritage of Hebraism, and the other belongs to the tradition of Hebraism and Hellenism. The two concepts are the most important virtues required for preserving stability in society. These two commands are compatible, in an exclusive relationship to each other. To ultimately seek their reconciliation, the precise concept analysis and understanding of each of them should be premised on, due to the multi-layered meaning of implications of the two concepts. To this end, we first have started with a lexical meaning and have done a conceptual analysis of what these two concepts are expressing. We have looked at Paul $Ric{\oe}ur$ in his interpretation of the discourse of love and justice. Finally, we looked at how these two concepts are narrated in literature. Through the literary works of Stendal, Albert Camus, and Dostoevsky, we have seen examples of literary configurations that have been embodied in life. In this way, through conceptual analysis, discourse analysis, and narrative analysis of the two concepts, the following conclusions were drawn. Love and justice were not a matter of choice. We could see coldness and unrealism of a society lacking love or with a problem of unclean love, through Stendhal's and Albert Camus' novels and their actual debate. In addition, in unclean paternalism, risk of the power of love blocking certain a certain touch of justice was also confirmed. So, it was necessary for a healthy future society to explore the possibility of the coexistence of love and justice. We confirmed the possibility of compatibility in a 'considerate balance' wherein the 'moral judgment in situation' is required, as Paul $Ric{\oe}ur$ expressed. This ideal situation may be realized when forms of love involving solidarity, mutual care, and compassion with pain like Dostoevsky are combined with the principle of distributional justice. When Albert Camus pursued justice and eventually faced reality and mentioned the need for mercy, he could have made a moral judgment based on this situation. In the end, love protects justice, and justice contributes to the realization of love. Justice reduces super-ethical love to moral categories, and love plays a role in enabling justice to exert its full force.

• Journal of Korean Academy of Nursing
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• v.1 no.1
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• pp.27-43
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• 1970

This study is designed to find out proper nursing activities for the needs of the colostomy patients, i.e., mental and psychological as well as physical needs for rapid recovery, and to help them build up the follow-up care for proper social adjustment. The study is based on 268 cases out of 381 colostomy patient's records kept in Ewha Womans University Hospital, Yonsei Medical Center, and National Medical Center in between the period from Jan. 1953 to Jan. 1970. The items of study are mainly on etiology, sex, age, duration of hospitalization, mortality rate, seasonal frequency, time from the onset of illness to the admission of the hospital, signs and symptoms. 1. Frequency of onset by etiology: Neoplastic disease 112 cases (42%), Inflammatory disease 33 cases (12%), Congenital malformation 30 cases (11%), Intussusception 25 cases (9.3%), Trauma 24 cases (9%), Volvulus 17 cases (6.3%), and Crohn's disease 6 cases (2.2%). 2. By sex: male 167 cases (62.9%), and female 101 cases (37.1%). So the ratio of portion of male and female 2:1. 3. By age: under 1·year·old 27 cases (10.1%) highest, 41-50 yrs 54 cases (20.2%), 51-60 yrs 42 cases (15.5%), above 71 yrs 5 cases (1.9%). 4. Duration of hospitalization: the shortest is 2-days and the longest is 470 days. 1-20-days 52%, 40-60 days 14%. 5. Mortality rate: Under the 10-days-admission 19.5%, and the beyond 30-days-admission 3.9%. 6. Seasonal frequency: Higher in summer (32% ). 7. Signs and symptoms: abdominal pain (56%), abdominal distention (54%), vomiting (40%), bloody mucoid diarrhea (38%) , pain of anal region (18%), abdominal tenderness, anorexia, indigestion, constipation, disuria, tenesmus, high fever and chilling sensation, bile tingled vomiting. Nursing activities for the patient's physical needs are as follows: Skin care for colostomy region, Prevention of colostomy constriction and depression, Removal of an offensive odor, The use of colostomy bag-selection for, and demonstration of the use of inexpensive colostomy irrigation equipment, Personal hygiene, general skin care, care of hair, finger nails and toe-nails, Oral hygiene, sleep and rest, aquate, Daily activities, etc. Measures for regulation of bowl movement. Keeping the instruction of taking food, Preparing the meal and help for anorexia, Constipation and it's solution, Prevention of diarrhea, helping the removal of mucous, and stretch constricted steam as needed. Nursing activities for pt's socio-psychological needs are as follows; Help the patient to make decision for the operation, Remove pt's anxiety toward operation and anesthesia, To meet the pt's spiritual needs at his death bed, Help to establish family and friends cooperation, Help to reduce anxiety at the time of admission and it's solution, Help to meet religious need, Help to remove pt's anxiety for loosing his job and family maintenance, Follow-up studies for 7 cases have been done to implement the present thesis. The items of the personal interviews with the patients are as follows: Acceptability for artificial anus, The most anxious thing they had in mind at the time of discharge, The most anxious thing they hat·e in mind at present, Their friends and family's attitudes toward the patient after operation, Relations with other colostomy patients, Emotional damage from the operation, Physical problem of enema, irrigation, Control of diet, Skin care, Control of offensive odor, Patient's suggestions to nurses during hospital stay and after discharge. In conclusion, the follow-up care for colostomy patients shares equal weight or perhaps more than the post-operative care. The follow-up care should include the spiritual care for moral support of the patient, to drag him out of isolation and estrangement, and make him fully participate in social activities. It is suggested that the following measures would help to rehabilitate the colostomy patients (1) mutual acquaintance with other colostomy patients if possible form a sort of club for the colostomy patient to exchange their experiences in care (2) through the team work of doctor, nurse and rehabilitation specialists, to have a sort of concerted effort for betterment of the patient.

• Proceedings of the Korean Association for Survey Research Conference
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• 2005.12a
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• pp.187-220
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• 2005

The purpose of this study is to analyze supporters' community formation motives/ Process/consumption experiences and community characteristics. For this purpose, this study collected the data using ethnographic interview. participant observation, documents and media reports. The results of this study show that supporters communities' formation and diffusion process were influenced by individual characteristics(e.g., personality, hobby and etc.), community characteristics(e.g.,team performance, star player, facilities and etc.) and external factors(ex: media movement etc.) and supporters have experienced various emotions such as intimacy. cohesion, pride and so on through various activities at on-line and off-line site. Community characteristics were classified into we-ness, rituals/traditions, moral responsibility. We found that we-ness influenced emotional dimensions such as joy, pleasure, fun and excitement. rituals and traditions made members feel passion. hope. love and vitality. and moral responsibility provided satisfaction. enthusiasm anxiety. regret and so on. Also, emotional attachment and brand loyalty were increased by these experiential aspects of community consumption.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.10
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• pp.6722-6742
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• 2015

This study is intended to look for implications through longitudinal exploratory research on the change of children's problem behaviors for their temperament and parenting behaviors. The results are as follows. The factors influencing children's problem behaviors rose to 62 factors between 1990 and 2000, and 93 factors between 2000 and 2010 from total 41 factors between 1970 and 1990, which they were more than doubled after the 2000s compared with the earlier studies, subdividing children's problem behaviors. The proportion of the factors influencing children's problem behaviors showed that parents' moral thinking had the highest, and their negative thinking or emotion for children were higher than their moral thinking, which their problem behaviors were more greatly affected by parenting attitudes toward them than their own temperament or attitudes. The earlier studies were more likely to find the cause of children's problem behaviors for looking into the factors and causes influencing children's problem behaviors in terms of children's personal mental health, but there was more proportion of social environment, peer and teacher relationship while soaring family, relationship, home environment and child care center environment factors as well as children's personal factors after the 2000s. Consequently, the alternative resources or the environments of the times should be applied in other ways.

• Korean Journal of Culture and Social Issue
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• v.23 no.4
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• pp.557-585
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• 2017

In this research, it was examined whether predicting the ripple effects of events influences decision-making difficulty. In addition, it was examined whether perceived accountability for decision-making results mediates the relation above. In Study 1, participants were presented with policy decision-making vignettes and were asked to report on the ripple effects of their policy decisions as well as on the difficulty of making the decision. Consistent with the hypothesis, the bigger the expected ripple effects, the greater difficulty participants felt in making policy decisions. In Study 2, ripple effect magnitudes were experimentally manipulated such that participants were led to predict big ripple effects in one condition and relatively small ripple effects in another condition. It was investigated whether participants predicting bigger ripple effects would perceive decision-making to be more difficult than participants predicting smaller ripple effects. Whether this relation would be mediated by perceived personal accountability for the results of decision-making was also examined. Consistent with expectations, it was found that in the moral domains of Harm/care, Fairness/reciprocity, and Ingroup/loyalty, participants predicting bigger ripple effects reported more difficult decision-making than their counterparts. The relation above was mediated by perceived personal accountability for decision-making results only in the domain of Ingroup/loyalty. In combination, these results showed that bigger predicted ripple effects contributed to greater decision-making difficulty. In addition, participants felt more responsible for the results of their decisions when predicting bigger ripple effects, which led them to feel greater decision-making difficulty in the domain of Ingroup/loyalty. The implications of these results and future directions for research are discussed.

• Health Policy and Management
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• v.27 no.4
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• pp.273-275
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• 2017

It has been forty years since the implementation of National Health Insurance (NHI) in South Korea. Following the 1977 legislature mandating medical insurance for employees and dependents in firms with more than 500 employees, South Korea expanded its health insurance to urban residents in 1989. Resultantly, total expenses of the National Health Insurance Service (NHIS) have greatly increased from 4.5 billion won in 1977 to 50.89 trillion won in 2016. With multiple insurers merging into the NHI system in 2000, a single-payer healthcare system emerged, along with separation policy of prescribing and dispensing. Following such reform, an emerging financial crisis required injections from the National Health Promotion Fund. Forty years following the introduction of the NHI system, both praise and criticism have been drawn. In just 12 years, the NHI achieved the fastest health population coverage in the world. Current medical expenditure is not high relative to the rest of the Organization for Economic Cooperation and Development. The quality of acute care in Korea is one of the best in the world. There is no sign of delayed diagnosis and/or treatment for most diseases. However, the NHI has been under-insured, requiring high-levels of out-of-pocket money from patients and often causing catastrophic medical expenses. Furthermore, the current environmental circumstances of the NHI are threatening its sustainability. Low birth rate decline, as well as slow economic growth, will make sustainment of the current healthcare system difficult in the near future. An aging population will increase the amount of medical expenditure required, especially with the baby-boomer generation of those born between 1955 and 1965. Meanwhile, there is always the problem of unification for the Korean Peninsula, and what role the health insurance system will have to play when it occurs. In the presidential election, health insurance is a main issue; however, there is greater focus on expansion and expenditure than revenue. Many aspects of Korea's NHI system (1977) were modeled after the German (1883) and Japanese (1922) systems. Such systems were created during an era where infections disease control was most urgent and thus, in the current non-communicable disease (NCD) era, must be redesigned. The Korean system, which is already forty years old, must be redesigned completely. Although health insurance benefit expansion is necessary, financial measures, as well as moral hazard control measures, must also be considered. Ultimately, there are three aspects that we must consider when attempting redesign of the system. First, the health security system must be reformed. NHI and Medical Aid must be amalgamated into one system for increased effectiveness and efficiency of the system. Within the single insurer system of the NHI must be an internal market for maximum efficiency. The NHIS must be separated into regions so that regional organizers have greater responsibility over their actions. Although insurance must continue to be imposed nationally, risk-adjustment must be distributed regionally and assessed by different regional systems. Second, as a solution for the decreasing flow of insurance revenue, low premium level must be increased to an appropriate level. Likewise, the national reserve fund (No. 36, National Health Insurance Act) must be enlarged for re-unification preparation. Third, there must be revolutionary reform of benefit package. The current system built a focus on communicable diseases which is inappropriate in this NCD era. Medical benefits must not be one-time events but provide chronic disease management. Chronic care models, accountable care organization, patient-centered medical homes, and other systems that introduce various benefit packages for beneficiaries must be implemented. The reimbursement system of medical costs should be introduced to various systems for different types of care, as is the case with part C (Medicare Advantage Program) of America's Medicare system that substitutes part A and part B. Pay for performance must be expanded so that there is not only improvement in quality of care but also medical costs. Moreover, beneficiaries of the NHI system must be aware of the amount of their expenditure through a deductible payment system so that spending can be profiled and monitored. The Moon Jae-in Government has announced its plans to expand the NHI system; however, it is important that a discussion forum is created so that more accurate analysis of the NHI, its environments, and current status of health care system, can take place for reforming NHI.

• The Journal of the Korea Contents Association
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• v.18 no.1
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• pp.268-276
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• 2018

This study examined the effects of indemnity private health insurance on the medical utilization among the Korean adults. The used data were the 2014 survey data of Korea Health Panel, and the number of subjects was 11,436. Authors employed instrumental variable regression model where the instrument variables for controlling for endogeneity of indemnity were the purchasing of private pension and number of family members. The results showed that the number of outpatient visits and the number of hospitalizations for indemnity private health insurance subscribers were higher than non-subscribers. The number of household members and the private pension variables were proved to be appropriate as instrumental variables. This paper recommends the Korean government to monitor and evaluate the effects of indemnity private health insurance on the medical utilization in order to improve the efficiency of health care finance.

• Health Policy and Management
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• v.22 no.4
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• pp.597-627
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• 2012

As misalignments among images, identity, and legitimacy of health professionals and institutions have been on the rise, CEOs of health care organizations have been required to enhance organizational accountability. Despite the accumulation of literature on the conceptual discussions of accountability, only a few studies empirically investigated key barriers to accountability and its facilitators. To identify perception on accountability with key barriers and facilitators of organizational accountability, a semi-structured interview with 11 CEOs of Korean hospitals was conducted. A short survey was taken to get quantitative data on CEO's perception on organizational accountability. To CEOs, accountability was very complex and unfamiliar concept, but understood as physician's code of ethics by nature and basic principle of hospital management. CEOs thought accountability could be improved through ethical leadership, financial stability and learning climate of hospitals. Distrust of the government, which failed to provide economic incentives for hospitals to increase accountability activities, was emphasized as a serious barrier to hospital accountability. There was consensus among hospital CEOs as to the importance of accountability in management. However, there were concerns that, without policy instruments to motivate hospitals toward increasing community benefits as well as collective efforts among health professionals to rebuild moral climate for being accountable, greater accountability would not be achieved in hospitals.