• Health Policy and Management
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• v.3 no.1
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• pp.53-83
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• 1993

A small number of high cost patients usually spend a larger proportion of scarce health resources. Korea is no exception. Under the national health insurance, 12% of the insured persons have consumed approximately half of the national health insurance expenditures. Therefore, it is necessary to identify the characteristics of the high cost patient group, if we would like to reduce them. This study has defined high cost patients as those who have spent one and half million won and over per 6 months. The study reveals that high cost users are those who have a longer length of stays(LOS), 40days of LOS in the 6 months, have multiple admissions, 2 to 3 admissions per 6 months and are the elderly patients. They have spent 814.126won per on the average, and commonly suffered from malignant neoplasms, circulatory diseases, fracture, diabetes mellitus, etc. Unlike the case of western developed countries, early readmissions are not the major causes of high cost spending in Korea. Undoubtedly, a lengthy admission is the main cause of large spending. Health policies should vigorously be explored to respond appropriately. There are evidences that hospital beds are often misused. As the Korean health care system is lacking in a mechanism of patient evaluation under the fee-for-service remuneration system, an idea of progressive patient care needs to be tested. The Goverment should set up health policy to diversify the role of long-term care facilities and encourage people to establish them. Further studies are needed to identify factors influencing large medical bills necessary for formulating the health policy on cost containment.

• Journal of Korea Entertainment Industry Association
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• v.14 no.3
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• pp.443-454
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• 2020

This study aims to develop one-stop support service for the ALS. To achieve the purpose, the cases of Korea and Japan were researched. The data used in the multiple-case study mainly referred to diaries, blogs, social networking sites, Youtube, and interviews of the disabled with ALS disease in Korea and Japan, and analyzed support services of both countries. The result of the study showed that, in the onset stage of ALS disease, a fellow counselor should be assigned by family member or person who experienced the disease from KALSA or other organizations to which a patient belongs. Also, it need a counseling by fellow counselor in the stage of softening disability. And after the gastrointestinal procedure, the number of home visits by visiting nurses should increase, and other services by OT and PT are required. In the stage of wearing a respirator, it needs to train and dispatch volunteers for ALS exclusive activities. And it is necessary to set up a family rest area or a respite service for the mentally and physically exhausted primary caregiver by long-term care. Most of all, these services should be one-stop support with linking step by step, not fragmentary support.

• Journal of agricultural medicine and community health
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• v.16 no.2
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• pp.97-119
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• 1991

Korea has made a rapid economic development since the last three decades. This has helped Korea narrow the gap in health service differences in resource availability and in quality of care. However urban and rural differentials are still remarkable. This study has maintained that health status of rural residents is inferior to that of urban dwellers. Therefore, this study was carried out to develop policy measures for improving health services in rural areas. In order to achieve the objective of this study the authors collaborated closely and made field visits, interviews and conducted an extensive literature review regarding rural health services. The following policy options are recommended as a summary ; First, the quality of rural health personnel is a single most important factor influencing the level of rural health services. An innovative program for public health doctors to the internship and/or residency training program such as specialty board program of family medicine. Second, dissatisfaction regarding employment of public health doctors is problematic. More rational employment and deployment programs are needed to meet their personal desire. One way to do this is to make it wide open and competitive. Third this study shows how to increase physician productivity in the rural public health sector. Incentive system needs to be elaborated for the career development of rural health workers. University linked job opportunity as clinical professor is an example. Fourth, without straightening the function of health centers and subcenters, the future of rural health services is doomed to failure. Straightening primary health care is one way to enrich the program of public health facilities and reactivating the operation of health center/hospital is another. A close linkage of public facilities with private hospitals is a minimum requirement for the operation of health delivery system within a health district. Fifth, some measures are urgently required to enhance hospital services in medically underserved areas. Financial subsidy, tax exemption, long-term public loans and higher priority of health manpower deployment are some of them. Sixth, new health programs should be in tiated to meet changing needs of peoples in rural areas. Home health care program, hospice program, nursing home, residential program for the elderly are recommended.

• Korea Journal of Hospital Management
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• v.6 no.3
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• pp.148-166
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• 2001

The purpose of this study is to classify elderly patient in long-term care facilities using RUG(Resource Utilization Group)-III. It is designed by measuring patient medical characteristics and medical staff time. Elderly patients are classified into 7 categories by clinical(medical and behavioral) hierarchical typology of patients. Through the tertiary split, all 44 groups are formulated. This classification is explained by each patient resource(staff time) utilization level which is called CMI(Case-Mix Index). Major findings are as follows; 1. The objects in this study were classified into 35 groups out of 44 groups. The most frequent category is clinical complex category(CCC; 38.9%). And extensive service category(ESC; 18.8%), reduced physical function category(RPC; 13.1%), special rehabilitation category(SRC; 12.8%), and impaired cognitive category(ICC; 0.00%) are followed. 2. The mean of total CMI was $1.02{\pm}0.36$, ranging from 0.68 to 1.44(1 vs 2.12). The mean of CMI of SRC is only 1.17 which should be the highest. The means of ESC and see are equally 1.20. The means of CMI of CCI, ICC, BPC, and RPC were 0.90, 0.75, 0.83 and 0.96, respectively. 3. The validity of this classification was tested. Trend-test using Regression Analysis was done in the secondary split level. SCC, CCC, ICC, and RPC which covered 68.4% of this research objects showed linear trend of CMI in interim classification. This results were statistically significant. 4. In clinical hierarchy, the trend were showed linearity. But the multiple comparison of categories using Scheffe-test showed that SRC, ESC and see had same level of CMI means and CCC and ICC, too. This results were statistically significant. Classifying elderly patients with RUG-III, the results showed partly linear trend in clinical hierarchy and in interim classification in conclusion. But, in clinical hierarchy, it was failed to show the consistent order of CMI. It can be explained by two reasons. One is that this research subjects were overlapped in each clinical hierarchy group. And the other is that the some of the characteristics for clinical hierarchy is not appropriate for them. For the further study, it needs to have proper sample size and to modify RUG-III to K-RUG to consider our.. medical environment.

• KDI Journal of Economic Policy
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• v.12 no.3
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• pp.47-69
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• 1990

The measures taken to reform the Dutch health insurance system hold valuable lessons for countries such as Korea, where there has been increased concern regarding the efficiency and effectiveness of the health services provided. The growing literature on comparative health insurance policies suggests that nations can learn from each other. In addition, Korean policymakers have shown great interest in the health insurance systems of foreign countries, particularly in Japan. The development of Korea's health insurance scheme during the past 12 years has made a significant contribution to the increased accessibility of health care services. Although the insurance coverage is universal, the health insurance system today in Korea is by no means a product of systematic and planned efforts. Moreover, it lacks due considerations of insured's needs as well as the long-term objectives of the social security health care system. There are growing gaps in premium burdens and benefits between the rural health insurance program and the employee's health insurance programs. Furthermore, the regional health insurance program is experiencing financial difficulties in spite of the fact that the amount of the government subsidy has been sharply increased in recent years. Under the present payment method solely based on the fee-for-service schedule, both consumers and providers are encouraged to utilize and prescribe more services. The combination of the utilization-inducing reimbursement system and continuous pushes for expanding health insurance has played a crucial role in raising the country's medical bills. Current trends in Korea's health care sector and those anticipated in the near future necessitate changes in the structure and funding of health care. As indicated in the above, there are various shortcomings in this context, the health policy authority in Korea can draw valuable lessons from the Dutch experiences in reforming their health insurance system. The main elements of the Dutch reform measures are a restructuring of the insurance system and a greater role for market forces in the health care system. On this basis a new system will be created which reflects the social nature of health care while at the same time containing sufficient mechanisms to allow the health care sector to operate in a cost-effective and efficient manner.

• Korean Journal of Health Education and Promotion
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• v.19 no.3
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• pp.97-105
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• 2002

This study attempts to develop a program for obesity prevention and management for students in primary, middle, and high school and was carried based on the program development process as suggested by Ewles and Simnett. Data were collected from September 1st to September 30th, 2000. The study method is as follows: 1) Reviewing the present obesity control programs practiced in primary, middle, and high school (196 schools total) in metropolitan, medium-sized, and small cities, 2) Surveying obesity students'(682 students total) perception of the obesity management in their school. 3) Reviewing the annual plan for obesity in primary, middle, and high schools 4) Analyzing the educational data (CD, VIDEO) for obesity The results are as below: I. The media researched related to obesity were mainly CD and video, aimed primarily primary school students and are biased in nature. 2. The results of how to manage obesity in students: the difficulty of obesity education in the primary school, is the arousal of a sense of shame among obese students and the lack of various educational data are the most. In the middle and high schools, a lack of various educational data, and no time or lack of time were prevailing concerns. Paramount in managing obesity is weight control, as answered by majority of primary, middle, and high school students. The major problem of obesity management is the non-cooperation of children. 3. Asked whether the weight controlling aspect of health care class was helpful or not, 51.4% of primary school students, and 71.6% of middle and high school students answered not. The most popular educational method used in health care class is the computer, with a 56.4% approval rating. Most 43.5% of respondents answered that they wanted the content of obesity management program to focus on how to lose weight. Therefore, based on the results, the obesity management program is constructed to the steps of assessment, planning, implementation, and evaluation. Assessment includes administering surveys on health needs among students and their parents and physique tests. Planning includes the set-up of long term and short term educational goal and the establishment of an operation system. Implementation includes education, exercise, behavior modification, and health service programs. Evaluation includes step-by-step evaluations for obesity reduction. After this study is conducted, the following should be further researched: More practical and systematic obesity management programs should be developed for the evaluation results. In addition, it is important to develop an appropriate media for obesity management the primary, middle and high school students.

• Journal of the Korea Convergence Society
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• v.11 no.1
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• pp.141-150
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• 2020

This paper studies the activities characteristics of the elderly aged 60-75 years old who can take care of themselves in the community public space, and puts forward the design principles of the community public space in the aging society. Using the methodology of experience design, through naturalistic observation, questionnaires, interviews and shadowing, the spatial and temporal characteristics of daily activities of the elderly are analyzed. In the community public space, the behavior of the elderly is essentially a social activity to get more attention and communication. This determines the needs, time, frequency and duration of activities of the elderly in community public space. In the community public space, the behavior of the elderly has the characteristics of long-term and regularity, and its behavior changes slightly with the space, the objective factors that affect the elderly are gender, age and climate. The subjective factors are lifestyle, family members and income level.

• Journal of agricultural medicine and community health
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• v.24 no.1
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• pp.91-101
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• 1999

The home nursing care system is an integral part of the health care delivery system in order to meet the various needs of consummer, in particular, early discharge patient from the hospital, patient with long term care needed and the elderly. To find out the cost of home nursing care services, the home nursing care records of patients registered by home nursing care units established in public hospital with 150beds during the period of 1996 - 1997 were analyzed. The subjects were 102patients, 45 of male patients and 57 of female patients, those who live in a rural area in Kymiggi - Do The results obtained are as follows : 1. The male patients accounted for 44.1% of the total, with 45cases : group aged 60 years and more was the largest group, accounting for 79.5%. 2. The most frequent disease revealed was the osteoporosis which constitute 35.3% of the total registered patients, followed, in order, by malignant tumor, cerebrovascular disease. 3. It revealed that the cost per visit for the male was 47,764won ; the female, 46,078 won per visit. Noteworthy the cost per visit was high in the older patient. It was clearly that the gender, years of age and the cost per visit were statistically significant at 0.01 level and 0.05 level. 4. The cost per visit for the non complicated disease was slightly higher than the complicated disease, but it is not statistically significant, the cost per visit by type of disease varied, the cost per visit for COPD was the highest, followed, in order, by in malignant tumor, cancer, diabetes, osteoporosis etc. 5. It revealed that home nursing care cost for a eligible disease for home nursing care was less than the cost for hospitalization of the same disease, therefore, we expect that the home nursing care is cost efficiency. In conclusion, the home nursing care costs are needed to analyze further in comparison with the hospitalization costs for a certain disease.

• Journal of Convergence for Information Technology
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• v.10 no.5
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• pp.75-82
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• 2020

This study is a descriptive research study to identify Unmet Dementia Information Needs (UDIN) for caregivers of dementia patients at Dementia Relief Center and to understand the effectiveness of the program for workers. The subjects were 114 caregivers and 217 practitioners from dementia relief centers in 25 autonomous districts of S city from November 1, 2019 to January 31, 2020. The UDIN questionnaire is a 7-point Likert scale. The Crisis Management Questionnaire is a Likert 5-point scale consisting of 10 questions from 6 categories. As a result of the study, the proportion of depressed caregivers experiencing UDIN was 12.3times higher than those who did not (p<.001). The program effectiveness was 8.98times better than those who perceived the lack of risk management as good (p=.004), and social workers were 2.81times better than nurses (p=.091). It is necessary to conduct interactive operations to meet the needs of the community residents by listening to their diverse opinions rather than simply implementing a one-sided policy to raise the service of a dementia relief center to the highest level in a short period of time.

• KDI Journal of Economic Policy
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• v.34 no.3
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• pp.31-65
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• 2012

We study the sustainability of the current fiscal policy of Korea, and the effects of the social welfare policy expansion, which has been recently discussed among the political circles, on the government budget and the generational equity, using generational accounting. We follow the generational accounting approach, considering the fact that most of the social welfare policies are the entitlement programs, which imposes the limitation of the policy maker's discretion to control the cost of their provision. The social welfare expenditure will change due to the change in the policy environments of the future, such as population aging. Therefore, we need to take into account the government cash flow of the future as well as of the present to investigate its effects on the fiscal sustainability, which implies that the national debt or the budget balance is not a proper index for the investigation. Our findings are as follows. The current fiscal policies are not sustainable, and the long-term budgetary imbalance is shown very serious. The required tax adjustment, which is defined as the percentage change of tax burden required to attain the long-term budgetary balance, is very large. Unless the level of the government expenditure is properly controlled, the tax burden and the social contribution level will rise to the untolerable level. Moreover, the expansion of the social welfare policies, which has been discussed among the political circles, will substantially increase the fiscal burden of the future generations. Even though the provision of the free lunch to the primary and the secondary school students, the free child care, and the discounted college tuition do not increase the fiscal burden much, because their magnitude at present is not large and will decrease due to the decrease in the number of the newborns and the students resulting from the fall in the fertility rate, that of the free health care service will increase tax burden of the future generations very much, because the magnitude of the government expenditure needed at present is very large and the population aging will further increase the magnitude of the health care expenditure. The findings indicate that the structural reforms, to prevent the explosive increase in the social welfare expenditure in the future, are necessary before the implementation of the welfare policy expansion. In particular, the cost control of the social transfers to the elderly needs to be made, because the speed of the population aging of Korea is among the highest in the world. The findings also indicate that the budget balance or the national debt can cause the fiscal illusion, which makes the Korean government budget look sound, even though the fiscal policy will rapidly increase the social welfare expenditure in the future, as the population ages. The generational accounting, which takes into account the cash flow of the future as well as of the present, unlike the budgetary balance and the national debt, which shows the results of the government financial activities of the past and the present, is a useful method to overcome the fiscal illusion.