• 보건행정학회지
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• 제16권1호
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• pp.95-116
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• 2006

According to rapid increase of the population of senior citizens, there has been growing concern of Long-Tenn Care(LTC) services recently. Long-Tenn Care services, however, haven't been established systematically in Korea and the supply of LTC services is not sufficient despite the increase in the current social demand. This study aims to estimate the 'Willingness to Pay(WTP)' for LTC insurance which the government plans to introduce by means of social insurance, using Contingent Valuation Method(CYM). In addition, this study analyzes the factors affecting WTP for LTC insurance. An interview survey was carried out to derive WTP for LTC from 450 people who lived in Seoul aged 20 and above during the period from 16th to 21st of June 2003. Double-Bounded Dichotomous Choice Method was applied among several CVMs available to estimate both use value and no-use value of goods. There was pilot survey carried out prior to the main survey. The results show that the average monthly. WTP for LTC provided in home and residential setting is 18,192Won and 19,293Won, respectively. In the case of home care, WTP goes higher depending on reliability of LTC insurance policy and need for LTC insurance, as well as marital status, education and average monthly income. On the contrary, WTP is conversely affected by higher age and higher bids. In the case of institutional care, the factors affecting WTP are similar to those of home care, except age. This study followed NOAA's suggestions generally and the value derived through survey could be reliable. However, there can be the least bias in the process of survey because the CVM should be used under the supposed circumstances. Despite those limitations, it can be concluded that the amount the citizens are willing to pay for LTC is high enough to meet the costs needed to provide LTC.

• 가정간호학회지
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• 제6권
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• pp.5-18
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• 1999

This study was attempt to encourage for developing on rehabilitation delivery system and programs as a substitute service instead of hospitalization for accident patients at work, such as hospital based home health care nursing service. It needs vary substitutes service of hospitalization to curtail the length of stay for inpatients who were hospitalized with workers compensation insurance. It focused on developing an estimation of early discharge day of accident inpatients based on a detail statement of treatment for 115 inpatients who were hospitalized at General Hospital in 1997. This study has four specific purpose as follows. First, to find out the status of health service utilization. Second, to estimate the early discharge days and income increasing effect based on the early discharge for those patients. Third, to identify the factors to affect total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze of the length of stay and medical expenditure for inpatients who were hospitalized due to the accident, the authors conducted with micro-analysis and macroanalysis from medical records and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria. such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the tests consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, stable conditions. In addition to identify affected variables for medical expenditure. the length of stay and income effect due to early discharge day, the data was analyzed with multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study as follows. First, the mean length of stay was 37.1 days, whereas the mean length of stay due to early discharge was 28.2 days at the hospital. The estimation of early discharge days were shown that depends on the length of stay. The longer length of stay, the longer length of early discharge days, such as under 7 days length of stay patients was to estimated the mean length of stay was 4.9 days and early discharge days was 4.6. whereas the mean length of stay was 122.6 days and early discharge days was 92.0 respectively. The mean medical expenditure per day were found to be 133.409 Won. whereas the mean medical expenditure per day was shown negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to 11 early discharge days per bed was around 2,150,000 won. However, it means not the real benefits from early discharge, but the income increasing amount without considering medical prime cost in general hospital. Therefore, it needs further analysis on the cost containments and benefits under the considering as well turn over rates per bed as the medical prime costs. The length of stay was most significant and the sign was positive to the total medical expenditure, as expected. Surgery and patient's residential area also an important variable in explaining medical expenditure. The level of complications was most significant variable in explaining the length of stay. The level of the needs on horne health care nursing service which can be used for early discharge accident patients were shown very high. The needs distribution varied from 65.5% of patients and 88.9% of caregivers, to 96.4% of doctors, and 99.1% of nurses. In addition horne health nurse responded that they can be managed the accident inpatients from early discharge. From these research findings. the following suggestions has been drawn it needs to develop strategies on rehabilitation delivery system in order to focused on consumer's side which is planned for 21 century health policy in Korea. Vary intermediate facilities and horne health care would have been developed in the community based for comprehensive rehabilitation services as a substitutes of hospitalization for shortening the length of stay of hospitalizations. In hospital based horne health care nursing service, it's available immediately to utilize for the patients who wanted rehabilitation services as a substitutes of hospitalization under the cooperations with workers compensation insurance company.

• Journal of Community Nutrition
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• 제2권1호
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• pp.12-26
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• 2000

In Japan, a new nursing insurance system was enforced in April 2000, where premiums were paid according to the level of necessary care. Our project, Nutrition Care and Management(NCM) for the elderly was started in 1995, funded by the Ministry of Health and Welfare of Japan. The NCM project was to provide appropriate nutrition care for the elderly and to see that it effectively functions as part of the health care services. There were 4 stages to the project : the first stage was to find out the PEM status among the elderly patients in hospital and home-care settings in Japan. The 2nd stage was to develop and evaluate nutritional assessment methods, anthropometry, resting energy expenditure measuring methods using of portable indirect calorimeter, and the convenient protein energy intake assessment methods, etc. for the elderly patients with PEM risk. The 3rd stage was to examine the effectiveness of the nutrition care plan induced of protein energy supplement and team care in improving nutrition among the elderly patients. The last stage was to develop the NCM set for the elderly patient based on the past three years of scientific evidence. it is expected that the NCM system for the elderly will provide adequate nutritional care management, improve the elderly care environment and create effective resource management.

• 한국콘텐츠학회논문지
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• 제9권8호
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• pp.294-308
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• 2009

고령화의 급속한 진전에 따라 국가유공자 대상 보훈정책에서도 고령유공자의 노후생활 지원서비스를 확충하고 관련 정책을 체계적으로 운영해야할 필요성이 점차 커지고 있다. 하지만 전통적인 보훈정책은 잔여적 복지 관점에서 이루어지고 있고 국가재원이 한정적으로 지원됨에 따라 비용-효과성의 확보가 어려운 문제점이 있다. 또한 소득보전과 보건치료에 집중됨에 따라 국가유공자의 (개인)활동과 일상생활을 지원하는 보훈서비스의 활성화는 아직 요원한 현실이다. 이에 기존 보훈정책의 잔여적 특성을 넘어 보편적 보훈서비스를 통해 유공자로서의 상징과 예우를 보장하면서도, 노인으로서 필요한 각종 돌봄서비스의 혜택을 비용-효과적으로 받을 수 있는 적극적인 보훈정책의 모색이 요구되는 것이다. 이러한 관점에서 본 연구는 고령유공자에 대한 체계적이고 비용 효과적인 대안적인 재가돌봄서비스 공급방식을 구상하고, 특히 지역사회복지서비스체계와의 연계를 강조하고 있다.

• 지역사회간호학회지
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• 제15권4호
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• pp.539-550
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• 2004

Purpose: The purpose of this study was to evaluate the achievements of the project, and also to find out its strengths and weaknesses. Method: This evaluative study employed system theory and analytic techniques by using criteria which were relevance, appropriateness, adequacy, progress, effectiveness and satisfaction for input, process, output, and outcome of program. Study subjects were participants in the home health care program implemented in G public health center in Inchon metropolitan city in 2003. Results: Input factors including recruitment personnel, and support organization development were not adequately met for the program. However. the goal and objectives of the project were really appropriate for the community needs as well as government's policy. For the Process evaluation, home health care record form and computer data base had not progressed as scheduled, but overall program activities were finished on time. However, cooperation between organizations in the health center during service activity were not supportive. Managerial ability of program charged personnel about coordination and integration of team members was not affirmative. Output and outcome evaluation showed that people improved self care ability were 221 (17.5%). and 71 (5.62%) of subjects were moved into category of possible self-care. Client's satisfaction for this project showed a high degree. Conclusions: Based on the above results support organization and staff personnel for this program should be developed. Also, a community network of resources should be established and case management services should be focused continuously in community based home health care.

• 대한가정학회지
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• 제41권6호
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• pp.143-156
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• 2003

The present study was initially designed to figure out the general condition of care giving system for the elderly women who need long term care and the level of their depression according to the conditions of care. And This research is intented to present appropriate policy that could help the establishment of supporting system for the fragile elderly women.1 used the data from <2001 National Study on the Needs for the Long-Term Care Elderly> by Korea Health and Population Institute. The results are as follows: First, Two third of all the respondents had serious problems (2-9 activities limits) in Instrumental Daily Living Ability(DAL). Most respondents reported “low” in satisfaction level related to receiving care, meaning the elderly had negative perception for the care from the family. The elderly expected their children to be as the primary care giver and mostly wanted to live with them in the future. Second, The majority of the long term care elderly women haven't used community service facilities very often and said they are not likely going to use the facilities in the future. Third, The respondents reported high in depression level as to lower satisfaction with their children's support, poorer health condition, more reluctant to use service facilities due to the cost, and fewer friends and neighbors resources around them. Therefore I could say that negative factors for the elderly women's psychological health were having unsatisfactory relationship with intimate people, developing physical illness, being in economic difficulties. That is, receiving less help from close family members, shrinking social network, and experiencing economic hardship would have negative effects on elderly women's psychological health. In the basis of these results, I suggest that in the mean time we shouldn't overlook the importance of the private support when we develop the public elderly support system.

• 간호행정학회지
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• 제6권2호
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• pp.195-209
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• 2000

The purpose of this study is to estimate the population requiring nursing home services among elderly people in Korea. This study identifies the need of nursing home services determined by health care professionals and estimates the proportion of elderly people requiring nursing home service according to the admission criteria. Surveys were conducted on health care professionals including medical doctors, home care nurses, and nurse practitioners. They were asked to assess nursing home need based on four content areas: Physical function (Activities of Daily Living), chronic disease, Physical symptoms (incontinence), mobility, eating, and sensory function. Based on the professionally determined need criteria the proportion of elderly people requiring nursing home services was estimated using secondary data from the 1994 Survey on the Living Status of the Korean Elderly. The number of study subjects to estimate nursing home need who were 60 and older totaled 2,058. The most important factor contributing to the admission eligibility criteria was the elderly living alone. Other factors related were the elderly being unable or having difficulty carrying out activities, and having insufficient help from other our activities, and having insufficient help from other members of the household. Using only physical function, the proportion of elderly people requiring nursing home was $8{\sim}9%$. When only chronic disease was used, proportions varied widely; for the doctor's group, the proportion was over 30%. Using all areas, the proportions of elderly people requiring nursing home were between 13% and 38%. The estimate using chronic disease and physical function was similar to the on using all areas.

• 대한간호학회지
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• 제26권3호
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• pp.576-590
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• 1996

Advanced countries such as the USA and Japan are eagerly seeking ways to improve health and welfare of the elderly. One of the services is home health care service using the telephone. Various types of services using the telephone have been developed, improved and are being utilized ranging from the basic consulting to emergency response systems in the area of health care for the elderly. A demonstration project was launched to study the feasibility of a consulting system and telemedicine for the elderly using the public phone system in Korea. For this project, a gathering site for the elderly was selected and those who visited this place were interviewed to find out what kinds of services they wanted and what kind of system they needed to provide the required services. Based on the users' requests and the surrounding environment, a telephone consulting facility was established at the Research Institute of Nursing Science at Seoul National University and consulting personnel was recruited, trained and posted at the center. An Application program for home health care nurses to use when they visited the patients at their homes was developed. This system operates on a notebook Computer and allows nurses to communicate with a doctor at a local hospital through a modem and telecommunication line. These systems were implemented for three months and problems which developed during operation of the systems were identified and progressively modified. Through system evaluation, it was found that a consulting system using phone service will be an invaluable system for the welfare of the elderly in the future. But in order to meet the elderly's need, more services than mere consultation are needed. That is, communication with physicians and hospitals are needed. Thus, when there is any need for physicians' attention, physicians or hospitals should be contacted directly. Similarly for telemedicine, when the home health care nurse visits elderly patients she can assess the patient's problem and provide nursing care, access a physician or hospital to refer her patient to or consult directly using the telecommunication the system. The above mentioned system is a basic form of futuristic telemedicine for the elderly and those who have chronic disease problems. This kind of system will be of great value when it is used on the national information super-highways in the future. In order to get to that stage, of course, this project needs great improvement in the technical, academic, and legal aspects.

• 대한가정학회지
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• 제43권12호
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• pp.97-111
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• 2005

Early Head Start (EHS) can provide services to a child and family from pre-birth until the child is three years old. Services are comprehensive, intensive, individualized and flexible according to child and family needs, and integrated with community service delivery systems. The local program designs and operations were developed and carried out within the framework of the Head Start Revised Performance Standards, which included specific provisions for services to pregnant women, infants and toddlers and emphasized prevention, early intervention, safety, and health education. As with preschool Head Start, EHS programs are required to make available 10 percent of their enrollment for infants and toddlers with disabilities as defined by Part C regulations of the state in which the program operated. Quality child care has become a priority for EHS. A majority of EHS children need child care, and the quality is important to their development. An evaluation of EHS in 17 programs selected from the first program cohorts showed that the program had significant and positive impacts on a wide range of parent and child dimensions, some with implications for children's later school success. Among the issues for policy attention identified by American EHS for the Korean system are: - The need to create a comprehensive infant/toddler care system - The need to address access of teachers for young children - The need to improve quality.

• 지역사회간호학회지
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• 제14권2호
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• pp.299-311
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• 2003

Purpose: This is a phenomenological study to describe the experiences of nursing students on home visiting nursing service as a community nursing practice. Method: Individual interviews were conducted on subjective experiences of 17 nursing students. Data were analyzed through Colaizzi's method in which meaningful statements were extracted and these were clustered into 6 themes. Result: The nursing students started practice with anxiety and expectation at the same time. They were frightened at the clients' inferior environment and their level of loneliness. They also felt pity and experienced complicated feelings for the clients. However, the home visiting practice was a chance for them to discard prejudice on the clients. Positive experiences on visiting nursing practice reported by the nursing students included lively interactions between nurses and the clients, and variable provision of primary nursing care. However, facts such as much limited visiting time, non-professional and limited scope of practice were reported as negative experiences. They felt both worthiness of the home visit service and restricted self-capability at the same time through the practice. They also felt sorry for the clients because the home visit services were carried out during limited time period. Regardless of this, the home visit experience provided them an opportunity of self-growth. This self-growth includes increased awareness of issues for elderly, building of self-identity as a nursing student, self-reflection, and realization of the value of family. Conclusion: This study may provide data for better understanding of nursing students experiences of home visiting nursing services. However, more study on the barriers of their community health practice is needed in the future. Moreover, it is needed to establish desirable practice environment through the collaborative relationships between the university and staffs in the public health center.