• 농촌의학ㆍ지역보건
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• 제1권1호
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• pp.5-9
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• 1976

The categories of national health problems may be mainly divided into health promotion, problems of diseases, and population-economic problems which are indirectly related to health. Of them, the problems of diseases will be exclusively dealt with this speech. Rurality and Disease Problems There are many differences between rural and urban areas. In general, indicators of rurality are small size of towns, dispersion of the population, remoteness from urban centers, inadequacy of public transportation, poor communication, inadequate sanitation, poor housing, poverty, little education lack of health personnels and facilities, and in-accessibility to health services. The influence of such conditions creates, directly or indirectly, many problems of diseases in the rural areas. Those art the occurrence of preventable diseases, deterioration and prolongation of illness due to loss of chance to get early treatment, decreased or prolonged labour force loss, unnecessary death, doubling of medical cost, and economic loss. Some Considerations of Innovative Approach The followings art some considerations of innovative approaches to the problems of diseases in the rural Korea. 1. It would be essential goal of the innovative approaches that the damage and economic loss due to diseases will be maintained to minimum level by minimizing the absolute amount of the diseases, and by moderating the fee for medical cares. The goal of the minimization of the disease amount may be achieved by preventive services and early treatment, and the goal of moderating the medical fee may be achieved by lowering the prime cost and by adjusting the medical fees to reasonable level. 2. Community health service or community medicine will be adopted as a innovative means to disease problems. In this case, a community is defined as an unit area where supply and utilization of primary service activities can be accomplished within a day. The essential nature o the community health service should be such activities as health promotion, preventive measures, medical care, and rehabilitation performing efficiently through the organized efforts of the residents in a community. Each service activity should cover all members of the residents in a community in its plan and performance. The cooperation of the community peoples in one of the essential elements for success of the service program, The motivations of their cooperative mood may be activated through several ways: when the participation of the residents in service program of especially the direct participation of organized cooperation of the area leaders art achieved through a means of health education: when the residents get actual experience of having received the benefit of good quality services; and when the health personnels being armed with an idealism that they art working in the areas to help health problems of the residents, maintain good human relationships with them. For the success of a community health service program, a personnel who is in charge of leadership and has an able, a sincere and a steady characters seems to be required in a community. The government should lead and support the community health service programs of the nation under the basis of results appeared in the demonstrative programs so as to be carried out the programs efficiently. Moss of the health problems may be treated properly in the community levels through suitable community health service programs but there might be some problems which art beyond their abilities to be dealt with. To solve such problems each community health service program should be under the referral systems which are connected with health centers, hospitals, and so forth. 3. An approach should be intensively groped to have a physician in each community. The shortage of physicians in rural areas is world-wide problem and so is the Korean situation. In the past the government has initiated a system of area-limited physician, coercion, and a small scale of scholarship program with unsatisfactory results. But there might be ways of achieving the goal by intervice, broadened, and continuous approaches. There will be several ways of approach to motivate the physicians to be settled in a rural community. They are, for examples, to expos the students to the community health service programs during training, to be run community health service programs by every health or medical schools and other main medical facilities, communication activities and advertisement, desire of community peoples to invite a physician, scholarship program, payment of satisfactory level, fulfilment of military obligation in case of a future draft, economic growth and development of rural communities, sufficiency of health and medical facilities, provision of proper medical care system, coercion, and so forth. And, hopefully, more useful reference data on the motivations may be available when a survey be conducted to the physicians who are presently engaging in the rural community levels. 4. In communities where the availability of a physician is difficult, a trial to use physician extenders, under certain conditions, may be considered. The reason is that it would be beneficial for the health of the residents to give them the remedies of primary medical care through the extenders rather than to leave their medical problems out of management. The followings are the conditions to be considered when the physician extenders are used: their positions will be prescribed as a temporary one instead of permanent one so as to allow easy replacement of the position with a physician applicant; the extender will be under periodic direction and supervision of a physician, and also referral channel will be provided: legal constraints will be placed upon the extenders primary care practice, and the physician extenders will used only under the public medical care system. 5. For the balanced health care delivery, a greater investment to the rural areas is needed to compensate weak points of a rurality. The characteristics of a rurality has been already mentioned. The objective of balanced service for rural communities to level up that of urban areas will be hard to achieve without greater efforts and supports. For example, rural communities need mobile powers more than urban areas, communication network is extremely necessary at health delivery facilities in rural areas as well as the need of urban areas, health and medical facilities in rural areas should be provided more substantially than those of urban areas to minimize, in a sense, the amount of patient consultation and request of laboratory specimens through referral system of which procedures are more troublesome in rural areas, and more intensive control measures against communicable diseases are needed in rural areas where greater numbers of cases are occurred under the poor sanitary conditions.

• 의학교육논단
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• 제21권2호
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• pp.80-91
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• 2019

The tripartite mission of 'academic medicine' is education, research, and patient care. Academic medical centers (AMCs) are carrying out the mission and ultimately aiming to improve the health of people and communities. Globally, AMCs are facing a tremendous financial risk stemming from the changes in health insurance reimbursement plans and a shortage of human resources. Innovative AMCs in the United States are trying to transform their physician-centered, and siloed structure into a patient-centered, and integrated structure. They are also building integrated systems with primary healthcare groups to provide continuous patient care from primary to tertiary levels and making strategic networks based on value-based payment and the patient-centered model. These changes have been proven to improve outcomes of patient care and increase fiscal revenues, which are both crucial in supporting education and research. To address the shortage of human resources, programs are being built to develop newly appointed faculty for the future. AMCs have different approaches to bringing changes into their organizations; however, there is a common emphasis on 'a patient-centered approach,' which helps them set more explicit organizational values and make strategic decisions based on their values. Korean AMCs are facing similar challenges to AMCs in the United States in spite of many differences between the countries' healthcare systems. The innovative efforts of AMCs in the United States to address the challenges will be helpful, well-worked examples for Korean AMCs with similar challenges.

• Journal of Preventive Medicine and Public Health
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• 제46권5호
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• pp.237-248
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• 2013

Objectives: The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea. Methods: We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners. Results: The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010. Conclusions: We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care.

• Asian Pacific Journal of Cancer Prevention
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• 제14권10호
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• pp.6173-6180
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• 2013

Background: Our objective was to determine the knowledge and attitudes of Thai generalists (general physicians) toward palliative terminal cancer care (PC) in a primary care setting. Materials and Methods: We performed a cross-sectional descriptive survey using a self-administered questionnaire. The total number of completed and returned questionnaires was 63, giving a 56% response rate. Data analysis was based on these (Cronbach's alpha=0.82) and percentages and mean values were assessed using the Fisher's exact test to determine the correlation of variables. Results: Overall, attitude and knowledge levels were slightly satisfactory. Results indicated that general physicians had moderate scores in both attitudes (84.1%) and knowledge (55.7%) regarding palliative terminal cancer care. However, they had insufficient knowledge regarding truth telling, pain control and management with morphine, emergency management in terminal cancer care and treatment of fluid intake in terminal stages. Attitude and knowledge scores were statistically correlated (p=0.036). Knowledge scores were further positively associated with being taught palliative care in their medical curriculum (p=0.042). Conclusions: Formal education in palliative care and development of palliative care services are very much needed in Thailand to provide holistic care to terminally ill patients.

• 보건교육건강증진학회지
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• 제32권4호
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• pp.59-65
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• 2015

Objectives: Health screening in Korea is very active in both the public and private sector. However, primary prevention for health promotion has not been activated yet. Quaternary prevention is the prevention of unnecessary medical interventions or the prevention of overmedicalization. Methods: Data was collected after a search of the literature focusing on keyword. The curriculum guidelines for family medicine residents were collected from the homepage of the American Academy of Family Physicians. Results: This quaternary prevention is just beginning. The first step to enhance the health promotion services in the community is to identify the barriers pertaining to the delivering of health promotion activities. These barriers are related to the patient, the physician, attitudes, health promotion programs and the healthcare system. The second step is to establish new changes, such as expansion of insurance coverage, improvement of medical payment system, provision of consumer-oriented services, connection and integration of providers, and the service provider education and training. Conclusions: In order to enhance the health promotion services in the community we need to identify the barriers and to establish several changes to overcome them.

• Journal of Preventive Medicine and Public Health
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• 제29권2호
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• pp.311-329
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• 1996

This study was designed to compare the level of medical utilization between the urban and rural areas of Korea and to explain the differences between the two regions. Data from the National Health Interview Survey performed by the Korean Institute of Health & Social Affairs in 1992 were used for this study utilizing a sample size of 21,841 people. The level of medical utilization such as the number of physician visits and the number of hospital admissions was compared between the regions with ANOVA. Various determinants for medical use were also compared by univariate analysis. Statistical models which included enabling factors, predisposing factors, need factors and region were constructed for bivariate analysis in order to further elucidate the level of medical utilization. The results were as follows: 1. There was greater medical use, both in terms of physician visits and inpatient care in the rural areas in spite of insufficient health resources. The particular reasons for higher medical utilization in rural areas were attributed to a higher number of initial physician visits as well as a longer the length of stay per hospital admission. Therefore, indicators representing the degree of met need (utilization/need) showed no significant difference between rural and urban areas in spite of the fact that the medical need is larger in rural areas. 2. Use of public health facilities received a significant portion of physician visits in the rural area. The government's effort to enhance primary health care through health centers, health subcenters and the nurse practitioner's post in rural areas has contributed to the increase of access to medical care in the rural areas. 3. There were some differences in the socio-demographic characteristics between two regions ; There were more elderly people over the age of 65: unstable marital status, less education and lower incomes also characterized the rural areas. Therefore, among rural people, there were more predisposing factors for medical use. Additionaly, need factors such as poor self-reported health status and high morbidity level were also high in the rural area. 4. In contrast it was learned that, the supply of health resources was mostly concentrated in the urban areas except for public health facilities. Therefore, geographical access to medical care was lower in the rural area both in terms travel time and travel cost. 5. The coefficient of the region variable was insignificant in the regression model which controlled the supply factor only. However, utilization was significantly higher in urban areas if the model included predisposing factors and need factors in addition to the supply factor. The results were interpreted as rural people have greater medical needs.

• 한국병원경영학회지
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• 제20권2호
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• pp.15-27
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• 2015

환자의 만족도는 더 나은 의료서비스 결과물을 위한 중요 요소이기에, 환자만족도와 관련 요인에 대한 연구는 그 필요성이 대두하고 있다. 따라서, 본 연구는 의사의 환자를 향한 공감적(empathetic) 태도와 같은 잠재적 요인이 환자만족도와 어떤 연관성을 가졌는지를 분석했다. 이를 위해, 편의표본추출법을 통한 환자설문조사 자료 중 총 273,994 개의 사례들을 분석한 단면연구가 수행되었다. 연구의 독립변수 및 종속변수들은 각각 의사의 태도 및 의사와 진료소(office setting or clinic) 관련 환자만족도로 정의되었다. 연구결과에 의하면, 의사와 진료소 관련 환자만족도는 각각 100점 만점에 평균 78.08과 78.62로 나타났고 상응하는 표준편차는 각각 0.14와 0.12였다. 또한, 의사의 태도가 의사와 진료소 관련 환자만족도와 유의한 관계에 있음을 확인하였다(p < 0.001). 의료에 대한 환자만족도를 높이기 위해서는, 의사의 공감적 의사소통 능력개발을 위한 지속적인 노력이 기울여져서 환자에 의한 의사의 공감적 태도가 인지되어 질 수 있기를 본 연구는 제언한다.

• 보건행정학회지
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• 제24권1호
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• pp.92-99
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• 2014

Background: Korea's primary care clinics are seeking increase in consultation fees by expanding supply within the frame of the health insurance system, but inequality of physician income between regions and individuals is exacerbating. The purpose of this study lies in analyzing the distribution of patients of primary care clinics, their specialized field, and the degree of inequality between medical fee income according to region. Data was acquired from the Health Insurance Review and Assessment Service on charged bills made by clinic-size medical institutions from 2008 to 2011. Methods: By comparing the outpatient number per clinic according to the clinic's specialized field, results showed that ophthalmology, otolaryngology, dermatology, orthopedics, and internal medicine showed high numbers whereas plastic surgery, neuropsychiatry, cardiothoracic surgery had fewer outpatients. The number of outpatients for clinic according to region showed Chuncheonnam-do, Jeju-do, Gangwon-do, Chungcheongbuk-do, Ulsan to have higher numbers of outpatients. For those four years, clinics in the Seoul area had a rather lower number. Results: As a result of comparing the decile hierarchy distribution ratio between specialized fields according to primary care clinics income from National Health Insurance, the inequality degree showed that obstetrics and gynecology and general medicine were each 0.130, 0.280 for the decile distribution ratio, which was the highest degree of inequality within the specialized field. Their Gini coefficient were also relatively high at 0.691, 0.528 respectively. On the other hand, the decile distribution ratio for otolaryngology and orthopedics were 0.510, 0.468, respectively, while their Gini coefficient each at 0.318, 0.314 makes their inequality degree relatively lower than other fields. Conclusion: This study is limited in that the data used was the health insurance charges submitted by clinics, which does not provide total information of the doctors' income. However, because most clinics are largely dependant on their income to come from health insurance reimbursements. Therefore, the results of this study can be used effectively. In the future, research that includes data on non-covered service income should be conducted to closely examine policy plans with a new medical fee policy which can resolve the medical fee income inequality issue between clinics as well as revitalize primary medical care.

• 대한전자공학회:학술대회논문집
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• 대한전자공학회 2002년도 하계종합학술대회 논문집(5)
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• pp.269-272
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• 2002

In this study, we designed the expert system for the diagnosis of stroke. The causes of stroke in central nervous systems are very diverse, so a doctor who treats the patients with stroke must have the expert knowledge for the quick and correct diagnosis and for the adequate medical management. But the primary physician who engaged in the primary care of the patient with stroke does not have the export knowledge for the stroke. So, we need to develop the expert system for assisting the diagnosis of stroke. Also the diagnosis system can be used as simulator for the medical students who study the neurology. In this study, we developed the diagnosis expert system that offer a pathological name provided by artificial neural networks. And we designed the inference engine and interfaces. The artificial neural network is a system that provide a possible diagnosis of stroke. We implemented the system using Windows2000 Server, IIS5.0 and ASP.

• 지역사회간호학회지
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• 제4권1호
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• pp.5-13
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• 1993

The objective of this study was to analyze the status of health examination, and the health care management of industries in Seoul. This will provide effective industrial health care services. 46 industries were selected as a sample, and were given self administered questionnaire developed by the academic affairs of community health nursing. The results of this study are as follows: (1) The general characteristics of industries: The greater part of the industries were manu facturing companies, 300-900 workers, in a one shift system. (2) The general characteristics of health man ager: 96% of the companies had industrial nurses and the larger industries had comprehensive health managers. 90% of the industrial nurses were full-time employees and 77% of the industrial physician were part time employees. 80% of the industrial physician were age 50 or older, while 59% of the industrial nurses were 25-29 years of age. (3) Health examination and follow up care: The proportions of the workers who took general health examination was 94%. Of those, 12% took secondary examinations. In secondary examinations, 36% were evaluated at the C-grade, 20% were evaluated at the D-grade. The proportion of the workers who were required to take special examination were 29% and of that, the proportion of the workers who actually took the examination was 88%. 85% of the workers who were recommended for follow up cares were given follow up care while working. The physical agents among the special examination were done the most frequently to detect the examination effects. (4) Health care services: Industrial nurses performed health examination most frequently and health education was done the least. There were significant differences in health care services according to the size of the industries. Companies with 300 workers or less had higher health care services than other groups. The three primary reasons of health care management and examinations of workers are: First, industrial nurses are requires to accumulate professional knowledge and experience through continuos' activities. Second, systematic and concert examination for industrial workers should be performed periodically. Third, it needs developing health education strategies that are important workers for health promotion in industries.