• Journal of Preventive Medicine and Public Health
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• v.26 no.2 s.42
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• pp.293-309
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• 1993

With expanded and extended coverage of the national medical insurance and fast growing health care expenditures, appropriateness of health service utilization and quality of care are concerns of both health care providers and insurers as well as patients. An accurate patient classification system is a basic tool for effective health care policies and efficient health services management. A classification system applicable to Korean medical information-Korean Diagnosis Related Groups (K-DRGs)-was developed based on the U.S. Refined DRGs, and the performance of the developed system was assessed in this study. In the process of the development, first the Korean coding systems for diagnoses and procedures were converted to the systems used in the definition of the U.S. Refined DRGs using the mapping tables formulated by physician panels. Then physician panels reviewed the group definition, and identified medical practice patterns different in two countries. The definition was modified for the differences in K-DRGs. The process resulted in 1,199 groups in the system. Several groups in Refined DRGs could not be differentiated in K-DRGs due to insufficient medical information, and several groups could not be defined due to procedures which were not practiced in Korea. However, the classification structure of Refined DRGs was retained in K-DRGs. The developed system was evaluated fur its performance in explaining variations in resource use as measured by charges and length of stay(LOS), for both all and non-extreme discharges. The data base used in this evaluation included 373,322 discharges which was a random sample of discharges reviewed and payed by the medical insurance during the five-month period from September 1990. The proportion of variance in resource use which was reduced by classifying patients into K-DRGs-r-square-was comparable to the performance of the U.S. Refined DRGs: .39 for charges and .25 for LOS for all discharges, and .53 for charges and .31 for LOS for non-extreme discharges. Another measure analyzed to assess the performance was the coefficient of variation of charges within individual K-DRGs. A total of 966 K-DRGs (87.7%) showed a coefficient below 100%, and the highest coefficient among K-DRGs with more than 30 discharges was 159%.

• Journal of Society of Preventive Korean Medicine
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• v.18 no.3
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• pp.11-21
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• 2014

The rapid development and distribution of information communication industry facilitates the changes of hospital administration, introducing EMR(Electronic Medical Record) instead of paper-based medical record in the medical field. The developed countries such as U.S. have established EMR system after in the middle of 1970s because the primary advantages of EMR is to store and handle vast amounts of records efficiently and increase the quality of health care. Most of health organizations in Korea also apply medical record system to their administration. As the result, they have accomplished a scientific administration system through the use of medical record to handle a variety of patient's information including patient's confidentiality and privacy such as family history, social status, income level, and so on. However, access to and the misuse of EMR causes illegal infringement of patient's information and finally it becomes a very serious medical issue. Potential leakage and misuse of records may seriously infringe patient's privacy rights. In this respect, the related agencies in the public and private sector have been making efforts to prevent patient's records leakages. Especially, the revision bill of Medical Law in 2002 establishes the ways on the security and standards of electronic records. However, it does not provide the proper guidelines which is applied to the rapid changes of the medical environment. One of the most priorities in the hospital administration is the production and maintenance of an accurate medical records fulfilled by medical recorders. Therefore, it is very important for health care providers to hire ethical-based medical recorders. But, unfortunately most of hospitals overlook the importance of their roles. All parts including government, physician and patient must have more concerns on the problems related to EMR. Therefore, this study aims to propose the proper ways to resolve the problems coming from EMR.

• Journal of Preventive Medicine and Public Health
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• v.40 no.4
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• pp.329-335
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• 2007

Objectives : To identify the effects of supplemental private health insurance on health care utilization and expenditure under the mandatory National Health Insurance(NHI) system in Korea. Methods : The data were collected by the National Cancer Center in Korea. Cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer were included as study subjects. Data were gathered using a structured questionnaire from face-to-face interviews, the hospital Order Communication System (OCS) and medical records. Clinical, socio-demographic and private health insurance related factors were also gathered. The differences of health care utilization and expenditure were compared between those who have private health insurance and those who do not using t-test and multivariable regression analysis. Results : Individuals with private health insurance spent larger inpatient costs than those without, but no differences were found in utilization in other service such as hospital admissions, hospital days and physician visits. Conclusions : We found that private health insurance exerts a significant effect on the health care expenditure in inpatient service. These study results can provide a rational basis to plan a national health policy regarding private health insurance. Further studies are needed to investigate the impacts of private health insurance on cancer patients' outcomes and survival rates.

• 대한예방의학회:학술대회논문집
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• 2005.10a
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• pp.368-368
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• 2005

• Korea Journal of Hospital Management
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• v.5 no.1
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• pp.24-39
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• 2000

This paper aims to analyze the effects that marketing mix variables have on the marketing performance of pharmaceutical manufacturers. It examines how product characteristics, price, marketing channel and promotion effort influence the sales and market share of anti-ulcer drugs in the markets for clinics and hospitals separately. Empirical results from 29 products of anti-ulcer drugs show that sales in hospitals are affected by the profit per prescription to the physician, brand name drugs relative to generics, and the age of ingredients since its introduction to the markets. Profit per prescription to the hospital, relative price, age of ingredients and promotion effort have positive effects on the market share.

• Journal of Preventive Medicine and Public Health
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• v.14 no.1
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• pp.33-38
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• 1981

During 2 months from December 1979 to January 1980, Medical practitioners in Chonnam province were grouped into Si (city), Eup (town) and Myun (rural area) groups according to the locations of their clinic. 40 practitioners were randomly selected in each group and were asked their opinions about rural medical care in general. Total of 88 practitioners replied to the question as 73.9 percent of response rate in average. The most frequently mentioned advantages of rural practice were ease of clinic opening in Si-and Myun-group respondents and good social relationship in Eup-group respondents. The most frequently mentioned disadvantages were medical isolation in Si-group respondents and residents' ignorance in medicine in Eup-and Myun-group respondents. In all groups, most respondents thought that rural medical care should be delivered by and controlled by physician. Suggestions made by Eup-and Myun-group respondents for improving rural medical care by structural change focused on the regional medical insurance system, while Si-group respondents noted district hospital or hospital linkage as the most preferrable system.

• Health Policy and Management
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• v.14 no.3
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• pp.97-121
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• 2004

Recently, human embryonic stem cell research raises exciting public expectation on medical possibilities as well as ethical debate. Embryo management has become an integral part of the management of infertility treatment, researches on embryo and human embryonic stem cells and so on. Britain has permitted the research on stem cells derived from human embryo which made the first nation to allow the cloning of human embryo for the stem cell research. However, new technologies such as the assisted reproductive technologies and human embryonic stem cell research continue to pose an increasing source of ethical dilemmas for physician, scientists, legislators, religious authorities and the general publics to deal with. None the less, the United Kingdom has adopted the most liberal policies regarding human embryo and human embryonic stem cell research. The implication of the British embryo management system are as follows: 1) the development of reproductive technologies and new stem cell research technologies continue to pose legal and ethical debates, since those involve several parties; 2) the UK has taken the legal and institutional approaches to cope with those serious issues; 3) the UK adopted most liberal policies regarding embryonic and human embryonic stem cell researches; 4) the British HFE Act is consistent with the existing Acts related to human embryo management and researches; 5) through amending the HFE Act to accomodate the changes of technologies, the UK try to minimize the legal and ethical burden on undertaking research regarding embryo. The debates about the researches on human embryo and human embryonic stem cells is likely to continue in the Korean society. Because of the controversy and competing ethical values, as well as the evolving technologies, so far no consensus exists in our society. It suggest that it is premature to bring closure by ruling out any particular approaches. Thus our society needs to make an efforts to find a basis which could resolve the societal controversies through enriching the societal conversation about the profound ethical issues regarding embryo management.

• Journal of Preventive Medicine and Public Health
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• v.31 no.3 s.62
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• pp.460-470
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• 1998

By expanding health insurance, customers will carry a smaller burden of medical costs. As a result, the number of visits to a physician increase and this result in the improvement of medical accessibility. But medical care utilization may be changed not only by insurance status but also by socio-demographic factor, economic status and other factors. The question thus remains, at which level of accessibility and what price of medical care service in health insurance will the customer and the medical care service be satisfied. The price of medical care service ls comprised of the customer's out-of-pocket money and the costs not covered by health insurance. If the price of medical care services in health insurance are appropriate, medical care utilization should not differ because of the difference in income status or the acuteness of illness. But If the price is not adequate, low income groups will receive relatively low medical care utilization, particularly in the case of chronic disease. The purpose of this study is to evaluate the differences in medical care utilization among the various income groups and those with varying acuteness of illness. The major hypotheses to test in this study are : (i) whether there are differences in medical care utilization among different income groups exist, (ii) whether differences in medical care utilization among different income groups exist with the hospital type. (iii) whether differences in medical care utilization among different income groups exist with the acuteness of illness and with age. The data was collected from the JongRo District Health Insurance Society in Seoul. A total of 118,336 persons were selected as the final sample for this study. The major findings of this study were as follows; 1. The volume of ambulatory utilization among users was statistically significant by income level. 2. Among different income groups, the volume of ambulatory utilization was statistically significant by the acuteness of illness. 3. Higher income groups with chronic diseases had a greater volume of ambulatory utilization than other groups.

• Journal of Preventive Medicine and Public Health
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• v.48 no.6
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• pp.287-300
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• 2015

Objectives: Self-rated health is a measure of perceived health widely used in epidemiological studies. Our study investigated the determinants of poor self-rated health in middle-aged Korean adults with diabetes. Methods: A cross-sectional study was conducted based on the Health Examinees Study. A total of 9759 adults aged 40 to 69 years who reported having physician-diagnosed diabetes were analyzed with regard to a range of health determinants, including sociodemographic, lifestyle, psychosocial, and physical variables, in association with self-rated health status using multivariate logistic regression models. A p-value <0.05 was considered to indicate statistical significance. Results: We found that negative psychosocial conditions, including frequent stress events and severe distress according to the psychosocial well-being index, were most strongly associated with poor self-rated health (odds ratio $[OR]_{\text{Frequent stress events}}$, 5.40; 95% confidence interval [CI], 4.63 to 6.29; $OR_{\text{Severe distress}}$, 11.08; 95% CI, 8.77 to 14.00). Moreover, younger age and being underweight or obese were shown to be associated with poor self-rated health. Physical factors relating to participants' medical history of diabetes, such as a younger age at diagnosis, a longer duration of diabetes, insulin therapy, hemoglobin A1c levels of 6.5% or more, and comorbidities, were other correlates of poor reported health. Conclusions: Our findings suggest that, in addition to medical variables, unfavorable socioeconomic factors, and adverse lifestyle behaviors, younger age, being underweight or obese, and psychosocial stress could be distinc factors in predicting negative perceived health status in Korean adults with diabetes.

• Journal of Korean Clinical Nursing Research
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• v.25 no.3
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• pp.209-220
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• 2019

Purpose: A significant amount of public opinion about nurse bullying is expressed on the internet. The purpose of this study was to analyze the linkage structures among words extracted from comments on internet articles related to nurse workplace bullying using semantic network analysis. Methods: From February 2018 to April 2019, comments made on news articles posted to the Daum and Naver web portal containing keywords such as "nurse", "Taeum", and "bullying" were collected using a web crawler written in Python. A morphological analysis performed with Open Korean Text in KoNLPy generated 54 major nodes. The frequencies, eigenvector centralities, and betweenness centralities of the 54 nodes were calculated and semantic networks were visualized using the UCINET and NetDraw programs. Convergence of iterated correlations (CONCOR) analysis was performed to identify structural equivalence. Results: This paper presents results about March 2018 and January 2019 because these months had highest number of articles. Of the 54 major nodes, "nurse", "hospital", "patient", and "physician" were the most frequent and had the highest eigenvector and betweenness centralities. The CONCOR analysis identified work environment, nurse, gender, and military clusters. Conclusion: This study structurally explored public opinion about nurse bullying through semantic network analysis. It is suggested that various studies on nursing phenomena will be conducted using social network analysis.