• Health Policy and Management
• /
• v.24 no.2
• /
• pp.109-119
• /
• 2014

In accordance with the government's plan to expand the national health insurance (NHI) coverage for severe diseases such as cancer, heart disease, cerebrovascular disease, and rare and incurable disease, the diagnostic ultrasound services have been covered by NHI from October 1, 2013. The quality is very important factor in providing diagnostic services because they influence on the diagnosis, treatment, and outcome of diseases. In particular, equipments and health care providers plays an important role in providing qualitative services. The purpose of this paper is to examine the major feature of ultrasound services covered by health security system and to review quality assurance policies in other countries such as Australia, Japan, the USA, and Canada. In addition, we assessed the implication of those policies. We especially put emphasis on the types and qualifications of healthcare professionals and measures to manage equipments. All countries have reviewed on policies to promote the quality such as educational requirements of professionals or restrictions on the duration of equipment usage. Various measures should be implemented to assure the qualitative ultrasound service.

• Journal of Korean Society for Quality Management
• /
• v.39 no.1
• /
• pp.15-23
• /
• 2011

The biggest change in the current medical service market is the shift from producer-based approach to customer-based approach. Thus, there is a high necessity for an introduction of market-oriented and customer-oriented marketing activities in medical institutions. Especially, revisitation and positive word-of-mouth of customers are the most effective marketing methods of consistently obtaining customers and drawing new loyal customers. Hence, the factors influencing the reuse of medical services and word-of-mouth are demonstrated using SERVQUAL, and the results show that the service factors influencing reuse intentions on medical services are assurance, responsiveness, and tangibles and the factors strengthening word-of-mouth are empathy and assurance on the services provided by medical institutions. This study has determined that revistation and word-of-mouth of customers are not only influenced by satisfaction on medical services but by the quality itself as well. Therefore, medical service providers need to pursue standardized strategies in order to enhance the quality of medical services simultaneously in addition to simply increasing the customer satisfaction level.

• Proceedings of the Korean Society of Medical Physics Conference
• /
• 1999.11a
• /
• pp.49-51
• /
• 1999

• Child Health Nursing Research
• /
• v.17 no.2
• /
• pp.74-83
• /
• 2011

Purpose: The purpose of this study was to develop a child health care protocol for teachers in child day care centers. Methods: The ADDIE model with 10 Kid Keys was applied to develop this child health care protocol. All contents were developed through content validity test by 7 professionals and need assessment and evaluation by child day care center teachers. Results: This protocol consisted of 10 keys, as follows: "Health Examination/Growth & Development", "Practice of Health Life", "Management of Communicable Disease", "Negligent Accident", "Coping with Emergency and Transference", "Child Abuse", "Nutrition/Obesity", "Quality Assurance of Staff", "Parent Education", "Guidance & Supervision of Child Day Care Centers". The contents contained goals, objectives, teaching content, suggested activities for children, writing forms related to each subject, and self-evaluation sheet. Conclusion: This protocol can be practical and effective for child health care in child day care centers and it is hoped that it will be utilized in more child day care centers.

• Quality Improvement in Health Care
• /
• v.18 no.1
• /
• pp.71-78
• /
• 2012

Background : The objective of this study was to examine the effect of management system for the appropriate prophylactic use of antibiotics in surgical patients at a tertiary hospital from 2007 to 2010. Methods : We collected clinical data of three different surgical procedures(colectomy, heart surgery, hysterectomy) for three months of 2007 and 2010, respectively. The number of total cases was 245(137, 54, 54) in 2007, 240(133, 42, 65) in 2010. We measured the rate of use of inappropriate prophylactic antibiotics, administration within 1 hour prior to the incision and the antibiotics prescription days after surgery. To evaluate the effectiveness of the management system, the results of the two groups(Group1=2007, Group2=2010) were compared by t-test, chi-square test or Fisher's exact test. Result : The rate of Aminoglycoside uses decreased drastically from 11.4% to 0.8%(P<.001). The selection of 3rd/4th Cephalosporin dropped from 11.8% to 5.8%(P=.020). The combination of antibiotics decreased from 27.8% to 11.7%(P<.001). The antibiotic prescription rate on discharge declined from 11.8% to 2.5%(P<.001) and the number of antibiotics prescription days after surgery was shortened from 4.2 days to 2.3 days(P<.001). No significant difference in the rate of administration within 1 hour between two groups was found. Through 3-year management, 5 out of 6 measures were significantly improved(except the administration within 1 hour). The rate of surgical site infection decreased from 2.4% to 1.3%(P=.504). Conclusion : The findings demonstrate that the management system for the prophylactic use of antibiotics in surgical patients was effective in decreasing the rate of surgical site infection during 3 years.

• Quality Improvement in Health Care
• /
• v.4 no.1
• /
• pp.116-124
• /
• 1997

Background : As parking problem caused by increasing owner-driver and patients concentrating to a general hospital is becoming one of the dissatisfactions in medical care. It is time that a general hospital should solve the parking problem in a desirable way. The purpose of this survey is to let the clients understand the basic motivation of the pay parking and develop the better parking system. Methods : Clients of a tertiary care hospital in Chon-ju were surveyed by means of a questionnaire. All in all, 193 subjects answered the questionnaire. Results : In relation to previous experiences, 39.6% of the subjects experienced inconvenience with confused parking lot and the shortage of parking space. Under the current parking system, the subjects who felt the available parking space was enough were more than those who didn't 62.7% of the subjects answered that they could find the parking lot easily. 33.2% of the subjects mentioned that it was not easy to drive in the parking area ; The reasons were pointed out the shortage of space, disordered parking, and insufficient guide. 12.8% of the subjects satisfied with the current administering system of parking lot. The outpatients were more affirmative than the admitted patients about the charging system. As for the parking fee, 64% of the subjects answered that it is expensive, and 89.5% of the subjects thought imposing of parking fee is irrational. Conclusion : To say as a whole, the basic purpose of the charging system are more or less accepted. However, the management details like parking facilities and payment method are dissatisfactory, so it is necessary to improve the management system. It is also noted that the inpatients showed more negative attitude than the outpatients with the charging system. To secure a more convenient parking, the parking system should be considered in relation to the information service, kind guidance, improve facilities, personnel cooperation, fix outpatient scheduling system, etc.

• Health Policy and Management
• /
• v.3 no.1
• /
• pp.25-52
• /
• 1993

Variation in the utilization of medical services is a very important issue in cost containment and quality assurance of health care. Practice variation directly affects health care expenditure especially in fee-for-service system, which is the payment system of health insurance in Korea. In addition to cost issue it is generally accepted that variations in medical practice and the cost of inpatient care suggest the possibility of inappropriate quality of care. This study is to closely examine the patterne and degrees of variation in cost structure of inpatient care among types of hospital and individual hospitals in some tracer diseases, and also to inquire into the service items which contribute much to the variation of total medical care cost. Foru common diseases, i.e. Cesarean Section, appendectomy, cataract extraction and pediatric pneumonia, were selected as tracer diseases. In most tracer diseases there were statistically significant differences in total medical care cost among hospitals in same type of hospital as well as among types of hospital(p<0.01). When total medical care cost were subdivided into the types of service, cost of medication and diagnostic examination varied the most prominenly. When the cost of medication were subdivided again, cost of parenteral antibiotics showed the most prominent variation. Of total medical care cost, medication was most contributory to the variation of total medical care cost(58.1~82.3%), and cost of antibiotics was most contributory to the variation of medication cost(63.9~92.2%). The results of study implicated that reducing the variation of medication may plays a significant role in containing the cost of inpatient care. In order to sort out the factors affecting practice variations including drug prescription pattes further researches are required.

• Health Policy and Management
• /
• v.13 no.4
• /
• pp.28-47
• /
• 2003

The purpose of this study was to assess the user's satisfaction of health care service in public health centers in Busan. The study respondents were 212, those who visited health centers for health care service. Data were collected in July 2002 by using SERVQUAL(comprehensive service quality measurement scale) and 3 open questions for more details about service satisfaction and the needs for health care service. SERVQUAL has 5 dimensions； tangibles, reliability, responsiveness, assurance and empathy. The results were as follows ： 1. The users reported more satisfaction at 'just service cost', 'convenient service procedure' and 'clean physical environment' at SERVQUAL. Among them the highest rated item was 'service cost'. And the less satisfaction items were 'understanding and individual concerns about service users', 'medical equipment' and 'health center facilities'. 2. There were no statistical differences by general characteristics except for the kind of services rendered. Those who visited for physical examinations and laboratory tests reported lower satisfaction than any other groups. 3. At the open questions, the respondents expressed that they were satisfied with the low service cost, kindness of employee and clean environment. But they criticized the old facilities and worn medical equipment, in addition to the less than kind attitudes. These strengths and weaknesses of health center's service could be applied for planning of customer­centered health care service.

• Quality Improvement in Health Care
• /
• v.2 no.2
• /
• pp.112-129
• /
• 1996

Background : A small number of high cost patients usually spend a larger proportion of scarce health resources. Aged, long-term care and readmitted patients usually belong to these high cost patient group. Among others, long length of stay and readmission can be reduced by checking its cause, and these are the areas needed most of quality improvement activity. Characteristics of high cost medical users between health insurance program and medical assistance program were reviewed. Methods : The inpatient claims of health insurance and medical assistance program were analyzed. Patients were divided by 6 groups; long-term, mid-term, short-term, readmitted, cancer and aged. We defined high cost patients as those who had spent one and half million won and over per 6 months. Characteristics of high cost patients for each group were reviewed. Results : medical assistance patients used much more resources than the insured members in the average hospital cost per case but less in daily hospital cost. The former had a longer length of stay and had much heavier diseases. Major diseases of both group were cancer, diseases of circulatory system and chronic degenerative diseases. Gallstone and schizophrenia were more in the insured program. However, pulmonary tuberculosis, asthma were more common among the medical assistance patients. Early readmission before 2 weeks were 28-30% of the total readmission. Readmission rate in the malignat neoplasm and renal failure were 80% and more. Q.A program should be installed to prevent unnecessary readmissions. Conclusion : Almost 30% of early readmissions and admissions due to complications and long length of stay should be reviewed carefully to keep cost down and to enhance the quality of hospital care.

• Quality Improvement in Health Care
• /
• v.10 no.1
• /
• pp.42-56
• /
• 2003

Background : The purpose of this study is to investigate the influencing factors on the length of emergency department stay of patients with acute myocardial infraction. Methods : we reviewed medical records of all patients who were Hospitalized with acute myocardial infraction from March 1, 2002 to February 28, 2003. Results : The average length of stay in the emergency room of the subjects was 182.74 minutes. After the emergency room treatment, 48.1% of the subjects were transferred to intensive care unit. The hospitalization through emergency room mostly took place in the office hours. There were more patients on Monday. The influencing factors on the length of stay in the emergency room of patients with acute myocardial infraction were emergency room arrival time which was classified in seasons, treatment hours of specialized doctors, medical care insurance and required time of radiologic examination. Conclusion : In order to reduce the length of emergency room stay, it might be an available solution secure enough spaces, facility, and staff of the radiologic test only for the patients of the emergency room. And the effective use of emergency facility and space, establishment of standardized treatment guideline, and provision of emergency treatment support system are also needed.