• 제목/요약/키워드: Rural Hospitals

검색결과 143건 처리시간 0.028초

병원 단위비용 결정요인에 관한 연구 (Analyses of the Efficiency in Hospital Management)

  • 노공균;이선
    • 한국병원경영학회지
    • /
    • 제9권1호
    • /
    • pp.66-94
    • /
    • 2004
  • The objective of this study is to examine how to maximize the efficiency of hospital management by minimizing the unit cost of hospital operation. For this purpose, this paper proposes to develop a model of the profit maximization based on the cost minimization dictum using the statistical tools of arriving at the maximum likelihood values. The preliminary survey data are collected from the annual statistics and their analyses published by Korea Health Industry Development Institute and Korean Hospital Association. The maximum likelihood value statistical analyses are conducted from the information on the cost (function) of each of 36 hospitals selected by the random stratified sampling method according to the size and location (urban or rural) of hospitals. We believe that, although the size of sample is relatively small, because of the sampling method used and the high response rate, the power of estimation of the results of the statistical analyses of the sample hospitals is acceptable. The conceptual framework of analyses is adopted from the various models of the determinants of hospital costs used by the previous studies. According to this framework, the study postulates that the unit cost of hospital operation is determined by the size, scope of service, technology (production function) as measured by capacity utilization, labor capital ratio and labor input-mix variables, and by exogeneous variables. The variables to represent the above cost determinants are selected by using the step-wise regression so that only the statistically significant variables may be utilized in analyzing how these variables impact on the hospital unit cost. The results of the analyses show that the models of hospital cost determinants adopted are well chosen. The various models analyzed have the (goodness of fit) overall determination (R2) which all turned out to be significant, regardless of the variables put in to represent the cost determinants. Specifically, the size and scope of service, no matter how it is measured, i. e., number of admissions per bed, number of ambulatory visits per bed, adjusted inpatient days and adjusted outpatients, have overall effects of reducing the hospital unit costs as measured by the cost per admission, per inpatient day, or office visit implying the existence of the economy of scale in the hospital operation. Thirdly, the technology used in operating a hospital has turned out to have its ramifications on the hospital unit cost similar to those postulated in the static theory of the firm. For example, the capacity utilization as represented by the inpatient days per employee tuned out to have statistically significant negative impacts on the unit cost of hospital operation, while payroll expenses per inpatient cost has a positive effect. The input-mix of hospital operation, as represented by the ratio of the number of doctor, nurse or medical staff per general employee, supports the known thesis that the specialized manpower costs more than the general employees. The labor/capital ratio as represented by the employees per 100 beds is shown to have a positive effect on the cost as expected. As for the exogeneous variable's impacts on the cost, when this variable is represented by the percent of urban 100 population at the location where the hospital is located, the regression analysis shows that the hospitals located in the urban area have a higher cost than those in the rural area. Finally, the case study of the sample hospitals offers a specific information to hospital administrators about how they share in terms of the cost they are incurring in comparison to other hospitals. For example, if his/her hospital is of small size and located in a city, he/she can compare the various costs of his/her hospital operation with those of other similar hospitals. Therefore, he/she may be able to find the reasons why the cost of his/her hospital operation has a higher or lower cost than other similar hospitals in what factors of the hospital cost determinants.

  • PDF

일부 농촌지역 손상 및 중독 발생에 관한 역학적 연구 (Epidemiologic study of injury and poisoning occurrence in a rural area)

  • 윤희섭
    • 지역사회간호학회지
    • /
    • 제10권2호
    • /
    • pp.467-479
    • /
    • 1999
  • The mortality and morbidity caused by injury and poisoning has been major public health problem in Korea. This study was carried out to get information indispensable in developing prevention srategies peculiar to korean rural area. In this study 1.499 people of 496 households. who are living in five rural villages of Chooncheon City. Kang-Won Province. were interviewed in accordance with structured questionaire in 1996. The results obtained are summarized as follows: 1. The age-standardized annual incidence rates of injury and poisoning per 100 persons surveyed were 4.2 in males and 1.9 in females. The difference between sex was statistically significant. 2. The places where most of injuries and poisonings occurred were road 66.7% among males. road 31.6% among females. 3. The occurrence of the injuries and poisonings were clustered in intensive farming season in both males and females. 4. The laceration and stab wound were the most frequent nature of injuries in males and the fracture was the most frequent nature of injuries in females. The fracture. sprain were more frequent among males but sprain and contusion were more frequent among females. 5. Incidence rates of injuries and poisoning by cause were higher in traffic accidents among males. though falls among females. The cause specific incidence rate by age was high in traffic accident for 30-59 year age group. and for the aged people older than 60 years. 6. In the management pattern, 78.8% of the injuries and poisoning were received medical care in hospitals and clinics, and the duration of the treatment over 4 weeks in 37.0%. The results obtained indicate that organized community effort is urgently required to prevent injuries and poisonings in rural area.

  • PDF

Telemedicine Protocols for the Management of Patients with Acute Spontaneous Intracerebral Hemorrhage in Rural and Medically Underserved Areas in Gangwon State : Recommendations for Doctors with Less Expertise at Local Emergency Rooms

  • Hyo Sub Jun;Kuhyun Yang;Jongyeon Kim;Jin Pyeong Jeon;Sun Jeong Kim;Jun Hyong Ahn;Seung Jin Lee;Hyuk Jai Choi;In Bok Chang;Jeong Jin Park;Jong-Kook Rhim;Sung-Chul Jin;Sung Min Cho;Sung-Pil Joo;Seung Hun Sheen;Sang Hyung Lee
    • Journal of Korean Neurosurgical Society
    • /
    • 제67권4호
    • /
    • pp.385-396
    • /
    • 2024
  • Previously, we reported the concept of a cloud-based telemedicine platform for patients with intracerebral hemorrhage (ICH) at local emergency rooms in rural and medically underserved areas in Gangwon state by combining artificial intelligence and remote consultation with a neurosurgeon. Developing a telemedicine ICH treatment protocol exclusively for doctors with less ICH expertise working in emergency rooms should be part of establishing this system. Difficulties arise in providing appropriate early treatment for ICH in rural and underserved areas before the patient is transferred to a nearby hub hospital with stroke specialists. This has been an unmet medical need for decades. The available reporting ICH guidelines are realistically applicable in university hospitals with a well-equipped infrastructure. However, it is very difficult for doctors inexperienced with ICH treatment to appropriately select and deliver ICH treatment based on the guidelines. To address these issues, we developed an ICH telemedicine protocol. Neurosurgeons from four university hospitals in Gangwon state first wrote the guidelines, and professors with extensive ICH expertise across the country revised them. Guidelines and recommendations for ICH management were described as simply as possible to allow more doctors to use them easily. We hope that our effort in developing the telemedicine protocols will ultimately improve the quality of ICH treatment in local emergency rooms in rural and underserved areas in Gangwon state.

코로나19 대유행 시 지역사회 요양병원 종사자의 근무경험: 혼합연구방법 (Working Experience of the Community-based Long-term Care Hospital Workers during the COVID-19 Pandemic: Mixed Methods Research)

  • 장현정;박정언
    • 한국농촌간호학회지
    • /
    • 제18권1호
    • /
    • pp.27-39
    • /
    • 2023
  • Purpose: This study is a mixed methods research that was conducted to verify factors affecting the working experience of community-based long-term care hospital workers during the COVID-19 pandemic. Methods: The study was carried out from July 19 to November 3, 2021 for 340 nurses who worked at 10 long-term care hospitals located in G city. Results: As the study results, factors that affected job stress of the workers working at community-based long-term care hospitals included job satisfaction (β=-.27, p<.001), work demand (β=-.25, p<.001), fatigue (β=.19, p=.001), and cooperation and leadership (β=-.12, p=.049). It was found that the participants were struggling with physical and mental stress caused by the increased workload due to the preventative measures taken to stop the infection and spread of COVID-19. Despite this, they accepted their situation as necessary to overcome the pandemic and shared the quarantine guidelines of the government and community health centers while actively responding to prevent the spread of COVID-19 under the leadership of their supervisors. However, they were experiencing psychological and emotional burnout in the prolonged pandemic situation. Conclusion: It is considered necessary to help relieve their stress and provide psychological and mental support by adopting a policy to develop and apply comprehensive programs.

경상남도 간호사의 직장선택, 직무수행의 어려움, 이직의도에 영향을 미치는 요인 (A Study on Factors Affecting the Workplace Selection, Job Performance Difficulties, and Turnover Intention of Nurses in Gyeongsangnam-do)

  • 홍현미;김혜원;이승근;김민주;김영수;정백근
    • 한국농촌간호학회지
    • /
    • 제18권1호
    • /
    • pp.57-71
    • /
    • 2023
  • Purpose: This study aims to provide primary data for policy alternatives by identifying the problem of the nursing workforce shortage. Methods: For quantitative data, 446 questionnaires were analyzed. The mean and standard deviation were used for content description. ANOVA analysis and Scheffe? test were used to compare the differences according to the hospital level. For qualitative data, 1:1 in-depth and group interviews were conducted for six participants. Results: The factors nurses prioritized when choosing a workplace were salary, commuting distance, and work-life balance. Clinical nurses cited low wages, heavy workloads, and burnout as the most considerable difficulties in performing their duties. Factors influencing nurse's turnover intention were low wages, unmanageable workload, and rotation to unwanted departments in that order. New nurses tend not to apply to small-medium-sized hospitals, experienced nurses in their 30s-40s leave hospitals due to childcare and shift work difficulties, and nurses in their 50s and older tend to move to nursing homes rather than acute hospital settings. Conclusion: In this study, wage and workload were mentioned as the most critical factors in nurses' workplace selection, job performance difficulties, and turnover intention, so it is necessary to pay attention to this aspect when improving treatment for nurses.

일부(一部) 농어촌주민(農漁村住民)의 상병(傷病) 및 의료이용도(醫療利用度)에 관(關)한 조사연구(調査硏究) (A Study on Sickness and Utilization of Medical Care in a Rural Area of Kyunggido)

  • 장용태
    • Journal of Preventive Medicine and Public Health
    • /
    • 제9권1호
    • /
    • pp.139-146
    • /
    • 1976
  • This survey attempted to determine the overall health situation in Kyunggido in terms of sickness prevalence, sickness distribution, demand for medical care by type, and utilization of medical care. The survey was conducted on 766 households, or 4,065 people, from July 1-31, 1975. The findings from the survey are as follows: 1) In terms of age distribution, 28.7% of the sample was from 10-19, the 40-49 age group was the next largest group, and those over 60 made up 7% of the sample. 2. The education distribution is as follows, 30.4% completed primary school, 22.4% had no formal education, 20.6% attended but did not onplete primary school, and 1.8% attended unversities or higher. 3) In terms of occupation, 55.9% were unemployed or family employees, which represents a large dependent population, 30.4% of the workers were employed in farming or fisheries. 4. The marital status is as follows, 58.8% of the women were married, 32.3% unmarried, and 7.5% divorced. 5) The prevalence rate of mouthy illness was 19.7% of 100 infant, 42.8% became fatally ill within the first year of life. This is a very high percentage compared with more developed nations. 6) Of those reportion on illness, 54.6% sought treatment. The rate of treatment was highest in infants at 77.7%. Us age increased, demand for treatment decreased to 43.1% for those in the aldest age group. The oldest age group also had the highest rate of non treatment at 56.8%. 7) The demand for medical care showed that 65.6% utilized drug stores, 20.2% utilized hospitals and clinics, 5.4% used herbdrug-stores and herb clinices, and 3.9% relied upon folk medicine and withch craft. 8) The utilization of medical facilties by sex is as follows, 65.1% of the men and 66.0% of the women used drug stores, and 19.2% of the men and 20.2% of the women used hospitals and clinics. However, more men (3.5%) were hospitalized than women (1.8%) 9) In terms of out-patient care, the largest age group of males was 10-19 (28.2%), and the largest age group of females was 0-9 (30.8%). There was no sex difference in the use of western pharmacies. Menaged 30-39 and women aged 50-59 were the most frequent users of herb clinics. 10) The rate of receiving treatment at drugstore hospitals went towards declining level in the second case of what While increaing much more at herb clinics and folk medicines in the second case than the first one. 11) After primary utilization of hospitals, 32.7%. of the adults aged 20-59 used drug-stores as a secondary source of care, and 12.8% of children and youth under age 20 continued receiving care at hospitals. 12) After primary utilization of drug-stores, 32.5 % of the adults continued to seek care at drug stores and 1.8% used hospitals. 4.2% of those over age 60 utilized folk medcine and witch craft.

  • PDF

증상인식(症狀認識)과 예기적(豫期的) 의료추구(醫療追求)에 관한 연구(硏究) (Symptom Recognition and Anticipatory Health Care Seeking)

  • 우철제;차형훈;조병희;염용태
    • 농촌의학ㆍ지역보건
    • /
    • 제7권1호
    • /
    • pp.33-42
    • /
    • 1982
  • It is discussed in a social epidemiology that a symptom would be regarded as an illness or not by the inhabitants' socio-economic status, ages and races, and the aspects of health care seeking are various according to the above-mentioned characteristics. This paper surveyed the symptom recognition and health care seeking following a questionnaire that, of 14 symptom groups presented, which symptom would be regarded an illness necessary for medical treatment, and if it is regarded as an illness, which kind of medical treatment would be thought to be reasonable. As a result, differently from the general theory of social epidemiology, statistical differences according to independent variables was not found in symptom recognition, which indicates that Korean medical culture is similar between urban and rural areas. But in anticipatory health care seeking, various health care seekings were performed following the symptoms. Especially, general hospitals' medical care was thought to be more desirable by the inhabitants in city area than in rural area ; youngers than olders; high-incomers than low-incomers ; new or old middle class or urban laborers than rural farmers ; and the highly educated than the low educated. Conversely, the latters seeked some treatments by pharmacy.

  • PDF

일부 농촌지역 사망신고자료에 기재된 사인에 관한 연구 -사망신고사인과 조사사인의 비교- (A Study of the Cause-of-Death reported on Official Death Registry in a Rural Area)

  • 남해성;박경수;선병환;신준호;손석준;최진수;김병우
    • Journal of Preventive Medicine and Public Health
    • /
    • 제29권2호
    • /
    • pp.227-238
    • /
    • 1996
  • This study was conducted to evaluate the accuracy of the official death registry in rural area. The base data used for the study was 379 deaths registered during the period of 1993 and 1994 in 4 rural townships of Chonnam province. The interview survey for cause-of-death was performed on the next of kin and/or neighbor. Additional medical informations were collected from hospitals and medical insurance associations for the purpose of verification. The underlying cause-of-death of 278 cases presumed by the survey was compared to the cause on official death registry. There was a prominent disagreement of cause-of-death between the survey data and the registry data(agreement rate: $38.9\sim44.6%$, according to disease classification method). These results may be caused by extremely low rates of physicians' certification, which were mostly confined to the poisoning and injury. Symptoms, signs, and ill defined conditions on death registry could be classified into circulatory disease(32.3%), neoplasm(21.2%), digestive disease(7.1%), injury and poisoning(7.1%) and so on. These results suggest that careful attention and verification be required on utilization of death registry data in rural area.

  • PDF

농촌지역 영유아의 모유수유 관련 요인 (Brestfeeding Rate and Its Related Factors In Rural area)

  • 김현지;김건엽;황보정연
    • 한국산학기술학회논문지
    • /
    • 제15권3호
    • /
    • pp.1671-1680
    • /
    • 2014
  • 본 연구는 농촌지역의 모유수유 실태를 파악하고 이에 영향을 미치는 관련 요인을 살펴보고자 하였다. 2012년 3월 20일부터 4월 19일까지 울산광역시 울주군의 보건소 및 보건지소와 어린이집을 다니는 60개월 미만의 영유아를 둔 어머니 139명을 대상으로 실시하였다. 자료분석은 SPSS Win 18.0 프로그램을 이용하였고 영역별 분석은 평균과 표준편차, 다중회귀분석으로 통계적 진술하였다. 다중 로지스틱 회귀분석 결과 모유수유에 영향을 미치는 관련 요인으로는 어머니의 직장유무, 산전 모유수유 교육 여부, 생후 1개월에 완전모유수유 유무가 영향을 미치는 것으로 나타났다. 지속적인 완전모유수유율을 높이기 위해서는 분만 전 병의원이나 보건소 등을 통한 교육의 실시, 직장 여성에게는 출산휴가나 육아휴직 사용 등으로 인한 불이익이 없는 지역사회 환경이 필요할 것으로 사료된다.

도시와 농촌에서 발생한 독사 교상 환자의 임상적 양상과 합병증 비교 연구 (A Comparative Study on the Clinical Features and Complications of Snake Bite Patients in Urban and Rural Areas)

  • 홍성준;이주환;최우익;진상찬;전재천
    • 농촌의학ㆍ지역보건
    • /
    • 제45권3호
    • /
    • pp.154-161
    • /
    • 2020
  • 이 연구는 도시와 농촌에서 발생한 독사 교상환자의 임상적 특징과 합병증 발생의 차이를 비교하고자 시행하였다. 독사 교상으로 응급실에 내원한 18세 이상의 환자를 대상으로 2013년 1월부터 2019년 12월까지 7년간의 의무기록을 이용하여 조사하였다. 환자는 독사 교상이 발생한 지역에 따라 도시지역 그룹과 농촌지역 그룹으로 나누어 임상적 특성과 합병증을 비교하였다. 그 결과 전체 77명의 연구대상 중 44명(57.1%)이 농촌지역 그룹으로 조사되었다. 도시에서 발생한 독사 교상 환자보다 농촌지역 환자에서 평균 연령이 높았고, 중등도도 높았으며, 교상 장소에서 병원까지의 거리가 멀어 항뱀독소 치료를 포함한 응급처치 지연으로 급성 신기능 부전, 횡문근융해증, 혈액 응고 장애와 같은 합병증 발생이 많았다. 독사 교상에서 핵심이 되는 치료는 항뱀독소 치료로 교상 후 가능한 빨리 투여하는 것이 중요하다. 증상이 진행한 후에 항뱀독소를 투여할 경우, 초기투여 시보다 더 많은 양의 항뱀독소 투여가 필요하다. 농촌은 의료 취약 지역으로 의료 접근성이 떨어지고 고령의 비율이 높아 상대적으로 나쁜 예후를 나타낸다. 따라서 이러한 문제 해결을 위해서는 지방의 중소형 병원에서도 항뱀독소 이용이 가능하도록 해야 하며 그러지 못할 때는 빠르게 대형 병원으로의 이송이 필요하다.