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The Seosan County Family Planning/Maternal & Child Health Service Research Project, Korea -Project Design and Findings of the Baseline Survey- (가족계획(家族計劃) 및 모자보건사업(母子保健事業)의 효율적 통합방안(統合方案)에 관한 연구(硏究)(서산군(瑞山郡)) -기초조사보고(基礎調査報告)-)

  • Bang, S.;Cho, T.H.;Lee, S.J.;Han, S.H.;Lim, K.J.;Ahn, M.Y.
    • Journal of Preventive Medicine and Public Health
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    • v.16 no.1
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    • pp.163-192
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    • 1983
  • In order to facilitate the Korean government's efforts in integrating family planning and maternal & child health at the primary health care level (or township level), the Soon Chun Hyang College of Medicine, with the financial and technical assistance of WHO, has under-taken a service research project. The project has employed a quasi-experimental study design introducing interventions tat provide crucial factors lacking in the ongoing government programs such as midwives and qualified referral physicians. The study is being conducted in three locations, one control area and two study areas. Before introducing trained Nurse/Midewives into the study areas, a baseline prevalence survey was undertaken from 15 July 1981 to 10 August 1981 in selelcted townships of Seosan County. In this sample survey of bath the study and control areas, 2,484 eligible women (97% reponse rate) were interviewed to obtain benchmark data on basic evaluation indicators related to family planning and maternal and child health. The salients results were summarized as follows.: 1. CONTACT RATES WITH HEALTH WORKERS; During the year preceding the survey, 12% of women were visited by government health workers. The primary reason for such visits by health workers was family planning (45% of the visits). About 34% of the women visited the health centers during the year. The primary reason for visiting health centers was immunizations for their children (45% of the visits). 3. FAMILY PLANNING USE RATE; The baseline data showed little difference between women in the study area and the control area on contraceptive use. Approximately 59% were currently using some methods. However, among those current users, almost half were practicing less effective methods of birth control such as rhythm or withdrawal. Among other methods, the tubectomy was the most popular (16%), while use of the IUD, oral pill and condom together reached only 14%. 3. PRENATAL CARE RATE; About 75% of the women reported no prenatal care for their last births (the youngest child of each women), Additionally, among women received prenatal care, over half had only one visit. 4. ATTENDANCE AT DELIVERY; Most of the women surveyed (over 80%) were attended by a non-medical person during their last delivery. These figures are somewhat comparable to the national figure of 84% for remote areas. 5. POSTNATAL CARE; The proportion of women reporting postnatal care was only 4.5%, and postnatal care was not received by the majority of women surveyed. 6. CHILD HEALTH CARE: In contrast to the low rate of maternity care for women themselves, most women reported obtaining immunization care for their children. About 75% of the women obtained Polio and/or DPT, 58% BCG, and 44% Measles vaccine for their children. However, in terms of illness care, while 35% of the women stated that their youngest child had been sick during the month preceding the survey, only 28% of these women took their child to the clinic for treatment. 7. COMPLICATIONS OF PREGNANCY AND DELIVERY AND ABNORMALITIES IN THE NEWBORN; Among all last deliveries, 18% of the women had pregnancy complications and 9% of the women had complications during delivery About 5% of the women reported abnormality in their most recent newborn. 8. REPRODUCTION EFFICIENCY; PERINATAL MORTALITY AND INFANT MORTALITY Based on data from the pregnancy history in this survey, reproduction efficiency was estimated. Out of the 11,154 pregnancies reported by all women surveyed, foetal loss was 21% (almost 16% were induced abortions) and infant deaths before reaching one year old were 3.1%. The reproduction efficiency was, therefore, reduced to 76%. In terms of perinatal and infant mortality rates, the former was 40.2 per 1,000 total births and the latter was 39.3 per 1,000 live births. Both rates described J shaped relationships with age of mothers and parity, and they were also correlated with birth interval and mother's education. In summary, this baseline survey data indicated a need for (1) improving contraceptive practices with more effective methods to prevent unwanted pregnancies and (2) providing better services for maternal and child care to protect wanted pregancies. In the Korean rural setting. the author believes that the latter is more important as the value of each child has increased as a result of the family planning campaign for the past two decades. This calls for more effective integration of Family Planning and MCH programmes to meet the needs of the family in each stage of the child bearing and rearing period with deploying more qualified personnel than the current government program personnel.

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Analysis of Source of Increase in Medical Expenditure for Medical Insurance Demonstration Area before(1982-1987) and after(1988-1990) National Health Insurance (의료보험 시범지역의 전국민 의료보험실시전후의 진료비증가 기여도 분석)

  • Cha, Byeong-Jun;Park, Jae-Yong;Kam, Sin
    • Health Policy and Management
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    • v.2 no.2
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    • pp.221-237
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    • 1992
  • The reasons for cost inflation in medical insurance expenditure are classified into demand pull inflation and cost push inflation. The former includes increase in the number of beneficiaries and utilization rate, while the latter includes increase in medical insurance fee and the charges per case. This study was conducted to analyze sources of increases of expenditure in medical insurance demonstration area by the period of 1982-1987 which was earlier than national health insurance and the period of national health insurance(1988-1990). The major findings were as follows: Medical expenditure in these areas increased by 9.4%(15.1%) annually between 1982 and 1990 on the basis of costant price(current price) and for this period, the yearly average increasing rate of expenses for outpatient care[10.5%(15.8%)] was higher than that of inpatient care [7.3%(12.6%)]. Medical expenditure increased by 6.3%(8.9%) annually between 1982 and 1987, the period of medical insurance demonstration, while it increased by 10.7%(18.9%) after implementing national health insurance(1988-1990). Medical expenditure increased by 35.9%(45.9%) between 1982 and 1987. Of this increase, 115.2%(92.1%) was attributable to the increase in the frequencies of utilization per beneficiary and 61.0%(68.1%) was due to the increase in the charges per case, but the expenditure decreased by 76.2%(60.2%) due to the reduction in the number of beneficiaries. Beteen 1988 and 1990, the period of national health insurance, medical expenditure increased by 21.2%(41.4%). Of this increase, 87.5%(46.4%) was attributable to the increase in the frequencies of utilization per beneficiary and 52.4%(73.4%) was due to the increase in the charges per case, and of the increase in the charges per case, 69.6%(40.8%) was attributable to the increase in the days of visit per case. Medical expenses per person in these areas increased by 78.2%(89.0%) between 1982 and 1987. Of this increase, 76.6%(69.1%) was attributable to the increase in the frequencies of utilization per beneficiary and 23.4%(30.9%) was due to the increase in the charges per case. For this period, demand-pull factor was the major cause of the increase in medical expenses and the expenses per treatment day was the major attributable factor in cost-push inflation. Betwee 1988 and 1990, medical expenditure per person increased by 31.2%(53.1%). Of this increase, 60.8%(37.2%) was attributable to the demand-pull factor and 39.2%(62.8%) was due to the increase in the charges per case which was one of cost-push factors. In current price, the attributalbe rate of the charges per case which was one of cost-push factors was higher than that of utilization rate in the period of national health insurance as compared to the period of medical insurance demonstration. In consideration of above findings, demand-pull factor led the increase in medical expenditure between 1982 and 1987, the period of medical insurance medel trial, but after implementing national health insurance, the attributable rate of cost-push factor was increasing gradually. Thus we may conclude that for medical cost containment, it is requested to examine the new reimbursement method to control cost-push factor and service-intensity factor.

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The Present State of Food Serviee by the Covered Wagon Bars (포장마차 영업실태조사(營業實態調査))

  • Yoon, Eun-Young;Choi, Kyung-Suk;Park, Young-Sook;Mo, Su-Mi
    • Journal of the Korean Society of Food Culture
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    • v.3 no.2
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    • pp.187-195
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    • 1988
  • In accordance with the rapidly growing number of street food service without a registration, a study was undertaken to determine the present state of food service by the covered wagon bar, through an investigation in Jamwondong, around the south gate market and Kangnam subway station, in Seoul, between July 25th and August 25th of 1987. The survey was comprised of three parts: 1) foodservice operation in covered wagon, 2) personal and food handling hygiene, 3) food behaviors of customers. A total of 54 covered wagon bars, consisting of 51.8% mobile bars and 48.2% non-mobile bars, operating in the above three locations, were investigated. Survey results show non-mobile covered wagon bars to be more popular among persons in their thrities and fourties than among teens or the elderly; also among males than females; among company employees and college students than others. Seventy five percent of the mobile covered wagon bars served snack type foods and others served wine and foods for wine, in contrast to hundred percent of the non-mobile covered wagon bars served wine and foods for wine. The survey found many problems of hygiene, in method of food purchasing, menu planning, food preparation, dish washing treatment of leftovers and water supply, as well as personal hygiene. However, customers prefer the casual and popular atmosphere at the counter of the covered wagon bar. Finally, the study emphasizes a need for better operation of covered wagon bar, improvement of food stuff handling and the way of food services and personal hygiene. A change of the registration system from the illegal operation are urgently needed for better quality food services of covered wagon bars.

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Analysis of Literatures Related to Crop Growth and Yield of Onion and Garlic Using Text-mining Approaches for Develop Productivity Prediction Models (양파·마늘 생산성 예측 모델 개발을 위한 텍스트마이닝 기법 활용 생육 및 수량 관련 문헌 분석)

  • Kim, Jin-Hee;Kim, Dae-Jun;Seo, Bo-Hun;Kim, Kwang Soo
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.23 no.4
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    • pp.374-390
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    • 2021
  • Growth and yield of field vegetable crops would be affected by climate conditions, which cause a relatively large fluctuation in crop production and consumer price over years. The yield prediction system for these crops would support decision-making on policies to manage supply and demands. The objectives of this study were to compile literatures related to onion and garlic and to perform data-mining analysis, which would shed lights on the development of crop models for these major field vegetable crops in Korea. The literatures on crop growth and yield were collected from the databases operated by Research Information Sharing Service, National Science & Technology Information Service and SCOPUS. The keywords were chosen to retrieve research outcomes related to crop growth and yield of onion and garlic. These literatures were analyzed using text mining approaches including word cloud and semantic networks. It was found that the number of publications was considerably less for the field vegetable crops compared with rice. Still, specific patterns between previous research outcomes were identified using the text mining methods. For example, climate change and remote sensing were major topics of interest for growth and yield of onion and garlic. The impact of temperature and irrigation on crop growth was also assessed in the previous studies. It was also found that yield of onion and garlic would be affected by both environment and crop management conditions including sowing time, variety, seed treatment method, irrigation interval, fertilization amount and fertilizer composition. For meteorological conditions, temperature, precipitation, solar radiation and humidity were found to be the major factors in the literatures. These indicate that crop models need to take into account both environmental and crop management practices for reliable prediction of crop yield.

The Public Health Welfare Conception of the Beveridge Report and Its Realization via the NHS (베버리지 보고서의 의료보장 구상과 NHS를 통한 구현)

  • Juneyoub Han;Jiyong Park
    • The Korean Society of Law and Medicine
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    • v.24 no.3
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    • pp.59-104
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    • 2023
  • This essay attempts to analyze the public health welfare conception within the text of the Beveridge Report and its realization via the NHS in Great Britain. Once referring to the influence of the Report to create the foundations of the 20th-century welfare system, the quest to scrutinize the original intentions of the Report and its succession to the NHS is certainly intriguing. Furthermore, when regarding the significance of public health policy for a modern state, the effort to engage in Beveridge's conception and its realization is more than timely. In light of such a premise, this paper indulges in its study by the following methods. First, the historical background of the Report - namely, the role of the spirit of the age and the experience of the Emergency Medical Service are to be analyzed to identify the origins of the welfare policies proposed by Beveridge. Furthermore, the public health welfare conception of the Report conceived from its time is reflected upon by engaging on the goal towards social welfare and public health scheme. Lastly, the aims of the NHS and its management, treatment classification, and rehabilitation program are reviewed for comparative analysis with the Report to survey the realization of Beveridge's design. In this process, this paper not only takes into account the original text of the Report - but also other essential works of law and public policy, including the NHS Constitution for England and the National Health Service Act of 1946. The intentions of this study are not bound by merely coinciding with the Report, but resonate significance via reflecting upon the Beveridgian legacy on the modern welfare state from the current perspective. The structured analysis to research the aims and policies of the Report and to compare them to the reality of the NHS may provide an opportunity to confirm the realization of Beveridge's scheme in British society. In addition, this essay is part of an academic endeavor to critically assess the past and the present of the welfare institution in the public health sector. As such, it is hopeful that the essay sheds light on further studies concerning the constructive remedies of the Korean welfare system as well.

A Study on FTA Rules of WTO (WTO의 FTA룰에 관한 연구)

  • Lee, Gyun
    • Journal of Arbitration Studies
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    • v.17 no.1
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    • pp.183-215
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    • 2007
  • The purpose of this paper is to study of WTO regulations related FTA such as Understanding on the Interpretation of Article XXIV of the General Agreement on Tariffs and Trade(GATT) 1994 and General Agreement on Trade in Service(GATS). In this study, the First introduced FTA rules of WTO in the chapter 2. The WTO agreement includes the "General Agreement on Tariffs an Trade(GATT) 1994". This instrument, known as "GATT 1994", is based on upon the original General Agreement on Tariffs and Trade referred to as "GATT 1947". The Second analyzed the relations between FTA and Article XXIV of GATT 1994 in the chapter 3. The Article XXIV of GATT 1994 is an agreement between the distinctive members for liberalizing trade. The Article XXIV of GATT 1994 is consist of three parts such as customs unions, free-trade area, and interim agreements that WTO is referred to as "Regional Trade Agreement(RTA)". There is a difference between the customs unions and the free-trade area. In the customs unions rules, the members should have the same tarifficatio and the same trade provision against non-members, but in the free-trade are a rules, the member is not necessary to have the same tarifficatio and the same trade provision against non-members. But, the both rules have a liberalization of trade in a common as a revoking tariffs and the government regulations for interfering with trade. In this case, however, the both rules include an inconsistency ele ment under WTO rules such as Most-Favoured-Nation Treatment(MFN) and National Treatment on Internal Taxation and Regulation(NTITR). This study reviewed neither inconsistency nor consistency on the both rules with the RTA of WTO under Article XXIV of GATT 1994. The Third analyzed the relations between FTA and Article V of GATS under WTO in the chapter 4. The GATS is a rule of WTO for the growing importance of trade in services for the growth and development of the world conomy. The GATS is a new rule rather than GATT's rule for concerning goods trade. The Article V of GATS under WTO is a rule that makes based on upon the Article XXIV of GATT. Therefore, If it is to be examined the Article V of GATS, it should be referred to a and an interpretation of the text of the Article XXIV of GATT. However, the Article V of GATS is on the undeveloped stage compare to the Article XXIV of GATT. Because, the statistics of WTO showed that the RTAs under the Article XXIV of GATT have 150 cases completed between nations, but the RTAs under the Article IV of GATS have 10 cases completed between nations. The Forth examined the interpretation of FTA rules under WTO in the chapter 5. Concerning the consistency issue of customs unions and free-trade area under the Article XXIV of GATT, the working parties in customs unions and in free-trade area have been reviewed the consistency is sue which had been not if to GATT. However, the parties finished to get up with one accord the both that are a consistency of argument and an inconsistency of argument with the interpretation of the Article XXIV of GATT. The interpretation of the Article XXIV of GATT has been raised as the issues when EEC by Rome Treaty established in 1957. However, the consistency is sue only agreed 6 working parties out of 69 working parties finished the reviewing of the interpretation up to the end of 1994. Also the consistency issue concerned with the special privilege measure of the customs unions and tree-trade area under the Article XXIV of GATT discussed only 3 cases between working parties up to now and did not accepted as an issue for working parties' report. In conclusion in the chapter 6, this study raised the issues of WTO that are a conference of a new round under WTO and the issues of clarity between FTA rule and WTO regulation.

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Analyses on the Mean Length of Stay of and the Income Effects due to Early Discharge of Car Accident Patients at General Hospital (3차 병원에 입원한 교통사고환자의 평균 재원기간과 조기퇴원시의 수입증대효과 분석연구)

  • Ryu, Ho-Sihn
    • Research in Community and Public Health Nursing
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    • v.10 no.1
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    • pp.70-79
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    • 1999
  • This study attempts to encourage the development of a rehabilitation delivery system as a substitute service for hospitalization such as a community based intermediate facility or home health care. We need substitute services for hospitalization to curtail the length of stay for inpatients due to car accidents. It focused on developing an estimation for early discharge based on a detailed statement of treatment from medical records of 109 inpatients who were hospitalized at General Hospital in 1997. This study has three specific purposes: First, to find the mean length of stay and mean medical expenditure. Second, to estimate the mean of early discharge from the mean length of stay. Third, to analyize the income effect per bed from early discharge. In order to analyze the length of stay and medical expenditure of inpatients the author conducted a micro and macro-analysis with medical expenditure records. To estimate the early discharge we examined with a group of 4 experts decreases in the amount of treatment after surgery, in treatments, in tests, in drug methods. We also looked their vital signs, the start of ROM exercise, the time removel, a patient's visitations, and possible stable conditions. In addition to identifing the income effect due to an early discharge, the data was analyzed by an SPSS-PC for windows and Excell program with a regression analysis model. The research findings are as follows: First, the mean length of stay was 47.56 days, but the mean length of stay due to early discharge was 32.26 days. The estimation of early discharge days was shown to depend on the length of stay. The longer the length of stay, the longer the length before discharge. For example, if the patient stayed under 14 days the mean length of stay was 7.09 while an early discharge was 6.39, whereas if the mean length of stay was 155.73, the early discharge time was 107.43. The mean medical expenditure per day of car accident patients was found to be 169,085 Won, whereas the mean medical expenditure per day was shown to be in a negative linear form according to the length of stay. That is the mean expenditure for under 14 days of stay was 303,015 Won and the period of the hospitalization of 15 days to 29 days was 170,338 Won and those of 30 days to 59 days was 113,333 Won. The estimation of the income effect due to being discharged 16 days was around 2,350,000 Won with a regression analysis model. However, this does not show the real benefits from an early discharge, but only the income increasing amount without considering prime medical cost at a general hospital. Therefore, we need further analysis on cost containments and benefits incending turn over rates and medical prime costs. From these research findings, the following suggestions have been drawn, we need to develop strategies on a rehabilitation delivery system focused on consumers for the 21st century. Varions intermediate facilities and home health care should be developed in the community as a substitute for shortening the length of stay in hospitals. In home health care cases, patients who want rehabilitation services as a substitute for hospitalization in cooperation with private health insurance companies might be available immediately.

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Enhancement of Antioxidant Activities of Codonopsis lanceolata and Fermented Codonopsis lanceolata by Ultra High Pressure Extraction (초고압 추출 처리에 의한 더덕 및 발효더덕의 항산화 증진)

  • Park, Sung-Jin;Park, Dong-Sik;Lee, Su-Bock;He, Xin-Long;Ahn, Ju-Hee;Yoon, Won-Byung;Lee, Hyeon-Yong
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.39 no.12
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    • pp.1898-1902
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    • 2010
  • This study was designed to evaluate antioxidant activity of low-quality Codonopsis lanceolata treated by fermentation process followed by hydraulic high pressure extraction. C. lanceolata was subjected to 5,000 bar for 30 min at $25^{\circ}C$. The highest phenolics content was observed in the combined treatment of fermentation and high pressure extraction (35.11 mg/100 g), followed by high pressure extraction alone (14.78 mg/100 g) and conventional extraction (14.56 mg/100 g). The content of flavonoids followed the similar pattern as that of total phenolics, showing 280.86 mg/100 g of C. lanceolata treated by the combined fermentation with high pressure extraction whereas 193.05 mg/100 g of C. lanceolata treated by the conventional extraction. The DPPH scavenging activity was 69.32% at 0.6 mg/mL of C. lanceolata treated by the combined process, while the DPPH scavenging activities of C. lanceolata treated by high pressure extraction alone and the conventional extraction were 60.35% and 30.92%, respectively. The highest reducing power of C. lanceolata extract (1.0 mg/mL) was observed at the combined treatment (0.926), followed by high pressure extraction alone (0.881) and the conventional extraction (0.733). The combination of fermentation with high pressure extraction significantly increased the contents of phenolics and flavonoids and also enhanced the antioxidant activity. Therefore, the combined application of fermentation and high pressure extraction can be an alternative technique for the extraction of C. lanceolata. These results provide useful information for enhancing biological properties of low-quality C. lanceolata.

A Study on Health Seeking Behavior - Focused on Shopping-Around Phenomenon in Banwol-Eup Residents (일부(一部) 지역사회(地域社會) 주민(住民)의 의료(醫療) 행태(行態)에 관(關)한 연구(硏究) - 반월읍(半月邑) 주민(住民)의 Shopping-around 현상(現象)을 중심(中心)으로 -)

  • Choi, Young-Teak;Lee, Eun-Il;Kim, Hyo-Joong
    • Journal of agricultural medicine and community health
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    • v.11 no.1
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    • pp.44-54
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    • 1986
  • This study was aimed at investigating the health seeking behaviors of patients; For the purpose of analyzing the research theme we classified the study into two phase. First, the types of patients' health seeking behavior were categorized into a scheme according to what medical care resources were utilized in patients' coping process. Second, from patients' first visits to third visits to medical resources, we analyzed variations of factors which noted as crucial elements in constituting the patients' sickness career. To grasp the generalized characteristics from complicated empirical data, we limited the scope of our analysis to third stage of health seeking. A total of 121 persons who had beer suffering from chronic diseases more than 3 months was sampled among the residents of Banwol-Eup, the target Area of Korea University Health Project. The findings are as follows ; 1) In the course of visiting medical care resources, 34 different types of health seeking Behavior were found. From this result we inferred the idea that patients in Banwol-Eup had not any stable norms to cope with their pains. Clinics, hospital, pharmacy, Herb-doctors', folkways (self-treatment) were accessed by patients in orders. But more than half of patients who had utilized clinics or hospitals from their first to third visits, changed medical care resources to others, for example herb doctors or folkways, which had fundamentally different treatment models. Upon these two facts, the diversified types and capricious patterns in the health seeking behavior of Banwol patients, we observed a typical Shopping-Around phenomenon. 2) Factors which influenced patients' to their sickness career were changed along the courses of health seeking, from first to third visits as follows ; $\cdot$ Perceived seriousness of diseases were tended to decrease. $\cdot$ Professional medical personnel tended to be influencial in the patients' sickness career, (5.0%, 25.0% and 65.7%). The influence of the primary interaction groups such as parents, friends, neighbours, tended to decrease ; (90.9%, 71.2% and 30.0%). $\cdot$ The subjective reasons why to choose such a medical care resource were related to economic affordability and disease-itself as main motives. Credibility of health resources tended to increase 14.9%, 24.0% and 31.4 sequently. $\cdot$ Geographic accessibility factors did not change significantly. Most of patients had utilized health resources in Banwol and Anyang area. 3) Cultural inclination in the shopping-around phenomenon has shown difference among age groups. The age group' over 50 years' preferred traditional health resources to modern health resources. 4) Consistency of health seeking behavior on the shopping around phenomenon has shown difference according to the degrees of patients' economic affordability and those of psychological satisfaction toward modern health services. However, there were some restrictions in this thesis ; a) the study was limited to the 3rd health seeking career so it did not allow us to collect more informations after that, b) the study was not able to carry out causal analysis on patients health behavior determinated by explanatory model of health resources, and c) the study was not able to take into consideration of factors connected with social structural circumstances. Despite of restrictions described above, we are sure that this thesis would promote health providers' understanding toward patients' inclinations, through which they could provide efficient and accurate medical service.

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Analysis on the trends and causes of inhabitant's behavioral changes in medical institutions's utilization after enforcement of regional medical insurance. (pilot-project area of regional medical insurance; mainly Kun-wi and Kwang-hwa county) (의료보험(醫療保險) 실시이후(實施以後) 지역주민(地域住民)의 의료기관이용행태(醫療機關利用行態) 변화(變化) 추이(推移)와 그 요인(要因)에 관한 조사연구(調査硏究))

  • Park, Jung-Yeon
    • Journal of Korean Public Health Nursing
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    • v.3 no.2
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    • pp.47-76
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    • 1989
  • The objectives of this study was to analyze the major causes of decreasing utilization rate of health care institutios in pilot-project area of regional medical insurance, Kwang-hwa and Kun-wi country. After the implementation of medical insurance, utilization rate of health institutions turned out' to be lower than it was estimated, when the pilot-project of regional medical insurance was planned. It might be due to changes in inhabitant's behavioral attitude toward medical insurance. So this study was made to find measures for financial stability by increasing utilization rate of health care institutions and to be available for basic demand-supply program of medical care. The hypothesis of this study was as follows; First. there is difference in understanding health care institutions between Kun-wi and Kwang-hwa. Second. respondesnts of inquiry survey have exact knowledge of their past experience of treatment taken prior to enforcement of medical insurance, Questionaire survey was made as to each 700 household among total 11, 884 households in Kun-wi and 20,919 households in Kwang-hwa. In case of Kun-wi, 70% of inquired households (491) gave their answers. In Kwang-hwa, the number was 560 households (80% of inquireds). Dollected data was processed and analyzed by way of using SPSS batch system. To evaluate facto rs distribution aspects of data and to make comparison between two area, percentage and $X^2$ distribution were applied. The results were as follows; L The utilization rate of health care institutions in Kun-wi and Kwang-hwa was lower than it was estimated. when pilot-project of medical insurance was planned. 2. Prior to the implementation of medical insurance. inhabitants in two area chose the medical institutions considering such factors. First was medical care fee cheap. second in habitant's residence, Third was the institutions conveniently easy of access. 3. After the implementation of medical insurance. 26.1% of inqurieds in Kun-wi and 41.6% in Kwang-hwa, changed medical institutions. In case of Kwn-wi, from health care institution (p 0.05), and in case of Kwang-hwa, vice versa, from general medical institutions to health care institutions. 4. Evaluation by factors were made such as follows. Inquired gave high marks to following facts: In case of Kun-wi, general medical institutions were difficult of access and relation between patients: was not friendly, but burden of medical expenditure was light. Effects of treatment and facilities was good. In case of Kwang-hwa, inquired gave high evaluation marks to the follow ing facts; facilities of medical institutions was not good, but the burden of medical expenditure was light. 5. After the implementation of medical insurance, the services was evaluated as good, but inquired hopec for lessening the burden of medical expenditure. 6. In case of exact understanding of cost-sharing, the evaluation rate in Kwang-hwa was higher than that of Kun-wi (p < 0.005). And positive attitude toward necessity of medical insurance was also good in Kwang-hwa (p < 0.05). 7. In case of inquired's attitude toward medical institutions, Kwang-hwa showed positive response (p < 0.05) 8. In the case of comparison between general medical institution and health care institution, two area showed similar positive response; medical manpower, facilities of medical institutions and effest: of treatement was good. 9. In comprehensive evaluation of benefit-service; the general medical institution's positiveness was higher than that of health care institutions in Kun-wi. But in Kwang-hwa vice-versa. 10. If the medical expenditure of general medical institution and health care institutions was equal 77% of inquireds in Kun-wi and 59.1% in Kwang-hwa answered that they chose general medical insurance. Considering results above mentioned, the conclusion of this study was made as follows. 1. In Kwang-hwa county, where the understanding of health care institutions's was good, the utilization's of health care institutions was shown high. Therefore, in case of Kwang-hwa, betterment: should be made to induce increasing utilization rate for negative factors of health care institutions. 2. In case of Kun-wi, where the understanding of health care institutions was on the decrease, measures for changing such negative factors should be taken by way of strengthening public relations. And cases of Kwang-hwa should also be studied. 3. On the side of financial stabilization and establishing health care delivery system, primary health care should be available. Therefore, the major cause of inhabitant's avoiding health care institutions should be known. And measures for activating that institutions have to be taken. So, the facilities of health care institution have to be improved up to the level of clinic. And supportive measures for securing equipment and improving health care services should also be taken. It is necessary that strategy for public relations should be employed with policy considerations and supports.

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