• Journal of agricultural medicine and community health
• /
• v.29 no.1
• /
• pp.195-206
• /
• 2004

Objectives: This study was conducted to investigate the patterns of medical utilization and factors affecting medical utilization of population living in islands of province of ChungCheongNam-Do. Methods: Demographic and socioeconomic state, medical utilization of 447 persons were surveyed from Sept. 9th to Sept. 18th, 2002. Results: In elder age group and lower educational group, the rate of medical utilization was high. As subjective health states get lower, the group used medical institution more(p<0.05). The group having more number of chronic diseases showed more medical utilization. And the group who needs 2 to 3 hours to reach to the medical institution showed high medical utilization(p<0.05). The factors having negative effect on using medical institution were economic concern and lack of proper clinic in the neighborhood. Conclusions: The lower economic level and the insufficiency of medical facilities on islands affect the utilization rate negatively. More accessible and effective medical systems for these population are expected.

• Journal of Preventive Medicine and Public Health
• /
• v.29 no.2 s.53
• /
• pp.311-329
• /
• 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.

• Korea Journal of Hospital Management
• /
• v.18 no.4
• /
• pp.78-96
• /
• 2013

The purpose of this study is to analyze the emergency health care utilization using status according to income class. The target was the 2011 data out Korea Health Panel's raw data. 2011 data composed of total 17,035 people from total 5,741 households. This study set total 1,101 adults over full-20-years old having used an emergency health care utilization as its analysis target. In order to find out the number of emergency health care utilization use according to income class and the influential factors on emergency health care utilization cost, this study conducted the multiple regression analysis. And in order to more accurately analyze the emergency health care utilization use status depending on the income class and the features of emergency health care utilization use status, this study developed Models. As the result, this study found following findings. First, as the income class was lower, the gender was male, the age was lower, and the user has spouse, the user was not a business owner or a paid worker, the user is a house owner, the emergency medical facility type was a clinic, the means of transportation was others rather than 119 ambulance, the reason visiting emergency medical facility was belonged to others rather than accidents or poisoning, then the number of emergency was increased. Second, as the user was in higher income class, received the health insurance benefits, the using medical facility was general hospital, used 119 ambulance more often, stay days in emergency was shorter, then health care utilization cost was increased. In this study investigating the data out of Korea Health Panel, it was found that while the number of emergency health care utilization use was increased in the lower income class, but the emergency health care utilization cost was increased for higher income class. It is considered that this finding was caused from the facts that lower income class was more often exposed to dangers for physical health, so the number of emergency health care utilization use was increased, but their health care utilization cost was decreased because of their economic burdens against various examinations and their difficulties to pay such costs, comparing to that of higher income class. Therefore, in order to solve unequal problem of emergency health care utilization use between lower and higher income classs, it is required to set suitable solutions like the disease prevention effort by facilitating national health check-up programs, the enhancement of public health services in quantity and quality, the emergency health care utilization securing policy at using medical facilities, the promotional, educational activities about emergency health care utilization delivery system, the enhanced accessibility of emergency health care utilizations and emergency medical facilities.

• Journal of Korean Public Health Nursing
• /
• v.3 no.2
• /
• pp.47-76
• /
• 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.

• Korea Journal of Hospital Management
• /
• v.12 no.4
• /
• pp.1-21
• /
• 2007

The relaxation of the regulation in selection of medical institution allows patients to use their own judgement in choosing proper institution for their diseases. Since the change of the regulation, there should have been many changes in medical institution selection behavior. The analysis of the change in disease specific selection pattern is critical because there be an optimal selection criteria that ensure the efficient and effective utilization of medical resources. This study analysis the institution selection factors by comparing the choice among the cases of acute diseases, the cases of chronic diseases, inpatient services, outpatient services, and emergency medical service. The comparisons performed in terms of size, class and other characteristics of medical institutions. For the study the nationally surveyed database was used and the data were analyzed using logistic regression procedure. The results indicates that the primary care facilities were not properly utilized. This study speculates that the reason for the undesirable pattern of utilization is that the roles of primary care facilities in the healthcare delivery system was not clearly defined. Based on the results, the medical policy implications are discussed.

• Health Policy and Management
• /
• v.9 no.2
• /
• pp.77-94
• /
• 1999

The purpose of this study is to establish strategy by subdividing consumer market according to the lifestyle which influences the use of medical facilities. The subject of this study were 700 adults who were over 20 years of age and residing in Suwon and its vicinity. To collect data trained staff conducted person-to-person interviews with the assistance of structured questionnaires. The questionnaires cover the areas of life style pattern study. the characteristics of demographic sociology, decision-making process related to the use of medical service. The influencing factors were analyzed and as a result total 18 factors were singled out. Cluster analysis was performed to differentiate similar responses. Each group was named as 'health-unconcern type' 'passive health-concern type' 'regular health-concern type' and 'active health-concern type' according to the characteristics. Each group showed statistically significant difference in the characteristics of demographic sociology. Decision-making process regarding the use of medical service according to lifestyle was analyzed. As a result following items showed significant difference:whether the information was utilized, what was the criteria in selecting medical facilities for serious illness or complicated examination. who was the decision maker in selection medical facilities, and with whom one discussed in selecting medical facilities. The result of this study has its limitation in that it can not be applied directly to market subdivision. However, this will help medical facilities understand customers' lifestyle. which will eventually provide medical facilities with marketing tools in establishing effective PR strategy. In order to apply the lifestyle as a marketing tool of medical facilities, following tasks are to be carried out: the development of the questionnaire which can better analyze consumers' lifestyle related to the use of medical service. the examination of precise characteristics of subdivided market according to lifestyle. and the continuing study on the relationship between lifestyle and the process in selecting medical facilities.

• Journal of Preventive Medicine and Public Health
• /
• v.17 no.1
• /
• pp.37-45
• /
• 1984

This study was conducted to identify the problems in the medical aid program by reviewing the medical care utilization pattern of the beneficiaries. The data were abstracted from the monthly bills and vouchers for medical care of the whole benefi챠aries(17,527) in Gyeongsan Gun submitted by the physicians to county government for the period of 1 calendar year from October 1981 to September 1982. The number of medical aid beneficiary accounted for 12.7% of the total county population, a higher proportion than the national average-9.5%. Monthly primary care utilization rate per 100 beneficiaries was 9.3 persons with 14.0 visits and 42.9 medication days. for the 2nd and 3rd care, there were 1.7 admissions and 9.3 OPD visits per 100 beneficiaries per year. The beneficiaries of the first class medical aid program had a higher utilization rate of both the primary and secondary/tertiary care facilities. Females utilized more the primary care facilities than males while males utilized more the secondary/tertiary care facilities than females. A significantly lower utilization rate was observed in January than in the other months and this was seemed due to the renewal process of the medical aid certificate. Among 1,931 patients utilized the 2nd/3rd care facilities 84.4% was out-patients and the lowest ratios were in the minor specialties including ENT, ophthalmology, dermatology and urology. The average hospital days per in-patient were 21.2 days and OPD days per out patient were 4.7 days. The average hospital days for a psychiatry in-patient was 74.4 days which was the longest average hospital days among all the specialties. Average medical care cost per beneficiary in a year was W9,821:W24,240 for the 1st class and W7,464 for the 2nd class. The medical care cost for the primary care per patient was W3.901 and W840 per day compared with W49,875 per patient and W5,822 per day for the secondary/tertiary care. From the findings of this study following recommendations were made to improve the medical care program: 1) The renewal process of the medical care certificate should be expedited. 2) Minor specialty clinics should be designated as the primary medical care facility for the medical aid program to reduce the expenses by absorbing more patients referred to the secondary/tertiary care facilities directly. 3) The medical care cost for the primary care facility should be escalated to reduce the differential between the primary and secondary/tertiary care facilities.

• Health Policy and Management
• /
• v.1 no.1
• /
• pp.116-135
• /
• 1991

Few studies have been conducted on the detailed routes of medical care utilization under the National Health Insurance. This study was undertaken to identify the utilization patte군 of health care facilities among industrial workers and their dependents. One of the largest health insurance association was purposively chosen for this objective. The association had 345, 757 members as of 31 December, 1990. The study sample of 297, 948 subjects have been drawn from the membership pool on the basis of their continuous membership status during 1 January through 31 December 1990. This study has tried to identify differential utilization patterns between acute and chronic conditions, and among standard income classes. All the diagnoses were recoded in a manner to achieve the objective of this study. As for acute diseases, most age group had used one medical facility as much as by 60% except the age group of 1-4, This young age group had used over three different health facilities as much as by 10.9-15.8%. The finding suggests that some policy measures by sought for remedying the excessive/inappropriate use of services. In addition, mid-income classes(between 17 and 48) were more likely to use multiple sources of care than lower income classes(between 1 and 16) and upper income classes(above 49). This study has revealed that chronic cases are more likely to pursue multiple sources of care, however those with chronic conditions tend to use single health facility more than those with acute conditions(67.9% versus 52.4%). As many as 12.2% have visited more than three health facilities in chronic conditions, but 5.9% for acute conditions. The most likely source of care was primary clinics for both acute and chronic conditions. Compared with the role of general hospital, small-size hospitals found to play a minimal role in the care and referral of patients. This indicates the need of strengthening the function of small-size hospitals. While a minor cross utilization of western medicine and pharmacy was noted, no significant boundary crossing was identified between western medicine and oriental medicine, or between pharmacy and oriental medicine. It is too early to confirm that whether there is substitutability or cross utilization among these alternative sources of care. A further study is needed to identify these relationship.

• Journal of Korean Academy of Nursing
• /
• v.15 no.2
• /
• pp.5-15
• /
• 1985

This study was conducted for the purpose of fin-ding out the variance explaining the medical facilities utilization behavior, which is defined adaptation behavior Process by focal, contextual, residual stimuli in Roy's Adaptation Model. What kinds of characteristics can explain adaptation behavior in Roy's Model? And which is the relative importance of input variables? For this analysis, stepwise multiple regression and path analysis was used. The data come from the 1981 Baseline Household Interview Survey in remote rural area. The findings of the analysis can be summarized as follows: First, Total variance of independant variables for adaptation behavior, that is medical facilities utilization including clinic, drug store, health center, herb medicine was shown 16.2 percent. The most important variable which explain the dependent variable was the occurance of illness with the Ra of value 0.112. The illness symptom, living level, regular care source was shown important variables with relatively high the R²value and significant beta coefficient. Second, in the path analysis of variables which is selected important variables, the occurance of illness was shown variable which has the highest direct effect which 0.297 path coefficient. Also the education level of household was shown variable which has the highest indirect effect through living level and the occurance of illness in causal model. Third, This analysis suggests that the occurance of illness belonging focal stimuli are more influenced than others. To sum up, It is seem to the occurance of illness, illness symptom belonging focal stimuli have high explanation ability through direct effect, education level of household among contextual stimuli have explanation ability through indirect effect.

• Korea Journal of Hospital Management
• /
• v.12 no.4
• /
• pp.119-142
• /
• 2007

Although Korea joined OECD in 1996, there has still seen much unbalance in medical care and welfare standard between urban and rural area. The unbalance of medical demand between urban and rural area deepened low utilization of rural hospitals. So it caused many hospital's failure and conversion in rural area. Many rural hospitals are in difficulty managing business because of low medical demand along with the shortage of medical manpower, medical equipment and facilities. The objectives of this study were to reveal the cause of low utilization of hospitals in rural area, and to increase utilization of those hospitals. In this study the improvement methods of rural hospital's utilization were presented by examining were placed in difficult management condition, in respect of hospital's management conditions, manpower input, patient medical treatment record, financial record, and actual output. The causes of rural hospital's low utilization were as follows; 1) changes in number and structure of population 2) rural people's preference for large hospitals and hospitals which located in urban area 3) rural hospitals lacking in hospital management skill. Consequently rural hospital's operation condition got more and more deteriorated. To raise rural hospital's utilization, method for social policy, method for health policy, and intrinsic method of hospitals were presented in turn. For rural residents to utilize medical service conveniently, it is necessary for rural hospitals operated normally. So government must insist that rural hospitals solve the problems which come out from their internal management problems. And also these rural hospitals should be supported and nurtured by the government until their management is operated normally.