• Journal of Preventive Medicine and Public Health
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• v.43 no.6
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• pp.496-504
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• 2010

Objectives: The purpose of this study was to analyze the effect of outpatient cost-sharing on health care utilization by the elderly. Methods: The data in this analysis was the health insurance claims data between July 1999 and December 2008 (114 months). The study group was divided into two age groups, namely 60-64 years old and 65-69 years old. This study evaluated the impact of policy change on office visits, the office visits per person, and the percentage of the copayment-paid visits in total visits. Interrupted time series and segmented regression model were used for statistical analysis. Results: The results showed that outpatient cost-sharing decreased office visits, but it also decreased the percentage of copayment-paid visits, implying that the intensity of care increased. There was little difference in the results between the two age groups. But after the introduction of the coinsurance system for those patients under age 65, office visits and the percentage of copayment-paid visits decreased, and the 60-64 years old group had a larger decrease than the 65-69 years old group. Conclusions: This study evaluated the effects of outpatient cost-sharing on health care utilization by the aged. Cost sharing of the elderly had little effect on controlling health care utilization.

• The Korean Journal of Emergency Medical Services
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• v.26 no.1
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• pp.129-138
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• 2022

Purpose: To analyze the frequency of emergency room visits according to socioeconomic factors of emergency room visitors. Methods: In this study, frequency analysis, percentage analysis, and x² test were performed using the SPSS 23.0 program based on the 2018 data from the Korea Health Panel. Results: Among 1,648 participants included in this study, 1,279 visited the emergency room only once in the past year, while 369 visited the emergency room more than once. The relationship between frequency of emergency room visits and socioeconomic factors was analyzed using x² test, and no statistically significant relationship was noted between emergency room visits and education, economic activity, insurance type, and individual quartile income. However, a significant relationship was noted between emergency room visits and being handicap and living in households with quintile income. Conclusion: The study determined the relationship between frequency of emergency room visits and socioeconomic factors. A follow-up study analyzing socioeconomic factors of outpatient departments, 119 ambulance transport services, and frequency of emergency room visits among chronically ill patients is needed to provide basic data for establishing health policies among different socioeconomic strata.

• Korea Journal of Hospital Management
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• v.28 no.3
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• pp.39-46
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• 2023

Purpose: Korean medical services are not balanced across regions and social classes. To prevent mortality gaps, Korea must distribute its medical resources more efficiently. Patient factors affecting emergency room visits serve as basic data for determining best practices for public healthcare distribution. Methods: The data included 18 473 visits by 14 949 de-identified patients who visited a public emergency room over one year. The dependent variable was the number of emergency room visits. A Poisson regression was conducted with the independent variables, comprising sociodemographic, socioeconomic, and spatial accessibility factors and patient characteristics. Results: Older men with higher Korean Triage and Acuity Scale scores visited more frequently. Greater patient-hospital distance decreased visits; however, the presence of a hospital within 1 km of a patient's residence did not affect the number of visits. The use of 119 services was negatively correlated with the number of visits. Visits increased with more medical benefits. Conclusions: Patient age, distance to hospital, use of 119 services, and medical benefits should be considered when planning or managing public hospitals in Korea.

• Journal of Preventive Medicine and Public Health
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• v.25 no.1 s.37
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• pp.73-87
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• 1992

The level of copayment increased in order to stabilize the financial condition of the health insurance on 1986. An important question regarding the policy was whether the increase in the level of copayments reduced the utilization of medical services in the poor selectively. In spite of the importance of the research question, no study has been reported. This study was designed to find out changes in numbers of physician visits, to explain characteristics influencing the difference of utilization before and after the program. Finally the interaction effect between the program and the level of income was examined for the abover question. A total of 10,421 persons from eight institutions was selected as the study sample. Research findings are as follows. 1. The number of physician visits decreased by ten percent as a result of increasing the level of copayment. 2. The decrease was remarkable in some groups such as children, rural area and large family. 3. The most important factor which explained the difference was the number of physician visits before the introduction of the new program. The more numbers of physian visits during the last year were, the more numbers of physian visits decreased after the program. 4. The interaction term between the program and the level of income was statistically significant in the multiple regression model which explained physician visits and its coefficient was negative. It means that an increase in copayment did not reduced the number of physician visits in the poor, selectively. 5. It can be concluded that imposing adequate copayment reduces the use of medical services as well as medical costs without serious damage in access especially for the poor people.

• Journal of Korean Biological Nursing Science
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• v.24 no.1
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• pp.46-57
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• 2022

Purpose: This study aimed to identify factors affecting the number of emergency department visits by caregivers of children with fever. Methods: Data were collected from 145 caregivers whose children aged six or less with two or more emergency department visits annually mainly because of fever. Collected data were analyzed with descriptive frequency analysis, independent t-test, Fisher exact, one-way ANOVA, Scheffé test, Dunnett T3, Pearson's correlation, and stepwise multiple regression using SPSS 25.0 software. Results: Regression analysis results revealed that among factors influencing the number of emergency department visits by caregivers of children with fever were state anxiety (β= .35, p= .009), self-efficacy (β= -.29, p= .029), and gestational age of the children (β= .17, p= .010). These variables had an explanatory power of 42.3% concerning the number of emergency department visits. Conclusion: Our findings revealed that caregivers' level of state anxiety and self-efficacy were major factors influencing the number of emergency department visits. It is expected that providing education concerning fever and emotional support for caregivers of children with fever can relieve their anxiety and enhance their self-efficacy levels, which in turn may reduce the number of unnecessary emergency department visits of children with fever and ultimately address the issue of over-crowding in emergency department.

• Journal of Korean Society of Industrial and Systems Engineering
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• v.14 no.24
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• pp.141-147
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• 1991

This paper presents extended model for the vehicle routing problem, which allows multiple visits to a node by multiple vehicles. Multiple visits enables us split delivery. After formulating this multiple visits model mathematically, a two stage heuristic algorithm is developed by decomposition approach. This model consists of two sub-problem. The one is fixed cost transportation problem and the other is transportation problem.

• Korea Journal of Hospital Management
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• v.26 no.2
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• pp.56-67
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• 2021

Background: Regular doctor visits are vital for hypertension patients, especially for who have never received hypertension medication or non-pharmacologic therapy. This study purposed to study factors affecting outpatient visits for patients diagnosed with hypertension. Methods: This study included 59,009 respondents with hypertension over 30 from 2019 Community Health Survey data. Outpatient visits were defined by having hypertension treatments such as medication or non-pharmacologic therapy. Logistic regression was used to examine the factors affecting outpatient visits using SAS ver. 9.3. Results: 57,081(96.73%) patients with hypertension were identified as those having a outpatient visit for hypertension treatments, whereas 1,928(3.27%) patients did not have visits. Patient's characteristics such as gender, age, periods of hypertension, education level, perception of the blood pressure, hypertension management education, place of living, body mass index, depression and diabetes were found to have statistically significant relationship with the outpatient visits. Practical Implications: There is a need to select patients with high blood pressure who are unlikely to visit for hypertension treatments based on the study results. For those, establishing a personalized management plan such as health education and counseling programs will be helpful for the successful implementation of national chronic disease management program.

• Health Policy and Management
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• v.3 no.2
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• pp.159-176
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• 1993

The utilization of outpatient care services involves two steps of sequential decisions. The first step decision is about whether to initiate the utilization and the second one is about how many more visits to make after the initiation. Presumably, the initiation decision is largely made by the patient and his or her family, while the number of additional visits is decided under a strong influence of the physician. Implication is that the analysis of the outpatient care utilization requires to specify each of the two decisions underlying the utilization as a distinct stochastic process. This paper is concerned with the number of physician visits, which is, by definition, a discrete variable that can take only non-negative integer values. Since the initial visit is considered in the analysis of whether or not having made any physician visit, the focus on the number of visits made in addition to the initial one must be enough. The number of additional visits, being a kind of count data, could be assumed to exhibit a Poisson distribution. However, it is likely that the distribution is over dispersed since the number of physician visits tends to cluster around a few values but still vary widely. A recently reported study of outpatient care utilization employed an analysis based upon the assumption of a negative binomial distribution which is a type of overdispersed Poisson distribution. But there is an indication that the use of Poisson distribution making adjustments for over-dispersion results in less loss of efficiency in parameter estimation compared to the use of a certain type of distribution like a negative binomial distribution. An analysis of the data for outpatient care utilization was performed focusing on an assessment of appropriateness of available techniques. The data used in the analysis were collected by a community survey in Hwachon Gun, Kangwon Do in 1990. It was observed that a Poisson regression with adjustments for over-dispersion is superior to either an ordinary regression or a Poisson regression without adjustments oor over-dispersion. In conclusion, it seems the most approprite to assume that the number of physician visits made in addition to the initial visist exhibits an overdispersed Poisson distribution when outpatient care utilization is studied based upon a model which embodies the two-part character of the decision process uderlying the utilization.

• Journal of East-West Nursing Research
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• v.24 no.2
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• pp.146-153
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• 2018

Purpose: This study aimed to identify characteristics and severity assessed by Korean Triage and Acuity Scale (KTAS) among 2,496 older adults aged 65 and over who visited an emergency department (ED) located in Chuncheon city. Methods: Data were collected via electronic medical records from two hospitals from January to December of 2016. Chi square test and logistic regression were applied using SPSS 22.0. Results: 53.5% of the participants were women and 17.6% of visits were done by aged 85 and older. ED visits by ambulance were 33.9%. More than two-third of older adults' ED visits were emergent status. Severity of the ED visits of older adults were rated by KTAS. Commonly reported chief complaints of the ED visits were dizziness, dyspnea, chest pain, abdominal pain, and hypoalbuminemia. Among them, dizziness, chest pain, dyspnea, and hypoalbuminemia were related factors for being-emergent condition. Conclusion: Strategies for older adults' chief complaints are needed in order to reduce unexpected ED visits.

• Journal of Korean Academy of Nursing
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• v.51 no.4
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• pp.465-477
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• 2021

Purpose: This study aimed to evaluate the effects of head monted display based home-visits virtual reality simulation (HVRS) program developed for undergraduate nursing students. Methods: A nonequivalent control group with a non-synchronized design was utilized and 84 participants (experimental group, 44; control group, 40) were recruited from August 31, 2020 to November 8, 2020 in Gwangju metropolitan city. The HVRS program consisted of scenarios of three nursing cases, hypertension, diabetes mellitus, and stroke. Data were analyzed SPSS version 25.0 for Windows. Results: At the completion of HVRS, significant differences were found between groups in knowledge of home-visits (t = 4.73, p < .001), self-confidence (t = 6.63, p < .001), self-efficacy (t = 3.13, p = .002), and clinical competency (t = 4.13, p < .001). No significant difference was shown between groups in nursing knowledge about strokes, a subcategory of knowledge pertaining to home visits. Conclusion: The HVRS program developed for undergraduate nursing students is effective in improving knowledge of home-visits, self-confidence, self-efficacy, and clinical competency for nursing students.