• Journal of Preventive Medicine and Public Health
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• v.57 no.3
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• pp.260-268
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• 2024

Objectives: Regional disparities in cardiovascular care in Korea have led to uneven patient outcomes. Despite the growing need for and access to procedures, few studies have linked regional service availability to mortality rates. This study analyzed regional variation in the utilization of major cardiovascular procedures and their associations with short-term mortality to provide better evidence regarding the relationship between healthcare resource distribution and patient survival. Methods: A cross-sectional study was conducted using nationwide claims data for patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by the relevance index (RI). The associations between the regional RI and 30-day mortality were analyzed. Results: The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p=0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91). Conclusions: Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex procedures. Disparities should be addressed through collaboration among hospitals and policy efforts to improve outcomes.

• The Journal of Korean Obstetrics and Gynecology
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• v.37 no.2
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• pp.109-119
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• 2024

Objectives: This study is aimed to survey public's experience of medical use for developing Korean medicine clinical practice guideline of female infertility. Methods: The study engaged women who had experienced infertility despite regular conjugal relations, selected from an online survey company's national panel. Participants were surveyed from November 3 to 8, 2021. The questionnaire, developed from prior studies on Korean medicine, was emailed to 29,465 adults; 550 responses were analyzed after exclusions. The study received an IRB exemption from Pusan National University Korean Medicine Hospital and utilized Microsoft Excel for statistical analysis. Results: Among 550 respondents, 32.2% had experienced infertility, predominantly due to unexplained causes (52%). About half had received medical treatment (49.3%), primarily at hospitals and general hospitals (54.2%) and obstetrics and gynecology clinics (49.4%), with Korean medicine facilities also utilized (24.7% for clinics, 14.4% for hospitals). The most common treatments included herbal medicine in Korean medicine and ovulation induction in Western medicine, with most treatments lasting less than six months (71.4%) and costing between 1 to 5 million won (50.5%). Efforts to conceive included lifestyle adjustments such as maintaining a warm lower abdomen, supplement intake, and avoiding alcohol and tobacco. Conclusions: It is necessary that the guidelines be revised to address female infertility and to integrate recommendations for combining Korean medical treatments and Western medical treatments, which will enhance patient care in managing female infertility.

• The Journal of the Convergence on Culture Technology
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• v.10 no.1
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• pp.633-640
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• 2024

The purpose of this study is to analyse the structural relationships, direct and indirect effects between children's academic stress, peer attachment, parental achievement pressure and career maturity. This study uses panel data from a total of 1,357 elementary school students who participated in the 13th Child Panel Study of the Korea Child Care Policy Institute. The data were analysed using SPSS 24 and AMOS 24.0 programs. The results showed that children's academic stress was negatively related to peer attachment, positively related to parental achievement pressure, and negatively related to career maturity. Each variable was found to have a direct effect, and academic stress had an indirect effect on career maturity through the mediation of peer attachment and parental achievement pressure. In conclusion, it is recommended that school social work support that considers the causal relationship of all variables is necessary to improve children's career maturity.

• The Journal of the Convergence on Culture Technology
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• v.10 no.3
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• pp.341-348
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• 2024

The purpose of this study is to analyze the structural relationship, direct and indirect effects between adolescents' peer attachment, self-resilience, academic stress, and smartphone addiction. The subject of this study used panel data of a total of 1280 middle school students who participated in the 14th study of the Children's Panel of the Korea Child Care Policy Institute. For data analysis, SPSS 24.0 and AMOS 24.0 programs were used. As a result of the study, children's peer attachment was positively correlated with ego resiliency, academic stress and negatively correlated with smartphone addiction. All pathways except peer attachment and smartphone addiction were found to have a direct influence, and adolescents' peer attachment had an indirect effect on smartphone addiction through ego resiliency and parental achievement pressure. In conclusion, in order to lower adolescents' smartphone addiction, practical interventions to improve ego resiliency and reduce academic stress through peer attachment are considered necessary.

• Journal of the Korea Society of Computer and Information
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• v.29 no.5
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• pp.131-142
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• 2024

In this paper, we propose antecedent factors that influence health promotion behaviors among rural older adults by gender. The study analyzed data from the 'Need Assessment Survey for the Development of Customized Care Programs for Rural Older Adults' conducted by the Rural Development Administration. The analysis utilized data from 502 individuals aged 65 and older residing in rural areas. The analysis method used SPSS 25.0 program to conduct descriptive statistics, chi-square analysis, correlation analysis, and hierarchical regression analysis. The analysis results showed differences between men and women in practicing health promotion behaviors. For men, lower age, lower education level, living with a spouse, and participating in social activities were associated with higher levels of health promotion behaviors. For women, older age, better self-rated health status, and participating in social activities were associated with higher levels of health promotion behaviors. This study provides baseline data to promote health promotion behaviors among rural older adults according to gender and suggests policy and practical implications based on the findings.

• Health Policy and Management
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• v.8 no.2
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• pp.125-148
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• 1998

Accurate vital statistics are essential for a national health planning and evaluation. Among various vital statistics, birth and death rates, and infant and matemal mortality rates together with the causes of death are the very basic ones for above purposes as well as for the maternal and child health management. These statistics are based on the birth and death reports. It is required by law to report every birth and death within one month after its occurrence. However, in case of a neonatal death occurring prior to the birth report, most of the birth and death are not reported. Thus accurate infant and maternal mortality rates are not available yet in Korea. The main objective of this study is to develop a birth and infant death reporting system via computer network. We designed a new birth report form based on the current form and data from the analysis of medical record forms of 14 hospitals. A new form is basically addition of essential medical information to the current birth report form. Since a revision of the rules and regulations related wtih the birth report is necessary to use a new form, we kept the current from intact to make it acceptable to the government office for a field trial. We also developed computer programs for data input for birth and death reports at a medical faciltiy, data processing for production of maternal and child health indices at a health center, and management of maternal and child health services including immunization and postantal care at health center. The birth certificate and birth report can be printed out at a medical facility. The computer packages were programmed by Borland Delphi 3.0 and can be run under Windows 95 system. We proposed a new birth and death reporting system via computer network after a field trial for data input, transmission, and processing. The medical and demographic data o birth and death at medical facilities will be sent to health centers directly via computer network. The health center will retain the medical data for analysis and forward only the data for birth and death reports required by current regulations to the Dong, Up, or Myun Office. Once the birth or death is reported via computer network to the Dong Office, then the Dong Office will notify the baby's mother of the birth report and request to submit the baby's name by mail. When the baby's name its submitted. the Dong Office will forward the birth reports to the Common Court and Statistics Agency in the same way as the current system, Upon the completion of birth registration of the Common Court, the court will issue the birth certificate to mother which will be used in lieu of the family record. The advantages of proposed birth and death reporting system via computer network ar as follows ; I) The accuracy, timing, and completeness of reporting will be improved and more accurate maternal and child health indices can be obtained, ii) The maternal and child health services of health center will be obtained, iii) Epidemiologic data for pregnancy and birth can be obtained, iv) Manpower for birth and death reporting will be saved.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.33 no.4
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• pp.16-31
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• 2020

Objectives : This study is designed to analyze outpatients who received medical treatment for skin diseases in ophthalmology & otolaryngology & dermatology clinic of Korean Medical Hospital from March 1st, 2016 to February 28th, 2019. To discover the tendencies of dermatology outpatients and provide the base data for future researches in dermatology patients' characteristics, korean medical treatments on dermatology field, more statistical analysis and establishment of korean medical health care policy. Methods : We classified dermatology outpatients who received treatments in ophthalmology & otolaryngology & dermatology clinic of Korean Medical Hospital from March 1st, 2016 to February 28th, 2019 according to gender, year, age, seasonal, main diagnosis, visit days. The statistical analysis was performed using IBM SPSS 23.0 Results : The results of the analysis on 651 dermatology patients treated in ophthalmology & otolaryngology & dermatology clinic of Dunsan Korean Medical Hospital for the past 3 years are as follows. 1. The number of outpatients who visited ophthalmology & otolaryngology & dermatology clinic of Dunsan Korean Medical Hospital for skin diseases were 651; 286 male(43.9%) and 365 female(56.1%). The number of female patients were approximately 1.27 times higher. 2. The average age of the dermatology outpatients were 37.6. The most frequent visitors turned out to be 20s, and the number of 20s, 30s patients were 267, consisting 41.0% of the whole patients. 3. By examining the change on yearly basis, we noticed that the number of outpatients treated with skin diseases steadily increased with the years. 1) In the analysis of the number of patients classified by gender and year, the number of male and female patients both increased with the years. 2) In the analysis of the number of patients classified by age and year, there were statistically significant difference between two groups. 3) In the analysis of the number of patients classified by season and year, there were statistically significant difference between two groups. 4) In the analysis of the number of patients classified by main diagnosis and year, there were statistically significant difference between two groups. 4. In the analysis of the number of outpatients by seasonal basis, the number of the outpatients visited in summer was the largest by 185(28.4%), followed by winter 181(27.8%), spring 148(22.7%), and the autumn 137(21.0%). 1) In the analysis of the number of patients classified by age and season, there were no statistically significant difference. 2) In the analysis of the number of patients classified by age and season, there were no statistically significant difference. 5. By classifying the outpatients according to main diagnosis, it turned out that there were 40 diagnosis, with eczema the largest followed by urticaria, allergic contact dermatitis, seborrheic dermatitis, and folliculitis. 6. The average number of visit days of dermatology outpatients were 10.24 days, and the number declined steadily with the years. 1) In the analysis of the number of patients classified by gender and visit days, there were no statistically significant difference. 2) In the analysis of the number of patients classified by age and visit days, the visit days of 70s were the shortest and the patients below 20s were longer than the other age groups. Conclusions : By analyzing the outpatients who received medical treatment for skin diseases in ophthalmology & otolaryngology & dermatology clinic of Korean Medical Hospital from March 1st, 2016 to February 28th, 2019 according to gender, year, age, seasonal, main diagnosis, visit days, We drew various meaningful results. The outpatients with skin diseases increased steadily by the years, and patients visited in winter especially shown the outstanding increase. And though the number of female patients were larger than male, the increase was bigger in male patients. We hope that this results would provide useful resources for future researches in dermatology patients'characteristics, korean medical treatment and establishment of korean medical health care policy.

• 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.

• Health Policy and Management
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• v.11 no.2
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• pp.141-168
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• 2001

Healthcare service organizations can apply the cost of quality(COQ) model as a method to evaluate a service quality improvement project such as Total Quality Management (TQM). COQ model has been used to quantify and evaluate the efficiency and effectiveness of TQM project through estimation between cost and benefit in intervention for a quality Improvement to provide satisfied services for a customer, and to identify a non value added process. For estimating cost of quality, We used activities and activity costs based on Activity Based Costing(ABC) system. These procedures let the researchers know whether the process is value-added by each activity, and identify a process to require improvement in TQM project. Through the series of procedures, health care organizations are service organizations can identify a problem in their quality improvement programs, solve the problem, and improve their quality of care for their costumers with optimized cost. The study subject was a quality improvement program of the department of radiology department in a hospital with n bed sizes in Metropolitan Statistical Area (MSA). The principal source of data for developing the COQ model was total cases of retaking shots for diagnoses during five months period from December of the 1998 to April of the 1999 in the department. First of the procedures, for estimating activity based cost of the department of diagnostic radiology, the researchers analyzed total department health insurance claims to identify activities and activity costs using one year period health insurance claims from September of the 1998 to August of the 1999. COQ model in this study applied Simpson & Multher's COQ(SM's COQ) model, and SM's COQ model divided cost of quality into failure cost with external and internal failure cost, and evaluation/prevention cost. The researchers identified contents for cost of quality, defined activities and activity costs for each content with the SM's COQ model, and finally made the formula for estimating activity costs relating to implementing service quality improvement program. The results from the formula for estimating cost of quality were following: 1. The reasons for retaking shots were largely classified into technique, appliances, patients, quality management, non-appliances, doctors, and unclassified. These classifications by reasons were allocated into each office doing re-taking shots. Therefore, total retaking shots categorized by reasons and offices, the researchers identified internal and external failure costs based on these categories. 2. The researchers have developed cost of quality (COQ) model, identified activities by content for cost of quality, assessed activity driving factors and activity contribution rate, and calculated total cost by each content for cost for quality, except for activity cost. 3. According to estimation of cost of quality for retaking shots in department of diagnostic radiology, the failure cost was ￦35,880, evaluation/preventive cost was ￦72,521, two times as much as failure cost. The proportion between internal failure cost and external failure cost in failure cost is similar. The study cannot identify trends on input cost and quality improving in cost of qualify over the time, because the study employs cross-sectional design. Even with this limitation, results of this study are much meaningful. This study shows possibility to evaluate value on the process of TQM subjects using activities and activity costs by ABC system, and this study can objectively evaluate quality improvement program through quantitative comparing input costs with marginal benefits in quality improvement.

• Health Policy and Management
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• v.34 no.2
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• pp.120-128
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• 2024

From February to now 2024, there continues to be controversy over the expansion of admission number to medical school. Some of the controversy arises from a mix of present and future time points. In the present time point, the controversy over whether physicians are some shortages or not has various aspects. Some aspects are presented as evidence of the physician shortage and others as non-shortage. Also, the presenting evidence of shortage is being disputed, and so is the evidence of the contrary. This controversy over whether there is a shortage or not in the present time point makes it difficult to reach a consensus. In 10 years, the shortage of doctors will increase due to the rapid increase in the elderly population, so the admission number of medical schools will need to be increased. However, the increase must be such that there is minimal deterioration in the quality of medical education. More admission numbers should be allocated to medical schools with a high quality of medical education. This study suggests that large-scale medical schools increase the admission number by 20%-30%, and small-scale medical schools increase the admission number by 40%-50%, if so, the total increasing number is 760 to 1,066. If the 2,000-person increase is enforced, the quality of medical education must be carefully evaluated and the results should be reflected in adjusting the admission number of medical schools. In 20 years later, the admission number of medical schools will have to be reduced. This is because the physician supply is changing to a linear function and the physician demand (medical care demand) is changing to a quadratic function. Even if the current number is maintained, there will be an excess of doctors from 2048, so the medical school admission number must be reduced and its size will be reduced to about 2,000, a 30% reduction from the current number. Because the same reduction rate for all medical schools will result in many small-scale medical schools, the M&A (mergers and acquisitions) strategy should be considered with 40 medical schools and 12 Korean medical schools. In Korea, the main contributor to estimating physician demand is the change in population structure. Due to the rapid decrease in the total fertility rate, future population projections are uncertain. The recent rapid increase in healthcare utilization should be reexamined in the forecasting of physician demand. Since the various factors that affect the estimate of doctor supply and demand are unclear, the estimate of physician supply and demand must be continuously conducted every five years, and the Health Care Workforce Committee must be established and operated. The effects of increasing the admission number of medical schools should be evaluated and adjusted annually.