• Journal of Preventive Medicine and Public Health
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• 제33권2호
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• pp.231-238
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• 2000

Objective : To estimate the burden of diseases in Korea especially caused by major cancers using the YLL(years of life lost due to premature death) measurement. Methods : First, we determined the parameters: such as age-specific standard life expectancy, age on death, sex, cause of death by analyzing the national death certificate data and life table collected during 1996 provided by the National Statistical Office. Secondly, we estimated the age group-specific YLL by employing standard expected years of life lost(SEYLL). Thirdly, final burden of disease due to premature death was estimated by using YLLs measurement which developed by global burden of disease study group. Results : The burden of premature death by cancer for male was attributed mainly to liver cancer(514.5 person-year), stomach cancer(436.4 person-year), and lung cancer(367.7 person-year). Each of these cancers was responsible for the loss of over 100 person-year based on our YLL measurement. The burden of premature death by cancer for female was attributed mainly to liver cancer(135.1 person-year), stomach cancer(252.1 person-year), and lung cancer(121.8 person-year). Each of these cancers was responsible for the loss of over 100 person year based on our YLL measurement. Conclusion : We found the YLL method employed in this study was appropriate to quantify the burden of premature death. Thereby, it would provide a rational bases to plan a national health policy regarding premature death caused by cancer.

• 보험의학회지
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• 제2권1호
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• pp.116-121
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• 1985

We've reviewed 518 cases of claims by death that had occured for one year from April, 1983 to March, 1984. As a result, we came to following conclusions; First, the greater part of the death were due to Accidental death(19.1%), Heart disease(18.9%), Malignant neoplasm(17.4%), Liver cirrhosis(10.6%), and the Cerebrovascular disease(9.7%), which were occupied by 75.7% of the whole. Second, classifying them by medical examinations or non medical, death in case of non medical examination showed 89% of the whole. And for age, section ranging from 41 to 50, from 51 to 60 and from 31 to 40 took the overwhelming portion by 27.4%, 26.6%, and 17.4% respectively, those of which showed 71.4% of the whole. Third, for the period elapsed, death within 1 year from the entrance showed 31% and that from 1 year to under 2 years 20.5%. Thus the rate of early death under 2 years stood for 51.5% of the whole.

• 보험의학회지
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• 제4권1호
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• pp.86-92
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• 1987

We've reviewed 704 cases of claims by death that had occured for one year from April, 1985 to March, 1986. As a result, we came to following conclusions; First, the greater part of the death were due to Accidental death(25.0%), Malignant neoplasm(21.2%), Heart disease(12.9%), Liver cirrhosis(9.1%), and the cerebrovascular disease(5.5%), which were occupied by 73.7% of the whole. Second, classifying them by medical examinations or non medical, death in case of non medical examinations showed 94.3% of whole. And for age, section ranging from 40 to 49, from 50 to 59, and from 60 to 69 took the overwhelming portion by 28.6%, 24.2%, and 16.6% respectively, those of wich showed 69.4% of the whole. Third, for the period elapsed, death within 1 year from the entrance showed 16.9% and that from 1 year to under 2 years 18.8%, Thus the rate of early death under 2 years stood for 35.7% of the whole.

• 보험의학회지
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• 제1권1호
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• pp.88-95
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• 1984

In Korea, life insurance policies are sold to the policy holders by insuring either the insureds undergo a medical examination at a clinic or the insureds' report their history of diseases ever experienced that replaces the medical examination. This study aimed to measure the level of death rates for the insureds between those who received medical examination and those who did not receive medical examination, and to examine differences of the rates in terms of the insureds' characteristics such as age, sex, cause of death and duration. A total number of 32,358 insureds were selected for the population of this study from the D. Life Insurance Company located in Seoul City. Out of the 32,358 insureds, 2,997 received medical examination and the rest of 29,381 did not received any medical examination. Results of analysis are summarized as follows: 1. Death rate per 100,000 insureds for the all was 19.3 in the first year, 96.3 in the second year, 143.8 in the third year 93.4 in the fourth year. For the group of medical examination received, the rate was zero in the first year, 41.3 in the second year, 55.4 in the third year and 268.8 in the fourth year, and for the group of non-medically examined the rate was 21.3 in the first year, 101.9 in the second year, 152.2 in the third year and 76.8 in the fourth year. The levels of death rates between the insureds with medical examsination and the inureds without medical examination were non-significant in the differences by duration except the levels of the third year, which indicated the death rate of non-medically examined group was higher than that of the medically examined group. 2. 73.0 per cent of the total deaths observed during the insured period were caused by various diseases and the rest of 27.0 per cent deaths were due to accidents. For the group of medical examination received, 55.6 per cent deaths were caused by diseases, and for the group of nonmedically examined, 74.7 per cent of deaths were due to diseases. 3. cancer was the most frequent cause which accounted for 22.0 per cent of the total deaths. Proportion of deaths due to cancer from the group of medical examination received was 22.2 per cent, and the corresponding rate for the group of non-medically examined also showed high rate of 22.0 per cent.

• Journal of Preventive Medicine and Public Health
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• 제36권4호
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• pp.325-331
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• 2003

Objectives : To analyze medical service utilization and trends among the elderly in the last year of life. Method : The subjects of this study were People that had died at the age sixty-five and above between January $1^{st}$ and June $30^{th}$ 2000 The names of the deceased and their dates of death were collected from the data of the funeral-expenses-receivers of the National Health Insurance Corporation (NHIC). This data was merged with that of the individual medical expenses of the NHIC. Results : In the first half of 2000, 84.2% of the funeral-expenses-receivers (53,063) utilized medical services during the year prior to their death; 51.0% (27,042) were female and 49.0% (26,021) male. In the last twelve months of life, the medical fees, the number of days receiving medical services and the number of days receiving medicine were 3,107,935 Won, 47.88 and 153.21, respectively, for each person. As the age of the groups increased, the level of medical service utilization decreased; the change was more obvious in female group. The level of medical service utilization during the twelve months prior to death drastically increased around the time of death. Conclusions : This study, from an analysis of the level of medical service utilization prior to death, shows a concentrated volume of medical services during a certain time period prior to death.

• 가정∙방문간호학회지
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• 제20권1호
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• pp.63-71
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• 2013

Purpose: This study was performed to identify nursing college students' attitudes towards death and was conducted as a pre-investigation to prepare them for coping with terminally ill patients in their clinical practice. Methods: The subjects consisted of 321 nursing students. Their attitudes towards death were measured by using the Collett-Lester Fear of Death Scale(CLFODS). The data obtained were analyzed by using the one-wayANOVA and Duncan's multiple test using the SAS 9.2 soft ware program. Results: The mean CLFODS score was 2.99. Among the 4 subscales, there were significant differences among the students with respect to grade, indirect experience of death, social isolation, daily life stress, and suicidal ideation in the past year. Conclusion: A negative attitude towards death was observed in the psychosocial characteristics, with indirect experience of death, social isolation, daily life stress, and suicidal ideation in the past year. It is necessary to educate students on how to care for dying patients before clinical practice. This education can be carried out by developing a death education program after considering the above mentioned psychosocial characteristics noted in this study.

• 의료법학
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• 제9권2호
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• pp.77-107
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• 2008

In Republic of Chaina (Taiwan), Natural Death Act named "Anning Huauhe Yiliao Tiaoli" which means palliative and hospice care act was enacted in year of 2000. And enforced in the same year. Many scholars say that Taiwan's Act took Many U.S.A.'s acts such as 'Federal Patient Self-Determination Act 1990', 'California Natural Death Act 1976' and 'Washington Natural Death Act 1979' for a model. Taiwan's Act adopts a few outstanding systems - 'advance declarations' including 'living will' and 'durable power of attorney for health care', 'family-determination system' for a patient who is in a persistent unconscious state. This paper disusses this Act. 'The content is as follow: 1. A background of legislation. 2. The purpose of legislation. 3. The concept of terms. 4. Patient's self-determination. 5. Subrogated determination by family. 6. Keeping documents. 7. Punitive provision. 8. The relationship with euthanasia. 9. Controversial issues.

• 보건행정학회지
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• 제22권1호
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• pp.29-48
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• 2012

The purpose of this study is to analyze medical expenses by decedents in their last year of life and compare them with those by survivors during the year 2008. This study is conducted firstly in Korea, except some studies focusing on medical cost of decedents from specific diseases. To study this, national health insurance(NHI) claims data was used with medicaid claims data. The study group(decedents) was selected from the insurance entitlement file who were dropped out from January to December of 2008. The control group(survivors) was selected from the entitlement file by stratified sampling with keeping age-sex composition of the study group. The medical expenses of decedents during one year before death were measured and compared with those of survivors by sex and age. And the medical expenses were analyzed by causes of death, and also the expenses were examined by each item of medical services. On average, the medical expense amounted to 11 million Korean Won per decedent during their last year of life in 2008. The medical expense per decedent was 9.3 higher than that of survivor. The death-related expense of under the age 35 was about 16 million Won, compared with 4 million Won in the case of over the age 95, in average. The death-related expense is higher in younger ages. This means that more medical resources are put in to save life in younger ages. Total death-related expenditure took 8.3 percent in total NHI expenditures. Of the death-related medical expenses, the largest one was injection-related cost which shares twenty five percent, and the second largest one was hospitalization charges, and then the third one was surgery cost. The results of this study suggested that we should pay attention to the medical expenses in the last of year of life when we study health care expenditure in Korea. In addition, we have to deliberate health care policy to cope with medical expenditures before death in more efficient way.

• 한국인구학
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• 제16권2호
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• pp.65-83
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• 1993

The purpose of this study is estimate limits of Korean life expectancy at birth by 'Gompertz growth curse Model', 'Cause-Elimination Model' and Multidimensional models of Senescencee and Mortality'. Data used in Gompertz curve were obtained from all life tables published from 1905 to 1990 in Korea, and life expectancies at birth of eighteen groups were selected at five-year interval in consideration of time-series changes. Data used in Cause-Elimination Model are 'Cause of Death statistics in 1991' published in 1992 by National Bureau of Statistics of Korea and 'life table of 1989' published in 1990 by National Bureau of Statistics, Economic Planning Board of Korea. The materials are all classifiable death data, 119, 253 cases of male and 82, 420 cases of female, which is from 1991 Causes of Death statistics. The cases of death analyzed belong to one of 8 categories; i.e., Infectious and Parasitic Diseases(001-139; with notation of Infectious Diseases), Malignant Neoplasms(140-208), Hypertensive Diseases(401-405), Ischemic Heart Dieases and Diseases of Pulmonary Circulation and Other Forms of Heart Diseases(410-429;with notation of Heart Disease), Cerebrovascular Diseases(430-438), Chronic Liver Diseases and Cirrhosis(571; with notation of Liver Diseases), Injury and Poisoning(800-999) and all other disease. Data used in 'Multidimensional models of senescence and mortality' were life table of 1989 published by National Bureau of statistics, Economic Planning Board of Korea and life table of 1970, 1978-79, 1983, 1985 and 1987. The major findings may be summarised as follows: 1. Estimate equations of Gompertz growth curve using life expectancy at birth during the 1905-1990 period are as the following. Male : y = 88.047697 $\times$ $0.199690^{0.903381x}$ Female : y = 95.632828 $\times$ $0.199690^{0.903381x}$ Limits of life expectancy at birth, which were estimated by Gompertz growth curve, are 88.05 for male and 95.63 for female. 2. The effect on life expectancy at birth eliminationg all causes death is 14.04 years(for male) and 10.86 years(for female). Astonishingly, eliminating the malignant neoplasms increase life expectancy at birth by 2.85 years for male 2.03 years for female in 1991. In table 8 we show the effect on life expectancy at birth of separately eliminating each of the 8 categorical causes of death. The theoretical limit to life expectancy by Cause-Elimination Model is 80.96 for male and 85.82 for female. 3. If the same rate of delay [0.376 year(male), 0.435 year(femable) per calendar year] continued, then life expectancy at birth would reach 74.82(male) years and 84, 10(female) years in 2010. With 14.04-years(male) and 10.86-years(female) effect attributable in 2010 would be 88.86 years(male) and 94.96(femable) years. 4. 'Multidimensional models of senescence and death' permits calculations of the value of the attribution coefficient (B), percent of loss per year of physiologic function. The results of Ro and B during the 1970-1989 period are listed in table 9. Estimate of limit to Korean life expectancy at birth by 'Multidimensional models of senescence and death' is 99.47 years for male and 104.74 years for female in 1989.

• Journal of Preventive Medicine and Public Health
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• 제38권1호
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• pp.9-15
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• 2005

Objectives : To analyze medical expenses by cancer site and survival time among cancer patients in their last year of life. Method : The study subjects were 45,394 people that had died of cancers in 2002, were registered by the Korea Central Cancer Registry and received National Health Insurance benefit in the last year (360 days) of life. Personal identification data, general characteristics, dates of death and cancer incidence, and site of cancer were collected from the National Statistical Office and the Korea Central Cancer Registry, and merged with the data of the individual medical expenses of the Health Insurance Review Agency. Results : Average monthly cost curves were U-shaped with high costs near the time of diagnosis and death, and lower costs in between. Medical expenses in the last year of life were around 30.3, 16.7, 13.0, and 12.1 million won among leukemia, lymphoma, ovarian cancer, and breast cancer patients, respectively. Digestive organ cancers including stomach, esophagus, liver, pancreas, and colorectal cancers had relatively low medical expenses. Medical expenses in the last year of life were inverse U-shaped with high expenses near one year of survival. Average monthly cost in the 12 months before death among the patients who had survived $10{\sim}15$ years were more than two-fold greater than the cost before diagnosis among those who had survived for less than one year. Conclusions : Leukemia was the most expensive cancer. It is possible that once diagnosed as cancer, medical expenses do not return to the level before diagnosis. Further research will be needed to understand the magnitude and change of the medical expenses among cancer patients with long term follow up data.