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Utilization and Expenditure of Health Care and Long-term Care at the End of Life: Evidence from Korea (장기요양 인정자의 사망 전 의료 및 요양서비스 이용 양상 분석)

  • Han, Eun-jeong;Hwang, RahIl;Lee, Jung-suk
    • 한국사회정책
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    • v.25 no.1
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    • pp.99-123
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    • 2018
  • Purpose: This study empirically investigates the utilization and expenditure of health care and long-term care at the last year of life for long-term care beneficiaries in Korea. Methods: This study used National Health Insurance and Long-term Care Insurance claims data of 271,474 LTCI beneficiaries, who died from July 2008 to December 2012. Their cause of death, place of death, health care costs, and the provision of aggressive care were analyzed. Results: Cardio-vascular disease(29.8%) and cancer(15.3%) were reported as their major cause of death, and hospital(64.4%), home(22.0%), social care facility(9.2%) were analyzed as the place of death. 99.3% of subjects used both health care and long-term care during the last 1 year of life. The average survival period were 516.2 days after they were LTCI beneficiaries. The health care expenditure gradually increased near the death, and the last month were three times more rather than the first month. Furthermore, 31.8% experienced some aggressive cares(CPR, blood transfusion, hemo-dialysis, etc.) at the last month of life. Conclusion: The results of this study suggest that it is important to develop the end of life care policies(for example, hospice, advanced care directives) for the LTCI beneficiaries. They might contribute to the improvement of quality of life and the reduction of health care expenditure of the elderly at the end-of-life.

Good Death Awareness, Attitudes toward Advance Directives and Preferences for Care Near the End of Life among Hospitalized Elders in Long-term Care Hospitals (요양병원 입원 노인의 좋은 죽음 인식, 사전의료의향서에 대한 태도 및 임종치료선호도)

  • Kim, Eunju;Lee, Yoonju
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.26 no.3
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    • pp.197-209
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    • 2019
  • Purpose: This study was done to examine good death awareness, attitudes toward advance directives (ADs), and preference for care near the end-of-life (PCEOL) of hospitalized elders in long-term care hospitals. Relevant characteristics were investigated as well as correlation of the variables. Methods: This descriptive research study involved 161 hospitalized elderly patients in long-term care hospitals. A self-report questionnaire was used to measure Good Death Scale, ADs Survey, PCEOL Scale, and general characteristics. Collected data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson correlation with SPSS/WIN 23.0. Results: In terms of good death awareness, a significant difference was observed; in according to age (F=3.35, p=.037), payer of treatment costs (F=3.98, p=.021), mobility (F=3.97, p=.021), heard discussion about ADs (t=-3.89, p<.001), and willing to complete ADs (t=2.12, p=.036). As far as attitudes toward ADs, the participants presented significant difference depending on religion (t=2.38, p=.018), average monthly income (F=3.91, p=.022), duration of hospital admission (F=5.33, p=.006), person to discuss ADs (t=-2.76, p=.006). On PCEOL, there was a significant difference, depending on religion (t=-3.59, p<.001) and perceived health status (F=3.93, p=.022). Finally, as for how the variables were related to each other, good death awareness and attitudes toward ADs had a weak positive correlation with PCEOL. Conclusion: To help seniors staying in nursing homes face a good death and enjoy autonomy, there should be educational and support systems that reflect each individual's sociodemographic characteristics so that the seniors can choose what kind of care they want to receive near the end-of-life.

PHRAGMEN-LINDELOF AND CONTINUOUS DEPENDENCE TYPE RESULTS IN GENERALIZED DISSIPATIVE HEAT CONDUCTION

  • Song, Jong-Chul;Yoon, Dall-Sun
    • Journal of the Korean Mathematical Society
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    • v.35 no.4
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    • pp.945-960
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    • 1998
  • This paper is concerned with investigating the asymptotic behavior of end effects for a generalized heat conduction problem with an added dissipation term defined on a three-dimensional semi-infinite cylinder. With homogeneous Dirichlet conditions on the lateral surface of the cylinder it is shown that solutions either grow exponentially or decay exponentially in the distance from the finite end of the cylinder. In particular, to render decay estimate explicit, we pattern after the analysis of Payne and Song [13, 15]. The continuous dependence effect of perturbing the equations parameters is also investigated.

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The Case Study of End of life EMU Treatment (전동차 폐차처리 실태)

  • Kim Yong-Ki;Mok Jai-Kyun;Hyoon Hee Taek;Lee Jae Young
    • Proceedings of the KSR Conference
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    • 2005.05a
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    • pp.1165-1171
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    • 2005
  • After 1974 an EMU, which is the first line opened, the car's term of endurance is introduced, End of life on the step, gradually the rate of cars out of service are increasing. In the country, we consider about recycled source, aspects of social economic of cars out of service and so on, treat efficiently and reasonable. According to research first we make investigations about the present situation and the actual condition of cars out of service then we should lay out schemes efficiently.

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The Characteristics of High-Speed Machining of Aluminum Wall Using End-Mill (엔드밀을 이용한 알루미늄 측벽 형상의 고속가공 특성)

  • 이우영;최성주;김흥배;손일복
    • Proceedings of the Korean Society of Precision Engineering Conference
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    • 2000.05a
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    • pp.912-916
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    • 2000
  • The term ‘High Speed Machining’has been used for many years to describe end milling with small diameter tools at high rotational speeds, typically 10,000 - 100,000 rpm. The process was applied in the aerospace industry fur the machining of light alloys, notably aluminium. In recent you, however, the mold and die industry has begun to use the technology for the production of components, including those manufactured from hardened tool steels. And the end mill is an important tool in the milling process. A typical examples for the end mill is the milling of pocket and slot in which a lot of material is removed from the workpiece. Therefore the proper selection of cutting parameter fur end milling is one of the important factors affecting the cutting cost. The one of the advantages of HSM is cutting thin-walled part of light alloy like Al(thinkness about 0.1mm). In this paper, firstly, we study characteristics of HSM, and then, we choose the optimal parameters(cutting forces) to cut thin-walled Al part by experiment.

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Nurses' Experiences of End of Life Care of Older Adults with Dementia (간호사의 치매노인 말기 돌봄에 대한 경험)

  • Kim, Chun-Gill;Lee, Young Hee
    • Korean Journal of Adult Nursing
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    • v.29 no.2
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    • pp.119-130
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    • 2017
  • Purpose: The purpose of this study was to understand the nurses' experiences of end of life care of older adults with dementia living in long-term care hospitals and geriatric care facilities. Methods: The participants were nine nurses. Open in-depth interviews were used to collect data from June, 2016 to November, 2016. Colaizzi's phenomenological approach was used to analyze the data. Results: Three categories were identified. The nurses' reported experiences of end of life care of older adults with dementia were 'warm care with living together', 'care for family', and the 'self-reflection and responsibility as a nurse'. There were ten clusters of themes and 24 themes. The participants stated that the end of life care of older adults with dementia were individualized holistic care with dignity, being in older adults with dementia and family, and responsibility as a professional. Nurses reported the need for dementia hospice care. Conclusion: These results could be considered in planning nursing intervention for hospice care. The findings support the need for educational strategies and programs to improve end of life care among older adults with dementia.

Clinical Analysis of Cases of Segmental Resection and Primary Anastomosis in Tracheal Stenosis (기관 절제 및 단단 문합술에 의한 기관 협착증의 치료)

  • 신호승;김영민
    • Korean Journal of Bronchoesophagology
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    • v.4 no.1
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    • pp.27-34
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    • 1998
  • Despite improvement in respiratory care, including use of low pressure and high volume cuffed tubes, tracheal stenosis remains a serious complication after a long-term tracheal intubation and tracheostomy. In such patients, tracheal resection and primary anastomosis is still considered ideal therapeutic modality. Between 1989 and 1997, we performed tracheal resections with end-to-end anastomosis on 14 patients with no operative mortality and some morbidity. Tracheal stenosis was caused by tracheostomy in nine patients, by endotracheal intubation in three patients and by thyroid carcinoma in two patients. The length of stenosis was various from 2cm to 4.5cm. All patient underwent segmental tracheal resection and primary anastomosis(14 patients) and additional procedures were cricoid cartilage reconstruction(2 patients), suprahyoid laryngeal release(3patients), carinal release technique(2 patients) and arytenoidectomy(2 patients). We have nine complications: granulona at anastomosis site in four patients, vocal cord palsy in two patients and restenosis, pneumonia, skin necrosis in each of those patients. The granuloma was removed by bronchoscopic forceps(4 patients). Vocal cord palsy was treated by arytenoidectorny(2 patients), restenosis by T-tube insertion, pneumonia by antibiotics and skin necrosis was treated by skin graft. We reviews our expenence of clinical features of tracheal stenosis and surgical treatment by tracheal one-to-end anastomosis with additional procedures to avoid postoperative complications for sucessful results.

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SIGNIFICANCE OF ACTINIDE CHEMISTRY FOR THE LONG-TERM SAFETY OF WASTE DISPOSAL

  • Kim, Jae-Il
    • Nuclear Engineering and Technology
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    • v.38 no.6
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    • pp.459-482
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    • 2006
  • A geochemical approach to the long-term safety of waste disposal is discussed in connection with the significance of actinides, which shall deliver the major radioactivity inventory subsequent to the relatively short-term decay of fission products. Every power reactor generates transuranic (TRU) elements: plutonium and minor actinides (Np, Am, Cm), which consist chiefly of long-lived nuclides emitting alpha radiation. The amount of TRU actinides generated in a fuel life period is found to be relatively small (about 1 wt% or less in spent fuel) but their radioactivity persists many hundred thousands years. Geological confinement of waste containing TRU actinides demands, as a result, fundamental knowledge on the geochemical behavior of actinides in the repository environment for a long period of time. Appraisal of the scientific progress in this subject area is the main objective of the present paper. Following the introductory discussion on natural radioactivities, the nuclear fuel cycle is briefly brought up with reference to actinide generation and waste disposal. As the long-term disposal safety concerns inevitably with actinides, the significance of the aquatic actinide chemistry is summarized in two parts: the fundamental properties relevant to their aquatic behavior and the geochemical reactions in nanoscopic scale. The constrained space of writing allows discussion on some examples only, for which topics of the primary concern are selected, e.g. apparent solubility and colloid generation, colloid-facilitated migration, notable speciation of such processes, etc. Discussion is summed up to end with how to make a geochemical approach available for the long-term disposal safety of nuclear waste or for the performance assessment (PA) as known generally.

A Public Relations Policy Studies on Recovered Confidence of the People for a Nuclear Power Plant (원자력 발전에 대한 국민 신뢰감 회복 PR 정책방안)

  • Yu, Seung-Yeob
    • Journal of Digital Convergence
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    • v.11 no.10
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    • pp.287-294
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    • 2013
  • This study were proposed for the promotion policy on public confidence in nuclear power recovery schemes. To this end, the existing survey and secondary data review and public distrust of nuclear power plant safety issues were raised. In addition, the meta-analysis data were analyzed by using. Promote public confidence in nuclear power plants recovered three major policy presented. First, the nuclear power plant for the economical / safety communication strategy, short term / long term in terms proposed. Second, strengthen the nuclear power plant reliability and short-term communication strategy / long term in terms proposed. Finally, Korea Hydro & Nuclear Power's long-term image building measures proposed. The results of this study Korea's nuclear power plants to increase confidence in the effect is expected to be presented.

Expansion Strategy of Home Visit Nursing Services of Long-Term Care Insurance (노인장기요양보험 재가방문간호 서비스 개발과 확대 방안)

  • Lim, Ji Young;Kim, Juhang
    • Journal of Korean Academic Society of Home Health Care Nursing
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    • v.27 no.3
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    • pp.241-249
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    • 2020
  • Purpose: This study aimed to investigate possible ways to expand the services of home-visit nursing through a review of the progress, achievements, and obstacles of home-visit nursing; a pilot project of an integrated home-service; the application of the Omaha System; as well as a case analysis of providing home-visit nursing services. Method: An integrated review was conducted using various source materials, including laws, previous studies, and a case analysis. Results: In case analysis of providing visiting nursing service, rehabilitation nursing, end-of-life nursing, and dementia care showed high nursing needs. It was necessary that the various home visit nursing services in the intervention area of the Omaha System, administrative services, case management, and center operation activities were all included in the payment systems of long-term care insurance. Conclusion: In the future, home visit nursing services of long-term care insurance should be reborn in the form of a center for integrated case management in the community, which would set long-term goals until the time of a client's death and encompass the realm of human rights for health, quality of daily life, and a dignity of life.