• 제목/요약/키워드: health care system

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노인의 질병 관념에 관한 문화기술적 연구 (An Ethnography of the Concept of Illness by the Elderly)

  • 조명옥
    • 성인간호학회지
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    • 제12권4호
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    • pp.690-705
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    • 2000
  • This ethnography was based on Kleinman's explanatory model of a health care system. It is conducted to make thick discription of illness conception of the elderly in a sociocultural context. The basic assumptions were as follows. 1) A health care system is a cultural system, and as with any other cultural system, it is a system of symbolic meanings anchored in a particular arrangement of social institutions and patterns of interpersonal relationships; 2) In all societies health care activities are more or less interrelated. Therefore, they need to be in a holistic manner as socially organized responses to disease that constitute a special cultural system; health care system; 3) Health and illness experiences are the natural process of disease. Individuals who recognized a for state of health, their family, neighbors, and communities define the state, search for causes of the health problems, and response to it. According by, they proceed to search for healing stratagies. So, understanding of the illness experience is the starting point for health care. The study participants were 12 elders aged 60 or more. The fieldwork was conducted in an agricultural clan village of Namwon city. The data collection and analysis were cyclic, from descriptive observation, domain analysis, focused observation, taxanomic analysis, selected observation, componential analysis, and finally cultural themes were all analysed. Proxemic and text analysis techniques were used according to the characteristics of the data. The data of sociocultural context and descriptive data were collected from 1990 to 1992. Informations on illness concepts were collected during 1994 using focused observation. Data confirming and contrast observations were conducted from 1997 and 1999. Illness concepts of the elderly were taxonomized supernatural cause, non-supernatural cause, immediate cause, and ultimate cause. The supernatural ones were ancestors, god of home, god of village, and ghost such as 'sal(evil force of dead man)' and 'gagqui(ghost of begger)'. The non-supernatural ones were Ki, natural phenomenones, natural objects, foods, human and human behaviors. Immediate ones were insufficiency and overflows, discretion and consolidation, disorder and out of order, cloudness and contamination, and fluctuation and stagnation of supernatural cause and non-supernatural ones. Ultimate causes were intrusion and loss of supernatural and nonsupernatural ones. The cultural themes of illness concepts of the elderly are: 1) illness concepts are not based on causality principle, but on reciprocal principle; 2) illness concepts are affected by social level and charicteristics of the patients; 3) the causes of disease are recognized as imposed both positive and negative effects on health based on interpretation of the indiviuals; 4) illness concepts reflects on principles of everyday life of the society members such as hierachial structure and group cohesiveness; 5) illness concepts are ruled on principle of reciprocity and spread; 6) illness concepts are interrelated with physical environment of the participants. It can be concluded that the illness concepts of the elderly in a traditional clan village are a component of health care system as a cultural system based on these results. The these results can be a useful basis for gerontological nursing practice and education.

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Korean National Health Insurance Value Incentive Program: Achievements and Future Directions

  • Kim, Sun-Min;Jang, Won-Mo;Ahn, Hyun-Ah;Jeong, Hyang;Ahn, Hye-Sook
    • Journal of Preventive Medicine and Public Health
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    • 제45권3호
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    • pp.148-155
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    • 2012
  • Since the reformation of the National Health Insurance Act in 2000, the Health Insurance Review and Assessment Service (HIRA) in the Republic of Korea has performed quality assessments for healthcare providers. The HIRA Value Incentive Program (VIP), established in July 2007, provides incentives for excellent-quality institutions and disincentives for poorquality ones. The program is implemented based on data collected between July 2007 and December 2009. The goal of the VIP is to improve the overall quality of care and decrease the quality gaps among healthcare institutions. Thus far, the VIP has targeted acute myocardial infarction (AMI) and Caesarian section (C-section) care. The incentives and disincentives awarded to the hospitals by their composite quality scores of the AMI and C-section scores. The results of the VIP showed continuous and marked improvement in the composite quality scores of the AMI and C-section measures between 2007 and 2010. With the demonstrated success of the VIP project, the Ministry of Health and Welfare expanded the program in 2011 to include general hospitals. The HIRA VIP was deemed applicable to the Korean healthcare system, but before it can be expanded further, the program must overcome several major concerns, as follows: inclusion of resource use measures, rigorous evaluation of impact, application of the VIP to the changing payment system, and expansion of the VIP to primary care clinics.

입원 아동 부모의 병원서비스 기대수준과 만족도 (Expectation and Satisfaction of Parents with Inpatient Hospital Service)

  • 최은경;김선희;정송이;조은희;최경숙;심소정;목미수;강은경;조윤경;변은숙;김경희;유일영
    • 임상간호연구
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    • 제17권2호
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    • pp.228-238
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    • 2011
  • Purpose: The purpose of this study was to investigate parent expectation and satisfaction with respect to pediatric inpatient care and to identify the variables related to parent satisfaction. Methods: The study was conducted in pediatric wards of a tertiary children's hospital in Korea. The participants were 361 parents of children who were inpatients. Data were collected using a structured questionnaire (The Pediatric Family Satisfaction Questionnaire) at the time of discharge. Results: The highest parent expectation domain was medical service. The parents were most satisfied with nursing service and least satisfied with general hospital service and accommodation. The parents expressed lower satisfaction with hospital facilities, equipment, noise, cleanliness, and communication by health care professionals. Parents with younger children reported higher expectation from the complete hospital service and those who had a longer length of stay reported higher expectation from the nursing service. Conclusion: To improve the quality of hospital services, we need to understand parent expectation and improve and provide clear communication. In addition, the general hospital service and accommodation should not be overlooked for improvement.

종별 의료기관 외래 경증질환 약제비 본인부담 차등정책 효과분석 (An Analysis of Effects of Differential Coinsurance Policy and Utilization of Outpatients Care by Types of Medical Institutions)

  • 박윤성;김진숙
    • 보건행정학회지
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    • 제27권2호
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    • pp.128-138
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    • 2017
  • Background: The purpose of this study is to analyze the effects of differential coinsurance policy on prescription drug coverage of outpatients by types of medical institutions. Methods: In this study, we used a sample cohort database of the National Health Insurance Service and frequency analysis and marginal logistic regression model using generalized estimating equation were used for statistical analysis. Results: The summary on the major research is followed. First, about 16% of patients who used only tertiary or general hospital due to 52 ambulatory care sensitive conditions before policy implementation moved to hospitals and clinics. However, about 57% of them still use tertiary or general hospital. Second, the factors influencing the utilization of hospitals and clinics after the implementation of the policy were gender, age, and income level. As a result, the policy is effective to reduce the medical use of outpatient mental patients in tertiary or general hospital, but the effect is not significant. Conclusion: Therefore, in order to achieve the purpose of the policy for establishing the health care delivery system, it is necessary to adjust the co-payment so as to feel the burden on the co-payment when the outpatient for 52 ambulatory care sensitive conditions is used at the tertiary or general hospital.

미국의 일차의료 평가 동향 및 시사점: 미국의 리얼월드 평가 안내서를 중심으로 (Trend and Implication of Primary Care Evaluation in U.S.)

  • 서유신;김희선;유빛나;김진희;박종연
    • 보건의료기술평가
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    • 제6권2호
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    • pp.88-94
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    • 2018
  • This review aims to provide implications for relevant domestic policies and researches from Patient-Centered Medical Home (PCMH), a reinforcement model for primary care and its evaluations in the United States. As chronic diseases became dominant, changes in the health care delivery system in which primary care is central was required. The United States initiated primary care-reinforcing policies based on the PCMH following the increased demand for evidence-based health care policies. The current activities of the United States such as sharing research tools used to evaluate primary care interventions and circulating evaluation findings provide examples to Korea. Systematic evaluations for primary care interventions are required and appropriate methods using various types of data to reflect the real-world settings should be prepared. It is necessary to conduct policy assessment studies of public interests considering regional context. Support for the researches to make and advance from the existing environment must be examined.

Comparison of the Health Insurance Systems of South Korea and Peru

  • Kim, Yanghee;Tantalean-Del-Aguila, Martin;Dronina, Yuliya;Nam, Eun Woo
    • 보건행정학회지
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    • 제30권2호
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    • pp.253-262
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    • 2020
  • Background: The public health care system of a country is shaped and driven by its historical background as well as social, economic, and cultural structures. This study sheds light on the unique features, strengths, and weaknesses of the health insurance systems of South Korea (Korea) and Peru. Methods: The capacity mapping tool was used to explore the Korean and Peruvian population and geographical structures; health insurance laws, regulations, and policies; payment systems; eligibility and contribution collection; and long-term care insurance. Results: The study found that the Korean government took the lead in integrating multiple insurers into a single-payer system in an effort to reinforce and stabilize its health insurance system in 2000. Peru has been developed mixed model such based on taxes and contributions, to address a gap between different social classes. Peruvian government developed a two-axis system, one for low-income earners, financed by taxes, and another financed by contributions paid by workers and government officials in the formal sector. Peru has introduced many variations to its fee payment and insurer systems, target population, and coverage scope, and maintains its health insurance system accordingly to this day. Conclusion: The current study provides observation of the Health Insurance System in two different countries and helps to understand possible ways to improve the health insurance system in both countries. Based on this study, Peru will be able to see how its system differs from Korea's and benefit from the related policy implications.

일본의 노인보건시설에 대한 연구 (Study of the Geriatric Health Care Facility in Japan)

  • 조유향
    • 보건교육건강증진학회지
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    • 제9권1호
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    • pp.79-87
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    • 1992
  • The objective of the present study is to review of the system, type of care and utility of the Geriatric Health Care Facility(GHCF) in Japan. Geriatric Health Care Facilities in Japan were started with subsidies from the Ministry of Health and Welfare in 1987 to encourage return of the elderly from hospitals to their homes rather than other destinations such as nursing homes or hospitals. Concerning to the type of care, there is the difference between GHCF and other geriatric care facilities(i.e., geriatric hospital and nursing home). GHCF provides both medical and nursing care. The following services are available for the GHCF's user's. As institutional care services, rehabilitation training, ADL exercise, nursing care and management of medicine, are available. For the out-patients, supplying meals, taking a bath, and rehabilitation services, are also available. The medical treatment fee at the facilities is about US $ 1,500 per month. Expenses for meals, daily necessities, shall be borne by the recipient, Those expenses are about US $ 360 per month. In anticipation of the coming of the aging society, the Goverment must be formulated consecutively several vital policies of measures, especially GHCF, for the elderly in the future few years.

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헬스 케어를 위한 무선 모니터링 시스템 구현 (An Implementation of Wireless Monitoring System for Health Care)

  • 엄상희;남재현;장용훈
    • 한국정보통신학회:학술대회논문집
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    • 한국해양정보통신학회 2007년도 추계종합학술대회
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    • pp.67-71
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    • 2007
  • 최근 고령 인구의 증가에 따른 헬스 케어 수요가 증가하고 있고 환자뿐만 아니라 일반인들에게서도 헬스 케어 모니터링에 대한 요구가 급증하고 있다. 또한 의료 서비스를 제공받으려는 대상자의 불편을 최소화하고, 지속적인 모니터링을 통한 헬스 케어가 가능할 수 있는 의료 기술과 의료 정보서비스에 대한 수요도 늘어나고 있는 추세이다 본 논문에서는 헬스 케어를 위한 무선 생체 신호 모니터링 시스템을 구현하였다. 구현된 시스템은 생세 신호 측정부와 무선 통신부로 구성된 센서 노드(sensor node)와 원격 시스템의 모니터링 프로그램으로 구성된다. 센서 노드에서는 심전도, 혈압, 맥파, 동맥혈산소포화도, 심박수를 측정할 수 있고 블루투스 기술을 이용하여 무선 전송을 하여 모니터링 시스템에서 실시간 무선 모니터링이 가능하도록 구현하였다.

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헬스 케어를 위한 무선 모니터링 시스템 구현 (An Implementation of Wireless Monitoring System for Health Care)

  • 엄상희;장용훈
    • 한국정보통신학회논문지
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    • 제12권8호
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    • pp.1401-1407
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    • 2008
  • 최근 고령 인구의 증가에 따른 헬스 케어 수요가 증가하고 있고 환자뿐만 아니라 일반인들에게서도 헬스 케어 모니터링에 대한 요구가 급증하고 있다. 또한 의료 서비스를 제공받으려는 대상자의 불편을 최소화하고, 지속적인 모니터링을 통한 헬스 케어가 가능할 수 있는 의료 기술과 의료 정보 서비스에 대한 수요도 늘어나고 있는 추세이다. 본 논문에서는 헬스 케어를 위한 무선 생체신호 모니터링 시스템을 구현하였다. 구현된 시스템은 생체신호 측 정부와 무선 통신부로 구성된 센서 노드(sensor node)와 원격 시스템의 모니터링 프로그램으로 구성된다. 센서 노드에서는 심전도, 혈압, 맥파, 동맥혈산소포화도, 심박수를 측정할 수 있고 블루투스 기술을 이용하여 무선 전송을 하여 모니터링 시스템에서 실시간 무선 모니터링이 가능하도록 구현하였다.

요양병원의 성장과 운영상의 주요 이슈 (Key Issues on Long-Term Care Hospitals in Korea)

  • 오은환
    • 보건행정학회지
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    • 제28권3호
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    • pp.257-262
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    • 2018
  • This study reviews the advent of long-term care (LTC) hospitals and its key issues in Korea. For analysis, enforcement ordinances and enforcement rules related to LTC hospitals were reviewed. Official statistic data were used for quantitative analysis and Organization for Economic Cooperation and Development data were utilized for comparative analysis. Various references and expert interviews were conducted for status analysis. As of 2016, the number of LTC hospitals was 1,386 and the number of beds were 246,373. It showed the trend of increasing medical care costs and the cost of care at LTC hospitals increasing from 998.8 billion Korean won in 2008 to 4,745.6 billion Korean won in 2016, accounting for 7.3% of the total National Health Insurance expenditure. From the societal perspective, several issues were pointed out within the current health care system related to LTC hospitals: establishment of roles, concerns about the increase in medical expenses, and the quality of medical personnel.