• 한국보건간호학회지
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• 제3권2호
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• pp.47-76
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• 1989

The objectives of this study was to analyze the major causes of decreasing utilization rate of health care institutios in pilot-project area of regional medical insurance, Kwang-hwa and Kun-wi country. After the implementation of medical insurance, utilization rate of health institutions turned out' to be lower than it was estimated, when the pilot-project of regional medical insurance was planned. It might be due to changes in inhabitant's behavioral attitude toward medical insurance. So this study was made to find measures for financial stability by increasing utilization rate of health care institutions and to be available for basic demand-supply program of medical care. The hypothesis of this study was as follows; First. there is difference in understanding health care institutions between Kun-wi and Kwang-hwa. Second. respondesnts of inquiry survey have exact knowledge of their past experience of treatment taken prior to enforcement of medical insurance, Questionaire survey was made as to each 700 household among total 11, 884 households in Kun-wi and 20,919 households in Kwang-hwa. In case of Kun-wi, 70% of inquired households (491) gave their answers. In Kwang-hwa, the number was 560 households (80% of inquireds). Dollected data was processed and analyzed by way of using SPSS batch system. To evaluate facto rs distribution aspects of data and to make comparison between two area, percentage and $X^2$ distribution were applied. The results were as follows; L The utilization rate of health care institutions in Kun-wi and Kwang-hwa was lower than it was estimated. when pilot-project of medical insurance was planned. 2. Prior to the implementation of medical insurance. inhabitants in two area chose the medical institutions considering such factors. First was medical care fee cheap. second in habitant's residence, Third was the institutions conveniently easy of access. 3. After the implementation of medical insurance. 26.1% of inqurieds in Kun-wi and 41.6% in Kwang-hwa, changed medical institutions. In case of Kwn-wi, from health care institution (p 0.05), and in case of Kwang-hwa, vice versa, from general medical institutions to health care institutions. 4. Evaluation by factors were made such as follows. Inquired gave high marks to following facts: In case of Kun-wi, general medical institutions were difficult of access and relation between patients: was not friendly, but burden of medical expenditure was light. Effects of treatment and facilities was good. In case of Kwang-hwa, inquired gave high evaluation marks to the follow ing facts; facilities of medical institutions was not good, but the burden of medical expenditure was light. 5. After the implementation of medical insurance, the services was evaluated as good, but inquired hopec for lessening the burden of medical expenditure. 6. In case of exact understanding of cost-sharing, the evaluation rate in Kwang-hwa was higher than that of Kun-wi (p < 0.005). And positive attitude toward necessity of medical insurance was also good in Kwang-hwa (p < 0.05). 7. In case of inquired's attitude toward medical institutions, Kwang-hwa showed positive response (p < 0.05) 8. In the case of comparison between general medical institution and health care institution, two area showed similar positive response; medical manpower, facilities of medical institutions and effest: of treatement was good. 9. In comprehensive evaluation of benefit-service; the general medical institution's positiveness was higher than that of health care institutions in Kun-wi. But in Kwang-hwa vice-versa. 10. If the medical expenditure of general medical institution and health care institutions was equal 77% of inquireds in Kun-wi and 59.1% in Kwang-hwa answered that they chose general medical insurance. Considering results above mentioned, the conclusion of this study was made as follows. 1. In Kwang-hwa county, where the understanding of health care institutions's was good, the utilization's of health care institutions was shown high. Therefore, in case of Kwang-hwa, betterment: should be made to induce increasing utilization rate for negative factors of health care institutions. 2. In case of Kun-wi, where the understanding of health care institutions was on the decrease, measures for changing such negative factors should be taken by way of strengthening public relations. And cases of Kwang-hwa should also be studied. 3. On the side of financial stabilization and establishing health care delivery system, primary health care should be available. Therefore, the major cause of inhabitant's avoiding health care institutions should be known. And measures for activating that institutions have to be taken. So, the facilities of health care institution have to be improved up to the level of clinic. And supportive measures for securing equipment and improving health care services should also be taken. It is necessary that strategy for public relations should be employed with policy considerations and supports.

• 대한예방의학회:학술대회논문집
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• 대한예방의학회 2002년도 제54차 추계 학술대회 연제집
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• pp.241-242
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• 2002

• 보건행정학회지
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• 제23권1호
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• pp.90-100
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• 2013

Background: This study examined the relationships of dementia, stroke, and combined multimorbidity with long-term care utilizations among older people in South Korea. Methods: A nationally representative sample of 10,130 older adults who used long-term care services in 2010 were analyzed. We used the 5% sample of aged 65 years or older linked with National Health Insurance Corporation registry data of long-term care insurance system. The sample was categorized into three groups: dementia only (47.6%), stroke only (36.3%), and both dementia and stroke (16.1%). We estimated the use of institutional care, home care, and total expenditure of long-term care services, adjusting for the severity of each function (such as daily life, behavior or cognitive change, nursing care needs, and rehabilitation care needs) and sociodemographic characteristics. Results: Having dementia symptoms was positively associated with the use of institutional care services, on the other hand, having stroke symptoms was positively related with the use of home care. The total long-term care cost was higher in the group of having both dementia and stroke. Conclusion: Older persons with dementia symptoms and stroke symptoms have different patterns of long-term care utilization, and the multimorbidity increased the overall expenditure of long-term care utilization. These findings imply a need for differentiated management strategy targeting physically and cognitively impaired older persons, and special concerning for persons with multimorbidity conditions for long-term care insurance program in Korea.

• 보건행정학회지
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• 제32권3호
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• pp.245-246
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• 2022

Concerns about a global economic recession are rising following the coronavirus disease 2019 (COVID-19) pandemic. Accordingly, government entities, which are committed to overcome two barriers to severe inflation and economic recession, are showing high interest in spending management so as not to undermine fiscal soundness. Since the health care sector especially accounts for a large proportion of fiscal expenditure, it should be managed in a manner that the expense is appropriately spent. The National Health Insurance System and Healthcare System have secured international competitiveness and reliability by effectively responding to the COVID-19 pandemic. Likewise, considerable efforts should be made to reorganize the welfare and healthcare systems so that they can be sustainable during the post-COVID-19 era and the recession.

• 지역사회간호학회지
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• 제30권4호
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• pp.528-538
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• 2019

Purpose: The purpose of this study was to follow-up the frailty of the old who received home health care by Registered Nurse in Public Health Center over 8 years. Methods: We used the second wave data which was a comprehensive longitudinal data set, Public Health Information System of a public health center located in Seoul from 2010 to 2018. For statistical analysis, a mixed model of repeated measures by R program was used. Results: Frailty (range: 0~31) was getting worse significantly from 5.38 on registration to 6.54 on 4th year, 7.40 on 7th year, 7.69 on 8th year with adjustment for age, sex, economic status, the number of family, and the number diseases. The coefficient of parameters with frailty change was serviced year (β=0.29, p<.001), age (70~79 to 60~69; β=0.98, p=.018) and sex (female to male; β=2.55, p<.001). Conclusion: This study showed that the home visiting health service needs to take attention to aged 70s and over, female. The home health care of public health center need to be extended more practical and effective services in terms of 'community care'and 'ageing in place'.

• 보건행정학회지
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• 제21권1호
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• pp.93-114
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• 2011

This study was conducted to identify college students' supportive attitude toward the elderly and their awareness of the socialization of care for the elderly, since they will have the responsibility for and the support of the aged society in the near future. This study was also conducted to analyze the factors which affect the socialization of elderly care, and to contribute to building a care system which promotes ahealthy and happy lifestyle for the elderly. After conducting a survey of 1,100 students from13 universities around the entire country, I have analyzed 1,089 data forms, and omitted 11 data entries which had errors or were not answered. 1. Those surveyed are 1,089 students from 13 universities around the entire country. Regional distributions are as follows : 263 students from 4 universities in Daegu and Kyongsangbuk Do(24.2%), 291 students from 3 universities in Busan and Kyongsangnam Do(26.7%), 272 students from 2 universities in Jeolla Do(25.0%), 263 students from 4 universities in Seoul and Gyeonggi Do. Males are 51.7% and females are 48.3% of these students. 2. Instrumental supportive sense level is high in men and emotional supportive sense level is higher in women. Also emotional supportive sense is higher in groups of those having more family members and coming from agricultural regions. 3. The sense of living with aged parents is higher in those living with grandparents than those living separate. The sense of living with sons and daughters after aging is stronger in the students from the Science and Engineering Departments than in the Social and Human Sciences Departments; also higher for men than women. 4. Recognition of elderly care socialization is higher in those from Social and Human Sciences Departments than from Science and Engineering Departments; higher in the case of upper classmenand aged groups, groups having fewer family members than more family members, and in the case of living separated from grandparents. 5. The factors affecting the sense of living with grandparents were family cohesion and instrumental supportive sense. The factors affecting the sense of elderly care socialization were family cohesion, instrumental supportive sense, and emotional supportive sense. From the results it is concluded that to insure a healthy and happy lifestyle for aged people, elderly care socialization offered by society and the country must provide desirable, appropriate care services based on the centralized support system of the family. In order to do this, we propose that elderly care needs inter-family and inter-generational fusion programs to improve family cohesion and care recognition. Also, elderly care is in urgent need to build a strong Family and Health Welfare System for care socialization.

• Journal of Preventive Medicine and Public Health
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• 제46권6호
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• pp.300-308
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• 2013

Objectives: The purpose of this study was to classify determinants of cost increases into two categories, negotiable factors and non-negotiable factors, in order to identify the determinants of health care expenditure increases and to clarify the contribution of associated factors selected based on a literature review. Methods: The data in this analysis was from the statistical yearbooks of National Health Insurance Service, the Economic Index from Statistics Korea and regional statistical yearbooks. The unit of analysis was the annual growth rate of variables of 16 cities and provinces from 2003 to 2010. First, multiple regression was used to identify the determinants of health care expenditures. We then used hierarchical multiple regression to calculate the contribution of associated factors. The changes of coefficients ($R^2$) of predictors, which were entered into this analysis step by step based on the empirical evidence of the investigator could explain the contribution of predictors to increased medical cost. Results: Health spending was mainly associated with the proportion of the elderly population, but the Medicare Economic Index (MEI) showed an inverse association. The contribution of predictors was as follows: the proportion of elderly in the population (22.4%), gross domestic product (GDP) per capita (4.5%), MEI (-12%), and other predictors (less than 1%). Conclusions: As Baby Boomers enter retirement, an increasing proportion of the population aged 65 and over and the GDP will continue to increase, thus accelerating the inflation of health care expenditures and precipitating a crisis in the health insurance system. Policy makers should consider providing comprehensive health services by an accountable care organization to achieve cost savings while ensuring high-quality care.

• 한국직업건강간호학회지
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• 제4권호
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• pp.48-57
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• 1995

The purpose of this study was to assess the performance of the role and function of some industrial nurses and to characterize the factors affecting the performance of their activities. Thus the results could be used to suggest the direction in the performance of industrials nurses' activities effectively. During a period from January 10 to March 31, 1994, the data were collected from 87 industrial nurses, who were working as health managers in the plants, in Ulsan city and the vicinity in Kyungnam province, using a structured questionnaire. The results were as follows : 1. The general characteristics of industrial nurses in this study were 82.8% being 30 years old or less, 60.9%, being not married, and 93.1% having eduction levels above junior college. 2. With respect to general work conditions, 94.3% were working in a separate room provided for health care division, 40.2% working under the safety and health department, and 98.9% working as common-level staffs. And 60.9% were working less than 44 hours a week, 70.1% had work experiences less than 5 years, and 50.6% had annual incomes ranging 10 to 14 million wons. 3. As work conditions related to health care activities, 49.4% performed the activities not related to health care as always or occasionally, and 87.4% answered that occupational physicians were appointed in their plant and among them, however, only 6.9% worked on full-time basis and 52.8% perform little activities as occupational physicians. For a decision related to health care activity, 69.0% discussed the problems with the supervisors, and 19.5% made decisions by themselves. 4. As for attitude and perception to their activities as health managers, 66.7% moderately recognized the importance of health manager in the workplace, with 63.2% being satisfied their wages and treatment from the company, 57.5% being satisfied with their job positions and 51.7% having positive attitudes as being health managers. 5. The degree of performance at least in one of health related activities were very high in activities such as general medical care(100%), general health examination(98.0%) and specific health examination(100%), and relatively high in health education(72%), new employee health examination(60.9%), document handling(79.3%) and activity for work environment(70.1%). However, the performance rate was very low in preparing protective equipment (20.8%). 6. The levels of activities related to health care were significantly high when making decisions by themselves, when occupational physicians not being full-time, and when satisfying their job positions, and, on the other hand, significantly decreased as work hours increased. 7. In addition to some kinds of periodic education asked by all of the nurses, 89.7% wanted a specialized licensing system for industrial nurse, and 97.4% wanted to apply for the license test. As a conclusion, it is suggested that industrial nurses should be given more authority and placed in more self-controlled system to perform health care and other activities more efficiently, and the role and function of the occupational physician should be clearly distinguished from that of the industrial nurse as a health manager to avoid an unnecessary overlapping.

• 지역사회간호학회지
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• 제23권4호
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• pp.347-357
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• 2012

Purpose: The purpose of this study was to explore the experiences of family caregivers who care for the elderly under Long-term Care Insurance. Methods: Data were collected using focus group interviews and analyzed using a phenomenological approach. The four focus groups consisted of eight caregivers, two social workers and three nurses in B city, Korea. Results: Five themes were identified: 'Obtaining a care-helper certification for employment', 'Taking care of the elderly in their homes', 'Difficulties due to life changes', 'Difficulties due to reduced wages' and 'Dissatisfaction with the Long-term Care Insurance operating system'. Conclusion: The results of this study demonstrate that the long-term care system for family caregivers faces many systematic challenges in providing care for the elderly harmoniously in their home. To help them succeed in their tasks, Long-term Care Insurance system must offer respite and support programs to family caregivers.

• 대한간호학회지
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• 제24권2호
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• pp.216-225
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• 1994

The cost of hospice care should be covered by the insurance system if it is to be promoted in our country and this, in turn, requires a proper method to the estimate of this cost. The purpose of this study was to set up the method to estimate the cost of hospice care. First the cost effectiveness of hospice care were studied. By tracing the activities of hospice nurses for a given period, all the relevant data such as the scope and load of activities as well as the cost were collected. Then these were analysed and compared with the data obtained from hospice and home care. The results showed that the cost of hospice care was the most economic, and indicate its qualification as .1n in-dependent system. The main part of the cost of hospice care was found to be the labor cost which was up to 83% of the total. Therefore a method to estimate the cost should reflect the real labor cost. Several methods have been proposed in the study in terms of unit labor cost, service time, material cost, and the weight of the labor cost. All variables, including the service time surveyed in this study, can easily be translated into numerical values and it would not difficult to estmate the cost of hospice care. Hence by letting the hospice care be insured, hospice care can be expected to function as a good alternative to the present medical system.