• 한국병원경영학회지
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• 제2권1호
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• pp.183-202
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• 1997

Health care organizations have been faced with financial difficulties under turbulent health care environment. This situation led hospitals to concentrate their efforts to improve their managerial efficiency in various ways. This study aims to evaluate technical efficiency of 31 tertiary hospitals in Korea and find determinants which are closely related with hospital efficiency. Data envelopment analysis(DEA) and Tobit Model were adopted for study. For the analysis, human resource factors such as number of physicians, nurses, and administrative staffs are used as input variables and the number of inpatients and outpatients) are used as output variables. Among 31 hospitals, in CCR model, 8 hositals showed efficiency score 1 which means they have been operated in very efficient ways and BCC model showed 13 of 31 hospitals as efficient organizations. Next, we analyzed determinants which are closely related with hospital efficiency. By using Tobit model, the study showed hospital size, Quality of care, value added per capita, and revenue per patient were closely related with hospital efficiency, However, it appeared that financial status of hospitals(i.e : making profit or not) was not related with hospital efficiency.

• Journal of Preventive Medicine and Public Health
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• 제50권2호
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• pp.91-99
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• 2017

Objectives: As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. Methods: A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. Results: The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. Conclusions: The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.

• 보건행정학회지
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• 제17권4호
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• pp.31-53
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• 2007

The purpose of a national health care system is to improve health care outcome among population. The objective of the study was to explore the determinants of health outcome in the 24 OECD countries between two health care financing systems. The study employed the pooled time series and cross-sectional analysis with tax-funded and social insurance-funded countries over the period of 1980 to 1999 using OECD Health Data 2002. The study revealed that health expenditure per capita, physicians per 1,000 of the population and calorie intake were positively significantly associated, smoking rate was negatively associated with health outcome while controlling all variables in the tax-funded countries. But in the insurance-funded countries, health expenditure per capita and the number of physicians were not statistically significant factors explaining health outcome. Only the calorie intake was positively associated with, and smoking rate, alcohol consumption per capita, and total nitrogen oxide emission per capita were negatively significantly associated with health outcome. In conclusion, healthy life style factors were much more important to improve health outcome in the both systems.

• Journal of Preventive Medicine and Public Health
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• 제49권1호
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• pp.69-78
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• 2016

Objectives: The suicide rate in Korea is increasing every year, and is the highest among the Organization for Economic Cooperation and Development countries. Psychiatric patients in particular have a higher risk of suicide than other patients. This study was performed to evaluate determinants of mental health care utilization among individuals at high risk for suicide. Methods: Korea Health Panel data from 2009 to 2011 were used. Subjects were individuals at high risk of suicide who had suicidal ideation, a past history of psychiatric illness, or had utilized outpatient services for a psychiatric disorder associated with suicidal ideation within the past year. The chi-square test and hierarchical logistic regression were used to identify significant determinants of mental health care utilization. Results: The total number of subjects with complete data on the variables in our model was 989. Individuals suffering from three or more chronic diseases used mental health care more frequently. Mental health care utilization was higher in subjects who had middle or high levels of educational attainment, were receiving Medical Aid, or had a large family size. Conclusions: It is important to control risk factors in high-risk groups as part of suicide prevention strategies. The clinical approach, which includes community-based intervention, entails the management of reduction of suicidal risk. Our study identified demographic characteristics that have a significant impact on mental health care utilization and should be considered in the development of suicide prevention strategies. Further studies should examine the effect of mental health care utilization on reducing suicidal ideation.

• 보건행정학회지
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• 제14권3호
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• pp.20-44
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• 2004

The National Health Insurance Expenditure has been increased rapidly since the introduction of the separation of prescription and dispensing in 2000, and this trend of rapid growth in overall spendings rate has been observed predominantly among medical practitioners. This study was conducted to investigate the growth rate and distributional changes in private medical practitioners' expenses from 1999 to 2002 and its determinants using the National Health Insurance claims data. The total increasing rate of all medical practitioners' expenditure paid by the National Health Insurance between 1999 and 2002 was $41.71\%$, which exceeding that of general hospitals by $20\%$p. But the income distribution among each practitioner was improved as the changes in Gini coefficient(from 0.40 to 0.38) and decile distribution ratio(from 0.25 to 0.29) during the same period showed. However, this improvement in distributional patterns is not enough since even in 2002 it turned out that the highest $10\%$ income group earned 33times more than the lowest $10\%$ income group did. Also, higher Gini coefficient was observed in larger cities and some department like plastic surgery, obstetrics and gynecology. The major causes of this differentials in medical practitioners' expenses were factors related to medical demand like proportion of old population, residential economic status in a given area. In addition, providers' economic incentives also played an important role in determining their income distribution. The large income differentials among physicians may imply a skewed distribution of patients and thus long waiting time, inefficient utilization of resources and potential inadequate quality of care. In this sense, unreasonable distributional gaps should be reduced, so effective measures as well as ongoing monitoring would be necessary to correct current distributional problems.

• 보건행정학회지
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• 제30권2호
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• pp.199-210
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• 2020

Background: Based on the importance of ceasing smoking programs to control the regional disparity of smoking behavior in Korea, this study aims to reveal the variation of smoke rate and determinants of it for 229 provinces. An evaluation of the relative efficiency of the cease smoking program under the consideration of regional characteristics was followed. Methods: The main sources of data are the Korean Statistical Information Service and a national survey on the expenditure of public health centers. Multivariate regression is performed to figure the determinants of regional variation of smoking rate. Based on the result of the regression model, clustering analysis was conducted to group 229 regions by their characteristics. Three clusters were generated. Using data envelopment analysis (DEA), relative efficiency scores are calculated. Results from the pooled model which put 229 provinces in one model to score relative efficiency were compared with the cluster-separated model of each cluster. Results: First, the maximum variation of the smoking rate was 16.9%p. Second, sex ration, the proportion of the elder, and high risk drinking alcohol behavior have a significant role in the regional variation of smoking. Third, the population and proportion of the elder are the main variables for clustering. Fourth, dissimilarity on the results of relative efficiency was found between the pooled model and cluster-separated model, especially for cluster 2. Conclusion: This study figured regional variation of smoking rate and its determinants on the regional level. Unconformity of the DEA results between different models implies the issues on regional features when the regional evaluation performed especially on the programs of public health centers.

• Journal of Preventive Medicine and Public Health
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• 제54권2호
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• pp.103-109
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• 2021

Objectives: The aim of this study was to calculate the burden of stroke in Kurdistan Province, Iran between 2011 and 2017. Methods: Incidence data extracted from the hospital information system of Kurdistan Province and death data extracted from the system of registration and classification of causes of death were used in a cross-sectional study. The World Health Organization method was used to calculate disability-adjusted life years (DALYs). Results: The burden of stroke increased from 2453.44 DALYs in 2011 to 5269.68 in 2017, the years of life lost increased from 2381.57 in 2011 to 5109.68 in 2017, and the years of healthy life lost due to disability increased from 71.87 in 2011 to 159.99 in 2017. The DALYs of ischaemic stroke exceeded those of haemorrhagic stroke. The burden of disease, new cases, and deaths doubled during the study period. The age-standardised incidence rate of ischaemic stroke and haemorrhagic stroke in 2017 was 21.72 and 20.72 per 100 000 population, respectively. Conclusions: The burden of stroke is increasing in Kurdistan Province. Since health services in Iran are based on treatment, steps are needed to revise the current treatment services for stroke and to improve the quality of services. Policy-makers and managers of the health system need to plan to reduce the known risk factors for stroke in the community. In addition to preventive interventions, efficient and up-to-date interventions are recommended for the rapid diagnosis and treatment of stroke patients in hospitals. Along with therapeutic interventions, preventive interventions can help reduce the stroke burden.

• 보건행정학회지
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• 제12권3호
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• pp.36-53
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• 2002

The purpose of this study is to investigate the determinants of intent to leave of hospital pharmacists. The independent variables contain three groups of determinants: environmental variables(job opportunity and external support), psychological variables(met expectations, growth desire, self-efficacy, and positive/negative affectivity) and structural variables (power, legitimacy, job variety, job significance, workload, physical environment, job security, pay, internal support, job growth, and promotional chances). The sample used in this study consists of 252 pharmacists working at hospitals in Seoul City, Inchon City and Kyunggi Province. Data were collected with self- administered questionnaires from Oct. 24 to Nov. 14 in 2001 and analyzed using path analysis. The results of this study indicate that the following variables, listed in order of size, have significant negative effects on intent to leave of hospital pharmacists; met expectations, organizational commitment, job satisfaction, promotional chances, and job variety. Job opportunity was found to have significant positive effect on the intent to leave of hospital pharmacists. Implications for hospital administrators and discussions for further research were suggested.

• 보건행정학회지
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• 제13권1호
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• pp.69-97
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• 2003

This study focuses on the determinants of the community health service utilization. Theories suggest seven models for community health service utilization, which are divided largely into two groups such as Health Service Supply Model and Health Service Demand Model: Supply Model includes Medical Implements Model, Personnel and Budget Model, Management System Model, Staffs' Behavior Model, Service Quality Model; Demand Model includes Area Model and Clients' Characteristics Model. This paper tests how the above models influence on the community health service utilization. After interviewing some administrative staffs of the Community Health Service Center at Pusan, questionnaires were made and mailed to the staffs of 198 Korean Community Health Service Center as a universe, among which from 98 centers we got response. Analyzing the data from the questionnaires, we found "the number of personnels in the health service center" and "demands for medical service" as important variables to affect the utilization of the community health service center. These two variables are typical factors representing Supply Model and Demand Model each. However, the variables selected from Management System Model, Administrative Behavior Model, Service Quality Model and Area model are not significant in a statistical sense. The paper suggests that to recruit the personnels, especially nurses, and to make out the demands of the clients for health service be the precedent conditions to increase the utilization of the Community Health Service Centers in Korea.ce Centers in Korea.

• 성인간호학회지
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• 제12권3호
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• pp.356-368
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• 2000

The purposes of this study were 1) to identify determinants of exercise behavior 2) to determine theoretical frameworks that were used in other research 3) to investigate the limitations of exercise research. seventy six research papers, published between 1984-1999, were selected by searching Medline for this study. Research subjects, determinants of exercise behavior, exercise measurement, the design of studies, statistical method and theoretical background were examined. The results are as follows. 1. On the research subjects, most research papers studied healthy adults. 2. Thirteen variables were identified that were used more than 5 times in various researches were self efficacy, barrier, social support, benefit, physiological characteristics, habit, personality, intention, health status, motivation, subjective norm, attitude, and affect. The most frequently supported determinant was self efficacy, the second one was social support, the third was affect and so on. But few research papers found any significant relationship between subject norms or attitude and exercise. 3. On exercise measurement, only 22.4% of research papers considered intensity, duration, frequency as elements of exercise, and 64.5% of researches were assessed by self-reported questionnaires. 4. In research design, 80.3% of research papers were survey type research. The most frequently used statistcal method was Regression. 5. 44.8% of research papers were done without any theoretical basis. Based on the above findings the following suggestions are made : 1. Research which includes diverse populations with different levels of health status needs to be studied. 2. Determinants of exercise may be dynamic and varing in their influence, therefore, stages of exercise behavior and processes of change need to be studied. 3. In research design, more prospective, longitudinal studies are needed to identify determinants of exercise habits. 4. It is necessary to develop a reliable, valid exercise measurement tool. 5. Studies are needed to develop a theoretical framework for exercise behavior.