• Korean Journal of Social Welfare
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• v.40
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• pp.68-96
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• 2000

Parental leave in Sweden is a part of the health insurance in national social insurance system. It has two kinds of benefits. One is parental cash benefit paid for both husband and wife on the occasion of child birth, currently 450days for each child. The other is temporary parental cash benefit when a child under the age of twelve or a caretaker for him is illness, which is six months for a child a year. Parental insurance in Sweden permits parents to take care of their children just after birth at home with the amount of 80% of monthly income for 360 days and 60 Swedish krone each day for 90 days more. It also permits parents with children under the age of eight of part-time work and return to former job at full-time base when they want. It consequently encourages women's economic activity in her whole life and contributes to promotion of equality in sex roles between husband and wife. This insurance scheme is beneficient in that it enhances individual and family welfare and also secures labour force. This case study on Swedish parental insurance offers implication how to resolve the conflict between women's increased demand for economic activity and maternal role.

• Journal of Preventive Medicine and Public Health
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• v.45 no.4
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• pp.259-266
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• 2012

Objectives: This study aims to determine the risk factors predicting rehospitalization by comparing three models and selecting the most successful model. Methods: In order to predict the risk of rehospitalization within 28 days after discharge, 11 951 inpatients were recruited into this study between January and December 2009. Predictive models were constructed with three methods, logistic regression analysis, a decision tree, and a neural network, and the models were compared and evaluated in light of their misclassification rate, root asymptotic standard error, lift chart, and receiver operating characteristic curve. Results: The decision tree was selected as the final model. The risk of rehospitalization was higher when the length of stay (LOS) was less than 2 days, route of admission was through the out-patient department (OPD), medical department was in internal medicine, 10th revision of the International Classification of Diseases code was neoplasm, LOS was relatively shorter, and the frequency of OPD visit was greater. Conclusions: When a patient is to be discharged within 2 days, the appropriateness of discharge should be considered, with special concern of undiscovered complications and co-morbidities. In particular, if the patient is admitted through the OPD, any suspected disease should be appropriately examined and prompt outcomes of tests should be secured. Moreover, for patients of internal medicine practitioners, co-morbidity and complications caused by chronic illness should be given greater attention.

• Korea Journal of Hospital Management
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• v.25 no.2
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• pp.45-56
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• 2020

Purpose: The purpose of this study is to investigate medical care behaviors influencing accuracy of the payment based New diagnosis-related groups (DRG) compared to fee for service (FFS) in hospitalized patients with medical illness. Methodology: In order to estimate the difference in medical costs between New DRG and FFS depending on medical care behaviors, medical records and hospital claims data (n=4,232) were utilized, which were collected from a single public hospital during the first-half of 2018. Data were analyzed by descriptive statistics, t-test, chi-square test, and multivariate binary logistic regression. Findings: The average difference in medical costs between New DRG and FFS were KRW 506,711±13,945 with incentives and KRW -51,506±12,979 without incentives, respectively. Forty-four point two percent (44.2%, n=1,872) of total subjects were shown to have negative compensation in overall medical costs with New DRG compared to the costs with FFS. Medical care behaviors that affected on the negative compensation were the presence of severe bed sores on admission, medical consultations, death, operations, medications and laboratory or imaging tests with unit price over KRW 100,000, hospital-acquired complications or underlying comorbidities, elderly patients (≧65 years), and hospitalized for more than average inpatient days defined by New DRG (p<0.001). The difference in average medical cost between New DRG and FFS for a group with mild illness was KRW -11,900±10,544, whereas it was KRW -196,800±46,364 for a group with severe illness (p<0.0001). Practical Implications: These findings suggest that New DRG payment model without incentives may incompletely cover the variation of medical costs in real clinical practice. Therefore, policy makers need to consider that the current New DRG reimbursement should be focused and refined to improve accuracy of payment on medical care resources utilized in severe and complex medical conditions.

• Journal of agricultural medicine and community health
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• v.2 no.1
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• pp.65-72
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• 1977

This study was made with 1394 clinical records obtained by a mobile charity health team in a rural Korea for 10 days from July 23 to Aug. 1, 1977 to see the disease pattern of the rural population in Korea. The health team consisted of 7 physicians in different clinical departments of the St. Mary's Hospital tried to cover as many as patients in that area by giving full informations and instructions before starting health services. which supposed to minimize the omissions of patients visits in that area. The proportion of each disease as well as its order in terms of the number of patients was reviewed by matching with age and sex distribution of patients, and with the duration of illness (complaints). Major findings obtained in this analysis were as follows; 1. Among 1394 patients, 536 (38.5%) was male and 858(61.5%) was female. As to the age distribution of the patients. those who are in the age group of 10-19 showed the highest proportion of 15.6% and those who are in the age group of 5-9 and 40-49 was the next with the proportion of 15.4% and 15.2% respectively. 2. The most prevalent cause of general morbidity were diseases of digestive system, diseases of nervous system and sensory organs, diseases of respiratory system, and diseases of skin and subcutaneous tissue in order. And their proportions among all patients were 21.8%, 20.7%, 14.5%, and 12.4% in respectively. The order of the diseases ranked by the number of patiens was slightly different in female population from that of total population, i. e. diseases of nervous system and sensory organs was the first. diseases of digestive system was the second, and the diseases of circulatory system was the third. 3. 23.2% of all patients were found to have had symptoms relating to their illness for more or less 5 years, and 18.3%, for more or less 6 months. Looking at the duration of illness by diseases, 28.6% of digestive tract disease patients and had the relating symptoms for about 1 week while 24.3% had had the symptoms for about 5 years, and in diseases of nervous system and and sensory organs, many(33.7%) had had symptoms for relatively long period (more than one year). On the other hand, in diseases of respiratory system, those who had had the relating symptoms for about 1 month was 24.3 % among all patients in this category and those who had had the symptoms for less than 1 week was 32.2%. 4. The duration of illness (complaints) was longer in females than in males and shorter in younger age groups than in older age groups.

• Journal of Preventive Medicine and Public Health
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• v.24 no.4 s.36
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• pp.485-495
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• 1991

This study examined the effects of referral requirements for insurance patients which have been enforced since July 1, 1989 when medical insurance coverage was extended to the whole population except beneficiaries of medical assistance program. The requirements are mainly aimed at discouraging the use of tertiary care hospitals by imposing restrictions on the patient's choice of a medical service facility. The expectation is that such change in the pattern of medical care utilization would produce several desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities. In this study, these effects were assessed by the change in the number of out-patient visits and bed-days per illness episode and the share of each type of facility in the volume of services and the amount of expenditures after the implementation of the new referral system. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for the patients treated during the first six months of 1989, prior to the enforcement of referral requirements, and those of the patients treated during the first six months of 1990, after the enforcement. The 1989 sample included 299,824 claims (3.6% of total) and the 1990 sample included 332,131 (3.7% of total). The data were processed to make the unit of analysis an illness episode instead of an insurance claim. The facilities and types of care utilized for a given illness episode are defined to make up the pathway of medical care utilization. This pathway was conceived of as a Markov Chain process for further analysis. The conclusion emerged from the analysis is that the enforcement of referral requirements resulted in less use of tertiary care hospitals, and thereby decreased the volume of services and the amount of insurance expenses per illness episode. However, there are a few points that have to be taken into account in relation to the conclusion. The new referral system is likely to increase the use of medical services not covered by insurance, so that its impact on national health expenditures would be different from that on insurance expenditures. The extension of insurance coverage must have inereased patient load for all types of medical service organizations, and this increase may be partly responsible for producing the effects attributed to the new referral system. For example, excessive patient load for tertiary care hospitals may lead to the transfer of their patients to other types of facilities. Another point is that the data for this study correspond to very early phase of the new system. But both patients and medical care providers would adapt themselves to the new system to avoid or overcome its disadvantages for them, so as that its effects could change over time. Therefore, it is still necessary to closely monitor the impact of the referral requirements.

• Journal of Yeungnam Medical Science
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• v.9 no.1
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• pp.44-53
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• 1992

We compared the efficacy of each modality of treatment group in reducing the frequency of coronary artery abnormalities and changes of clinical courses in children with kawasaki disease in the children of 81 cases who were admitted in pediatric department of Yeungnam University Hospital from September 1985 to August 1990, Group A(37 cases)-aspirin alone, Group B(44 cases)-intravenous gammaglobulin(400mmg/kg/day) for 5 consecutive days, plus aspirin. We studied the frequency of echocardiographic abnormalities, the duration of fever, and changes in the total white blood cell counts, platelet counts, ESR and CRP value at 1, 2 and 3 weeks of the illness and compared the results between the two groups. The results were as follows, 1) There as no significant intergroup difference in age and sex ratio. 2) The duration of the febrile period after the initiation of the therapy was significant shorter in group B($2.5{\pm}1.2$ days) than in group A:($5.2{\pm}3.5$ days)(p<0.01). 3) No significant difference was noticed in the WBC and platelet counts in two groups as measured at admission day, 1 and 2 weeks of the illness. However, at 3weeks of illness significant difference was noted. 4) The CRP values measured at 1, 2 and 3 weeks after treatment were significantly lower in group B($2.42{\pm}1.8$, $2.00{\pm}1.2$, $1.16{\pm}1.0$) than in group A($7.22{\pm}5.3$, $5.25{\pm}3.9$, $1.85{\pm}1.2$) respectively(p<0.01). 5) In 2D- Echocardiogram, coronary artery dilataton was more frequent in Group A than in Group B at 6month of illness(p<0.01). In conclusion, intravenous gammaglobulin therapy was effective in the shortening of the duration of fever and in the antiinflammatory action and somewhat effective in prevention of coronary artery aneurysm.

• Journal of Preventive Medicine and Public Health
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• v.7 no.1
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• pp.211-222
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• 1974

The survey was carried out on 1,031 primary school children for about 1 month, from June 1, to June 30, 1974, for the purose of understanding indirectly scio-medical status of a remote rural area, reflecting health status of primary school children. The summarized results were as follows: 1) The average age of surveyed children according to school year by sex was older in girls than in boys. The entrance in school at suitable age was peaked as 80.9% in boys of 5th school year and 72.4% in girls of 3rd school year, and also sunk 68.8% in boys of 2nd school year and 58.7% in girls of 1st school year. 2) Prevalence rate according to W.H.O. diseases classification during last a month and a year. a) During last month: The diseases of respiratory system remarked the highest 101.1 in boys and 116.6 in girls. The next were diseases of digestive system (24.2 in boys and 32.1 in girls), The girls were higher than boys in prevalence rate. b) During last year: The diseases of diegestive system ranked the highest 133.0 in boys and next, the diseases of respiratory system (108.6 in boys). c) Present illness: Number of code III ranked the highest 129.2 and next XII(127.3) in boys but inverted in girls such as XII(144.9) and III(116.7) and also, Number of code XVII was prevalenced twice in boys than in girls. d) Chief complaints by sex: Abdominal pain ranked the highest 71.2 per 1,000 population and next headache (34.7) in boys but headache ranked the heighest 88.5 and next abdominal pain (63.3) in girls. e) Water drinking habit: Number of code IX was higher in habit of raw water drinker than in habit of boiled water drinker and healthy children were higher in boiled water habit group than in raw water habit group. The diseases of respiratory system were the highest 124.74 in girls and next, the diseases of digestive system (52.3 in girls). According to school year, healthy children were increased to higher grades. 3) Average sick day per total surveyed children and patient during last month and last year. a) Per surveyed 1,031 children was 0.28 days during last month and 0.98 days during last year. And also per patient was 1.78 days during last month and 3.22 days during last year. b) Average sick day was higher in girls than in boys during last month, but inverted during last year. 4) Average absented day per total surveyed children and patient during last month and last year. a) Per surveyed 1,031 children were 0.43 days during last month and 3.81 days during last year (omitted 1st school year). b) Per absented children were 2.0 days during last month and 7.10 days during last year. c) Per absented children were 8.16 days in boys and 3.17 days in girls. 5) Utilization of medical facilities: The drug-store was consulted 91.2% of the total utilized boys and girls. The strengthening of medical facilities and medical care activities in health subcenter is urgently required 6) Medical Expenses by period and sex: a) Average medical expenses per surveyed 1,031 children were 35.95 won, per patient were 298.04 won during last month. b) Average medical expenses per survey children (omitted 1st school year) were 80.56 won, per patient were 243.98 won and per treated patient were 318.87 won during last year. c) Medical expenses were higher in boys than in girls. 7) Rohrer index by sex, present illness and school year. a) Average Rohrer index was 129.8 in boys and 126.2 in girls. b) Average Rohrer index was increased for 1st school year to 2nd school year and thereafter falling down step by step by school year. c) Under 151-160 Rohrer index number of code III was the highest and above 151-160 Rohrer index of code XII was peaked.

• Tuberculosis and Respiratory Diseases
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• v.70 no.1
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• pp.28-35
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• 2011

Background: The aim of the study was to describe the characteristics, treatments, and outcomes of critically ill patients with pandemic Influenza A/H1N1 2009 at a major medical center in Korea. Methods: This retrospective observational study examined critically ill adult patients with pandemic Influenza A/H1N1 2009, who were admitted to the AMC between August and December 2009. Results: 27 patients with confirmed pandemic Influenza A/H1N1 2009 were admitted to the intensive care unit (ICU) at the Asan Medical Center (AMC). The median age (IQR) was 59 years (41~67), and 66.7% of the patients were older than 51 years. A total of 81.5% of the patients had 2 or more co-morbidities. The median time (IQR) from symptom onset to presentation was 2 days (1~4), and the median time from presentation to ICU admission was 0 days (0~1.5). All patients received oseltamivir (300 mg/day) and 13 patients received triple combination therapy (oseltamivir, amantadine, ribavirin). Twelve patients required mechanical ventilation on the first day of ICU admission. A total of 6 patients (22.2%) died within 28 days of admission. The patients who died had significantly higher acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores at presentation. There were no significant differences in age, co-morbidities, or antiviral regimens between survivors and non-survivors. Conclusion: Critical illness related to pandemic Influenza A/H1N1 2009 was common in elderly patients with chronic co-morbidities. All patients were given high-dose oseltamivir or triple combination antiviral therapy. Nonetheless, patients with critical illnesses associated with pandemic Influenza A/H1N1 2009 had a death rate of 22.2%.

• Korean Journal of Clinical Pharmacy
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• v.15 no.2
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• pp.75-81
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• 2005

Community acquired pneumonia (CAP) remains a prevalent and potentially life threatening illness. American Thoracic Society and Infectious Disease Society America recommend combination therapies with ${\beta}-lactam$ plus a macrolide or a fluoroquinolone monotherapy for the empirical treatment of CAP. The aim of this study was to compare moxifloxacin monotherapy with cephalosporin plus azithromycin combination therapies. From January 2004 to March 2005, 18 patients in the moxifloxacin group(MG) and 21 patients in the cefuroxime or ceftriaxone plus azithromycin group(CAG) with CAP were retrospectively reviewed with regard to clinical, laboratory and microbiological data. Each patient was stratified into mild (risk class I-II), moderate (risk class III) and severe (risk class VI, V) group according to and PSI (Pneumonia Severity Index) score. Each group was compared for microbiological eradication, clinical assessment, the length of hospital stay. As results, Total 39 patients with CAP were reviewed. The appropriateness of admission was 83.3% in MC vs. 76.2% in CAC. The mean length of the hospital day was for 8.31 days vs. 7.39 days, days switching parenteral to oral antibiotics in 5.19 days vs. 5.28 days, clinical improvement in 2.43 days vs. 2.61 days in MG vs. CAC. Radiological improvement required 3.75 days vs 3.63 days in MG vs. CAG and bacteriological eradication rate at discharge was the same in the both groups. Mortality rate was 11.1% (2 of 18) vs 14.3% (3 of 21) in MG vs. CAG (p=0.77). Drug cost of the mean 5 hospital days requiring parenteral antibiotics was the most inexpensive in moxifloxacin group for the 147,045 won, and ceftriaxone 1g-azithromycin group for the 170,285 won, cefuroxime bid-azithromycin group for the 207,800 won, ceftriaxone 2g-azithromycin group far the 220,570 won, cefuroxime tid-azithromycin group for the 251,700 won. There was no significant statistical difference in clinical, bacterial, radiological cure and hospital days, and switch to oral days. In conclusion, that i.v. moxifloxacin monotherapy was as effective as azithromycin plus cefuroxime or ceftriaxone combination therapies fur the treatment of CAP. In drug cost analysis, moxifloxacin is less expensive than CAG.

• The Journal of Pediatrics of Korean Medicine
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• v.13 no.2
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• pp.187-224
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• 1999

Background: In recent years, pediatric chronic sinusitis patients who don't respond with antibiotics are increasing, but there are a few reports on the herbal medicine therapy treating pediatric chronic sinusitis, so this report was studied. Objective: To demonstrate the effect of herbal medicine therapy in the chronic sinusitis before and after treatment using computed tomograpy (CT) and plain radiograpy. Materials and methods: Ninty patients (45 mail and 45 femail) treated in our hospital between February 1998 and August 1999 were studied. Ages ranged from 3 to 13 years (mean age :6.5 years). Sixty two patients had a underlyiing family history (allergy or sinusitis of parents or brothers), In the past history, 68 patients had asthma, allergy of milk, atopic dermatitis, bronchiollitis and irritable bowel syndrom. Illness period was from 10 days to 96 months (mean period:12.4 month). Duration of treatment were from 25 days to 200days (mean:96 days). To ascertain the efficacy of treatment, CT in the 42 and plain radiopgrapy in the 48 patients were checked out. In the CT, three images were obtained 2cm interval on the coronal and axial plan. CT findings of the chronic sinusitis were analyzed for mucoperiostal thickening before and after treatment using 4 grades;(normal, mild, moderate, severe). Normal was defined as below 3mm thickening of mucoperiosteum; mild was 3-5mm thickening; moderate was 5mm-1cm thickening; severe was above 1cm thickening. Plain radiograpy using Water's view provided maxillary sinus, anterior ethmoid sinus, frontal sinus. Normal was defined as simillar to density between sinus and oronasal cavity; mild was defined as generally increased density with no significant mucoperiosteal thickning; moderate was partial mucosal thickening without bony hypertropy; severe was total haziness with mucoperiosteal thickening. Gamihyunggyeyungyo-tang was administered mainly. Gamigwaghyangjeungki-san, Gamizwakwi-eum and Gamihyangso-san were administered for through oral route additional symptoms Results: Of the 90 patients, 84 patients showed complete recovery (93%), 4 patients showed no significant interval change(4%) and 2 patients were aggrevated (2%). Sixty patients were severe(67%) and 26 patients were moderate (29%), 4 patients were mild(4%) The duration of treatment was varied with patient conditions (91 days in average); severe were 101.7 days, moderate were 70 days and mild were 63 days. Fifty three patients with maxillary and ethmoid sinusitis were 114 days, 35 patients with maxillary sinusitis only were 71.5 days. Fifty eight patients with both maxillary sinusitis were 94.6 days, 26 patients with either maxillary sinusitis were 65 days. The symtoms of chronic sinusitis were nasal obstruction(75%), cough(69%), purulunt or mucosal discharge(62%), lymphoid follicle(54%), postnasal dripping(49%), headache(23%) and nose bleeding(22%). Conclusion: We know that herbal medicine therapy is the effective treatment of pediatric chronic sinusitis using plain radiograpy and CT. The duration of treatment may be significant assosiation with the location and degree of chronic sinusitis.