• 한국노년학
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• v.40 no.4
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• pp.707-727
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• 2020

This study aims to empirically analyze the role that perception of the probability of lonely death among the elderly people living alone plays in the relationship between perceived social support and preference for institutional care based on Andersen's expanded Behavioral Model (2002). The subjects (n=676) of this study were the elderly people living alone, extracted from the "2018 Seoul Aging Survey." With "perceived social support" as an independent variable, "preference for institutional care" as a dependent variable, and "perception of the probability of lonely death" as a mediator variable, we conducted a Binary Logistic Regression to follow the three steps of analyzing mediation effect, as suggested by Baron and Kenny (1986). The results showed that perceived social support has a negative effect on the preference for institutional care and perception of the probability of lonely death among the elderly people living alone; at the same time, perception of the probability of lonely death was found to have a positive effect on their preference for institutional care. Lastly, perception of the probability of lonely death was found to partially mediate the effect of perceived social support among the elderly people living alone in terms of their preference for institutional care. Based on these findings, the practical implications of this study can be summarized as follows. First, various programs and support should be provided to the elderly people living alone in order to enhance the level of perceived social support, a factor that has been confirmed to increase preference for institutional care among the elderly people living alone. Second, as the perception of the probability of lonely death was confirmed to be a psychosocial factor of the preference for institutional care, we need to promote education and support for older people living alone to prepare them for lonely death. These efforts are expected to form a foundations for implementing a community-based integrated care system, "Aging in Place," which is the policy direction required for older people care.

• Health Policy and Management
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• v.12 no.4
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• pp.91-113
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• 2002

We report and analyze the Korean physicians' recent general strike over the implementation of the Separation of Prescribing and Dispensing Practice (SPDP) in which more than 18,000 private clinics and 280 hospitals participated. Utilizing game-theoretic models of bargaining we explain why the Korean physicians were so successful in organizing intense collective action against the government and securing very favorable policy outcomes. In particular, we highlight the role of distributional conflict among social actors in shaping the details of institutional reform. The introduction of the SPDP was a necessary first step in the overall reform of health care system in Korea. However, the SPDP was perceived to be a serious threat to the economic viability of their profession by the vast majority of Korean physicians who had long been relied on the profits from selling medicines to compensate for the loss of income due to the low service fee under the previous health care system. The strong political coalition among heterogeneous physicians enabled them to organize an intense form of collective action, the general strike. Thus, physicians were successful not only in dragging the government to a bargaining table, but also winning in the bargaining and securing an outcome vastly favorable to them. On the other hand, the lack of an overall reform plan in the health care policy area, especially the finance of the National Health Insurance and the need for maintaining an image as a successful reform initiator, motivated the government to reach a quick resolution with the striking physicians.