• Health Policy and Management
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• v.5 no.2
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• pp.155-172
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• 1995

This study is an empirical analysis on the equity in the delivery of heatlh care under the Korean Medical Insurance Corporation System. The purposes of this study are to find out effects of income on the health care utiliztion and measure the income-related inequity in the distribution of health care. This study was carried out based on the fact that the health insurance program has been organized to achieve the equity objective, "equal treatment for equal needs". Of 41, 828 insured persons who had been diagnosed in the 1993 Health Screening Test and utilifzation data from 1, January 1993 through 31, December 1993 were derived from the Benefit Managment File. Inequity was measured by means of I) share approach, ii) standardization concentration curve approach, iii) inequity index, iv) test for inequity. The major findings were as follows : 1. The expenditure shares of the top two quintile groups exceeded their morbidity shares, whereas the opposite was true of the bottom three quintile groups, Which showed a positive HI$_{LG}$ inequity index, suggesting the presence of some inequity favoring the rich group. 2. Compared with other residential areas, the rural area showed the highest positive HI$_{LG}$ irrespective of need indicatior applied. 3. Standardized expenditure concentration indices adjusted by age, gender and need structure were also found to be positive, and therefore still indicated that there has been inequity favoring the rich after the standardization. 4. The Loglikelihood Ratio (LR) test for the statistical significance of income-related inequity of medical care utilization was carried out using the logistic regression model. The resulting loglikelihood ratio test statistic value was 176, which did exceed the 0.5 percent critical value of the chi-square distribution with 28 degrees of freedom, which is 50.993. Therefore, the null hypothesis of no income-related inequity of medical care utilization was rejected at the 99.5 percent confidence level. 5. The Regression based F-test has been carried out for analyzing the income-related inequity of medical expenditure in terms of age, gender, morbidity indicators as explanary variables. The hypothesis of the absence of income-relate inequity was rejected for all need indicators at the 95% confidence level.nce level.

• Journal of Environmental Health Sciences
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• v.35 no.1
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• pp.1-10
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• 2009

This study assessed the relationships between levels of $PM_{10}$ and hospitalization rates for asthma among children from 2003 to 2005 at four major cities in Korea. In addition, we estimated the reduced number of asthma hospitalization associated with an ambient $PM_{10}$ improvement to the acceptable levels as recommended by the World Health Organization (WHO). The Generalized Additive Model (GAM) was used to estimate the relative risks (RR) of asthma hospitalization associated with changes in $PM_{10}$ The RRs of children's asthma hospitalization for every $10{\mu}g/m^3$ increment in $PM_{10}$ were 1.009(95% CI = 1.004-1.014) in Seoul, 1.013(95% CI = 1.006-1.021) in Incheon, 1.009(95% CI = 1.002-1.016) in Busan, and 1.021(95% CI = 1.005-1.037) in Ulsan. We assessed $PM_{10}$ related health benefits from implementing the WHO's guidelines (24-hour average $50{\mu}g/m^3$) using the U.S. Environmental Protection Agency's Environmental Benefits Mapping and Analysis Program. The estimated benefits were 439(95% CI = 216-666) reduced asthma hospitalization in Seoul, 720(95% CI = 304-1,151) in Incheon, 260(95% CI = 66-459) in Busan, and 126(95% CI = 30-228) in Ulsan. It was concluded that improving $PM_{10}$ condition to the WHO guideline would make a significant contribution to the reduction in asthma hospitalization among children. Therefore, public health measures are still needed to improve air quality in Korea.

• The Journal of the Korea Contents Association
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• v.19 no.4
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• pp.598-608
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• 2019

This study is empirically intended to look into the effects of safety income system on recipient's economic independence and life satisfaction under the social security system. To achieve this, a survey was carried out to 650 adult householders benefiting from the social security system. The SPSS 23 statistical program was used to apply measurement variables related to the safety income system. The results of this study are summarized as follows. The social insurance and the social assistance of safety income system were adopted, having a significant effect on the economic independence. The effect of economic independence on life satisfaction was rejected, while the effect of social assistance on life satisfaction was adopted, showing a difference in the effect of each factor. The findings imply that social insurance and social assistance with support for safe income can be a positive help for economic independence, and unemployment benefit, national pension, long-term care subsidy and health insurance can help to achieve real economic independence, adopting only social assistance with limitation to life satisfaction. Consequently, the safety income system is very useful in helping recipients to achieve their economic independence through its introduction, but there is some distance to meet their life satisfaction.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.8
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• pp.3383-3389
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• 2014

Background: Prostate cancer is rapidly increasing in Korea and professional societies have requested adding prostate specific antigen (PSA) testing to the National Cancer Screening Program (NCSP), but this started a controversy in Korea and neutral evidence on this issue is required more than ever. The purpose of this study was to provide economic evidence to the decision makers of the NCSP. Materials and Methods: A cost-utility analysis was performed on the adoption of PSA screening program among men aged 50-74-years in Korea from the healthcare system perspective. Several data sources were used for the cost-utility analysis, including general health screening data, the Korea Central Cancer Registry, national insurance claims data, and cause of mortality from the National Statistical Office. To solicit the utility index of prostate cancer, a face-to-face interview for typical men aged 40 to 69 was conducted using a Time-Trade Off method. Results: As a result, the increase of effectiveness was estimated to be very low, when adopting PSA screening, and the incremental cost effectiveness ratio (ICER) was analyzed as about 94 million KRW. Sensitivity analyses were performed on the incidence rate, screening rate, cancer stage distribution, utility index, and treatment costs but the results were consistent with the base analysis. Conclusions: Under Korean circumstances with a relatively low incidence rate of prostate cancer, PSA screening is not cost-effective. Therefore, we conclude that adopting national prostate cancer screening would not be beneficial until further evidence is provided in the future.

• THE INTERNATIONAL COMMERCE & LAW REVIEW
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• v.57
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• pp.283-303
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• 2013

When a trade conflict arises related to an officially supported export credit programme, The World Trade Organization(WTO), decides on whether the programme is a forbidden subsidy stipulated in the Agreement on Subsidies and Countervailing Measures(the ASCM Agreement). Korea was taken to the WTO panel two times for the export credit programme. One is the semiconductor case in 2002 and the other was the shipbuilding disputes in 2004. And, In 2012, the U.S. Commerce Department ruled K-SURE's export insurance for Korean refrigerator manufacturers as a forbidden subsidy even if the case was not taken to the WTO. This paper examines the significance of export credit programmes on the WTO ASCM Agreement and discusses how to operate these programmes so they would not infringe upon the Agreement by analyzing the actual cases of WTO subsidy conflicts that involved Korean enterprises in relation to export credit programmes for the purpose of determining the related issues and impacts. From this research the results were as follows: First, on whether export credit is a prohibited subsidy, the deciding factor was whether a benefit has been conferred to the beneficiary. On the presence of a benefit, the WTO panel used market benchmarks as the main criteria. Thus, official export credit agencies(ECAs) should be careful not to provide export credit support which had been granted to the beneficiary at better than market terms. Second, in the case of export credit, the special status of ECA as a public body receiving government support itself does not constitute a subsidy. However, caution must be taken not to provide export credit that may lead to WTO ASCM subsidy conflicts involving a certain exporter or industry by setting up clear and valid regulations and fair work processes in the operation of export credit programmes. Third, item (j) of Annex I cannot be interpreted reversely as this item is for interpreting the presence of a prohibited subsidy, not the presence of a benefit. Thus, an export credit program that confers a financial contribution, a benefit and specificity, could qualify as a prohibited subsidy. Fourth, ECAs not only have to maintain long-term account balance but also introduce additional measures to meet this long-term balance such as a clear and systematic premium system. Finally, export credit programmes that are not defined in item (j) of Annex I of the ASCM Agreement would not deemed as an prohibited export subsidy as long as the continued support of the programmes are not being forced.

• Journal of Ecology and Environment
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• v.40 no.2
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• pp.89-106
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• 2016

Many plant species have two modes of reproduction: sexual and asexual. Both modes of reproduction have often been viewed as adaptations to temporally or spatially variable environments. The plant should adjust partitioning to match changes in the estimated success of the two reproductive modes. Perennial plants showed that favorable habitats in soil nutrients or water content tend to promote clonal growth over sexual reproduction. In contrast, under high light-quantity conditions, clonal plants tend to allocate more biomass to sexual reproduction and less to clonal propagation. On the other hand, plants with chasmogamous and cleistogamous flowers provides with a greater tendency of the opportunity to ensure some seed set in any stressful environmental conditions such as low light, low soil nutrients, or low soil moisture. It is considered that vegetative reproduction has high competitive ability and is the major means to expand established population of perennial plants, whereas cleistogamous reproduction is insurance to persist in stressful sites due to being strong. Chasmogamous reproduction mainly enhances established and new population. Therefore, the functions of sexual and asexual propagules of perennial or annual plants differ from each other. These traits of propagule thus determine its success at a particular region of any environmental gradients. Eventually, if environmental resources or stress levels change in either space or time, species composition will probably also change. The reason based on which the plants differ with respect to favored reproduction modes in each environmental condition, may be involved in their specific realized niche.

• 한국노년학
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• v.31 no.4
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• pp.985-998
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• 2011

This study was conducted to understand current management status of 'day and night care' facilities and to explore the related factors with rates of operation of them. The nationwide mailing survey was conducted with structured questionnaires from July, 14, 2010 to July, 28, 2010. The subjects were 277 facilities (response rate 24.5%). Regarding the types of operating, 79.1% of faculties was run by cooperation, and 17.8% and 3.6% for individuals and national/public institutes respectively. The average of operation rate was 70.15%. National/public institutes showed higher in the rate of operation(79.08%) than 72.49% of cooperations and 57.78% of individuals. The number of manpower was not nearly different by the types of operating bodies, but the number of nurse was significantly different among them. The national/public institutions had 1.07 nurses while individual institutions have only 0.08. We found that facilities run by national/public institutes and founded before 2008 years showed higher rate of operation. In case of providing regular monitoring and evaluation services, and music program for patients showed higher rate of operation. In addition, the number of managers, social workers, and nurses increase the rate of operation. We suggest that quality management and monitoring program for the facilities which run by individuals or established after 2008 years would be developed. We also call for development of programs for facilitating utilization of 'day and night care' facilities such as expanding the family support.

• Health Policy and Management
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• v.11 no.2
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• pp.141-168
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• 2001

Healthcare service organizations can apply the cost of quality(COQ) model as a method to evaluate a service quality improvement project such as Total Quality Management (TQM). COQ model has been used to quantify and evaluate the efficiency and effectiveness of TQM project through estimation between cost and benefit in intervention for a quality Improvement to provide satisfied services for a customer, and to identify a non value added process. For estimating cost of quality, We used activities and activity costs based on Activity Based Costing(ABC) system. These procedures let the researchers know whether the process is value-added by each activity, and identify a process to require improvement in TQM project. Through the series of procedures, health care organizations are service organizations can identify a problem in their quality improvement programs, solve the problem, and improve their quality of care for their costumers with optimized cost. The study subject was a quality improvement program of the department of radiology department in a hospital with n bed sizes in Metropolitan Statistical Area (MSA). The principal source of data for developing the COQ model was total cases of retaking shots for diagnoses during five months period from December of the 1998 to April of the 1999 in the department. First of the procedures, for estimating activity based cost of the department of diagnostic radiology, the researchers analyzed total department health insurance claims to identify activities and activity costs using one year period health insurance claims from September of the 1998 to August of the 1999. COQ model in this study applied Simpson & Multher's COQ(SM's COQ) model, and SM's COQ model divided cost of quality into failure cost with external and internal failure cost, and evaluation/prevention cost. The researchers identified contents for cost of quality, defined activities and activity costs for each content with the SM's COQ model, and finally made the formula for estimating activity costs relating to implementing service quality improvement program. The results from the formula for estimating cost of quality were following: 1. The reasons for retaking shots were largely classified into technique, appliances, patients, quality management, non-appliances, doctors, and unclassified. These classifications by reasons were allocated into each office doing re-taking shots. Therefore, total retaking shots categorized by reasons and offices, the researchers identified internal and external failure costs based on these categories. 2. The researchers have developed cost of quality (COQ) model, identified activities by content for cost of quality, assessed activity driving factors and activity contribution rate, and calculated total cost by each content for cost for quality, except for activity cost. 3. According to estimation of cost of quality for retaking shots in department of diagnostic radiology, the failure cost was ￦35,880, evaluation/preventive cost was ￦72,521, two times as much as failure cost. The proportion between internal failure cost and external failure cost in failure cost is similar. The study cannot identify trends on input cost and quality improving in cost of qualify over the time, because the study employs cross-sectional design. Even with this limitation, results of this study are much meaningful. This study shows possibility to evaluate value on the process of TQM subjects using activities and activity costs by ABC system, and this study can objectively evaluate quality improvement program through quantitative comparing input costs with marginal benefits in quality improvement.

• Journal of Preventive Medicine and Public Health
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• v.11 no.1
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• pp.86-97
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• 1978

The mobile medical service has been operated for many years by a number of medical schools and hospitals as a most convenient means of medical service delivery to the people residing in such area where the geographical and socioeconomic conditions are not good enough to enjoy modern medical care. Despite of official appraisal showing off simply with numbers of outpatients treated and medical persons participated, however, as well recognized, the capability (in respect of budget, equipment and time) of those mobile medical teams is so limitted that it often discourages the recipients as well as medical participants themselves. In the midst of rising need to secure medical service of good quality to all parts of the country, and of developing concept of primary health care system, authors evaluated the effectiveness of and problems associated with mobile medical servies program through the community diagnosis of a village (Opo-myun, Kwangju-gun) to obtain the information which may be halpful for future improvement. 1. Owing to the nationwide Sae-Maul movement powerfully practiced during last several years, living environment of farm villages generally and remarkably improved including houses, water supply and wastes disposal etc. Neverthless, due to limitations in budget time and lack of knowledge (probably the most important), these improvements tend to keep up appearances only and are far from the goal which may being practical benefit in promoting the health of the community. 2. As a result of intensive population policy led by the government since 1962, there has been considerable advances in understanding and the rate of practicing family planning through out the villages and yet, one should see many things, especially education, to be done. Fifty eight per cent of mothers have not received prenatal check and the care for most (72%) delivery was offered by laymen at home. 3. Approximately seven per cent of the population was reported to have chronic illness but since only a few (practically none) of the people has had physical check up by doctors, the actual prevalence of chronic diseases may reach many times of the reported. The same fact was observed also in prevalence of tuberculosis; the patients registered at local health center totaled 31 comprising only 0.51% while the numbers in two neighboring villages (designated as demonstration area of tuberculosis control and mass examination was done recently) were 3.5 and 4.0% respectively. Prevalence rate of all dieseses and injuries expereinced during one month (July, 1977) was 15.8%. Only one tenth of those patients received treatment by physicians and one fifth was not treated at all. The situation was worse as for the chronic patients; 84% of all cases either have never been treated or discontinued therapy, and the main reasons were known to be financial difficulty and ignorance or indifference. 4. Among the patients treated by our mobile clinic, one third was chronic cases and 45% of all patients, by the opinion of doctors attended, were those who may be treated by specially trained nurses or other paramedics (objects of primary care). Besides, 20% of the cases required professional managements of level beyond the mobile team's capability and in this sense one may conclude that the effectiveness (performance) of present mobile medical team is quite limitted. According to above findings, the authors would like to suggest following for mobile medical service and overall medicare program for the people living in remote country side. 1. Establishment of primary health care system secured with effective communication and evacuation (between villages and local medical center) measures. 2. Nationwide enforcement of medical insurance system. 3. Simple outpatient care which now constitutes the main part of the most mobile medical services should largely be yielded up to primary health care unit of the village and the mobile team itself should be assigned on new and more urgent missions such as mass screening health examination of the villagers, health education with modern and effective audiovisual aids, professional training and consultant services for the primary health care organization.

• Journal of Korean Academy of Nursing
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• v.11 no.2
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• pp.33-54
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• 1981

The purposes of this study were to determine the relevant nursing needs of patients following discharge; to identify the degree of their nursing needs; to identify types and status of discharge order and information given to patients; and to determine their specific nursing needs according to their diagnosis. In addition, opinions toward home care services provided by hospitals or by public health nurses and appointment plans with their physicians were also asked in order to determine the necessity of follow-up care for the patient after discharge. Nine hundred and eighty eight subjects were collected among patients being discharged from one national university hospital and four city hospitals. Data were collected from June,1979 to December,1979 using questionnaires and interviews. On the bases of these data the following findings were observed; 1) Almost 40 percents of total subjects discharged from the hospital with some or great degree of nursing needs in general. The most problematic nursing needs were needs for comfort which include needs for releaving pain, for sound sleep and rest, because these needs can only be met by professional help. More than 50% of total subjects have this problem. 2) Needs for mental health, general metabolism, general hygiene and activities and safety were observed in more than 20 percent of subjects. 3) Discharge orders on diet and oral medication were recorded in patients' charts in 70% of all cases. However, more than fifty percents of patients have not been told these information from doctors or nurses. Even though some of them might have had appointment plans with their physicians, they would not keep the appointments unless they completely understood the necessity of the follow-up care. If they have not had any appointment or would not visit the out-patient clinic, there is no method of caring them and prerenting funther discomfort or complications. Even in injection, ski care, dressing and bath, only one thirds of the subjects having recorded discharge orders understood what they need after discharge. The rest of cases have not known what to do for their further care. 4) More than 80 percents and 70 percents of total subjects agreed to a system of home care services provided by hospitals or public health nurses respectively. That is, regardless of sources of medical expenses, most of patients wanted to be taken care of at home following discharge. 5) While more than half of the patients having benefit of medical insurance or paying fully by themselves had appointment plans with their physicians, only one thirds of the patients fully or partially paid by government had appointment plans with their physicians. These results ex-plain that the appointment plan is directly associated with their economic power. This indicates that the home care services are more needed to the people with lower economical status. 6) Those who have been in the hospital more than 24 days wanted !o have home care services more than those who had less hospital days. They also had more appointment plans than other groups. 7) More than 70 percents of the subjects who had been in a university hospital and approximately 30 percents of the subjects in the city hospitals had appointment plans with their physicians. 8) Those who had the cerebrovascular disease, cancer or hypertension demanded more nursing needs such as needs for comfort, for general metabolism and for mental health. 9) Factors which were associated with the degree of patients' nursing needs were age, duration of hospitalization, opinion toward home care services given by public health nurses, hospital appointments and types of hospital. That is, the older they were and the longer the periods of hospitalization were, the higher were their nursing needs. The more they had nursing needs, the more they wanted to have nursing services and had appointment plans. It can be concluded that there is a great demand for a positive and systematic home care services to the people who have been discharged from hospitals following critical care. This program is definitely demanded for the low income groups of people with less education with the financial assistance of the government or other funding agencies.