• Journal of Preventive Medicine and Public Health
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• 제25권1호
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• pp.88-100
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• 1992

1989년 7월 1일부터 실시된 의료전달체계가 3차진료기관에 미친 영향을 분석하기 위하여 실시전(1988년 7월 1일$\sim$1989년 6월 30일)과 실시후(1989년 7월 1일$\sim$1990년 6월 30일) 각 1년간 영남대학교 의과대학 부속병원의 내과, 일반외과, 소아과 외래를 이용한 공무원 및 사립학교교직원 의료보험 대상자 전원을 대상으로 실시한 성적을 요약하면 다음과 같다. 내과 환자는 의료전달체계 실시전 9,669건에 비해 실시후 6,181건으로 36.1% 감소했고, 일반외과는 1,864건에서 1,422건으로 23.7%, 소아과 환자는 3,372건에서 2,128건으로 36.9% 감소하였다. 내과 환자의 평균연령은 의료전달체계 실시전에 49.7세였으나 실시후 52.5세로 증가하였고, 일반외과도 46.5세에서 49.7세로 증가하였다. 성별 분포는 세 과 모두에서 큰 변화는 없었으나 일반외과의 경우 여자 환자가 약 3.0% 포인트 증가하였다. 지역별 분포에서 내과와 소아과 환자는 대구시내 이용자의 비율이 의료전달체계 실시후에 약간 증가하였고, 타 대진료권에서 방문한 환자 비율은 감소하였으나, 일반외과의 경우는 이와 상반된 결과를 보였다. 신환자의 비율은 내과의 경우 의료전달체계 실시전 24.4%에서 실시후 14.6%로 감소하였고, 일반외과는 36.0%에서 23.5%로, 소아과는 15.5%에서 8.3%로 현저히 감소하였다. 의료전달체계 실시 전후의 외래 방문 횟수는 내과가 각각 1.7회와 1.6회로 감소하였으나, 일반외과와 소아과는 큰 변화가 없었다. 의료전달체계 실시전후의 건당 외래진료 일수는 내과의 경우 각각 16.1일과 19.3일, 일반외과 12.0일과 15.2일, 그리고 소아과는 8.9일과 11.2일로 세 과 모두에서 실시후에 유의하게 증가하였다(P<0.01). 의료전달체계 실시 전후의 건당 검사건수는 내과가 각각 2.2건과 2.5건(P<0.01). 소아과가 0.8건과 1.1건(P<0.05)으로 유의하게 증가하였고, 일반외과의 검사건수도 약간 증가하였다. 건당 평균진료비를 불변가격으로 보았을 때, 일반외과가 실시전 75,900원에서 실시후 78,500원, 소아과는 실시전 12,700원에서 실신후 13,500원으로 증가하였으나, 내과는 43,900원에서 42,500원으로 실시후에 오히려 감소하였다. 질병분류를 17대 분류로 했을 때, 내과의 경우 내분비계질환, 순환기계 질환, 호흡기계 질환 등의 비율은 실시후에 증가하였으나, 소화기계 질환, 비뇨생식기 질환, 증상증후가 불명확한 질병은 감소하였다. 일반외과의 경우는 신생물 환자의 비율이 증가하였으나, 순환기계 질환과 증상증후가 불명확한 질병은 감소하였다. 소아과는 신생물, 신경감각계질환, 순환기계 질환 등의 비율은 증가하였으나, 호흡기계질환과 증상증후가 불명확한 질병은 감소하였다. 그리고 10대 다빈도 질환은 일반외과에서는 의료전달체계 실시후에 그 비중이 증가하였으나, 내과와 소아과는 변화가 없었다. 내과의 경우 위 십이지장염, 기타 간질환, 위기능 장애 등의 비율이 감소하였으나 본태성고혈압, 당뇨병, 폐결핵, 협심증 둥의 비율이 증가하였다. 일반외과의 경우에는 치핵, 항문열상, 종기 등의 비율이 감소하였고, 위암, 대장암, 담낭암 등의 비율은 증가하였다. 소아과의 경우 급성상기도염, 기관지염, 불명확한 장관감염 등의 비율은 감소하였고, 간질, 폐결핵, 천식, 임파성백혈병 등은 증가하였다. 이상의 결과로 보아 의료전달체계가 실시됨으로써 3차 진료기관의 외래 방문 환자의 건수, 건당 진료기간, 건당 방문횟수, 건당 검사건수, 건당 진료비, 질병의 구성 등에 변화를 준 것으로 생각된다. 향후 더욱 광범위한 자료를 이용하여 각 수준별 의료기관 간의 환자 흐름을 파악하고 세분화 된 질병분류를 이용하여 질병구조의 변화를 분석하는 연구가 필요할 것으로 생각된다.

• 한국병원경영학회지
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• 제10권4호
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• pp.23-50
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• 2005

The main objectives of this study are to compare the regional differences and to analyse the affecting factors of customer satisfaction. The subjects are 9 hospitals(5 Daegu region, 4 Seoul region) patient satisfaction index that were surveyed the 2004 Hospital Accreditation Program performed by KHIDI(Korea Health Industry Development Institute) and MOHW(Ministry of Health and Welfare). The sample used in this study consisted of 450 inpatients and 454 outpatients. The survey instrument is composed of physical environment items, physician factors, nursing staff factors, ancillary staff factors, administrative procedure items, and quality of hospital stay items. And overall satisfaction, intent to revisit, and intent to recommend as dependent variables are measured. Basically, the reliability and validity of survey items was evaluated. And the T-test was performed to compare regional differences of customer satisfaction. Finally to analyse the affecting factors on overall satisfaction, and customer loyalty(intent to revisit and intent to recommend), the multiple regression analysis was used. This study shows firstly, the Daegu region's patient satisfaction level of inpatients and outpatients is lower than Seoul region. Especially, nursing staff factors and quality of hospital stay items are very low on inpatient's satisfaction. Also all independent variables except the sufficiency of goods in hospital stand are very low on outpatient's satisfaction. Secondly, as a result of multiple regression analysis, ancillary staff factors(Beta=0.281) have a significant effect on overall satisfaction of inpatient cases in Daegu region. In regard to intent to revisit and intent to recommend, physical environment factors have a significant effect. Thirdly, in Seoul region, physical environment factors(Beta=0.430) have a significant effect on overall satisfaction of inpatient cases. In regard to intent to revisit and intent to recommend, administrative procedure items and nursing staff factors have a significant effect, respectively. In conclusion, these results indicate that hospitals in Daegu region make an effort to improve the customer satisfaction level, especially, of physical environment factors on inpatients and administrative procedure factors on outpatients

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제18권4호
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• pp.39-51
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• 2012

Purpose: Hospitals for patients and their guardians can, from the concept of healing, be removed from just gaining profits, but suggest a future-oriented direction for the hospital. Accordingly, there have been studies related to the selection of hospitals, but most were related to preference and satisfaction, and only recently did research from the concept of tradeoffs of factors for selection began to grow rapidly. Methods: From this context, this study evaluates the level of importance for factors of selecting hospitals using the analytical hierarchy process, and identifies the correlation with users, gender, age group, and outpatient features in order to identify the difference of awareness among different groups for selecting hospitals. In the factors for selection 26 factors in six categories were set through studies of preceding research, and after surveying 144 people, the following results were attained. Results: 1) The overall analysis results were found in the order of medical level, medical service, and fame, and low for facilities, which is similar to the cases of preceding studies. 2) For user analysis, it was similar between patients and guardians, but there was a slight difference in awareness among nurses, who are also medical service providers. Nurses showed relatively high level of importance in direct factors such as medical technologies and medical services, while guardians of patients showed higher importance in indirect factors such as facility environments and convenience. 3) Women showed higher assessments of importance levels in environmental factors, while men in physical factors. 4) The older the age group, the lower level importance there was on medical level, while the importance on fame reduced the further the commute to the hospital was.

• 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.

• 한국융합학회논문지
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• 제11권4호
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• pp.265-275
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• 2020

본 연구는 내러티브 탐구를 활용하여 정신과 낮병원 이용 환자들의 경험을 연구하였다. 연구자들은 낮병원 이용경험이 있는 정신과 환자 4명을 대상으로 3회 이상 심층면담을 실시하였으며 낮병원 퇴원 후 외래 진료 과정에서 추가 면담을 실시하여 자료를 수집했다. 연구 참여자들의 낮병원 이용 경험의 의미는 '세상과 끊어진 줄을 다시 묶다.', '힘이 되는 마음의 안식처.', '삶에 대한 방향성을 찾다.' 세 가지 주제로 나타났다. 본 연구는 정신과 낮병원 이용 당사자들의 이야기를 깊이 있게 다루었다는 점에서 의의가 있다. 연구 결과를 바탕으로 정신과 환자의 고립 해소를 위한 제도적 지원, 다양한 지지체계 활성화 노력, 프로그램 개발 활성화의 정책적 제안을 한다.

• 보건행정학회지
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• 제23권2호
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• pp.132-144
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• 2013

Background: The purpose of this study was to analyze the medical expense change and influencing factors after introducing longterm care insurance system. The study period was 2 years before and after introduction of the system. Methods: We analyzed data collected from two divided group lived in Incheon. Four hundred and eighty-five elderly who received long-term care wage for one year were selected for experimental group. For control group, 1,940 elderly were selected by gender and age stratified random sampling. Difference-In-difference analyses was used for evaluating policy effectiveness. Also multiple regression analyses were conducted to identify the factors associated with total medical expenditures. The control variables were demographic variables, economic status, diseases, and medical examination variables. Results: Difference-in-difference analyses showed that total average medical expenses among long-term patients has decreased by 61.85%. Of these, the hospitalization expenses have decreased by 91.63% and the drug expenses have increased by 31.85%. Multiple regression analyses results showed that total average medical expenses among long-term patients have significantly decreased by 46.5% after introducing the long-term care insurance. The hospitalization expenses have significantly decreased by 148.5%, whereas the drug expenses have increased by 53.6%. And outpatient expenses have increased by 10.4%, but the differences were not statistically significant. Conclusion: The results showed that total medical expenses and hospitalization expenses have decreased after introducing the long-term care insurance. These results could support the opinion that the health insurance spending among long-term patients will be reduced gradually by long-term care insurance through changing medical demand.

• 대한예방한의학회지
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• 제24권2호
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• pp.31-41
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• 2020

Background : The introduction of policies expanding the coverage of uninsured Korean Medicine (KM) services have requires an understanding of the following components of the service : current financial expenses, degree of financial burden on the patient, and financial effect of the coverage expansion. Objectives : This study aims to determine the annual trend of outpatients' characteristics and the category of out-of-pocket spending in KM. Methods : This study uses data from the Korea Health Panel to analyze use of KM in the Korean population. Using the user characteristics and behavior drawn from the Korea Health Panel data, out-of-pocket spending trends of KM were analyzed by year. The diagnosis and prescription of out-of-pocket spending were also analyzed. Results : The proportion of patients receiving uninsured medical treatment and the number of uninsured medical treatment in outpatient clinics have increased. However, the average out-of-pocket spending per person and out-of-pocket spending per visit are consistent or have decreased. Meaningful trends are the increase of R00-R99 (unclassified symptoms) and the decrease of K00-K93 (digestive system disease) and J00-J99 (respiratory system disease). Conclusions : Expansion of KM medical service and insurance is influenced by uninsured medical treatment of KM. Hence, research to increase medical treatment categories for out-of-pocket spending or explore diseases where KM diagnosis has been proven effective should be further developed.

• 한국산학기술학회논문지
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• 제13권9호
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• pp.4082-4089
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• 2012

본 연구는 병원을 이용하는 외래환자들의 불만족요인과 만족요인들을 조사하여 보다 높은 고객만족경영을 위한 기초자료를 제시하고자 하였다. 연구대상은 대전에 소재하는 일개의 종합병원 외래환자를 대상으로 2011년 10월 24일 1일간 설문조사를 실시하였다. 자료 수집은 총 160부의 설문지를 배포하여 144부를 통계분석자료로 이용하였다. 연구결과 행정지원부문의 특성 중 전반적 만족도와 타인추천 의향에 대하여 가장 많은 영향을 미치는 요인은 접수 수납 절차의 신속 간편성인 편리성으로 나타났으며 검사실 외래 진료대기실의 쾌적성도 공통으로 영향을 주는 것으로 나타났다. 이상과 같은 결과 고객을 만족시킬 수 있는 고객지향적 병원경영시스템을 구축 운영한다면 병원의 경쟁력은 향상되고 병원의 지속가능성은 높아질 것이며 고객만족경영이라는 경영목표도 달성될 수 있을 것이라 사료된다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권6호
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• pp.2717-2720
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• 2012

Background: The rates of breast cancer have increased over the past two decades, and this raises concern about physical, psychological and social well-being of women with breast cancer. Further, few women really want to do breast cancer screening. We here investigated the socio-demographic correlates of mammography participation among 400 asymptomatic Iranian women aged between 35 and 69. Methods: A cross-sectional survey was conducted at the four outpatient clinics of general hospitals in Tehran during the period from July through October, 2009. Bi-variate analyses and multi-variate binary logistic regression were employed to find the socio-demographic predictors of mammography utilization among participants. Results: The rate of mammography participation was 21.5% and relatively high because of access to general hospital services. More women who had undergone mammography were graduates from university or college, had full-time or part-time employment, were insured whether public or private, reported a positive family history of breast cancer, and were in the middle income level (all P<0.01).The largest number of participating women was in the age range of 41 to 50 years. The results of multivariate logistic regression further showed that education (95%CI: 0.131-0.622), monthly income (95%CI: 0.038-0.945), and family history of breast cancer (95%CI: 1.97-9.28) were significantly associated (all P<0.05) with mammography participation. Conclusions: The most important issue for a successful screening program is participation. Using a random sample, this study found that the potential predictor variables of mammography participation included a higher education level, a middle income level, and a positive family history of breast cancer for Iranian women, after adjusting for all other demographic variables in the model.

• The Journal of Korean Physical Therapy
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• 제21권3호
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• pp.103-108
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• 2009

Purpose: The purpose of this survey was to assess the satisfaction of patients suffering from musculoskeletal pain with physical therapy (PT) in Busan, Daegu, and Kyeongsang provinces using a Korean-language version of the patient satisfaction questionnaire with physical therapy service (PSPT). Methods: A total of 654 patients, having PT for their musculoskeletal pains, participated. Consenting subjects completed a 20-item PSPT on their $6^{th}$ or last treatment day. Simple descriptive statistics were used for respondent characteristics, and mean of satisfaction score in each item. Regression analysis was performed on each item of the questionnaire. Results: 654 subjects responded during or after their PT services. 297 (45.5%) of them were male and the most common site of pain was the spine. The mean of each item score (1-5) ranged from 2.14 for "my therapist did not listen to my concerns" to 4.12 for "my therapist treated me respectfully". Receptionist's attitude, registration process, service time of the hospital, and answer to the patient's questions greatly affected the general satisfaction of the respondents. Conclusion: The results showed high levels of satisfaction to the general process for obtaining treatment as well as the therapist's attitudes toward their patients. They may provide valuable patients' feedback regarding PT service for musculoskeletal pain. Therefore, it may be used by physical therapists to improve future patient experiences with a view to improving the patient's attendance and compliance with the PT service protocols for patients suffering from musculoskeletal pain.