• 대한조현병학회지
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• 제22권2호
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• pp.34-41
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• 2019

Objectives: This study was performed to examine the effects of the public attention to 'crime of schizophrenia' on the use of mental health services in patients with schizophrenia using big data analysis. Methods: Data on the frequency of internet searches for 'crime of schizophrenia' and the patterns of mental health service utilization by patients with schizophrenia spectrum disorders by month were collected from Naver big data and the Health Insurance Review and Assessment Services in Korea, respectively. Their correlations in the same and following month for lagged effect were examined. Results: The number of outpatients correlated negatively with public attention to 'crime of schizophrenia' in the same month. The lagged relationship between public attention and the number of admissions in psychiatric wards was also found. In terms of sex differences, the use of outpatient services among female patients correlated negatively with public attention in the same month while the number of male patients' admissions in both same and following month correlated positively with public attention. Conclusion: These findings suggested that public attention to 'crime of schizophrenia' could negatively affect illness behavior in patients with schizophrenia.

• 한국병원경영학회지
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• 제17권3호
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• pp.23-36
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• 2012

Objectives : The coverage of Korean National Health Insurance is limited to basic level. Korean government encourages private health insurance for covering medical securities. So, many studies examined the determinants of purchasing private health insurance. However, 11% of Korean population is older than 65 in 2011. Considering the elderly is important to establish a health policy. The aim of this study is to examine factors determining the purchase of private health insurance among middle-aged and elderly Korean adults. Methods : We used the second Korean Longitudinal Study of Ageing (KLoSA), selected 8,688 sample of the aged 47 or older for the analysis. KLoSA collected information on demographic characteristics, income, health- related factors. KLoSA data include in the number of outpatient, inpatient, oriental hospital visit, dental clinic visit for two years. Logistic regression was used to examine the relationship between the determinants of purchasing private health insurance and the factors which include age, gender, education, residential district, marital status, smoking, drinking, physical exercise, economic activity status, national health insurance type, income, the number of chronic disease, and the number of outpatient, inpatient, oriental hospital visit, dental clinic visit for two years. Results : People who were older, did not live in a city, had higher IADL, currently drunk alcohol, did exercise regularly and had chronic diseases more than three were inclined not to purchase private health insurance. Females, the married, well-educated, past & currently smokers, the employed, high income earners, national health insurers, metropolitan citizens and someone who got high MMSE were more likely to purchase private health insurance. The more people experienced outpatients, inpatients, dental clinics and Chinese medicine clinics, the more private health insurance was purchased. The elderly people over 75 had more private health insurance than the aged 65-74. The strongest factors for private health insurance is gender, and economic status such as income. Conclusion : In this study, we found healthy-high income people were more likely to purchase private health insurance. In contrast, unhealthy-low income and older people did not. The economic factors were strongly related with private health insurance in aged over 75. These mean inequality exists in the using private health insurance. Therefore, the government should consider vulnerable social group before expanding private health insurance.

• 한국멀티미디어학회논문지
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• 제23권3호
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• pp.460-467
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• 2020

The medical service, accompanied by various disease and disease of modern people, must collect various information about patients through various tests, and demand continued to increase. As a result, interest in waiting time for medical services is rising, and various studies are underway to reduce waiting time. However, medical procedure is complex and diverse in the procedure of the services need to be conducted for each procedure. In this study, we are going to propose ways to improve the waiting time of the test procedures that are basically experienced by outpatients through the simulation experimental method. Based on the actual measurement data, the Arena Simulation program was used to implement the hospital's ophthalmic examination model and alternative model. Through this analysis, the waiting time of the examination procedure, the size of the queue, and density of the waiting room were analyzed.

• 한국병원경영학회지
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• 제12권4호
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• pp.1-21
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• 2007

The relaxation of the regulation in selection of medical institution allows patients to use their own judgement in choosing proper institution for their diseases. Since the change of the regulation, there should have been many changes in medical institution selection behavior. The analysis of the change in disease specific selection pattern is critical because there be an optimal selection criteria that ensure the efficient and effective utilization of medical resources. This study analysis the institution selection factors by comparing the choice among the cases of acute diseases, the cases of chronic diseases, inpatient services, outpatient services, and emergency medical service. The comparisons performed in terms of size, class and other characteristics of medical institutions. For the study the nationally surveyed database was used and the data were analyzed using logistic regression procedure. The results indicates that the primary care facilities were not properly utilized. This study speculates that the reason for the undesirable pattern of utilization is that the roles of primary care facilities in the healthcare delivery system was not clearly defined. Based on the results, the medical policy implications are discussed.

• Journal of Preventive Medicine and Public Health
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• 제54권2호
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• pp.129-136
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• 2021

Objectives: This study examined demographic factors hampering access to healthcare at hospitals and suggests policy approaches to improve healthcare management in Thailand. Methods: The data for the study were drawn from a health and welfare survey conducted by the National Statistical Office of Thailand in 2017. The population-based health and welfare survey was systematically carried out by skilled interviewers, who polled 21 519 384 individuals. The independent variables related to demographic data (age, sex, religion, marital status, education, occupation, and area of residence), chronic diseases, and health insurance coverage. The dependent variable was the degree of access to healthcare. Multiple logistic regression analysis was subsequently performed on the variables found to be significant in the univariate analysis. Results: Only 2.5% of the population did not visit a hospital when necessary for outpatient-department treatment, hospitalization, or the provision of oral care. The primary reasons people gave for not availing themselves of the services offered by government hospitals when they were ill were-in descending order of frequency-insufficient time to seek care, long hospital queues, travel inconvenience, a lack of hospital beds, unavailability of a dentist, not having someone to accompany them, and being unable to pay for the transportation costs. Multiple logistic regression analysis showed that failure to access the health services provided at hospitals was associated with demographic, educational, occupational, health welfare, and geographic factors. Conclusions: Accessibility depends not only on health and welfare benefit coverage, but also on socioeconomic factors and the degree of convenience associated with visiting a hospital.

• 간호행정학회지
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• 제5권1호
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• pp.63-76
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• 1999

The main objective of this study was to develop a concept of service marketing promotion in nursing that is derived from the concepts of service marketing theory. This research was a descriptive study, at the factor isolation level. The principle of concept derivation suggested by Walker and Avant (1988) and the Hybrid model suggested by Schwarz-Barcott and Kim (1993) were employed as the research method. The data were collected from December, 1997 to April. 1998 at a large general hospital located in Seoul. The procedures of this study were as follows: First. at the theoretical phase: the meaning, attributes, and definition of service marketing promotion were identified through an extensive review of the literature. Second, at the empirical phase: fieldwork was done to identify the promotional activities and events in nursing. Top nurse managers from 4 units (Director of Nursing, Head nurses of inpatient nursing unit, outpatient nursing unit. and home care nursing unit) were interviewed and the content of the interview was analyzed to identify the meaning and attributes of promotion in nursing. Other methods such as brochures and other audio-visual materials which were relevant to nursing promotion were used to supplement the interviews. Finally, the results of the theoretical and empirical analyses were intergrated to develop a concept of service marketing in nursing practice. A final definition of service marketing promotion in nursing was identified as follows. 1. Promotion as a marketing function in nursing service is concerned with communication to target markets on all information related to nursing service in order to satisfy the objectives of both a nursing service organization and the target markets. 2. The goals of nursing service promotion include: 1) increasing visibility of nursing services and delivering the information on nursing services, 2) affirming the value of nursing services, so it can contribute to formulation of reimbursement policy for nursing services. 3) advancing the general image of the nursing profession and nursing services. 4) achieving and attaining a desirable positioning for nurses among health care professionals. and 5) creating and stimulating the demand for nursing services. 3. In order to obtain these goals it is necessary to provide information on nursing services, to persuade target markets. to remind them about nursing services. and to establish a collaborative relationship with related departments. 4. The tools used to carry out the above functions of promotion in nursing are the providing nursing services, public relations and publicity. QA of nursing, advertising, and sales promotion. 5. The target markets of nursing service include the nursing customer markets. the internal markets, the influence markets. the recruitment markets. the supplier markets. and the nursing referral markets. In conclusion, the concept of promotion in other service marketing areas can be applied to the promotion of nursing service marketing. The promotion of nursing service is more than just effective communication in nursing service. it is the effective use of the concepts of service marketing promotion. Promotion of nursing service will contribute to create and expand nursing services.

• 대한영양사협회학술지
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• 제2권2호
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• pp.199-215
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• 1996

In Korea, the majority of hospital dietitians expend most of their time performing food management related activities, and only a few carry out nutrition care activities in full-time. This study was designed to measure productivity of the clinical nutrition team and assess the role of clinical dietitians in the only 2200-bed teaching hospital in Korea. Six full-time clinical dietitians collected time data for four weeks according to the nutrition care activities outlined. Three clinical dietitians assigned to 7 units recorded how often physicians implemented their recommendations for two months. Two kinds of survey questionaire were developed and sent to the patients and the health care team. The followings are a summary of the results. 1. The clinical nutrition team of 6 full-time dietitians expended 75% of their time performing patient care activities, 20% in non-patient care activities and 5% in delay and transit. 2. Each clinical dietitian assigned to the units carried out 56 patient care activities on daily basis. 3. The average time required for the clinical nutrition services was 60.2 minutes for outpatient counseling, 89 minutes for inpatient counseling, 72.5 minutes for nutrition management, 95 minutes for malnutrition consult and 121 minutes for dysphagia diet management. 4. Physicians' implementation of clinical dietitians' recommendations was 98.5%. 5. Most physicians and nurses viewed the clinical dietitians on the units assertive, contributing to the quality improvement of medical services, and helpful to the patients as well as the health care team. 6. Most patients viewed the clinical dietitians on the units considerate, attentive and helpful. Based on these results, it is suggested that (1) daily meal round and nutrition care monitoring are effective tools for nutrition intervention in the hospital setting. (2) unit assignment of clinical dietitians enhances the patients' satisfaction in the nutrition services provided as well as the perceptions of health care team on clinical dietitian's expertise.

• 보건행정학회지
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• 제23권2호
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• pp.103-111
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• 2013

Seven diagnosis-related groups (DRGs) prospective payment system is going to expand to all hospitals including university hospitals this year. However there are few studies on the change of practice pattern under prospective payment system in the university hospital setting. So This study was intended to predict the practice pattern change after the introduction of 7 DRGs prospective payment system in a university hospital setting. To predict the change of practice pattern, this study used simulation technique. Five hundred and nineteen patients classified as 5 DRGs in a university hospital were selected for simulation. The change of practice pattern were predicted based on clinicians' opinion. We also predicted payment change by service items. Major findings of this study are as follows. First, the total medical payment was reduced by 14.4%. The drug payment change (8.8%) took most of total payment reduction. The followings are the change of treatment material cost (3.2%), the change of laboratory tests cost (1.8%), the change of room charge (0.5%), and other payment change (0.1%), respectively. Second, most of the reduction in total medical payment resulted from the decreased amount of medical services themselves. The transfer of medical services to outpatient setting took up only 4.9% of the total payment reduction. The change of unit price or composition took up 5.5% of the total payment reduction. In this study we found that it is possible to reduce the inpatient services through practice pattern change in university hospital setting. However, it needs to be careful to adjust DRG payment after the reduction of provided services, because most of reduction was not due to service transfer but to service volume reduction. It is desirable to utilize the saving from practice pattern change as incentive to improve quality of care.

• 보건행정학회지
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• 제24권3호
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• pp.283-290
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• 2014

Background: This study aimed to examine the relationship between home-visit nursing services and health care utilization under the public long-term care insurance program in Korea. Methods: We analyzed the long-term care need assessment database and the long-term care and the health insurance claim databases of National Health Insurance Service between July 2011 and June 2012. The sample includes a total of 20,065 home-visit nursing recommended-older beneficiaries who use home-visit nursing and/or home-visit care, based on a standard benefit model developed by the Health Insurance Policy Institute of National Health Insurance Service. The beneficiaries were categorized into home-visit nursing use and non-use groups, and the home-visit nursing use group was again divided into high-use and low-use groups home-visit nursing, based on their total annual home-visit nursing expenditure. Two-part models and negative-binomial regression models were used for the statistical analysis. Results: The home-visit nursing use was negatively associated with the number of outpatient visit and cost, while adjusting for all covariates. The home-visit nursing use was also negatively associated with the inpatient cost among the high home-visit nursing use group. Conclusion: The findings implies home-visit nursing use prevents health care utilization. Further studies and policy strategies that can promote and strengthen home-visit nursing services under the public long-term care insurance are necessary in Korea.

• Journal of Preventive Medicine and Public Health
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• 제43권1호
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• pp.35-41
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• 2010

Objectives: In Korea, the top 10% of Medical Aid recipients represent nearly 60% of total payment, with the costs for those disabled for over 365 days representing approximately 30% of total payment. The purpose of this study was to compare Medical Aid use of the disabled with non-disabled recipients, and to identify contributing factors to the total payment in the top 2% of recipients identified as Medical Aid overusers. Methods: Subjects (n=2,211) selected were ${\geq}18$-years-of-age and received >1000 days of co-payment-free type I Medical Aid. Case managers (n=200) conducted interviews in December 2006, and collected data from Health Insurance Review & Assessment Service. Amounts over the 9 months from January September 2006 were analyzed descriptively and using Chi-square, ANCOVA, and robust multiple linear regression. Results: Disabled individuals (mean age 61.3 years) composed 36.6% of subjects; 44.8% of the disabled were male. On a monthly basis per capita, the disabled group averaged 10.5 outpatient days, total payment of 523,000 Korean Won(￦), inpatient payment of ￦359,000, and outpatient payment of ￦183,000. All values exceeded the monthly average for non-disabled individuals. Contributing factors were identified as male gender (￦82,000), elementary school or lower educational level (￦64,000), residence in a small city (￦82,000), lack of family support (￦61,000), kidney disability (￦673,000), intellectual disability (￦151,000), and multiple disabilities (￦119,000). Conclusions: The identification of contributing factors to Medical Aid use by those defined as disabled supports the adoption of comprehensive alternative policies such as strengthening of education and consultation services, provision of alternative facilities, and promotion of self-care.