Performance of Occupational Health Services by Type of Service : Cost Benefit Analysis (사업장 보건관리 사업의 형태별 수행성과 분석 -비용편익 분석을 중심으로-)
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- Korean Journal of Occupational Health Nursing
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- v.4
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- pp.5-29
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- 1995
Occupational health services in Korea have been operated as dual types : one is operated by occupational health care manager and the other is health care agency without their own personnel. The performance of occupational health service should be different due to the variety of characteristics of health care manager and workplace, qualification of health care manager. This study is to analyze performance of occupational health care services with a particular consideration of job performance shape and efficiency, based on comparing those two types of health care management to show on the basic data for the settlement of more qualitative health care management system at workplace. For this study, total 391 places in Seoul and Inchon city area ; 154 places (39.4%) managed by designated health care manager and 237 places (60.6%) by the agency with their commission are selected as research samples. Tools for data collection are questionnares that have been investigated during the period of 20 September 1993-20 December 1993. Those data are compared with percentiles, mean, standard deviation and B/C ratio using SPSS PC program. Conclusions observed from the tests and each comparison could be summerized as follows : 1. Occupational health care have been accomplished at workplaces with designated people than with agencies people, and coverage rate of the occupational health care services has differences, due to management types. The reason of these results is due to visit only one or two times monthly by the agencies, while their own health care manager obsess, at the workplaces all the times. 2. Most of the expense for environmental control of all health care services expenditures shows that there is almost no fundamental improvement because more expenses are needed for procuring personal protective equipment and measuring work environment instead of environmental improvement. 3. It is investigated how much the cost of occupational health care services needs per worker, and calculated how much the cost needs per service hour per worker. The results from this show that the cost of occupational health services at workplaces with their own managers used less than the cost of health care agencies, eventually the former gives better services with less cost than the latter. 4. Benefit/Cost ratio is also produced by total benefit/total cost. The result from the above way reads 4.57 as a whole, while their own manager having workplaces reads 4.82 and the agencies do l.56. Even if their own manager performing workplaces spent more cost, this system produces more benefit than the agencies management. 5. The B/C ratio for medical organization such as local clinic, health care center and pharmacy shows more than or equal to at the workplaces controlled by the agencies. It is inferred that benefit would be much less than the cost used, with so being inefficient. 6. It is assumed that the efficiency ratio of health education is equal to reduction rate of workers medical organization visit. Estimated reduction rate 5%, 10%, 15%, show that the efficiency ratio of health education have an effect on producing benefits. It is estimated that more benefit can be produced if more qualitative education will be provided for enhancing health care efficiency. 7. Results of this study cannot be generalized because there are large scale of deviation in case of workplaces with less than 300 full time workers, but B/C ratio reads 2.69 as a whole and 3.25 at workplaces with their own health care manager are higher than 1.63 at the workplaces manged by the agencies. Finally, all the benefit concerning health care services could not be quantified, measured and shown on the value of money. This is a reason that a considerable part of benefits are so underestimated. This is also thought that measurement tools should be developed for measuring benefits of health care services with a comprehensive quantification. in the future. It is also expected that efficiency of occupational health care services should be investigated using cost-effectiveness analysis.
Purpose: Since 2012, acetaminophen can be accessed easily not only at pharmacies but also at convenience stores. The relationship between the easy access of acetaminophen and the risk of poisoning has been controversial. Several studies also reported different results regarding the risk of acetaminophen poisoning after access to acetaminophen was relaxed. This study examined the long-term effects on the risk of acetaminophen poisoning after easy access to acetaminophen was implemented. Methods: This was a retrospective analysis of an emergency department (ED)-based in-depth Injury Surveillance Cohort by the Korea Center for Disease Control and prevention from 2011 to 2018. Poisoning cases were selected from the Cohort, and the incidence of acetaminophen poisoning and the characteristics of the cases of acetaminophen poisoning were analyzed. The purchase path and the amount of ingestion in acetaminophen poisoning were sub-analyzed from data of six EDs. Results: Of 57,326 poisoning cases, 4.0% (2,272 cases) were acetaminophen poisoning. Of 2,272 cases of acetaminophen poisoning, 42.8% (974 cases) required in-patient care after ED management. Two hundred and sixty-four of these 964 cases required intensive care. The rates of cases that required in-patient treatment and the rates of cases that required intensive care increased from 29.4% in 2011 to 48.1% in 2018, and from 3.1% in 2011 to 15.2% in 2018, respectively (p<0.001, p<0.001). In the poisoning group with in-depth toxic surveillance (n=15,908), the incidence and proportion of acetaminophen (AAP) poisoning increased from 55 cases per year to 187 cases per year and 4.9% to 6.1%, respectively (p=0.009, p<0.001, respectively). The most common age group of acetaminophen poisoning was teenagers, which is different from the most common age group of other pharmaceutical agents: the middle age group of 40-49 years (p<0.001). Of 15,908 in-depth toxic surveillance patients, 693 patients had AAP poisoning, of whom 377 cases (54.2%) purchased acetaminophen from a non-pharmacy. The proportions of the purchase path from non-pharmacy were 41.4% at 2011-12 and 56.4% (2013-18) (p=0.004). The amount of acetaminophen ingestion was 13.5±14.3 g at 2011-12 and 13.9±15.1 g at 2013-18 (p=0.794). Conclusion: Although the incidence of acetaminophen poisoning did not increase remarkably in the short term after the implementation of the new regulation, the incidence of acetaminophen poisoning has increased slightly during the study period of 2017-18. In addition, the proportion of the purchase path from non-pharmacies has increased since the emergence of new regulations for the easy access of acetaminophen in 2012. The incidence of acetaminophen poisoning might have been affected after the increasing accessibility of acetaminophen in convenience stores. Continuous control of acetaminophen poisoning is required. Furthermore, the prevention of acetaminophen poisoning should be focused on teenagers with specialized school education programs.
An explorative and descriptive study in order to determine the effect of family structure and other socio-demographic variables on health behavior, belief, locus, and value and utilization of public health service was carried out. Data were collected from 1,653 subjects randomly sampled in three areas, Seoul, Kyunggi province, and Cheju province. From Seoul 849 subjects were selected, 397 subjects Kyunggi, and 407 subjects from Cheju, respectively. Self-reporting questionaires were administered during the period from March to June, 1992. The major findings were as follows: 1) The subjects visited herb-doctor's at irregular intervals mainly to have tonic medicine prepared. They preferred herb-doctor's rather than with doctors at clinics and hospitals. Statistically significant difference was found among the regions studied (p<0.05). 2) The reason for visiting hospitals was primarily for treatment of diseases. They preferred hospital because they felt that the hospitals offer much highly reliable treatment services as well as medical accessibility. For the purpose of hospital utilization, statistically significant differences existed among sex, educational level, family type and region. However, no significance was found among sex, educational level, and region (p<0.05). 3) The subjects utilized general hospitals mainly for diagnosis and treatment of diseases. They preferred general hospitals because of their much better facilities and reliability. Statistical significance was found among sex, educational level, and region (p<0.05). 4) The subjects visited dentist at irregular intervals basis. They visited once half a year or three to four months. their purpose of visit was mainly for diagnosis and treatment of diseases. Statistical significance differences were found among educational level, region and economic standard (p<0.05). 5) Whenever their illnesses were mild and the pharmacies was located in nearby they visited to pharmacies. They visited once a month and patient medicines. Statistically significant differences were found among sex, educational level and region (p<0.05). 6) The subjects believed that herb medicine was quite efficacious for treatment of some diseases, particularly by information handed down through time-honored tradition and experience. However, they recognized that the efficacy of folk medicine can vary with type and severity of diseases. Statistical significance was among sex, educational level, region and economic standard (p<0.05). 7) The reason why subjects believed that pray and superstition are effective for treatment of certain type of diseases, particularly in neuropathy, was the belief in God's almighty. Statistically significant differences were found among sex, educational level, regions and economic standard (p<0.05). 8) Most of subjects under same condition preferred western medicine because they believed that it is more scientific and prompts in showing therapeutic effect. Statistical significance was not found in the choice of type of public health service among, regions. But significant differences were found among sex, educational level and region (p<0.05). 9) The subjects looked for pharmacy if they thought the symptom was mild. However, they visited hospitals for chronic disease and general hospitals for emergency treatment. Statistical significances were found among educational level, region and economic standard (p<0.05). 10) Although most of students wanted to have a healthy life as for the component of health standard and value, they think that they are not healthy (p<0.05). As for the health behavior, significant difference was found in the proportion of smoking and drinking between educational level and region (p<0.05). The health locus was affected by educational level, and health behavior was influenced by region, sex and educational level. The utilization of type of public health service was influenced by family type and region, and health belief by region and educational level, and the health values by region and economic standard respectively, most of correlation showed statistical significance. Among them, the highest correlation was seen between locus of control and external/internal locus of control, which is quite obvious. The correlation between health belief and behavior was the next highest, but still low (0.343). All the other variables are low but significant except only a few of those. These findings indicate that health education should be incorporated into the curriculum so as to develop desirable health habit, and ability of self-control in accordance with their growth stages. A systematic and scientific understanding on the herb/folk medicine is needed, and greater reliability of the utilization of public health services are is still required. Health policy for equal distribution of health service throughout the country along the hierarchical health service system and complementary mutual assistance and cooperation among various health organizations are also required.
The purpose of this study was to analyze the characteristics of socio-demographic, organizational culture, organizational conflict and organizational commitment, and to examine the interrelation of influential factors in the organizational commitment. The data for this study were collected through a self-administrated survey with a structured questionnaire to 1,027 subjects from several medical doctor staff members, nursing staff members, administration staff members, pharmacist, and technical expert of eleven hospitals. The data were collected by self-reporting questionnaire from July 29 to September 7, 2002. In this analysis frequency test, t-test, ANOVA, multiple regression were used. The main results of this research is as following; 1. According to socio-demographic characteristics the respondents' level of the organizational commitment was higher in a administration staff members than others, for males than females, and for employees aged more than forty, as working for longer time, and as higher level of the working position. 2. According to the organizational culture characteristics the progressive culture, affiliative culture, and task-focused culture among many types of organizational culture were moderately and positively correlated with the level of the organizational commitment while the hierarchical culture was negatively correlated. 3. According to the organizational conflict characteristics as the respondents who got less conflict experience in the organization, their level of the organizational commitment was higher. And, technical conflict experiences were expressed greater than hierarchical conflict experiences. 4. According to the job satisfaction characteristics as his or her satisfaction that is about the promotion, working itself, salary, and fellowship in the organizational was higher, the level of the organizational commitment was higher. The most important factor of the satisfactions was the fellowship among the respondents while the level of job satisfaction for the promotion and salary was average. 5. Overall, according to the result of Multiple Regression as older age and longer working hours, the level of the organizational commitment was higher and as a higher level of the satisfaction for the promotion, working itself, salary, and fellowship in the organization, it caused more effective factors for the organizational commitment. 6. According to the result of Multiple Regression for the doctor staff members in special hospitals rather than general hospitals the hierarchical culture and task focused culture was positively correlated with the satisfaction of working itself while hierarchical conflict factors in the organizational conflict characteristics was negatively correlated with the organizational commitment. For the nursing staff members the affiliative culture and the job satisfaction for the promotion, working itself, salary, and fellowship were positively correlated with the organizational commitment. For the administration staff members as the job satisfaction for the fellowship was positively correlated with the organizational commitment. For medical and pharmacy staff members as more working experience, correlation with the organizational commitment was positive. Besides, as he or she has a high perception of the affiliative culture, it caused statistically more effective factors for the organizational commitment. For the skill and technicians, male worker expressed greater organizational commitment in the organization than female worker. And also older age along with higher education also showed higher organizational commitment. Moreover, the job satisfaction for the fellowship was positively correlated with the organizational commitment. This study identified the major effective factors of the organizational commitment and analyzed the differences among the job category. In that respect, it is significant for the study to be able to provide a reference for managing hospital of industrial accident and organizational development. However, this study has a problem, which is not to identify a valuable model for examining the relationship between organizational factors such as organizational culture, conflict, satisfaction, and commitment. Therefore, further study is needed and strengthened in the field of organizational commitment for hospital for industrial accident.
In order that, investigating the feature of patients suffering arthritis, analysing its contents, and grasping a Primary factor affecting it, I might offerbasic datas which could help to plan and perform healthy affairs to thake precautions beforehand, I have investigated, analysed, and studied a total of 320 patients suffering arthritis, who have received physiotherapy in hospital located in Teaegu area for five months, from November 1 1995 to March 30 1996, of which summary and conclusion is this. 1. The general feature of patients in investigative objects In the distribution of the distinction of sex, men accounted for 26.9% and women, for 73.1%, and, in the fistribution of age, 60-year-old or more, most for 27.2% and from 20 to 29 years old, least for 14.0%. In the distinction of a vocation, housewives most accounted for 34.7% and students(jobless men), least for 19.3%. In the distinction of a matrimonial state, married persons most accounted for 76.7% and people living alone(divorce, separation by death, separation), least for 11.4%. In the distinction of an economic state, the middle classes most accounted for 73.5% and the upper classes, least for 2.9%. In the distinction of their academic careers, graduates of a primary school most accounted for 26.9% and graduates of university, for 14.1%, of which patients, having the ability to decode the national language, reached to 11.3%. In the distinction of the house form, people living in independent houses most accounted for 76.4% and residents in apartment(having an elevator), least for 9.4%. 2. In the distribution of the recurring state in the distinction of the feature, the recurring group was more than the group of patients falling that ill at first as 62.2% and in the distinction of the feature of the recurring group, the recurring group turned high in case of men being from 50s to 60s years old or more, people living alone (divorce, separation by death, separation), students (joblessmen), people working in farming, stockbeeding, forestry, fisheries, a simple labour, graduates of a primary school I having the ability to decode the national language, the upper classes, people part two years since they begined to suffer arthritis, people who had members having ever experienced arthritis among families. 3. In the distribution of arthritis on the distinction of bodily pars, a knee articulation most accounted for 50.2% and the articulation of fingers, for 8.8%, wile the simultaneous, several parts (multiple) accounted for 35.1%. In the distinction of the feature, arthritis of a knee turned high in case of men being from 20s to 30s years old, unmarried persons, people having academic careers of university, the middle classes, residents in apartment (having stairs). In the dictnction of a feature the case of several parts (multiple) turned high in case of women being from 50s to 60s years old or more, people living alone (divorce, separation by death, separation), people having the ability to decode th. national language, the graduates of a primary school, the upper classes, residents in apartment (having elevator). 4. In the distribution of arthritis on e distinction of a contracting term, two years or more most accounted for 51.6% and the case of contacting from one year to two years, for 15.3%. Analysing the distinction of the feature, the case of two years or more turned high in case of women being from 50s to 60s years old or more, people living alone (divorce separation by death, separation), the upper classes, people having the ability to decode the national language, residents in apartment (having elevator). 5. In the distribution of an treatment institution before patients came to help, their not curing most accounted for 39.1%, general, orthopedic, neurological surgery (physical therapy), for. 20.0%, and th. therapy of Chinese medicine (acupuncture, moxacautery, Chinese medicine), for 17.5%, and a pharmacy (medical therapy), for 13.4%. The case of patients not curing, in the distinction of a feature, turned high in case of men 20s years old, unmarried, the lower classes, people having academic careers of university, residents in apartment (having elevator). 6. In e distribution of the extent of satisfaction with treatment, common most accounted for 54.4% and some satisfaction, for 32.8%. The case of common, in the distinction of a feature, turned high, in case of men living alone from 50s to 60s years old (divorce, separation by death, separation), married persons, the upper classes, people having academic careers of university, residents in independent house, residents in apartment (having elevator), 7. In the distribution of the degree of knowledge of the cause of arthritis, patients knowing that the cause is to use very much a articulation in normal times most accounts for 60.1%, and patients knowing the state of short nutrition as a cause, for 2.5%. The case of patients knowing that the cause is to use very much in normal times, in the distinction of a feature, turned high in·case of ment being 20s and 60s years old or more, unmarried persons, e lower classes, people having the ability to decode. the national language, people having academic careers of university, residents in apartment (having stairs), 8. In the distribution of the state of physical exercise before arthritis contracted, patients exercising very much on the whole most accpimend for 40.3%, and patients not exercising, for 34.7%. The case of patients exercising very much on the whole, in the distinction of the feature, turned high in case of men being from 50s to 60s years old or more, people living alone(divorce, separation by death, separation), the lower classes, people having the ability to decode the national language, graduates of a primary school, residents in apartment (having elevator). 9. In the taste of patients suffering from arthritis, while the group of patients falling that ill at first and the recurring group didn't smoke cigarets, during alcohol and coffee on the whole, and the group of patients falling once again that ill drank a cup of distilled linquor and three cup of coffee or more on the whole per one day, and the group of patients falling that ill at first liked sort of vegetables and the recurring group liked very much sons of vegetables and fresh and meat in their loving food normal times. 10. Analysing the distribution on the dining table used by patients and the structure of a powder room, at first, in the structure of a powder room, the group of patients filling that ill have a toilet stool using as their sits, and a Bush toilet on the whole, and the recurring group, a toilet stool using as their sits and conventional type, and in the structure of a dinning table, the group of patients falling that ill at first and the recurring group turned high, each as 66.9% and 6.3%, who have a dining table carring here and there. 11. In the distribution of patients of arthritis in relation to stress, the case that they feeled severly symptoms of arthritis when thay got stress, turned high, each, as 78.6% in the recurring poop, and the case not knowing, as 61.5% in the first group. In the extent of stress normal times, the case that they got much stress on the whole turned high, each, as 72.4% in e recurring group, and the care that got less stress on the whole, as 60.0%. 12. In the distribution on the distinction of symptoms and impedimental extent, the recurring group turned high in each variable. Analysing the feature of the recurring group, in the distinction of symptoms, the case that they fooled much that the node of an articulation is stiff, turned high, as 71.6, and in the distinction of treatment before. patients came to helpk, the theraphy of Chinese medicine (physical theraphy), as 84.4%, the theraphy of Chinese medicine (acupuncture, moxacautery, Chinese medicine), as 73.2%, and in the distinction of the satisfing extent on treatment, the case of comman, as 72.3%, and in the cause of arthritis, the case not recruiting their health after a birth, as 68.5%, and the case not recovering wholely an articulation having got hurt, as 62.8%, and in the state of physical exercise before they begined suffering from arthritis, the case exercising very much on the whole, (as 74.2%), and in the extent of subjective impediment, the case of not being able to act almost, as 66.7%, the case of acting but feeling some hard, as 66.3%. 13. The correlation in variables in relation to arthritis Analysing realted variables, the recurring frequency showed correlation with such as the extent that patients got stress normal times, and the exercising state before suffering arthritis, and showed contra-correlation with academic careers, the wights, coffee. The cigaret, e loving food of taste, showed corralation with the weight, stature, alcohole as the loving food of taste. On the basis of this result medical members of heal, who are related to the regular education, public education or development of this program, should be concerned to prevent orthris.