• Korea Journal of Hospital Management
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• v.20 no.2
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• pp.28-38
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• 2015

This study was conducted by extending Ajzen's Theory of Planned Behavior(TPB) model in analyzing physician's observance behavior of National Health Insurance review standards. An extended TPB model was proposed by including 'background knowledge'and 'dorganizational commitment'in original model to predict physician's review standards observance behavior. Surveys for data collection were carried out on the physicians who were working in a general hospital, clinics, specialized hospitals, local medical centers and long term care hospitals located in Daegu and Kyoung-Buk province in Korea. Two hundreds twenty copies of questionnaires were distributed and 166 physicians responded. Data were analyzed using a structural equation model. The results show that an affirmative attitude and subjective norms have significant positive effects on physicians' behavior of observing review standards. However, the effect of perceived behavioral control on intention to behavior is not significant. The organizational commitment and background knowledge have a positive effect on the intention of observance of review standards. In conclusion, because physician's observance behaviors are affected by background knowledge and organizational commitment as well as attitudes, subjective norms, hospital managements should establish a communication system to share information on the review standards among physicians and provide appropriate measures to increase physician's organizational commitment.

• Health Policy and Management
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• v.7 no.1
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• pp.125-154
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• 1997

The hospital, clinical department and the physician factor in explaining variations of hospital resource use in surgically admitted patients was compared. This analysis was based on 6, 361 discharges in 28 hospitals for three surgical conditions - lens procedures anal and stomal procedures, uterine and ovarian procedures using medical insurnce claim data. The results were as follows: 1. Regression analysis indicated that the hospital and clinical department characteristics, such as hospital ownership and size, were more significant predictors of the resource use indicators than the physician and patients' social characteristics. 2. Regarding to the physician factors, the hospital where the physician received the residency training and the medical shool where he/she graduated had less effect compared to the hospitals where he/she currently works. Between the residency trained hospital and medical school, the is more important than the latter. 3. When the hospital charges were divided into type of service provided i. e. room, drug, laboratory & radiologic, procedure & operation, and anesthesic charges, variance due to the hospital factor was larger than that due to the physician factor in each item. In summary, the hospital and clinical departmental factor played an important role than physician factor ; indicating to reduce the variation in hospital resource use, the policy that affects hospital behavior would be more effective than that targets individual physician behavior.

• Health Policy and Management
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• v.4 no.2
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• pp.58-76
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• 1994

In order to study factors affecting the use of the ambulatory physician services. Andersen's model for health utilization was modified by adding the health behavior component and examined with three different approaches. Three different approaches were the multiople regression model, logistic regression model, and LISREL model. For multiple regression, dependent variable was reported illness-related visits to a physician during past one year and independent variables are variaous variables measuring predisposing factor, enabling factor, need factor and health behavior. For the logistic regression, dependent variable was visit or no-visit to a physician during past one year and independent variables were same as the multiple regression analysis. For the LISREL, five endogenous variables of health utiliztion, predisposing factor, enabling factor, need factor, and health behavior and 20 exogeneous variables which measures five endogenous variables were used. According to the multiple regression analysis, chronic illness, health status, perceived health status of the need factor; residence, sex, age, marital status, education of the predisposing factor ; health insurance, usual source for medical care of enabling factor were the siginificant exploratory variables for the health utilization. Out of the logistic regression analysis, health status, chronic illness, residence, marital status, education, drinking, use of health aid were found to be significant exploratory variables. From LISREL, need factor affect utilization most following by predisposing factor, enabling factor and health behavior. For LISREL model, age, education, and residence for predisposing factor; health status, chronic illess, and perceived health status for need factor; medical insurance for enabling factor; and doing any kind of health behavior for the health behavior were found as the significant observed variables for each theoretical variables.

• Journal of East-West Nursing Research
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• v.21 no.2
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• pp.156-164
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• 2015

Purpose: This study was conducted to identify the relationship of assertiveness and attitudes toward nurse-physician collaboration in general hospital nurses. Methods: The subjects were 196 clinical nurses from two general hospitals in P city. Data were collected from August 1 to 30, 2014 and analyzed by SPSS 18.0 program using descriptive statistics, t-test, ANOVA, $Sheff{\acute{e}}^{\prime}s$ test, and Pearson's correlation coefficients. Results: The mean scores of assertiveness and attitudes toward nurse-physician collaboration were $3.20{\pm}.42$ and $3.20{\pm}.30$, respectively. Assertiveness and attitudes toward nurse-physician collaboration according to the general characteristics showed significant differences on the numbers of advisors and job satisfaction. There was a significant positive correlation between assertiveness and attitudes toward nurse-physician collaboration. Conclusion: Based on results of this study, additional variables related to attitudes toward nurse-physician collaboration need to be identified. Educational programs to improve the attitudes toward nurse-physician collaboration should be developed.

• Journal of Preventive Medicine and Public Health
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• v.26 no.4 s.44
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• pp.614-627
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• 1993

It is well known that a physician's personal characteristic affects his practice pattern. Furthermore, a physician's specialty has powerful influences on his practice pattern. However, despite the fact that specialization has received the most attention for its influence on physician's service behavior, few studies have been conducted on the variations of contents and volume of physician's services. This study has intended to identify factors influencing the practice variations according to various physician characteristics. There are some other evidences that medical care providers are different in using of health services and resources in Korea. Four physician characteristics were selected for the analysis, two demographical factors, age and sex, and two practice factors, place of practice and medical specialty. Also, three indicators of service amount (total amount of insurance claim bill, number of visits per case, number of prescriptions per case) were selected. From the pool of insurance claims for ambulatory care received by the Korean National Federation of Medical Insurance(NFMI), 84,898 cases were randomly sampled. In the meantime using physician database of NFMI, 613 general practitioners (GP), 107 regular family physicians (FP), 483 'grandfather' family physicians(GFP), and 1,157 specialist practitioners(SP) were randomly sampled. Their different practice contents were compared concerning the specialty, age groups, sex, and practice sites (urban-rural) Specialist physicians tend to provide more costly care than do generalists. General practitioners and family physicians usually make fewer following visits and prescriptions. Age is also the important factor in determining the amount of services, which is highest at the physician's age group of 40's. Female doctors and urban practitioners use much more resources than their counterparts respectively. Research findings suggest that physician's characteristics particularly the specialty can affect practice patterns and resource utilizations. Other characteristics such as age and sex are not controllable but physician's specialty is relatively easily controllable during the entire phases of policy implementation. This is all the more true in the individual's initial decision of his specialty. Specialization therefore should receive policymaker's attention for its potential influence on medical care utilization and health care expenditure.

• Health Policy and Management
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• v.11 no.3
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• pp.121-150
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• 2001

This study was conducted to investigate provider's behavior change after releasing the information on the Cesarean section rate. Claims data filed at the National Health Insurance Corporation was used for this analysis and the focus of this study was the change of cesarean rate after the public disclosure of information. Average rates of the year 1999 and 2000 were compared, on the institutional basis, and range and coefficient of variation were estimated. For the last decade, Cesarean section rate has been increased dramatically. Clinical or demographic factors could not adequately explain the increase. Instead, nonclinical factors, such as financial incentive, physician's convenience, practice characteristics, etc., were more significant in explaining the increasing rate. Providers' behavior was significantly affected by the public release of information: after the release, average rate was decreased by 10.2%, and variations were also decreased. In particular, the extent of decrease was explained mainly by nonclinical factor rather than clinical ones. The results suggest that disseminating practice information to providers and consumers could contribute to reducing unnecessary medical service.

• Journal of Oral Medicine and Pain
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• v.23 no.4
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• pp.403-418
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• 1998

The aim of this study was to measure effects of the following items to pain and pain behavior reaction in patients with chronic orofacial pain. Items that contribute to the first factor(Environmental Influences) measure environmental sources of information that may affect illness behavior; Second factro(Loss of Control) measure appraisals and attributions perceived to influence personal views aobut pain; Third factor(Health Care Avoidance) measures a variety of avoidant behaviors; Fouth factor(Past and Current Experiences) measures experiences with treatment); Fifth factor(Physiological Responsivity) measures physiological parameters that are experienced in association with pain; Sixth factor(Thoughts of Disease Progression) measures thoughts regarding the etiology and progression of disease in relation to pain. 150 patients that were consist of 40 male and 110 female were participated in this study. The obtained results of this study were as follows : 1. Environmental influences and loss of control scales were recorded high score in patients with chronic orofacial pain 2. "Physician's descriptions of what your pain will be like" and "Physician's facial expression when they ask about your pain" items from the environmental influences were recorded high score. These results indicated that responsibility of doctro is very important to the pain reaction behavior of patients. Also, items from thoughts regarding the etiology and progression of disease in relation to pain influenced to the pain reaction. 3. There were significant defferences on the "nurses' descriptions of what you pain will be like", "physician's and nurses' facial expression when they ask about your pain", "TV and radio", and "Literature" items from the environmental influences between male and female patients. 4. There were no significant differences on the each scale between arthrogenous and combitnation group and significant correlated with all 6 scales.

• Korea Journal of Hospital Management
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• v.4 no.2
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• pp.286-304
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• 1999

The purpose of the study was to analysis physician's prescribing behavior. Data was collected from 320 medical doctors of 10 general hospitals from August to September in 1996. The major findings are as follows; 1) Prescribing dosage: 74% of total selected middle dosage. Resident doctors used maximum dosage. 2) The number of similar antibiotics: 72.4% of total used 1 antibiotic. Surgery depts. and resident doctors selected 2, 3 antibiotics. Physicians to consider of insurance benefit or non insurance benefit used the number of antibiotics less than not to consider. Physicians to think over patient's economic state used less the number of antibiotics than that not to consider. 3) Used term of antibiotics: Total mean was 7.39 days. medical parts had 9.11 days but surgery used 6.41 days. Specialists consumed 6.57 days and residents applied 7.80 days. Physician to reflect result of claim used short term of antibiotics than that don't reflected. 4) Optional order of antibiotics: First antibiotics were selected 68% of total respondents, by medical depts, but secondary, tertiary antibiotics was used surgery depts. Tertiary antibiotics was used residents doctors, universal hospitals, fill beds and over. 5) The number of the items of oral drug : 3-4 the items of oral drug were used 76% of respondent Surgery parts selected 1-2 the items of oral drug, medical depts. selected five and over. Physician to reflect result of claim used less the number of the items of oral drug than that don't reflected. Physician to prescribe different of class of insurance used less the number of the items of oral drug than that don't prescribe different.

• Journal of the Korea Convergence Society
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• v.9 no.1
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• pp.151-159
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• 2018

This study analyzes the impact of competitions clinics on the total treatment cost and anti-biotics prescription rate. The result of implementing the basic statistics, correlations, and regression analysis by facilitating the evaluation data by Health Insurance Review & Assessment Service in 2015 for acute otitis media in children is shown as follows. First, there is a significant difference for each si-gun-gu for the competition index between total treatment cost and clinics, but there is almost no significant difference for the anti-biotics prescription rate. Second, competition in clinics has statistically important impact on the total examination cost And, third, competition in clinics has no statistically important impact on the anti-biotics prescription rate. There is a need for additional studies on re-examination rate, treatment cost per visit and so forth in order to clarify other factors of competition for medical institutions impacting on the physician behavior in the future studies.

• The Journal of Korean Academic Society of Nursing Education
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• v.24 no.4
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• pp.326-336
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• 2018

Purpose: This study was conducted to identify the factors affecting nursing students' attitudes toward nurse-physician collaboration. Methods: The subjects were 200 nursing students from a college in K city, and the participants were recruited by posting a recruitment announcement. Data were collected from June 26 to 29, 2018 and analyzed using SPSS 22.0 and descriptive statistics, t-test, ANOVA, Sheff? test, Pearson's correlation coefficients, and hierarchical multiple regression. Results: Attitudes toward nurse-physician collaboration showed a statistically significant difference according to grade, the reflection of opinion within the family, and the number of the counselor in general characteristics. Assertiveness and attitudes toward nurse-physician collaboration showed weak positive correlation (r=.18, p=.011). In hierarchical multiple regression analysis, the most affecting factor was junior grade (${\beta}=.25$), followed by positive assertiveness (${\beta}=.18$) and the number of the counselor (${\beta}=.14$). These variables explained 12.0% of the total variance in attitudes towards nurse-physician collaboration. Conclusion: To create positive attitudes toward collaboration between nurses and physicians in nursing students, various educational programs related to assertiveness on communication skills need to be provided from the lower grades. Also, a multidisciplinary simulation program should be developed and applied to be able to experience the situation of nurses and physicians.