Background: Price control alone may not successfully restrain growth in health expenditures. This study aimed to propose fee adjustment model suitable for Korea reflecting health service volume and to clarify applicability of the model by comparing actual conversion factor with estimated conversion factor from simulation of this model. Methods: Fee adjustment model was developed based on Alberta's fee adjustment formula in Canada and 7 alternatives were assessed according to diversely applied parameters of the model. Results: Estimated conversion factors of the tertiary care hospital and the hospital were lower than actual conversion factors, since the utilization of heath service has been increased. However, there was no big difference between estimated conversion factors and actual conversion factors of the general hospital and the clinic. Eventually this fee adjustment model could estimate proper conversion factor reflecting health service volume. Conclusion: This model may be applicable to the mechanism as determining conversion factor between insurer and provider via negotiation and controling growth in health expenditures.
Purpose : The aim of this study is to review the current status of healthcare provision and its human resources administrative management and propose a coordinated human resource management plan for the more efficient operations of healthcare organizations. Methods : We reviewed the literature and held discussions with officials from the United States Department of Health and Human Services to survey United States Public Health Service Commissioned Corps operations. In addition, we surveyed the literature to analyze the current structure and responsibilities of governing bodies involved in public healthcare in Korea. Results : In Korea, there are several administrative offices involved in public health: the Ministry of Health and Welfare, the Ministry of Defense, the Environment Ministry and others. Since these diverse agencies don't integrate their operations, it is difficult to grasp their management of both public healthcare services and their personnel. A potential model is the United States Public Health Service Commissioned Corps, a sub-group of the Department of Health and Human Services and an elite team of highly qualified, public health professionals, which coordinates and manages the overall work and personnel of diverse healthcare organizations. Conclusion : We suggest the establishment of a federal level, public health administrative department of human resource management to centralize and coordinate the existing, disparate healthcare administrative agencies.
Objectives: The aim of this study was to evaluate the occurrence of microbiological contamination of kitchen utensils and environments of food service operations at university located in Seoul, Korea. Methods: We collected swab samples from the surfaces of knives, chopping boards, floors, and drains, as well as drinking water and airborne bacteria samples from 20 food service operations. Three bacterial indicators and five food poisoning bacteria were measured quantitatively and qualitatively, respectively. We used selective culture media and the PCR assay targeting 16S rRNA gene for the microbiological analysis. Results: We detected bacterial indicators on knives or chopping boards in eight different food service operations and, three food service operations (I, M, and O) showed more than 3 log colony forming units $(CFU)/100cm^2$ on their knives, significantly higher than the others. The levels of bacterial indicators on the floors and drains in the cooking areas were much higher than those on the cooking utensils. S. aureus was detected on 10 floors and 8 drains. Culturable bacteria were identified in 5 drinking water samples, and food service operation B ($431.1CFU/m^3$) and C ($551.2CFU/m^3$) showed more than $400CFU/m^3$ of total airborne bacteria. Conclusions: These results suggest that some of food service operations in this study may require additional investigation to secure the microbial safety of cooking environments. In addition, further actions including hygiene education for employees and proper guidelines to maintain clean cooking environments should be prepared.
Purpose: To improve and establish functions for public health centers in rural public, an analysis will be done on arrangement plan and area by function for public health centers in farming and fishing villages. After finding out this relationship and architectural characteristics, spatial organization and area ratio for providing efficient medical service and the relationship between the two will be examined. Methods: 8 of them were selected and site visit and interview with the person in charge were conducted to investigate the current status. The drawings collected for analysis were input as CAD data and schematized. The relationship between the arrangement type and area for the public health centers in farming and fishing villages was analyzed and based on this, an analysis was done on agricultural scale and characteristics, and putting these analyzed results together, an appropriate method of improvement was proposed for spatial organization by function for public health centers in farming and fishing villages and to provide efficient service. Results: Firstly, the Plan types found in the public health centers in farming and fishing villages could be classified into three including single-type, multiple-type and radial-type. Secondly, according to an analysis of areas by function, in the case of treatment function, there was a difference in the area ration for selective treatment. This ratio is considered to be greatly influenced by the project each public health center focuses on. Thirdly, I could become aware of the relationship between spatial organization and area ratio based on the analysis of arrangement and area derived above. Implication: As the data to refer to in future research on spatial organization for public health centers, if the object of analysis becomes more expanded and investigated, it will be utilized in detail for spatial planning of public health centers, thereby being expected to contribute to more efficient and qualitatively enhanced medical service provided by public health centers.
The aim of this study sets out to discover a desirable form of public centers among the alternative ones and make a health center model. Especially, this study attempts; (i) to investigate factors that affect the performance of health centers; (ii) carry out cost-effectiveness analysis (CEA) for the various type of health centers; (iii) identify innovative strategies to increase the use of health center. Cost-effectiveness analysis is used to compare the performance of all the centers. The following is taken to create the index. Wi = Ti x Mi x Eij (Wi: weight for service item I, Ti : time spent for service I, Mi ; number of health personnel involved in service I, Eij : years of schooling for personnel j in providing service I). As a result of these analyses, policy options as follows are recommended; (i) proper manpower, especially public health physician (oriental medical doctor), should be enough to provide health care adequately; (ii) facilities ad equipments in the health center should be provided sufficiently. (iii) the utilization of health centers should be raised by active operation of mobil service, community participation and health education program. Ultimately health centers in public sector are to be fostered for the promotion of health care by enhancing the financial and quality, continuity and efficiency of health services.
The aim of the study is to analyze and evaluate the Child Health Management Service that was promoted as a part of Mother-Child Health Guidance Project by the Public Health Center of BukCheju-gun in 1999, to reflect the problems needed to be improved, and, thus, to present the integral program model for the Child Health Management Service that guides childhood health, regarded as the foundation of that of the adulthood period, to the optimum level. The common results of the evaluation of the Child Health Management Service of BukCheju-gun public health center are as below: 1. In the aspect of public information, the existing simple material and method of public information was not effective. 2. The opportunities for the necessary training and education to develop the persons concerned and their ability for the Child Health Management were not enough.3. The environment under which the service, aimed to promote Child's health, was carried out was not clearly divided from that of the services related with the prevention and treatment of disease. And the service environment for the child health was threatening to the clients.4. Still, the actual result was pursued more than the quality management, while carrying out the project. With the reflection of the above result, the research has presented the program model of Child Health Management Program for the next. The main concept of the model is, through the establishment of the network for information offerings and effective convergence of a variety of opinions for the community around the Public Health Center and for the correct evaluation of the project and the reflection of the result from it, to achieve the ultimate goal of the optimal growth and development of the childhood by expanding the support necessary for carrying out Child Health Management Program more effectively.
The purpose of this study was to assess the user's satisfaction of health care service in public health centers in Busan. The study respondents were 212, those who visited health centers for health care service. Data were collected in July 2002 by using SERVQUAL(comprehensive service quality measurement scale) and 3 open questions for more details about service satisfaction and the needs for health care service. SERVQUAL has 5 dimensions; tangibles, reliability, responsiveness, assurance and empathy. The results were as follows : 1. The users reported more satisfaction at 'just service cost', 'convenient service procedure' and 'clean physical environment' at SERVQUAL. Among them the highest rated item was 'service cost'. And the less satisfaction items were 'understanding and individual concerns about service users', 'medical equipment' and 'health center facilities'. 2. There were no statistical differences by general characteristics except for the kind of services rendered. Those who visited for physical examinations and laboratory tests reported lower satisfaction than any other groups. 3. At the open questions, the respondents expressed that they were satisfied with the low service cost, kindness of employee and clean environment. But they criticized the old facilities and worn medical equipment, in addition to the less than kind attitudes. These strengths and weaknesses of health center's service could be applied for planning of customercentered health care service.
Purpose: The purpose of this study is to develop a day care center model focused on public health institutions for the elderly residing in their homes. Method: Research design for this study was a mult-level research, which consisted of a related literature review, an Internet search for knowledge of the current situation at home and abroad, on-site interviews, questionnaires collected from a sample of residents in a rural area, and a key-informants approach. Results: 1) The subjects of service - Generalized service should be provided to the elderly, 65 years and older, regardless of their assets. 2) The contents of service - Providing pre-health oriented and post-social welfare service that can integrate and satisfy a wide variety of public health and welfare needs of the elderly would strengthen the health care service of a day care center for the elderly. 3) Delivery system - Basic-level local self-governments should become a central operating body, and establishing a properly adjusted delivery system to a rural area after considering the efficiency and the access of vulnerable rural areas is needed based on modification of 'a Special Law for Agricultural and Fishery Areas' (rural public health center>rural health sub-center ${\rightarrow}$ unified health sub-center ${\rightarrow}$ public health hospital (public health center) ${\rightarrow}$ public welfare office). 4) Facility - Public health facilities such as public health centers and sub-centers should be located in areas that can easily access the facilities. 5) Funding - For day care center for the elderly in local self-government, the central government should modify a relevant implementation of subsidy in and provide some facilities and service regardless of the degree of self reliance of local self-government. 6) Human resources - It is needed to guarantee the period of workers of a day care center for the elderly, at least 3 to 5 years, with considering their specialty on aged care and avoiding circulation based positions. Furthermore, appropriate specially trained personnel such as medical workers and social workers should be placed to take care of both health service and welfare through strengthening of 'rules of law of elderly welfare,' Conclusion: future research is needed to test the model through a demonstration study using a model which may be developed in the future and to standardize the appraisal criteria of people hoping to enter a day care center for the elderly.
Purpose: This study attempted to estimate the need for home visiting nurse at public health centers. Methods: A model was generated to estimate a community's home visiting health service needs in 16 regions and a workload analysis was adopted to estimate the number of required Nurses. Data were collected from 16 public health centers using the South Korean government's open-information systems. Subjects were divided into three groups: vulnerable social group, bottom 10% income group, and bottom 20% income group. Results: The analysis revealed that 2,158 and 6,667 nurses were needed to provide home visiting health service for the bottom 10% and 20% income groups, respectively. It was estimated that for the vulnerable social group, 10,336 nurses were needed to provide home visiting health service, implying that the need-based demand for nurses is well over 5 times the number currently employed. Conclusion: The results indicate that the number of currently employed nurses is insufficient for the health management of vulnerable social groups. The government should consider active employment policies to encourage nurses to apply for home visiting health service.
Purpose: The purpose of this study was to suggest new direction for domiciliary care for elders provided by public institutions in rural areas. Method: The participants in the study were elders using one of 11 public health care institutions, of which 8 operated day care services exclusively, and 3 operated both day care and short-term respite care services. A survey was conducted using a structured questionnaire that included items on general characteristics of the service users, conditions of the services, personnel, financial status, facilities, and perception of the tasks of the staff. Result: The service content of the day care centers included Western and Chinese medical service, physical services, activities of ADL, nursing care services, meal services and transportation services. Domiciliary care centers provided a wide variety of health and social welfare service for elders. Personnel consisted of 3 to 8 staff for day care centers and 7 to 10 for domiciliary care centers. Both types of centers rely on financial support from local government for operation. The perception of the staff was the need for operation of these centers by public health facilities such as public health centers and sub-centers. Conclusion: The result suggest a need to activate the function of public institutions to provide domiciliary care for elders. For this new change, the role as a social support system must be developed.
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