- Abstract - Objectives: We examined the effects of diabetes mellitus (DM) case management program developed by National Health Insurance Corporation in Korea. Methods: One trained nurse performed the case management for 30 DM patients recruited through the reimbursement information of National Health Insurance in a rural community. The case manager had four home visits and two telephone calls for 12 weeks. We evaluated the effectiveness of the program in terms of self-efficacy, self-care behaviors and glyco-metabolic control. Results: The self-efficacy score was significantly increased from 70.0 of pre-intervention to 80.5 of post-intervention (p<0.001). The self-care score was also significantly increased from 2.86 to 3.60 (p<0.001). The scores of its components such as nutritional care, self-test of sugar level, foot care, oral care, and aerobic exercise were significantly improved (p<0.001). However, the improvement of score in medication management was statistically marginal (p=0.071). The fasting blood sugar level and HbA1c level was significantly decreased from 128.6 mg/dl to 114.5 mg/dl (p<0.001) and from 6.78 % to 6.54 % (p<0.001) respectively. Conclusions: The case management program was effective to improve the self-efficacy and self-care behaviors, and to control blood sugar level in DM patients.
This thesis explores the actual circumstances of Korean nursing by investigating its present situations. Ultimately, the intent of this study aims to establish a future direction of Korean Nursing. As such, the current conditions of Korean nursing is analyzed in the following categories: education, practice, research, nursing policy, expansion of nursing field, and entrepreneurship. In the final conclusion, an appropriate orientation of the future of Korean nursing is discussed. There are two primary Nursing programs, a three-year(63) and a four-year(53), in Korean Nursing education. Master's programs are available at 32 nursing schools or 32 professional graduate schools. A total of 15 nursing schools have a doctoral program in Korea. The ratio of graduates between the three-year and four year programs is 76:24. Hence, it is highly encouraged to expand four-year nursing programs, because it will help raise the social status of nursing professionals as well as the quality of nursing. In the clinical nursing field, independency and self regulation are critical. As such, organizational change, implementation of a standardized nursing m information system, appropriate workforce, and improvement of the reimbursement system in nursing is recommended. In community nursing, the following should be resolved to provide better nursing services: improvement of working condition and benefits, establishment of a law enforcing the hiring of nurses, and providing continuing education. The number of nursing research has increased and nursing studies are in great quantity. However, research in practices and theories are more in demanded. Hence, research that integrates theories and practices are very significant. Ultimately, it is critical to support nursing studies that will influence nursing policy. The Korean Nurses Association(KNA) is an organization that supervises the nation's nursing policy. The primary focus of KNA is to combine the three and four year undergraduate education systems into 4 years and to establish the Nursing Practice Act. The Ministry of Health and Welfare has adapted a system to educate and certify nurse specialists in 10 nursing areas in 21 nursing graduate schools expecting high-quality nursing services and a decrease of cost. The government also allowed nurses to operate facilities for health management or welfare agencies.
Purpose: The purpose of this paper is to analyze the demand and supply of advanced practice nurses and suggest alternative benefit strategies in the Korean national health insurance. Methods: A revised demand & supply model was used to estimate the excess supply of APNs, and policy making process and key actors in the Korean health insurance were considered to develop a political approach to the APN issue. Results: The social demand for APNs is currently estimated to be less than 50% of its supply and the APN education program fell into difficulties in recruits. No reimbursement mechanism for APN's services in the national health insurance has given no economic incentive to hospital managers who have monopsony power in nursing labor market, which has caused the demand shortage of APNs in hospital industry. Payment for APN's services recognized as one of the most significant strategies to booster the social demand for APN's services should be carefully designed and implemented in the national health insurance. In line with this, key actors in health insurance policy decision-making include government, national assembly, labor unions, NGOs, civic groups, medical associations, and academia. Conclusion: The basic researches for APN's activities and cost-effectiveness analysis in clinical settings are required to support the strategies aforementioned. Constructing a policy network among key actors is able to make the payment strategy feasible, which will increase the socal demand for APNs.
Background: Organizations in the pharmaceutical industry are highly dependent on the institutional environment. The introduction of pharmacoeconomics to the decision-making on the price and reimbursement decisions became strong constraints to pharmaceutical companies in Korea. As little is known about the issue on organization-environment interaction in the healthcare field, this study aimed to figure out how pharmaceutical companies adapted to the environmental changes. Methods: A multicase study method was used, selecting eight cases among multi-national pharmaceutical companies in South Korea. In-depth interviews were conducted with the managers of these organizations, and secondary data were reviewed to complement the interviews. Results: Pharmaceutical companies viewed the new policies as a big threat and sought for actions against them. One of the most distinguishing organizational changes was to construct a Market Access department. Other strategies managing the environment such as co-optation, forecasting, and bargaining were also implemented. These changes were consistent with the predictions of Resource Dependency Theory and Institutional Theory. Conclusions: The interactions between pharmaceutical companies and institutional environments in healthcare were first explored. This study presents a new perspective on how organizations change and the motives for the changes. The findings of this case study will form the basis of further empirical studies.
A cost analysis for hospitalized patients was performed based on the RBRVS in order to determine an appropriate nursing fee schedule. The study was conducted through three phases as follows: 1) Nursing activities provided for the inpatients currently in Korea were identified and classified using a taxonomy which was developed by our research team through the Delphi process. 2) The resource-based relative points for every nursing activity according to nursing time, mental effort and judgement, technical skill, physical effort and stress were determined through a survey of 300 clinical RNs working at 5 tertiary hospitals from May 25 to July 25. 1998. 3) The nursing cost of every nursing activity for hospitalized patients was estimated based on the RBRVS. As a result, 136 nursing activities were identified and classified by nursing processes and nursing domains. However, our classification system of nursing activities should continue to be refined, and all nursing practices should be standardized. The nursing activities were given resource-based relative points ranging from 100 to 400 points, then each nursing activity was assigned a value for the RBRVS, which was determined by the exponential function of 2resource-based relative point/100. Thus, a value of 2 was calculated for 100 points, 4 for 200 points, 8 for 300 points, and 16 for 400 points. Meanwhile, the unit cost of nursing was calculated as 170 Won. The nursing cost of 136 nursing activities was estimated using the RBRVS as shown in