• Korea Journal of Hospital Management
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• v.6 no.3
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• pp.130-147
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• 2001

This study is about major symptoms of elderly and medical services for elderly in long-tenn care facilities. The subject of this study was 298 patients over 00 years old staying in two geriatric hospitals and two nursing homes. The symptoms and medical services were level of patient classification from RUG(Resource Utilization Group)-III which is applied for both Medicare and Medicaid for skilled nursing facilities reimbursement system in US and designed for measuring patient characteristics and medical staff time. This classification is explained by each patient resource(staff time) utilization level which is called CMI(Case-Mix Index). In this study, the symptoms and services were compared by facility type and they were categorized by level and compared by CMI. Major findings are as follows; 1. There were more elderly who have cognitive function problems in nursing homes than patients in geriatric hospitals. There were more patients with behavioral problems in geriatric hospitals than residents in nursing homes. These results were both statistically significant. 2. The patients in geriatric hospitals received significantly more nursing rehabilitation services, rehabilitation services and extensive services than residents in nursing homes. Other hands, special care services were provided significantly more to residents in nursing homes than elderly in geriatric hospitals. 3. ADL and depression variables had higher CMI when the symptoms were heavier condition. The CMI were not matched with levels of cognitive function problems and behavioral problems. 4. The CMI matched well significantly with levels of nursing rehabilitation services, special care services, and clinically complex services provided for the patient in geriatric hospitals and only nursing rehabilitation services in nursing homes. The CMI for rehabilitation services level and extensive services had regular trends. From the result of this study, the resource utilization level and services provided for elderly in each long-term care facilities were figured out. For the further study, it needs to have more concern about RUG-ill which classification variables were just analyzed.

• Korea Journal of Hospital Management
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• v.25 no.2
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• pp.45-56
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• 2020

Purpose: The purpose of this study is to investigate medical care behaviors influencing accuracy of the payment based New diagnosis-related groups (DRG) compared to fee for service (FFS) in hospitalized patients with medical illness. Methodology: In order to estimate the difference in medical costs between New DRG and FFS depending on medical care behaviors, medical records and hospital claims data (n=4,232) were utilized, which were collected from a single public hospital during the first-half of 2018. Data were analyzed by descriptive statistics, t-test, chi-square test, and multivariate binary logistic regression. Findings: The average difference in medical costs between New DRG and FFS were KRW 506,711±13,945 with incentives and KRW -51,506±12,979 without incentives, respectively. Forty-four point two percent (44.2%, n=1,872) of total subjects were shown to have negative compensation in overall medical costs with New DRG compared to the costs with FFS. Medical care behaviors that affected on the negative compensation were the presence of severe bed sores on admission, medical consultations, death, operations, medications and laboratory or imaging tests with unit price over KRW 100,000, hospital-acquired complications or underlying comorbidities, elderly patients (≧65 years), and hospitalized for more than average inpatient days defined by New DRG (p<0.001). The difference in average medical cost between New DRG and FFS for a group with mild illness was KRW -11,900±10,544, whereas it was KRW -196,800±46,364 for a group with severe illness (p<0.0001). Practical Implications: These findings suggest that New DRG payment model without incentives may incompletely cover the variation of medical costs in real clinical practice. Therefore, policy makers need to consider that the current New DRG reimbursement should be focused and refined to improve accuracy of payment on medical care resources utilized in severe and complex medical conditions.

• The Journal of Korean Academic Society of Nursing Education
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• v.5 no.1
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• pp.97-105
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• 1999

Based on literature, status and role of the NP in America was reviewed. The process of developing NP program in America suggests us many things. In America, nurse practitioners have sustained a mutually beneficial status with their patients for over thirty years. Excel fence in academic education and clinical training will enable nurse practitioners to continue to provide quality health care. The magnitude changes in the health care system of the United States, the challange of providing real access of health care continues. Lack of access to adequate primary care was the driving force in the initial 1965 Federal Involvement in developing the NP role. In 1993 President Bill Clinton's health care reform initiative provided policy support for NPs as primary care providers. The Institute of Medicine explicitly recognized NPs as an integral part of the primary care team. In addition, several national reports recognized NPs as affordable, accessible, high-quality care providers. The recent passage of direct Medicare reimbursement for NPs reflected public policy statements coincided with and likely contributed to a growth spurt in the NP workforce. From 1965 to 1977 NP programs offered traditional primary care clinical tracks(adult, family, woman's health, and pediatrics) for relatively small clusters of students in a variety of institutional settings. From 1978 to 1990 these educational programs were incorporated into graduate schools of nursing. By 1990 the majority of NPs received educational preparation in master's-level nursing programs. A new emphases was placed on postmaster's NP programs designed for master's prepared clinical nurse specialists and nurse managers. he the health care system shifted hospital nursing resources toward community-based care, these master's -level nurses sought additional NP preparation. NP educational programs are defined as the educational structure in which one or more NP clinical tracks are offered. NP clinical tracks, in turn, offer curriculum and supervised clinical experiences that match standards in specific practice areas such as family(FNP), adult(AUP), geriatrics(GNP), pediatrics(PNP), women's health (WHNP), neonatal (NNP), and acute care(ACNP). There were indications that NP practice was expanding into new clinical areas as evidenced by new types of tracks, particularly in acute care and psychiatry. The increase in acute care NP students likely reflects the increased demand from hospitals and other acute care settings. In Korea, change of nurse's role into nurse practitioner's role may have many difficulties. The need of health consumer, policy support of government, approval of medical care team are all essential component. Every nursing personnel make effort to planning the new health care delivery system.

• Journal of Korean Academy of Nursing Administration
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• v.5 no.1
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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.

• Women's Health Nursing
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• v.5 no.1
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• pp.133-145
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• 1999

The purposesof the study are to analyze the community nursing center in U.S.A and to develop the model of nursing care system based on nurse-midwifery clinic in community for women's health in Korea. 1. In America nursing center is defined as nurse-anchored system of primary care delivery or neighborhood health center. Nursing centers are identified the following four types: (1) community outreach centers, which are similar to traditional public health clinics: (2) institutional-based centers following the mission of a large institution, such as a hospital or university: (3) wellness/health promotion centers, which offer screening, education, counseling, triage, and health maintenance services: and (4) independent practice. Nursing centers are a concept of services provided by nurses in practice arrangements in a community. Nursing centers offer a variety of services, ranging from primary care provided by advanced practice nurses with medical acute management and nursing care to the more traditional education, health promotion, screening wellness and coordination services. Some services, such as the care provided by advanced practice nurses are reimbursed under various insurance plan in some instances and states, where as others, such as preventive and educational services, are not. Thus, lack of reimbursement has threatened the survival of some centers. Licensing of nursing centers varies by state and program and accreditation of nursing centers is also limited. 52% of centers are affiliated with another facility and 48% are freestanding centers. The number of registered nurse at the nursing centers ranges from just one to 115, with a mean of eight RNs peragency and a median of three. Nursing centers avail ability varies: 14% are open 24 hours, 27% have variable short hours, 23% are open 6-7 days per week, and 36% are open Monday- Friday. As the result of my visiting three health centers in Seattle and San Francisco, the women's primary care nurse practitioners focus on a systematic and comprehensive assessment of the health status of women and diagnosis and management of common physical and psychosocial health concerns of women in ambulatory settings. Therapeutic nursing strategies are directed toward self-care, risk reoduction, health surveillance, stress reduction, healthy nutrition, social support, healthy coping, psychological well-being, and pharmacological therapy. They function as primary care providers for the well ness and illness care of women from adolescence through the older adult years and pregnant families. 2. In Korea a nurse-midwife practices independently for pregnant women's health including childbearing family at her own clinic in community. Her services are reimbursed under national health insurance but they are not paid on a fee-for-service schedule covering items. Analyzing the nursing centers in America, I suggest that nurse-midwifery clinics offer primary care for women and home care for chronic ill patients. The health law and health insurance policy should be reovised in order to expand nurse-midwife's and home care nurse's roles at nurse-midwifery clinic.

• The Korean Society of Law and Medicine
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• v.14 no.1
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• pp.355-401
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• 2013

The first legislation for terminal health-care decision was California's Natural Death Act (NDA) of 1976 that permitted any adult person to execute a directive directing the withholding or withdrawal of life-sustaining procedures. Advance directive legislation has subsequently progressed on a state-by-state basis. By 1992, all 50 states, as well as the District of Columbia, had passed legislation to legalize some form of advance directive. This state legislation, however, has resulted in an often fragmented, incomplete, and sometimes inconsistent set of rules. Statutes enacted within a state often conflict and conflicts between statutes of different states are common. In an increasingly mobile society where an advance health-care directive given in one state must frequently be implemented in another, there is a need for greater uniformity. In 1993, the Uniform Law Commissioners approved the Uniform Health-Care Decisions Act (UHCDA) in order to bring order to the existing chaos. Unfortunately, the Commissioners waited too long to act. By the time the UHCDA was approved, nearly all states had passed legislation governing advance directives. Consequently, the UHCDA has achieved only a limited success, picking up but one or two enactments a year. The UHCDA is currently in effect in around 10 states: Alabama, Alaska, California, Delaware, Hawaii, Kansas, Maine, Mississippi, New Mexico, Tennessee, Wyoming. In these states the previous laws related to the subjects have been all repealed. The overall objective of the UHCDA is to encourage the making and enforcement of advance health care directives including living will or individual instruction, power of health-care attorney and to provide a means for making health care decisions for those who have failed to plan. The U. S. House of Representatives in 1991 enacted the Patient Self-Determination Act (PSDA). The Act stipulates that all hospitals receiving Medicaid or Medicare reimbursement must ascertain whether patients have or wish to have advance directives. The Patient Self- Determination Act does not create or legalize advance directives; rather it validates their existence in each of the states. Now in America, terminal health-care decision or advance directive for health care is common and universal system. The problem, however, is how to let more people use these good tools to make their lives more beautiful and honorable.

• The Journal of Korean Academic Society of Nursing Education
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• v.6 no.2
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• pp.287-302
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• 2000

The purpose of the study are to examine the perception of the importance and performance of patient education of the clinical nurse and find out the interfering factors in practicing patient education. The data were collected from convenient sample of 256 clinical nurses working in the nursing units of adult patients except the psychiatric unit, obstetric unit, dental surgical unit and intensive care unit of one University Hospital in Seoul from September 29 to October 2, 1998. Three measurement tools of self-report- questionnaires developed by researcher used. For the content validity of the questionnaires, two sessions of panel discussion and a pilot test were done and finally factor analysis was done with Varimax method. Analysis of data was done with SAS program using frequency, percentage, means, standard deviation, Pearson's Correlation Coefficients, t-test and ANOVA. The obtained results were as follows : 1. The surveyed nurses perceived the importance of patient education at higher level with mean score of 4.08 among 5 point than their perception of practice( mean score : 3.42). 2. There was positive significant correlation(r=.29, p=0.0001)between nurses' perception of the importance of patient education and it's practice 3. Among the teaching contents for patients, 'information of diagnostic procedure and operation' and 'orientation of hospitalization' were perceived most important. And 'preparation for discharge' and 'understanding of disease and health promotion' were perceived least important 4. Among the teaching contents for patients, 'orientation of hospitalization' and 'information of diagnostic procedure and operation' were perceived highly performable. And 'understanding of disease and health promotion' and 'preparation for discharge' were perceived least performable. 5. Three types of interfering factors were identified as patient-factor, situational factor, nurse-factor. The mean degree of impediment with the interfering factors was at average level(3.09 among 5). The patient and situational factors of impediments were more interfering than nurse- factor for teaching patients. 6. In older age(p<.05), married state (p<.05), higher educational status (p<.01), higher clinical experience (p<.01) and higher position(p<.01), the score of perceived importance of patients education was more high. 7. In older age(p<.01), higher clinical experience(p<.001) and surgical unit (p<.01), the score of perceived performance of patients education was more high. In conclusion, in order to activate patient education practice in the clinical setting, the continuing education for patients education should be more emphasized and the effective teaching methods and materials should be developed to help patient teaching. And an organizational support such as budgeting for patient education and reimbursement system should be administrated.

• Korean Journal of Community Nutrition
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• v.7 no.6
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• pp.852-862
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• 2002

The purposes of this study were 1) to review the Medical Nutrition Therapy (MNT) Act of the United States, 2) to introduce the efforts of the American Dietetic Association (ADA) to expand the Medicare coverage for MNT and 3) to provide information about the reimbursement under Medicare Part B for the cost of MNT. The MNT Act defined MNT services as “the nutritional diagnostic, therapeutic, and counseling services provided by a Registered Dietitian or nutritional professional for the purpose of managing diabetes or renal diseases”. Also, the MNT Act defined “conditions for coverage of MNT”, “limitations on coverage of MNT”, and “qualifications of MNT service provider”. To expand the coverage of Medicare to include MNT, the ADA realized the need for development of a protocol for MNT, as well as studies to evaluate the effectiveness and cost-effectiveness of the MNT protocol developed. Therefore, the ADA supported the studies to develop a strong database of scientific investigations of nutritional services. Furthermore, the ADA needed credible data that could be used by Policy makers, so the ADA contracted with the Lewin Group to if out the study to gather the additional data needed to strengthen the ADA's position. In the report of the Lewin Group, which was entitled, “The Cost of Covering Medical Nutrition Therapy under Medicare : 1998 through 2004”, it was concluded, that if coverage for MNT in the Part B portion of Medicare had begun in 1998, by 2004, approximately $ 2.3 billion would have been saved through reduced hospital spending under Part A of Medicare ($ 1.2 billion) and reduced physician visits under Part B ($ 1.1 billion) Effective January 1 2002, the US Congress extended Medicare coverage to include MNT to beneficiaries with diabetes or renal diseases. The Centers for Medicare and Medicaid Services (CMS) established the duration and frequency for the MNT based on published reports or generally accepted protocols (for example, protocols suggested by the ADA). The number of hours covered by Medicare is 3 hours for the initial MNT and 2 hours for a follow-up MM. In 2002, a Medicare coverage policy was made to define the Physician's Current Procedural Terminology (CPT) codes 97802, 97803, and 97804 for MNT.

• The Korean Nurse
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• v.35 no.3
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• pp.61-76
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• 1996

The purpose of this study was to develop a nursing care delivery system which can provide patient focused care and increase satisfaction for both patients and nurses. This study was a quasi-experimental study to test the effectiveness of direct / indirect nursing care hours, patient satisfaction, nurse's job satisfaction, and the difference of the length of stay between model and control group. Control group data were collected from 100 patients who had lumbar disease in the neuro-surgical unit and model group data were from 66 patients who didn't have family residents from August 21, 1995 to February 29, 1996. Model unit was operated by modified PPM(Professional Practical Model) system for 3 months from December 1, 1995 to February 29, 1996. Working committee empowered nurses to make a decision to provide increased opportunities for autonomy, accountability, and control over the environment in which they deliver care. Satisfaction survey was done twice and analyzed by the SPSS program. The results of the study were as follows; 1. Mean direct nursing care hours of the model group was 90.47 minutes as it was 28.04 in the control group which shows significant statistical difference (t=-18.0, P=0.000). 2. Patient satisfaction to nursing care of in the model group was significantly higher than the control group (t=-6. 77, P=0.000) and it apples to the all subcategories, too. 3. Nurse's job satisfaction shows the significant increase in the model group than the control group(Z=-3.0405, p=0.0024). 4. There was no statistical difference between 2 groups in average length of stay except for the post-op patient which shows 5.4 days less in the model group. This study shows that patient satisfaction and nurse's job satisfaction were increased and length of stay was decreased in the model group. Even though this new developed Patient - Nurse Oriented Model can provide nursing with the opportunity to improve patient care to increase productivity and highly valued, it is very difficult to practice due to the limited nursing resources, higher acuity levels and nursing care cost. It is strongly recommended that the government needs to look at the unreasonable reimbursement system and recognize the nursing care costs to the high acuity level patients. Otherwise, make the patient responsible for the nursing care cost so that we can provide more efficient and patient focused care.

• Korean Journal of Construction Engineering and Management
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• v.16 no.3
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• pp.152-164
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• 2015

Enhancing clarity and transparency of the pricing guide for technical services for public construction works enables the prediction and reimbursement of the service cost for project owners and bidders, while it would also yield benefits for engineers who carry out the construction tasks. In order to improve the global competitiveness of construction service industry, the government revised its pricing guide for techical services for construction works recently, moving away from its previous percentage-of-construction-cost method towards the Cost Plus a Fee Method. However, since the Cost Plus a Fee Method results in the rise of the service price by 153%~197%, there is the need for a review on the method and basis of the adjustment in order to avoid controversies regarding the application of the revised method. In this context, this paper analysed the 2014 revision of the pricing guide for technical services for public construction works through comparison with foreign cases including those of the US and the UK. The analysis yielded the conclusion that, while the shift towards Cost Plus a Fee Method which is widely used in advanced economies is a very meaningful change in large measure, certain aspects still remain problematic. Unlike in advanced economies, the detailed break-down shows the direct labor cost includes certain indirect expenses. Also, indirec expenses are admitted so comprehensively as to include overhead costs and technology royalties. These problems results in redundant estimation of certain expenses, and obstructs transparency in spending details. This paper proposes various improvement measures to address these issues.