The study was designed to investigate what effect of working time reduction which will be gradually expanded to corporate size from June, 2004 could give to medical industries, and to provide basic information for hospitals and government to prepare the policy. 276 hospitals were surveyed about medical service income and manpower realities during the first half of 2003, using a structured survey tool. Response rate was 8% and 20 hospitals were finally analyzed. The effect of working time reduction in hospital management was different to the size of hospitals and the alternative. Income to existing service income was decreased by $2.2{\sim}4.6%$ in tertiary hospitals, by $3.2{\sim}5.7%$ in general hospitals with more than 300 beds, and by $3.7{\sim}6.0%$ in general hospitals with less than 300 beds. In preparation against such decrease in income, government is required to raise insurance payment, to calculate added service charge for day-off on Saturday forenoon, to retain emergency care payment, to expand emergency care facilities, to secure duty doctors, and to support middle and small sized hospitals. Hospitals are required to give self improving efforts such as fortifying of weekday care, development of weekend care program, strengthening of care capacity and function of emergency care center, and making manpower operation efficient.
Objectives : The purpose of this study was to investigate the number of remaining natural teeth in elderly people visiting dental care services and the factors affecting dental visit. This study will contribute the development of oral health promotion programs for the elderly people. Methods : Subjects were 172 elderly people recruited from 217 senior citizens visiting public oral health care services in 16 districts in Busan. They completed self-Corresponding Author reported questionnaires. Results : Elderly people had less remaining natural teeth (p<0.001). The remaining natural teeth ($15.07{\pm}8.75$) of the health insurance beneficiary were majority than those of the medicaid ($8.78{\pm}8.45$)(p<0.001). The respondents with better oral health condition had more remaining natural teeth (r=0.317, p<0.001), and those who were more worried about oral health had less remaining natural teeth (r=-0.599, p<0.001). Aging accelerates loss of natural teeth (p<0.001) of 3.203. Approximately 2.188 remaining teeth will be preserved by oral health care improvement (p=0.009). Conclusions : Frequent dental clinic visit will prevent natural teeth loss in the elderly people. Toothbrushing is the most efficient method of oral health care in the elderly people. Awareness towards oral health care is the motivation to preserve natural teeth in the elderly people.
From 1994-2001, 25 mutilated digits were reconstructed with immediate toe-to-hand transfer in acute hand injury in 21 patients. There were 15 cases of great toe-to-hand transfer(partial great toe transfer 8 cases, modified wrap-around procedure 2 cases, and trimmed great toe transfer 2 cases) for thumb reconstruction, 2 cases of second toe transfer for index reconstruction, and 4 cases of simultaneous two toe-to-hand transfer(great toe & second toe transfer 1 case, bilateral second-toe transfer 2 cases, combined second & third toe transfer 1 case) for reconstruction of multiple digit amputations. Two cases of emergency exploration(2/25, 8%) were successfully salvaged. The incidence of emergency exploration and postoperative infection was not significantly different from that of the elective toe-to-hand transfer cases. Duration of industrial insurance coverage was 225 days, which is much shorter than that of elective cases. Among 43% of patients maintained their original job even after injury and immediate toe-to-hand transfer. The subjective satisfaction self- assessment scores of aesthetic appearance and function on the new reconstructed thumb were 80 and 88 in average, respectively, over a total score of 100. These were higher than those of reconstruction of other digits, but lower than those of elective reconstruction. The donor site after harvest of the great toe was mostly unsatisfied in a view of appearance. Immediate toe-to-hand transfer provides many advantages over elective procedure in acute hand injuries such as single stage reconstruction, shortened convalescent period, early return to work and efficient socio-economic factor. Furthermore because there were no significant differences in success rate, frequency of complications or ultimate functional result, immediate toe-to-hand transfer is a safe and reliable procedure in case of limited indications for acute digits loss.
Objectives : To evaluate the cost and proportion of complementary and alternative medicines (CAM) in the total healthcare costs among the elderly in the last 6 months of life. Methods : The care-giving families of 301 persons older than 65 years, who died between July 1st and December 31st of 2001, and were also registered in Self-Employed Health Insurance Programs in Seoul, were interviewed. Results : The cost of CAM was 1.09 million Won, which as a proportion of the total healthcare cost was 38.1%. The elderly aged between 65 and 69 year-old, male, living with their spouse, Buddhist and having cancers had higher CAM costs in an ANOVA and simple regression analysis. After controlling of various factors, age was the only significant factor associated with the cost of CAM. The elderly above 80 years old, female, bereaved and Buddhist had higher proportional CAM costs, and the elderly having cancers or cardiovascular diseases had lower proportional CAM costs in an ANOVA and simple regression analysis. After adjusting for various factors, the elderly above 85 years old, female and Buddhist had higher proportional CAM costs, and the elderly having cancers had lower proportional CAM costs. Conclusion : The very old and Buddhist, and/or the ill with no clear diagnosis, may depend more on CAM. Further research will be needed on the meaning and impact of CAM and their costs to public health and the total healthcare system.
This study is conducted to investigate the current status on the utilization of health care and plan for solving this problem. The claims data of the fiscal tear 1995 obtained from the regional health insurance society are used for the study. The main findings of the study are summarized as follows. Indexes(The Extremal Quotient(EQ), coefficients of variance(CV's))which represent the regional difference in the admission rate of the tertiary medical diagnosis group report that there is difference in quantity and quality of utilization of health care. The admission rate is lower in the big city areas, Kyoungkido, Kangwondo and Chunlapukdo. Even after age-sex adjustment, the admission rate is still low in Kangwondo, Chunlapukdo and Kyoungsangpukdo. The big city areas tend to have higher rates in the expenses per claim, hospital days per claim, and daily expenses but the rates are still low in some area in Kangwondo, Chunlanamdo and Kyoungsangpukdo. This result remains as same after age-sex adjustment. There is a large regional difference in average utilization rate for the tertiary hospital of the tertiary medical diagnosis group: 57.2%(SD 11.53). The utilization rates for the tertiary hospital in their large catchment area are 96.34%, 83.19% and 73.22% in each Kyoungin, Kyoungnam and Kyoungpuk areas whereas it is lower in a Chungpuk and Chungnam areas. The regional differences of health care utilization of the tertiary medical diagnosis group gave some relationships with their geographical characteristics such as socio-economic characteristics and supply factors of medical services. It is important that many medical policies should be developed in order to minimize and balance out the regional differences of health care utilization. The service allocation policy should include the reconstruction of manpower policy, developing the resource allocating formula, finding the self-sufficient catchment area and reforcing of public health services. Moreover, in order to achieve the balanced development by region, they should investigate and consider each county's microscopic properties under the consistent macrocopic policy. The further studies to find causes of regional difference are needed.
Kim, Hyunsook;Lee, Myoungha;Kim, Hyeyoung;Nho, Juhee
Women's Health Nursing
/
v.24
no.2
/
pp.163-173
/
2018
Purpose: To identify factors influencing psychosocial adjustment in patients with surgical removal of benign breast tumor. Methods: With a survey design, data were collected using the Psychosocial Adjustment to Illness Scale-Self Report (PAIS-SR), Body Image Scale, Physical Discomfort Scale, and Family Support Scale with patients who had had surgical removal of a benign breast tumor from September to November 2017. Data were analysed with descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, and stepwise multiple regression. Results: The mean scores for physical discomfort, body image, family support, and psychosocial adjustment were $1.57{\pm}0.51$, $0.37{\pm}0.64$, $3.62{\pm}0.67$, and $4.00{\pm}0.45$, respectively. Family support, body image, physical discomfort, number of surgical removal of benign breast tumor (twice), and cancer insurance status (yes) were verified as factors influencing psychosocial adjustment. These factors accounted for 57.4% of psychosocial adjustment. Conclusion: In this study, family support, body image, and physical discomfort were identified as significant predictors of psychosocial adjustment. Therefore, this study can be used as fundamental data to develop nursing intervention strategies in order to increase psychosocial adjustment in patients with surgical removal of a benign breast tumor.
The purpose of this study was to analyze the relationship between objective oral health status determined by dentists, self-perceived subjective oral health status, and oral health related quality of life (OHRQoL) in the elderly. The related factors affecting OHRQoL in the elderly were also surveyed. Four hundred and thirty elderly individuals who visited the three public health centers and four dental clinics in Busan were selected by convenience sampling. Twelve dental hygienists investigated the subjective oral health status and OHRQoL using the 14-item Oral Health Impact Profile (OHIP-14) and twentyone dentists examined the objective oral health status, including healthy remaining teeth, treated remaining teeth, functional remaining teeth, missing teeth, and non-treated missing teeth. Data were analyzed using SPSS ver. 12.0. OHRQoL was higher when oral and periodontal status was perceived as healthy, when there was no toothache, no interference in mastication, and when study subjects had the ability of food softening. It was also higher when study subjects had ${\geq}20$ remaining teeth and <9 missing teeth, and were wearing denture. The related factors affecting OHRQoL of the elderly were the type of medical insurance, toothache, ability of food softening, perception of periodontal status, and the number of healthy remaining teeth. There was a significant relationship between the subjective-objective oral health status and OHRQoL in the elderly. A continuous oral health care system aimed at retaining ${\geq}20$ healthy remaining teeth is needed to improve oral health and OHRQoL for the elderly, especially for the elderly receiving medical aid.
Purpose: The aims of this study were to describe general characteristics and needs of home health care, and to find the differences between home health care needers and non-needers. Method: In this study, 642 subjects participated who lived in Muan, Jollanam-do. Data were collected in August 2001 using a self-reported questionnaire. The questionnaire was a revised and simplified form of the Organization of Community Health System Program at the Seoul National University. Collected data were analyzed through Kruskal-Wallis test. t-test. and Chi-squire for cross-sectional analysis. Result: The average age of the subjects was 52.6 years and 33.3% of them aged over 65 years. Twenty six percent of them had chronic degenerative diseases. The percentages of hypertension patients and D.M. patients were 6.4% and 2.5%, respectively. The number of family members was 2.95 on the average, 2.19 in cases of families with the elderly and 3.33 in cases of families without the elderly. The rate of disability of the elderly was 10.5%. Marital status (p=.000), the number of family members (p=.000), education (p=.000), job (p=.000) and health insurance (p=.027) were significantly different between home care needers and non-needers. Home care needers had less living expenses (p=.001), more frequent hospital admissions (p=.004), higher chronic disease rate (p=.000) and more frequent visits to public health center (p=.027) than non-needers. Home care needers who wanted free service were twice as many as non-needers. Conclusion: Home care need was very high in rural areas and the needers had worse characteristics (low educational level. low income, no job and no family). Therefore, it is necessary to develop cheaper and more accessible services for home care needers in rural areas.
Lee, Jin Yong;Lee, Sang-Il;Son, Woo-Seung;Kim, Hyun Joo;Ock, Minsu;Jo, Min-Woo
Korea Journal of Hospital Management
/
v.18
no.1
/
pp.42-58
/
2013
The purpose of this study was to investigate the awareness of long-term care hospitals on pay for performance(P4P) program in Korea. We conducted a cross-sectional, self-administered, the internet based survey from September to October in 2010. The questionnaire was consisted of the levels of awareness and agreement about the program, their preferred design and its possible effects and unintended consequences etc. Among 837 eligible long-term care hospitals in Korea, 114 hospitals(13.6%) were participated in the survey. About one-thirds of long-term care hospitals were not aware of P4P, namely it is important to heighten an awareness of P4P. There were pros and cons on introduction of P4P in Korea. The two major reasons of objections of P4P were the concerns of unintended consequences and the possibility of strengthening government control by implementing P4P. In conclusion, to successfully implement P4P to long-term care hospitals, the Health Insurance Review & Assessment Service(HIRA) in Korea should obtain the long-term care hospitals'opinion as to implementation of P4P.
Purpose: The purpose of this study was to investigate the relationship between health knowledge and health promoting behavior in the elderly. Methods: The participants of this study were 114 men and women over 65 years at P-myeon, Yeongju-si, Gyeongsangbuk-do. Data were collected from March 1st to April 9th in 2011. The survey was carried out via the face to face interview using structured questionnaires. Results: Eighty nine percent of the participants responded that they were aware of the types of healthcare service. The most desirable service was 'long term care insurance system'. The average of health knowledge was 7.94 (${\pm}1.51$) out of 10 and average of health promoting behavior was 2.81 (${\pm}0.30$) out of 4. Health promoting behavior showed a positive correlation with health knowledge (r=.189, p=.044). Conclusion: The health promoting behavior in the elderly was related with health knowledge. Therefore, the enhancement of health knowledge is needed to improve health promoting behavior in the elderly. Education for self care and providing information for health care are needed for health maintenance and improvement in elderly. In addition, program development for providing health knowledge and nursing intervention for supporting health promoting behavior are in need.
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