Recently, the importance of emergency medical services has emerged, as rapid advances in urbanization and industrial development. Accordingly, the need for effective emergency medical services is increasing, and the evaluation of an emergengy medical services centers is conducted to meet these policy needs. The purpose of this study was to analyse the relationship between the structure and the process domain of the evaluation of an emergency medical services center based on the Donabedian's model and to verify the validity as an index of quality evaluation through the results. As a result of the analysis, there were some indicators that showed a different direction than expected, but generally there was a significant correlation between the structure and process domains of the evaluation of an emergency medical services center. This suggests that the process can be improved by improving the structure. In conclusion, as structure and process indicators in evaluation of an emergency medical services center show significant relationship, it can be evaluated as validity as a tool to measure the quality of emergency medical services.

1) Purpose : The purpose of this research is to identify the trend of job stress of hospital nurses based on last 10 years of domestic research and to suggest directions for systematic future research. 2) Methodology : 101 studies between 2006 and 2016 were selected using key words such as registered nurse and job stress from Academic Information Service(Riss4u), the National Assembly Library and Korean studies Information Service System(KISS). 3) Findings : The researches on job stress of hospital nurses were increasing. The result showed that job stress increased for shift nurses. Especially, nurses of small-medium sized hospital showed remarkable effects to organization such as turnover intention. In addition, although the importance of approach to management is emphasized, there is little research on these aspects. 4) Practical Implications : It is necessary to develop systematic research on job stress directly effecting turnover intention of hospital nurses from hospital management aspect. The development of job stress measuring tools reflecting the characteristics of the medical institution, and the human resources management plan to resolve the imbalance in manpower for nurses should be required.

Purpose: The purpose is to understand the perception of medical providers at tertiary hospitals in Seoul on the importance-performance of the reform on a doctor-designation system, and to provide the policy suggestion of the perception on such a system. Methodology: To achieve the purpose, this study utilized structured survey tools to conduct a questionnaire survey of nursing, administrative and medical technology professionals at six tertiary hospitals in Seoul. An importance-performance analysis was utilized for an analysis that showed the perception of the reform on a doctor-designation system. Findings: First, it was identified that those medical providers had the highest perception of the importance about the performance of the reform on a doctor-designation system. Second, according to the result of action grid of an importance-performance analysis (IPA), it can be identified that in the 2nd stage of 'Concentrate here' included are the items as to design and effect of medical care quality and subsidies & patient infection and safety and control fees, effect of income security of the method for compensating for loss established by the government and offering sufficient information on general medical services and doctor-designation medical services. In the 1st stage of 'Keep up the Good Work', and the 2nd stage of 'Concentrate here' included is the item as to the performance of patients of the reform on a doctor designation system. Practical Implications: There could be identified the effect of the reform bill on the perception of medical providers. It is expected that a better environment would be provided for patients to use a hospital and for medical providers to offer medical services, if the goverment makes efforts to improve methods for compensating for loss and continuous monitoring of the performance of patients.

The purpose of this research is to evaluate Brand Value by using the K-BPI(Korea Brand Power Index) of Korea Management Association which is based on consumer awareness, as well as to identify how Brand Value which is composed of top of awareness, unaided awareness, aided awareness, image, possibility of purchasing, preference, affects on the Market Share perceived by consumers. This research subjects were 10 hospitals with more than 1,000 beds in Seoul and Gyeonggi-do, and survey subjects were 20 or older adults living in the metropolitan area of Korea. Using K-BPI for measuring Brand Value and used calculation of Market Share according to consumer preference model for measuring Market Share. The major results of this research are as follows: First, this research identified that the top 5 hospitals of largest hospitals in metropolitan area measured by using K-BPI and Market Share were same hospitals as Big 4 hospitals of previous research evaluating the comprehensive competitiveness of hospitals and also same as hospitals that appeared recently. Second, Big 5 hospitals ranked first to fifth in both Brand Value and Market Share. To identify the relationship between K-BPI items(top of awareness, unaided awareness, aided awareness, image, availability, preference) and Market Share, multiple linear regression was used by dividing 5 upper and 5 lower group of hospitals per each. The group of 5 upper hospitals had a significant effect on Market Share, with 'top of awareness', 'unaided awareness', 'aided awareness'. The group of 5 lower hospitals had a significant effect on Market Share with 'unaided awareness', 'aided awareness'. The results of this study and hospitals of the first to third hospitals published in the K-BPI press release reported by KMAC in 2017, and the previous studies evaluating the comprehensive competitiveness hospitals, all had one thing in common that Big 4 hospitals ranked high position. This suggests that evaluation of Brand Value also can be a evaluation measure of hospital. A new competitiveness of hospital is expected by managing brand awareness to have a brand competitiveness and by securing intrinsic Market Share of consumer to reach hospital use ultimately.

Purposes : In February 2014, the government said that the National Health Insurance Service (NHIS) will enforce plan for reducing the financial burden from two major non-covered services including physician surcharges and private room charges, the main causes to increase uninsured, by 2017. The purpose of this study is to analyze the policy effect that performed so far by comparing out-of-pocket payment rates of policy process Methodology: This study analyzed admission medical expenses that occurred from January 2013 to March 2016 at a upper grade general hospitals in Daejeon. Number of study subjects were 134,924 and the data were analyzed with SPSS 22.0 program by using frequency, percentage, mean, standard deviation, ANOVA. The effect of two major non-payment improvement plan on out-of-pocket rates was ascertained via generalized estimating equation. Findings: Out-of-pocket payment rates was statistically significantly declined 2.7 percent than enforcement ago. Also, out-of-pocket payment, physician surcharge, the proportion of out-of-pocket payment of hospital room charge to out-of-pocket payment was statistically significantly declined. However, a further analysis of the cause of the decline in total medical costs is needed. Practical Implications: Physician surcharges and private room charges improvement policy had a positive effect on the decline of out-of-pocket payment rate. The policy of physician surcharges was very effective after the first policy enforcement but it was less effective to medical aids and near poor that was a more greater coverage than national health insurance. Since the policy has not been finalized, we have to continue a research for the successful implementation of the policy.

The purpose of this study is to examine the structural causal relationships between service image, service satisfaction, affective commitment, and customer loyalty to customers who have experienced hospital medical services, and to identifies the mediating effect of relationship proneness in explaining the effects of service image, service satisfaction, and affectivel commitment on customer loyalty. For this study, 250 respondents were surveyed and data were analyzed using SPSS 21.0 and AMOS 20.0 statistical package. Statistical analysis tools, such as SPSS 21.0 and AMOS 20.0 were utilized for ensuring the validity and the reliability, whereas the SEM method was used for testing the research hypothesis. The results of study are as follows. Service image had significant influence on service satisfaction and emotional commitment. First, Service satisfaction was significant for emotional commitment and customer loyalty, and emotional commitment had a significant effect on customer loyalty. Therefore, the path relations between variables were all statistically significant. Second, there was differences the moderating effect of the relationship proneness in the effects of service satisfaction, service image and affective commitment on customer loyalty. In other words, the moderating effect of the relationship tendency was consistent with the research hypothesis and the adjustment effect was significant in the relationship between service satisfaction and customer loyalty. However, there was no control effect in relation to service image and customer loyalty and affective commitment and customer loyalty. Therefore, In order to secure long-term and stable profits by establishing a relationship with their customers, the medical service marketing strategies of hospitals should be promoted to enhance customer loyalty by raising the level of service satisfaction to high relationship proneness group and by raising the the level of affective commitment to low relationship proneness group.

Purposes: This study identifies local Chinese consumers' standard for selecting medical care provider and their standard for choosing medical staff, as well as their expectations and concerns regarding Korean medical care providers. Methodology: A survey was conducted in China, to identify Chinese medical care consumers' standards for selecting a medical provider and the factors that influence their use of general hospitals. A total of 1,500 people across three cities, between the ages 18 and 60 participated in the survey. Moreover, a multiple logistic regression analysis was used to analyze the factors that affect Chinese medical care consumers' use of general hospitals. Findings: A total of 75.5 percent respondents chose general hospitals as their most frequently-used medical provider. Those who have health insurance, visit general hospitals as outpatients or are hospitalized more frequently than those who do not have a health insurance. Furthermore, those who have private insurance visit general hospitals as outpatients or are hospitalized more frequently than those who are not signed up for private insurance. Major standards for selecting a hospital included: the doctor's skills, word-of-mouth regarding the hospital, and distance to the hospital from the respondents' home. Standards for choosing medical personnel included word-of-mouth regarding the medical team, recommendations from family members or acquaintances, and medical team's notoriety. Friends and neighbors, family members, television and other media outlets were the channels for acquiring information on a hospital. It was found that Chinese people mostly visit the cardiovascular department of Korean hospitals for treatment. For using Korean hospitals in China, the majority of respondents answered that they were concerned about the cost. Practical Implications: Backed by highly skilled medical experts and cutting-edge technology, Korean medical care providers are attempting to enter China's medical care market. To succeed in China's medical care market, it is vital to conduct a clear and precise analysis.

Purpose: 본 연구는 미국 캘리포니아와 플로리다에 위치한 의료기관을 대상으로 급성심근경색증, 심부전, 폐렴을 주진단으로 받은 메디케어 입원환자들에게 제공된 의료서비스의 과정적 질과 잠재적으로 예방이 가능한 30일 이내 위험 보정 재입원율과의 관계를 살펴보았다. Methods: 본 연구의 종속변수는 잠재적으로 예방이 가능한 30일 이내 위험 보정 질환별 재입원율이며 3M PPR 소프트웨어를 이용하여 재입원의 예방 가능 여부를 결정하였다. 미연방 의료 비용 및 이용 프로젝트 데이터베이스, 미국병원협회의 병원조사 자료, 미연방 보건복지부소속 메디케어 및 메디케이드 서비스 센터의 병원비교 자료를 이용하였다. 자료의 위계적 구조를 고려하여 다수준 로지스틱 회귀분석을 이용하여 분석하였다. Findings: 의료서비스의 과정적 품질과 퇴원 후 30일 이내 잠재적 예방 가능 위험도 보정 재입원율과의 관계는 질환별로 차이를 보였다. 폐렴의 경우 의료서비스의 과정적 질은 30일 이내 잠재적 예방 가능 보정 재입원율과 유의한 부(-)의 관계를 보였으나, 급성심근경색증과 심부전의 경우 대체로 유의한 관계를 관찰할 수 없었다. Practical Implications: 잠재적으로 예방 가능한 급성심근경색증, 심부전 재입원율을 줄이기 위해서는 의료기관에서 가이드라인으로 따를 수 있는 더욱 다양한 근거 중심의 과정적 질 지표의 개발에 대한 정부와 보건의료계의 노력이 필요하다.