• Health Policy and Management
• /
• v.9 no.2
• /
• pp.139-156
• /
• 1999

Recent changes in the health care environment have directed increasing attention to the number and specialty mix of practicing physicians. A major concern identified in Korean health care system is the serious oversupply of specialists and a relative lack of primary care physicians. Currently only 21% of Korean physicians are primary care physicians(general practitioners and family physicians), and less than 10% of recent medical school graduates are choosing to enter primary care. More primary care physicians are needed to deal with major problems in the current health care system, such as cost and access. The infrastructure that relies on primary care physicians is needed to deliver cost-effective and efficient care. To achieve a better balance of primary care to non-primary care physicians. more medical students need to choose careers in one of the primary care specialties(family medicine. internal medicine and pediatrics). This paper suggests the necessity of reforming the Korean graduate medical education system, that is, establishing the path of training primary care physicians in internal medicine and pediatrics residency training programs.

• Health Policy and Management
• /
• v.20 no.1
• /
• pp.87-102
• /
• 2010

The objective of this study were to examine the impact of medicaid coverage expansion policy aimed at improving access to primary care. The case-control study was conducted to compare preventable hospitalization(PH) rate in new medicaid recipients versus national health insurance(NHI) enrollees form 1996 to 2001. Rates of preventable hospitalization associated with ambulatory care sensitive conditions(ACSC) were calculated and standardized by age and sex. Multinomial logit regression model was used to control the confounding factors such as age, gender and charlson comorbidity index Annual PH rates in the new medicaid increased 1.64 times after medicaid expansion, with controling confounding factors. Meanwhile, annual PH rate in the NHI increased 1.68 times during the same period, with adjusting confounding factors. Current findings suggest that the new medicaid PH rate was less likely to rise than NHI PH rate after implementing medicaid expansion. This study is expected to provide policy-relevant evidence of medicaid expansion to include population with low income.

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

• Health Policy and Management
• /
• v.1 no.1
• /
• pp.95-108
• /
• 1991

The World Health Organization and its member states, in 1978, declared that primary health care is a key to attain the goal of Health for All by the goal of Health for All by the yeas 2000. As a member state of WHO, the Republic of Korea has participated in the declaration of ALMA-ATA and committed to put national efforts for devedoping and implementing primary health care approach with the spirit and content of this Declaration. Since 1978, to translate the spirit of the Declaration into realization, Korean goverment has developed a new category of health manpower such as Community Health Practitioners serving people living in remote rural areas and Village Health Workers serving voluntarily their own village, strengthened the function of Health Centers and Health Subcenters through their reorientation and improved the infrastructure by their new construction or renovation. While primary health care is viewed as an essential health care in Korea, there are some circles who follow a narrow definition in referring to the health care at the periphey of a health system, which is erroneous. Considering the PHC is accepted as the best alternative approach to health care to solve problems that modern health systems are facing, we propose the followings as desirable health policy directions that modern health systems are facing, we propose the followings as desirable health policy directions which might translate the persopective into action at the national level after reviewing past and current PHC approach in Korea : 1. To improve the equity through the reduction of gaps between those who have access to health care and those who have not. 2. To reinforce multisectoral approach and intersectoral coordination through the re- establishment of the National Health Council or establishment of equivalent organization at the central level. 3. To stengthen community participation through lacal people's empowerment by leadership training, changing planning process from the top-down approach to bottom-up and giving the priority to human resources rater than technology, 4. To reinforce the Ministries of Health and Social Affairs through upgrading its role and function to Coordinate Ministries which involve human welfare policies, and creating a Division which is in charge of PHC in the Ministry.

• Health Policy and Management
• /
• v.1 no.1
• /
• pp.54-71
• /
• 1991

Health of a nation is quite often represented by the statistics such as infant death rate and maternal mortality rate. It is indisputable that maternal child health(MCH) is the basis of health of a nation. MCH is also one of the cardinal component of primary health care. The importance of MCH is conspicuous especially in the developing countries. In Korea, People in the rural communities still have high access barrier to basic health care needs, including MCH services. Access to quality care during pregnancy and delivery seems to be the crucial factor in preventing deaths in women and children. The beneficial effects of prenatal and postnatal care on the outcome of pregnancy for mother and child, and those of health professional-attended institutional delivery on the health of mother and child have been well documented in many studies. Recognizing these effects, the government of Korea received IBRD loan of $30 million in 1979 for th purpose of constructing 89 rural MCH centers. The construction is complete now and all 89 MCH centers are under operation ti imporve primary health care for mothers and children in Korea. However, it has been observed over time that overall performance of public MCH centers is declining. The decline has been attributed partly to low quality services by public MCH centers, poor management by health center mangers, competition with for-profit private clinics, and to the development of national health insurance. This study investigates the utilization by rural communities in Korea of MCH services provided by public sector health centers deemed to be physically and financially accessible to the community but suboptimally used. It seeks also to determine the factors that influence people's utilizations. This study sets out to discover a desirable form of MCH center from among alternative forms of centers, thereby to construct a MCH model.

• Korean Journal of Health Education and Promotion
• /
• v.23 no.5
• /
• pp.29-46
• /
• 2006

Purpose: Since 1994, Asian Health Services, the Korean American Community Advisory Board, and the Center for Family and Community Health (University of California at Berkeley) have conducted periodic, population-based surveys on Korean American community health in Alameda County, California. The present study examines changes in health care access and utilization between 1994 and 2002 among Korean American adults in Alameda County, California. Method: We reanalyzed data from the 1994 and 2002 Korean Health Surveys. The primary variables of interest, health care access and utilization, were operationalized in terms of health insurance coverage, routine check-ups, a usual source of health care and reported barriers to health care. The frequency distribution of each indicator was calculated and its standard error was estimated using SUDAAN. The differences between 1994 and 2002 were examined with chi-square test. Results: Compared to 1994, Korean Americans in Alameda County were more likely to have health insurance coverage in 2002 (74.0% vs. 82.7%). Korean Americans in Alameda County were more likely to have received a recent (prior two years) routine health checkup in 2002 (50.4% vs. 57.2%). Health checkups increased over time for males, for adults with more than 12 years of education, and for employed adults. Also, compared to 1994, employed adults were more likely to have a usual source of health care in 2002 (66.5% vs. 78.4%). In both 1994 and 2002, high cost (58.0% vs. 47.8%) was the most commonly cited barrier to health care, and the next most frequently cited barriers were language (29.2% vs. 27.7%) and no time (29.2% vs. 30.3%). Conclusion: To improve health care utilization and health conditions, it is important to investigate factors related to health care and to monitor changing trends. Ongoing surveillance of health-related factors can contribute to the development of health education programs to reduce morbidity and mortality due to chronic disease, and thereby lead to improvements in health status among Korean Americans.

• Journal of Preventive Medicine and Public Health
• /
• v.39 no.5
• /
• pp.411-418
• /
• 2006

Objectives: The purpose of this study was to determine whether the disabled have worse access to primary care than the non-disabled. Methods: We used the National Disability Registry data and the National Health Insurance data for the calendar year 2003, and we analyzed 807,380 disabled persons who had been registered until December 2001 and we also analyzed 1,614,760 non-disabled persons for nine ambulatory care sensitive conditions (ACSCs). The rates of physician visits and hospitalizations for the patients with ACSCs were compared between the disabled and the nondisabled. Multiple logistic regression analysis was used to evaluate the association between medical care utilization and disability and to assess the association between hospitalization and the number of physician visits while controlling for potential confounders. Results: The numbers of physician visits per 100 patients were $0.78{\sim}0.97$ times lower for the disabled than that for the non-disabled with five of nine ACSCs. The numbers of hospitalizations per 100 patients were $1.16{\sim}1.77$ times higher for the disabled than that for the non-disabled with all the ACSCs. While the ORs of a physician visit for the disabled were significantly lower than that for the non-disabled with all the ACSCs (OR: $0.44{\sim}0.70$), and the ORs of hospitalization for the disabled were significantly higher (OR: $1.16{\sim}1.89$). The lower physician visit group (number of physician visits ${\leq}$1) was more likely to be hospitalized than the higher physician visit group (number of physician visits ${\geq}$2) (OR: $1.69{\sim}19.77$). The effect of the physician visit rate on hospitalization was larger than the effect of disability on hospitalization. Conclusions: The results suggest that the disabled were more likely to be hospitalized for ACSCs due to their lower access to primary care.

• Journal of Preventive Medicine and Public Health
• /
• v.54 no.2
• /
• pp.129-136
• /
• 2021

Objectives: This study examined demographic factors hampering access to healthcare at hospitals and suggests policy approaches to improve healthcare management in Thailand. Methods: The data for the study were drawn from a health and welfare survey conducted by the National Statistical Office of Thailand in 2017. The population-based health and welfare survey was systematically carried out by skilled interviewers, who polled 21 519 384 individuals. The independent variables related to demographic data (age, sex, religion, marital status, education, occupation, and area of residence), chronic diseases, and health insurance coverage. The dependent variable was the degree of access to healthcare. Multiple logistic regression analysis was subsequently performed on the variables found to be significant in the univariate analysis. Results: Only 2.5% of the population did not visit a hospital when necessary for outpatient-department treatment, hospitalization, or the provision of oral care. The primary reasons people gave for not availing themselves of the services offered by government hospitals when they were ill were-in descending order of frequency-insufficient time to seek care, long hospital queues, travel inconvenience, a lack of hospital beds, unavailability of a dentist, not having someone to accompany them, and being unable to pay for the transportation costs. Multiple logistic regression analysis showed that failure to access the health services provided at hospitals was associated with demographic, educational, occupational, health welfare, and geographic factors. Conclusions: Accessibility depends not only on health and welfare benefit coverage, but also on socioeconomic factors and the degree of convenience associated with visiting a hospital.

• Health Policy and Management
• /
• v.26 no.1
• /
• pp.4-11
• /
• 2016

Background: Hospital admissions for ambulatory care sensitive conditions (ACSCs), which are widely used as an indicator of poor access to primary care, can be used as an efficiency indicator of healthcare use in countries providing good access to health care. Korea, which has a national health insurance (NHI) system and a good supply of health care resources, is one such country. To quantify admission rates of ACSC and identify characteristics influencing variation in Korean health care institutions. Methods: By using NHI claims data, we computed the mean ACSC admission rate for all institutions with ACSC admissions. Results: The average ACSC admission rate for 4,461 institutions was 1.45%. Hospitals and clinics with inpatient beds showed larger variations in the ACSC admission rate (0%-87.9% and 0%-99.6%, respectively) and a higher coefficient of variation (7.96 and 2.29) than general/tertiary care hospitals (0%-19.1%, 0.85). The regression analysis results indicate that the ACSC admission rate was significantly higher for hospitals than for clinics (${\beta}=0.986$, p<0.05), and for private corporate institutions than public institutions (${\beta}=0.271$, p<0.05). Conclusion: Substantial variations in ACSC admission rates could suggest the potential problem of inefficient use of healthcare resources. Since hospitals and private corporate institutions tend to increase ACSC admission rates, future health policy should focus on these types of institutions.

• Health Policy and Management
• /
• v.16 no.4
• /
• pp.86-111
• /
• 2006

Either ways of understanding health care as a commodity or public work are at opposite ends of health care spectrum. These two rival conceptions reflected by viewpoint(ideology) would lead to different directions in policy-making for health care reform. The purpose of this study is to access the value differences of experts' policy views about health care issues by analyzing the extent of consensus among experts in the field of health care. Using primary data obtained through a mail survey of 558 experts in the field of health care, we analyzed the differences of experts' opinions about characteristics of health care market, policy issues and values Gdeology). The study represents from 50-50 split analysis, entropy index, and factor analysis that the wide spread disagreements over health policy, which is a major barriers to effective policy-making, could be caused by the ideological perception differences among experts. This implies that, if values play an important role in policy-making, we should identify the differences in value and seek ways to balance among the diverse values such as efficiency, equity, freedom, and security. For this, the policy issues debated on differences in values should be reconciled for narrowing gaps of experts' perceptions through various ways.