• Health Policy and Management
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• v.5 no.1
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• pp.31-58
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• 1995

The Korean government achieved the universal coverage of health insurance in July 1989, and concomitantly introduced a new measure of regulated health care delivery system in using medical care. There are three reasons why the government took the new health care delivery system. Firstly, there was ample room for improving the allocative efficiency in the use of medical facilities. And the second one was to constrain the dramatic increase of medical demand under health insurance. Thirdly, and the most important reason was to alleviate the patient crowdedness in big general hospitals, particularly tertiary hospitals. There are essentially two different ways to control the use of health care : one is to cut the demand for health care, and the other to regulate behaviors of providers through the use of incentives/disincentives, demand-side approach or supply-side approach. The objective of this study is to examine whether or not medical care utilization behaviors under health insurance scheme have been changed among medical facilities such as clinic, hospital, general hospital and tertiary hospital in comparison with those before and after the introduction, particularly whether the patient crowdedness in tertiary hospitals has been alleviated or not. In order to conduct this study, the insurance claim data during the period of January 1989 and July 1992 were analyzed by focusing on diagnosis of both inpatients and outpatients, and especially the fifteen most frequent diseases in ambulatory care and the seven most frequent diseases in hospitalizatio. In addition, the same analyses were made on the changes in medical care utilization by specialty department. This was because the five departments, such as family medicine, ENT, eye, dermatology and rehabilitation, were exempted from applying the regulated health care delivery system in tertiary hospitals. The study revealed that a remarkable alleviation effect in the crowdness was noted for tertiary hospitals. This effect was most conspicuous for the most frequent mild diseases of both inpatient and outpatient care. For example, the fifteen most frequent OPD care at tertiary facilities have decreased as much as by 40%, of which 34% belonged to the cut in initial visits. Meanwhile, the proportion of those who used general hospitals and private practitioner's clinics have increased due to the shift of patients. The cases from the five special departments were also decreased, but not so much as other departments. A problem was noted that, as time passed by, the decreasing tendencies of crowdness at tertiary hospitals due to the regulated system became slightly smaller. Therefore, through complementary remedies are needed for the future implementation.

• The Journal of Korean Obstetrics and Gynecology
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• v.31 no.3
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• pp.61-78
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• 2018

Objectives: The purpose of this study was to analyze the current characteristics of outpatients with postpartum disease and provide a treatment instruction in the clinical field. Methods: To analyze characteristics of outpatients with postpartum disease, We searched medical records from January 1, 2015 to December 31, 2017 using Z34 (Supervision of normal pregnancy), O94 (Sequelae of complication of pregnancy), U327 (産後風) and 388 postpartum patients were analyzed. Results: 1. The general characteristics of the subjects are as follows. The average age was $33.73{\pm}3.62$ years old, 356 (91.75%) patients are full term pregnancy, 201 (51.81%) patients are first delivery, 79 (20.36%) patients had past history of abortion and 63 (16.24%) patients had past history of gynecologic disease. 2. The most subjects visited in April (10.31%). The mean duration from delivery date to visiting date was $131.5{\pm}214.6$ days. The mean number of visits after the initial visit was $1.91{\pm}1.7$. 3. The characteristics related with pregnancy and delivery are as follows. The number of subjects taken assisted reproductive technology was 19 (4.9%) and suffering from gestational disease was 28 (7.22%). The mean body weight difference between full term pregnancy and visiting date was $-8.24{\pm}3.57kg$. The number of subjects discharging lochia on visiting date was 167 (43.04%) and breastfeeding was 262 (67.53%). 4. The most chief complaint was arthralgia in 217 (55.93%) followed by general weakness, cold sensation, edema, sweating disorder, dizziness, lower abdominal pain, digestion disorder, heat sensation, defecation disorder and urination disorder. 5. The most accompanied symptom was arthralgia in 322 (82.99%), followed by sleep disorder, cold sensation, general weakness, sweating disorder, defecation disorder, edema, dizziness, digestion disorder, urination disorder, lower abdominal pain and heat sensation. 6. A total of 356 subjects were taken herbal medicine. The most prescribed herbal medicine to subjects was Gungguijohyeol-eum-gamibang (29.59%). Conclusions: These results could be helpful to diagnose and treat postpartum patients in Korean gynecologic clinical fields.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.14 no.1
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• pp.336-343
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• 2013

The purpose of the present study was to determine the effect of 4 weeks course of motorized spinal decompression delivered via SpineMT(mobilization & traction) combined with therapeutic modalities on the treatment of patients with lumbar radiculopathy(LRP). A total of 15 patients with LRP (mean age, 36.63 years; age range 20-50years) participated in this study. 4 weeks course of spinal decompression delivered via SpineMT combined with therapeutic modalities was delivered to the patients for 6 days per week for the first two weeks, and four times per week for two additional weeks. The entire treatment consisted of 20 visits over 4 week period. Comparisons of changes in the muscle strengthening (MS), straight leg raise (SLR), and Oswestry disability index (ODI) at pre-intervention, after 10 treatment sessions, and at discharge (after 20 treatment sessions) were analyzed. There were significant improvements in the outcome measures of MS test, SLR test, and ODI score after 10 and 20 sessions of spinal decompression treatment combined with therapeutic modalities as compared with the pre-intervention(p<0.05). Spinal decompression treatment combined with therapeutic modalities appears to be a safe and efficacious, noninvasive treatment modality for patients with LRP.

• Journal of Preventive Medicine and Public Health
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• v.35 no.4
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• pp.340-350
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• 2002

Objectives : To evaluate the annual visit days, the annual prescription days and the medical costs of hypertensive patients. Methods : The medical insurance records of 40,267 incident patients with the diagnostic code of hypertension from September 1998 through August 1999 in Daegu city were reviewed. Results : The proportion of the most proper medical care pattern group (Group VIII) who visited for 6-15 days with 240 prescription days or more a year was only 6.2%. The proper care group (Group IX) who visited for more than 16 days with 240 prescription days or more a year was 9.3%. The overall proper care group (Group VIII+IX) was therefore 15.5%. The proportion of the insufficient care group (Group I, IV) in both the number of visiting days and prescription days was 57.4%. The mean prescription day of the most proper group (Group VIII) was 29 days; the mean annual medical expenses,453,587won; the mean annual amount paid by patients, 218,013won; and mean medical expenses per prescription day, 1,483won. The proportion of the overall proper care group (Group VIII+IX) was significantly higher in adults aged 50-59, those who were enrolled in industrial workers health insurance as well as government employees and private school teachers health insurance, and those who made a higher contribution per month (p<0.01). According to the type of medical facilities, the proportion of the most proper medical care pattern group was highest in the general hospitals (9.3%) but the overall proper care group was higher in the public health centers (22.1%) and private clinics (17.1%). Conclusions : The management system of hypertension should be reinforced urgently. Therefore, it is necessary to develop guidelines including the number of visiting days per year and prescription days per visit day, and make the system provide medical facilities to more properly care for hypertensive patients.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.10
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• pp.351-357
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• 2019

This study was conducted to evaluate outpatient experiences of a general hospital and help identify the medical service status experienced by the patients in the overall process of outpatient care, and analyze the major factors influencing patient experience and perception. A total of 100 patients having more than 2 outpatient clinic visits at a university hospital from May 14, 2018 to May 28, 2018, were selected to participate in the survey, comprising 60.0% females and 40.0% males. Considering age, majority belonged to the >60 years old age group (53.0%) as compared to <59 years (47.0%). "Hospital is close by" was the highest motivation to visit the hospital (42.0%), followed by "Medical staff is skilled" (36.0%), "Recommended by another hospital" (7.0%), and "Recommended by people" being the lowest (1.0%). Taken together, the results of this study can be used as basic data to identify the issues for providing better patient-centric medical services, and to formulate plans for creating medical services that meet the patient needs and differentiated medical services.

• The Journal of Korean Obstetrics and Gynecology
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• v.27 no.4
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• pp.69-87
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• 2014

Objectives: We analyzed retrospective clinical data of Korean medical institutes for infertility care and investigated current status and outcome of the Korean medical treatment of infertility as a part of foundational research for verifying validity of constructing national support system and developing appropriate policy on Korean medical treatment of infertility. Methods: We investigated data uploaded on the homepage of The Society of Korean Medicine for Subfertility (http://www.okinfertility.org) by Korean medical institutes for infertility care to get informations such as patients' age, body height, weight, methods of Korean medical treatment, cost and duration of treatment, success or failure of pregnancy and result of treatment. Results: The average age of patients was $33.1{\pm}3.8$ and the average body height was $161.2{\pm}5.3cm$ and the average body weight was $55.2{\pm}8.5kg$. The method of Korean medical treatment was Herbal medicine (97.5%), acupuncture (80.4%), moxibustion (57.7%), cupping (32.7%). The average cost of treatment was $1,160,625{\pm}882,499$ won, and the average medical cost per visit was $357,845{\pm}241,602$ won. The average duration of treatment was $11.26{\pm}10.58$ weeks, and the average number of visits per patient was $4.78{\pm}6.10$ times. The average duration of treatment was the longest in the group of infertile patients with the highest average medical cost per visit. The average pregnancy success rate was 30.9% overall, and that of the group of infertile patients was 25.8%. Conclusions: When we develop the standard project model with expectation for about 25% success rate of pregnancy and delivery in the group of patients who have idiopathic and ovulatory factors, it is desirable to perform acupuncture and moxibustion treatment 1-2 times a week with herbal medicine. The treatment period is set to at least 12 weeks. Average treatment fee maybe calculated by converting the averaged treatment cost of clinic's one month worth of daily treatment fee and medical hospital's ten day treatment fee into weekly treatment cost.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.35 no.2
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• pp.95-104
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• 2022

Objectives : This study is to report a case of otitis media with effusion accompanied by atopic dermatitis improved by Korean medicine monotherapy. Methods : A 31-year-old woman patient visited our clinic for aural fullness, hearing loss, and tinnitus of the left ear on August 14th, 2021. She also had abdominal pain, diarrhea, and general weakness because of side effects of antibiotics. Besides, she had nasal congestion, rhinorrhea, and dry skin. Through otoscopy, her tympanum was fully filled with yellow effusion. She only took Korean medicine therapy including acupuncture and herbal medicine weekly. The treatment continued for about 4 months(total 14 visits) until December 4th, 2021. Otoscopy, numerical rating scale(NRS), scoring atopic dermatitis(SCORAD) index were used to assess the symptoms. Results : On August 30, 2021, her intestinal symptoms improved. The left tympanum was recovered to normal condition as the treatment continued. The effusion disappeared on October 16th, 2021. On November 6th, 2021, peritympanic blood congestion also almost alleviated. Subjective symptoms including aural fullness, hearing loss, and tinnitus disappeared on October 16, 2021. Nasal symptoms and dry skin also improved. The SCORAD index dropped from 15 to 4. Conclusions : These results suggests that otitis media with effusion can be sufficiently managed by Korean medicine therapy. Further, active application of Korean medicine therapy to common otolaryngological diseases is necessary.

• Journal of the Korea Society of Computer and Information
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• v.27 no.6
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• pp.131-137
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• 2022

As the age increases, the oral cavity, that is, the teeth and periodontium, also begin to age, and accordingly, a preparation process is required. The preparation process is an important period for oral health management to start continuously with oral health education consisting of knowledge, attitude, and behavior from the 20s. Therefore, to design a clinical dental hygiene course for patients who visited a dental clinic in Gyeonggi-do and received continuous care in an oral health care room after treatment, we tried to analyze the data of the dental hygiene assessment. As a dental hygiene assessment tool, based on personal information and general medical history, dental visit experience, bleeding on probing(BOP), bad breath measurement, phase contrast microscopy, and O'Leary index were performed. The number of subjects who had dental visits was 75.4% and those without experience were 24.6%, and as a result of the periodontal examination, generally bleeding was found in 76.3%. In preventive oral care, the stage of dental hygiene assessment in the 20s is an important first step. From this point on, it is an important time to be systematically habituated so that you can take responsibility for your own oral condition. Therefore, in this study, the results of dental hygiene assessment through oral examinations of subjects in their 20s are derived and presented as basic data for the development of dental hygiene performance competency of dental hygienists during the clinical dental hygiene process in oral health education and oral health management.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.9 no.2
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• pp.227-236
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• 1998

Objectives：Conduct disorder is one of the most frequent diagnosis in outpatient and inpatient mental health facilities for children and adolescents. This study investigated the clinical characteristics of children and adolescents with conduct disorder. Methods：The study employed a retrospective review of 45 inpatients diagnosed with conduct disorder by DSM-IV criteria at SNUH Child Psychiatric Unit from 1993, March to 1998, September. Results：The results were as follows：1) The sex ratio was 2：1, male dominant. Mean age on admission was $12.8{\pm}2.4$ years old(male：$12.2{\pm}2.3$, female：$14.1{\pm}2.1$). The mean age of male subjects was significantly lower than that of female subjects(p<.05). 2) We classified all subjects according to child- or adolescent-onset type by DSM-Ⅳ. Childhoodonset type was 42.2%, and adolescent-onset, 57.8%. The onset of male subjects were significantly earlier than that of female subjects(p<.05). 3) The most common complaint was 'serious violation of rules'(77.8%) by DSM-Ⅳ dimensions, while the most common single symtom was 'run away from home overnight at least twice while living in parental or parental surrogate home'(48.9%). 4) The comorbid psychopathology of the subjects were frequently described as follows, in order of frequency：substance use(42.2%), ADHD(35.6%), depression(20.0%), tic disorder(11.1%), bipolar disorder(4.4%). 5) On MMPI, both Pd and Ma subscales got the highest scores. The mean of total IQ by KEDIWISC was $100.0{\pm}15.1$. Female subjects' IQ was higher than that of male subjects. 6) Regarding the number of visits to the OPD after discharge, many subjects(33.3%) had visited OPD fewer than four times. Conclusions：In this study, the male to female ratio of adolescent type showed a decreasing trend. An interesting finding was the fact that socio-economic circumstances, as well as the level of education among patients, were higher than those of previous studies. The subjects' problem were also principally self contered and posed no threat to others.

• Journal of Oral Medicine and Pain
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• v.35 no.4
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• pp.265-273
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• 2010

Understanding patients' expectation for health visits and providing appropriate care may increase patients' satisfaction with health care, leading to more positive treatment outcome. The study aimed to investigate expectations of the patients with temporomandibular disorders (TMD) at their first visit to university-based orofacial pain clinic and to evaluate any relation with duration of pain, presence of previous treatment, pain severity and pain interference. Inclusion criterion was patients aged over and 18 years old and diagnosed as TMD during 3 months' period from Aug to Nov 2010. They were asked to complete the questionnaires for patients' expectation and the Brief Pain Inventory (BPI) at waiting room prior to consultation. 322 TMD patients participated in the study(M:F=1:1.5, mean age=36 years old). The study indicated that the most important top 3 expectations were 'cure of pain', 'understanding their problem' and 'doctor-patient communication' in order. This finding was not affected by gender, duration and previous treatment history but affected by sub-category of TMD and BPI pain severity and pain interference. 'Pain relief' and 'understanding their problems' were relatively highlighted in the patients with muscle disorders and combination (joint-muscle) disorders of TMD than those with joint disorders who wanted communication and further investigation relatively more (p=0.000). While expectation for pain relief was expected more with increase of pain severity and interference, patients with mild level of pain severity and interference expected communication and further investigation relatively more (p=0.000, 0.017, respectively). Based on the results of the study, though pain relief was the primary concern for TMD patients suffering from pain, their satisfaction with care may be increased by explanation for etiology and mechanism of TMD to make them understand their problems better and doctor-patient communication and collaborative decision-making for treatment. Importance of patient-centered consultations and availability of written material or web sites for patient information should be stressed out.