• 지역사회간호학회지
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• 제32권3호
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• pp.356-367
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• 2021

Purpose: This study conducted an economic evaluation of hospital-based home care services for the patients who had undergone breast cancer surgery. Methods: A total of 12,483 patients over 18 years of age who had received breast cancer surgery in 26 tertiary hospitals in 2018 were analyzed with the claim data from the Health Insurance Review & Assessment Service using cost-minimization analysis and societal perspectives. Results: There were 156 patients who utilized hospital-based home care services within 30 days after breast cancer surgery, and they received 2.17 (SD=1.17) hospital-based home care service on average. The average total cost was 5,250,028 KRW (SD=1,905,428) for the group receiving continuous hospital-based home care and 6,113,402 KRW (SD=2,033,739) for the group not receiving continuous hospital-based home care (p<.001). The results of the economic evaluation of continuous hospital-based home care services in patients who had undergone breast cancer surgery indicated a total benefit of 953,691,000 KRW, a total cost of 819,004,000 KRW, and a benefit-cost ratio of 1.16 in 2018. Conclusion: Continuous hospital-based home care was considered economically feasible as the total costs for the group receiving continuous hospital-based home care were lower than those of the group not receiving continuous hospital-based home care. Therefore, policy modification and financial incentives are recommended to increase the utilization of hospital-based home care services for patients who had undergone breast cancer surgery.

• 한국병원경영학회지
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• 제26권1호
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• pp.55-70
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• 2021

Purpose: The purpose of this study was to examine the influencing factors of the patient leaning phenomenon in tertiary hospitals. Based on the results of this study, we intended to find implications for improving the problems of the delivery system imbalance in tertiary hospitals caused by patient leaning phenomenon. Methodology/Approach: Qualitative studies were conducted, using focus group interviews and in-depth interviews. The focus group interviews were conducted for 12 users of tertiary hospitals by 2 groups. And in-depth interviews were conducted for 6 tertiary hospital managers. This was considered to be the most effective approach to gather diverse and in-depth information about the influencing factor of patient leaning phenomenon in tertiary hospitals. Findings: In focus group interviews, the reason for choosing tertiary hospitals was the reliability of the hospital(physician, reputation, etc.). And the effect of the policy to strengthen coverage of National Health Insurance and private medical insurance was relatively small. In other words, we found that the individual's desire to receive medical services suitable for one's health status and disease condition was the biggest factor, rather than the cost and policy factors. Practical Implications: We suggested that the appropriate medical care provision should be strengthened according to the role and function of medical institutions. In addition, the education system needs to be reorganized to activate the referral program, expand community medical capabilities, and foster quality primary medical care.

• 지역사회간호학회지
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• 제29권4호
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• pp.530-538
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• 2018

Purpose: This study tried to identify changes in family burden after the introduction of the long-term care insurance and to examine the factors influencing subjective and objective caring burden and depression of family caregivers of elders receiving home-based long-term care. Methods: Data were collected from 203 family caregivers of elders from August 1 to 31, 2015 using questionnaires. They were analyzed in descriptive statistics, t test, ANOVA test, and multiple regression analysis. Results: The mean score of depression was 7.24, which suggested mild depression level. The subjective family burden was 2.71 and the objective burden 3.04. The factors affecting depression included subjective burden (t=5.08, p<.001), objective burden (t=2.80, p=.006), time of elderly care per day (t=-3.61, p< .001), caregiving duration (t=3.33, p=.001), age (t=3.13, p=.002), family relationship (t=2.48, p=.014), and economic status (t=1.99, p=.047). Conclusion: The family burden was most important influencing factor on caregiver's depression. Therefore, services and supports to alleviate caregivers' burden in the home-based care should be added to long-term care.

• 보건행정학회지
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• 제19권3호
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• pp.1-26
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• 2009

Objectives : To identify target areas and set priorities among those areas identified for national quality evaluation. Methods : Target areas were identified from: i) analysis of the national health insurance claims data, mortality and prevalence data ii) various group surveys, including representatives from 22 medical specialty associations, 19 physician associations, QI staffs in hospital, civil organizations, and commissioners of Health Insurance Review and Assessment Service(HIRA) ⅲ) literature reviews and RAM(RAND/UCLA appropriateness method). The priority areas for national quality evaluation represented the full spectrum of health care and the entire life span. The criteria for selecting the priority areas were impact, improvability, and measurability. The priority areas were divided into three categories : short-term, mid-term, long-term. Results: Based on the group surveys and the data analysis, 46 candidates were selected as quality evaluation priority areas. 13 areas were selected as having a short-term priority areas: tuberculosis, community acquired pneumonia, stroke, ischaemic heart disease, diabetes, hypertension, chronic lower respiratory disease(asthma, chronic obstructive pulmonary disease), intensive care unit, emergency room, nosocomial infection, use of antibiotics, multiple medication and renal failure. This results suggested that we need to enlarge the target priority areas to the chronic diseases in short-term. Conclusions: The priority areas identified from the study will assist healthcare quality associated institutions as well as HIRA in selecting quality evaluation areas. It is required to develope and implement strategies for improving the quality of care within the next 5 years.

• 지역사회간호학회지
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• 제24권4호
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• pp.419-426
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• 2013

Purpose: The purpose of this study is to examine factors influencing medication adherence in patients with hypertension. Methods: This study carried out a secondary analysis of data from the 2008 Korean National Health and Nutrition Examination Survey (KNHANES). Stratified sampling was used to select a participant sample that was representative of patients with hypertension throughout the country. Using the SPSS/WIN 18.0 program, data were analyzed using descriptive statistics, $x^2$ test, t-test, and logistic regression. Results: Of the patients with hypertension, 8.8% had showed non-adherence to medication. Medication adherence was associated with age, spouse, Medicare insurance, number of other diseases, and current smoking status. The cases with older age, a spouse, Medicare insurance, higher number of other diseases, and no current smoking status showed significantly high medication adherence. Conclusion: Nursing interventions and further studies are needed to achieve high levels of medication adherence based on factors influencing medication adherence such as age, spouse, Medicare insurance, number of other disease, and current smoking status.

• The Journal of Korean Physical Therapy
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• 제34권2호
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• pp.80-89
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• 2022

Purpose: In Japan, the long-term care insurance and health insurance acts have stipulated the visiting rehabilitation system to provide support at the national level. The prior case of Japan would provide guidelines for seeking a suitable policy direction in South Korea. This study aims to examine the historical transition process of the visiting rehabilitation system in Japan, and the issues that emerged in the process of the institutionalization of this system. Methods: To examine the historical transition process of the system, the regulations announced by the government and their reports were reviewed. The relevant issues were qualitatively analyzed based on the opinions of scholars, therapists, and interested organizations that were reported in published papers on the topic. Result: The visiting rehabilitation system has been implemented in the following chronological order: The Health and Medical Service Act for the aged (1982-2006), the Health Insurance Act (1988-), and the Long-term Care Insurance Act (2000-). Currently, visiting rehabilitation is provided through hospitals, clinics, visiting nursing stations, etc. The following issues came to the fore in the process of the institutionalization of the system: (1) the complexity of the system, (2) the necessity of changing perceptions into a life model approach, (3) insufficient service provision by therapists, (4) the lack of human resources and an education system, (5) the lack of awareness of care managers and doctors about visiting rehabilitation, and (6) the necessity of quality enhancement through a team approach. Conclusion: It is deemed worthwhile to refer to the visiting rehabilitation system in Japan and the issues that emerged in the process of institutionalizing the system while seeking a policy direction for a similar system in South Korea.

• 가정∙방문간호학회지
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• 제24권2호
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• pp.181-188
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• 2017

Purpose: The aim of this study was to compare between performance and requirements of visiting nursing care in long-term care insurance using the OMAHA system. Methods: The subjects were 72 nurses who had worked in a visiting nursing care center in long-term care insurance. Data were collected from December 5, 2016 to January 31, 2017 using self-recorded questionnaires. The collected data were analyzed using descriptive statistics and paired t-tests. Results: Four dimensions of the OMAHA system showed statistically significant differences between performance and requirements of visiting nursing care in long-term care insurance. The requirements of visiting nursing care were higher than was performance on all 40 items of the OMAHA system. The greatest difference was in environmental domain and then the psychosocial domain. Conclusion: Based on the results, we found that the environmental and psychosocial domains were the largest gap areas. Therefore, with the reality of elderly people living alone and the increase in elderly couples, active intervention connected with the community is needed in residential areas. Further, we suggest that the OMAHA system can be utilized as an integrated conceptual framework for developing and enhancing visiting nursing care in long-term care insurance.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제15권4호
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• pp.33-43
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• 2009

As a result of rapid aging speed in our society, many problems related to elderly people have happened in many parts of our society. Among them, supply for elderly housing is one of the biggest problems. To solve these problems, 'long-term care insurance' has been put in operation from July 2008. By the time of the insurance operation, Ministry of Health and Welfare is increasing facilities every year according to '10-year expending plan of Care service infra' from 2002. As a result, the supply rate of elderly facilities has been raised. But the differences of facility supply rate between regions are very high in some cases. Therefore older people who need care sometimes cannot get proper care services in some areas. In that case, the frail older people have to use other care facilities of other regions. This is not a proper situation from the point of "Aging in Place". In order to prevent that case, it is necessary to set up proper 'Daily Living Spheres' and establish elderly care plan for it. Considering the points above, this study proposes the size of 'Daily Living Spheres' for the elderly, the kind and amount of elderly care facilities in it for the construction of Community Based Elderly Care System.

• 보건교육건강증진학회지
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• 제25권4호
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• pp.67-82
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• 2008

Purpose: The objective of this study were to examine the determinants of self-rated health, specially focused on the effect of functional capacity of community dwelling sedentary older adults on self-rated health. Method: The data has been collected from 654 community-dwelling sedentary older adults (mean age: 75 years) during the period from April to June in 2007. The data were collected by the in-person interview and direct measurement of functional capacity. The data were analyzed using chi-square test and multiple regression analysis with the SPSS 9.1 program. Result: The elderly rated their health as very good (3%), good (28%), fair (38%), poor (29%0, and very poor (2%). The higher average daily walk minutes ($\beta$=0.12, p<.01), number of chair stand ($\beta$=0.10, p<.05), scores of self-efficacy ($\beta$=0.16, p<.001) and the lower number of disease ($\beta$=-0.44, p<.001) show better self-rated health. Conclusion: Self-rated health is the most commonly used indicators in social epidemiology and geriatric research because it has been known as the good predictor of mortality and reflects health related disability. The finding suggested that daily walking habits, lower body strength, physical self-efficacy should be considered to improve the senior's self-perception of health. The community-based intervention associate increase these factors should be considered.

• 보건행정학회지
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• 제15권2호
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• pp.1-15
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• 2005

The aim of this study was to compare medical cost of hospice care and that of conventional care during the last year of life, and identify factors that influenced the cost. From January to August 2003 592 terminal cancer patients receiving care from 5 hospice care units and 2 hospice care teams in general hospitals were enrolled to case group. Two hundreds and seventy two terminal cancer patients receiving conventional care from 7 general hospitals were enrolled to hospital-based control group, and 1,636 terminal cancer patients from 122 general hospitals located in same regions with the 7 hospitals were enrolled to community-based control. We used characteristics and medical cost from data of National Health Insurance Cooperation. Total medical cost per beneficiary in cases was about 10 millions won, 14.5 millions in hospital-based controls and 11.1 millions in community-based controls. The hospice care saved $45\%$ over the last year of life compared with hospital-based controls (p<0.0001). Saving of inpatient cost account for approximately $80\%$ of saving per beneficiary. Hospice care saved $29\%$ of medical cost per hospitalization day compared with hospital­based controls and $17\%$ compared with community-based controls (p<0.0001). Multiple regression analyses showed that hospice care significantly saved the medical cost. This study suggest that hospice care save medical cost compared with hospital-based control and community-based control. Most of saving of inpatient cost account for approximately $80\%$ of saving of medical cost.