• Health Policy and Management
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• v.33 no.4
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• pp.479-488
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• 2023

Background: By applying the suggested criteria for needs-based chronic medical care and long-term care delivery system for the elderly, the current status of delivery system was identified and regional delivery systems were categorized according to quantity and quality of delivery system. Methods: National claims data were used for this study. All claims data of medical and long-term care uses by the elderly and all claims data from long-term care hospitals and nursing homes in 2016 were analyzed to categorize the regional medical and long-term care delivery system. The current status of the delivery system with a high possibility of transition to a needs-based appropriate delivery system was identified. The necessary and actual amount of regional supply was calculated based on their needs, and the structure of delivery systems was evaluated in terms of the needs-based quality of the system. Finally, all regions were categorized into 15 types of medical and care delivery systems for the elderly. Results: Of the total 55 regions, 89.1% of regions had an oversupply of elderly medical and care services compared to the necessary supply based on their needs. However, 69.1% of regions met the criteria for less than two types of needs groups, and 21.8% of regions were identified as regions where the numbers of institutions or regions with a high possibility of transition to an appropriate delivery system were below the average levels for all four needs groups. Conclusion: In order to establish an appropriate community-based integrated elderly care system, it is necessary to analyze the characteristics of the regional delivery system categories and to plan a needs-based delivery system regionally.

• Journal of Korean Academy of Rural Health Nursing
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• v.1 no.1
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• pp.5-10
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• 2006

Purpose: This study was done to identify strategies for the reform of the primary health care delivery system in rural areas. Methods: Official documents on changes in the rural health care environment were reviewed along with previous articles on reform of the health care delivery system in rural areas. Results: The primary health care system in rural areas of South Korea has not been well developed by the government. The government has mainly invested in hardware like facilities and equipment but, not in software like the delivery system or personnel. Nowadays every country is confronted with an aging society, which means an increase in the prevalence of chronic disease. Thus they have again become interested in primary health care delivery system. Further, characteristics of the primary health care system have changed to be more comprehensive and to focus on chronic disease. The primary health care system in rural areas should have basic health care functions and a visiting medical officer(doctor) connected with basic health care. Conclusions: The primary health care delivery system is the best strategy when adjusted to the characteristic of the chronic diseases that are prevalent today. Cooperation of the central government and local government is important if these changes are to be realized.

• Journal of Korean Public Health Nursing
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• v.17 no.1
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• pp.5-16
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• 2003

This policy alternatives for establishment of rehabilitation health care delivery system for the disabled in the community were developed based on the data of current health status and situations of health care management for disabled persons in Korea. This research was conducted with secondary data analysis for identifying health status and current situations of managing health of disabled persons, and discussed current issues for establishing rehabilitation health care delivery systems in the community. Observing the health status and current situations of managing health of disabled persons, scope and target population of disabled person extended. so prevalence rates increased. and the severity of disability intensified and specified. The summary of issues of health management for disabled persons included; 1) absence of comprehensive and systematic policy in rehabilitation health care systems. 2) absence of consumer based rehabilitation health care facilities and delivery systems that are considered as the characteristics of disabled persons 3) fixed form of projects based on the provider and lack of variety in the programs. Hereafter. to overcome these problems. policy alternatives should 1) establish a comprehensive rehabilitation health care policy for disabled persons. 2) establish comprehensive and specific community based rehabilitation health care delivery systems that can promote preventing disability. providing medical care for disabled persons, establishing rehabilitation management for disabled persons and health care when returning to society. 3) provide training and secure manpower for rehabilitation, but the training case managers who will take the roles as an expert rehabilitation nurse mediators for multidisciplinary team work are needed immediately. and 4) include efficient connection and provision of independent services for welfare rehabilitation service and health care. Conclusively. a community based rehabilitation health care delivery system should be comprehensive policy vision of the government on rehabilitation health care delivery System rehabilitation service has to be constructed systematically under suitable facilities con consumer characteristics and rehabilitation health care policy. By doing this, consumer comprehensive community rehabilitation health care delivery system could be constructed disabled person.

• Women's Health Nursing
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• v.15 no.4
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• pp.353-361
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• 2009

Purpose: This study aimed to provide fundamental information about childbirth and antenatal care for pregnancy women and to find differences in mother's antenatal care and delivery service satisfaction between vaginal delivery and cesarean section. Methods: This study was conducted in 4 residential areas and a study sample of 184 postpartum mothers who agreed to collect data. Data was collected from September 1 to October 20 2007 and a structured questionnaire were recruited by the survey. The data was analyzed by t-test and chi-squire test using SPSS/WIN 12.0. Results: There was a significant difference in delivery place between vaginal delivery and cesarean delivery. Only 10.7% of vaginal delivery group delivered in general hospitals, however 24.5% of the cesarean section group delivered in general hospitals. Early antenatal care also showed statistical difference in mode of delivery. 43.5% of vaginal delivery mothers visited hospitals for the detection of pregnancy but 28.3% of cesarean section mothers did that. Vaginal delivery mothers more satisfied with her own delivery method and suggested a vaginal delivery to others. Conclusion: These results suggest that cesarean section mother's sensitivity of early antenatal care was less than vaginal delivery mother. Satisfaction related to delivery care services were higher in the vaginal delivery group.

• Korea Journal of Hospital Management
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• v.21 no.2
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• pp.24-36
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• 2016

The aims of this study is to investigate the status of nursing care delivery systems and nurse staffing levels and to analyze differences in the quality of nursing care by the type of nursing care delivery system. This research was based on data from 723 nurses working in 55 medical and surgical units in 26 general hospitals. Descriptive statistics on nurse staffing levels and the nursing care delivery system, and multi-level logistic regression were used to estimate the determinants of quality of nursing care. The number of patients per nurse is 17.74 patients in functional nursing care and 15.56 patients in total nursing care. In comparison to hospitals adopting total nursing care, hospitals with functional nursing care had greater patients. The nurses rated units using total nursing care as significantly better quality of nursing care than the units with functional nursing care. Total nursing care or modified total nursing care, rather than functional nursing care, could lead to improvement in the quality of care(total nursing care OR=3.895, modified total nursing care OR=2.475). Patient-centered approaches under proper circumstances can be successfully implemented and the positive effects demonstrated.

• Health Policy and Management
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• v.28 no.3
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• pp.197-201
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• 2018

There is a general consensus that many health care problems are attributable to the structural defects of the health care delivery system in Korea. The basic policy aimed to address these problems is to reform the delivery system so as that it incorporates two core principles: (1) stratification of medical care institutions into primary, secondary, and tertiary care providers according to the capability to perform specialized and complex services; (2) patients seeking care starting from the primary care provider and, if necessary, to be referred to the other provider step by step. This policy has been consistently pursued for about 30 years, but the achievement is far from success. Thus it is believed that the feasibility of the policy should be questioned. Starting from this question, based upon the observation of the current structure of the delivery system and its expected changes, the reform policy was discussed focusing on the assessment of its feasibility from both practical and theoretical viewpoints. The discussion leads to cast doubt on the policy for its possibility of making planned changes and producing expected desirable effects. Therefore it is advisable to investigate a wide range of alternative strategies and models for improving health care delivery.

• Journal of Korean Academy of Nursing
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• v.6 no.1
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• pp.51-59
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• 1976

Contemporary nursing is concerned with meeting patients physical psychological and secio-economical needs and with helping persons to sore their own problems. At the time of confinement and delivery, women often have physical and psychological disco- mort related to fear, tension or anxiety. Pain related to these causes varies with the individual woman. Effective nursing care to meet individual needs during labor and delivery is important if nurses are to understand and relieve woman's physical and psychological pain. A questionnaire prepared for the purpose by the investigator was administered to 162 women in two general hospitals, one in Seoul and one in TaeGu, during August 1 and September 20, 1975 and to the 13 delivery-room nurses who cared for them. It was hoped that the study would contribute to comprehensive nursing care during labor and delivery and to improve maternal and child health. 1. The sample of mothers ranged in age from 18 to 39; the majority were from 25 to 29 years old (54.3%). Most of them were housewives (87.6%). Sixty-three percent had high school or higher education. They had a range of one to seven deliveries. Sixty-one percent were primiparas Most had some prenatal care (87.6%). 2. The age of the group of nurses ranged from 22 to 39. Ten were 22 or 23. Five of the 13 had from six to ten months experience in the de]ivory room. Twelve were single and ten had a religious affiliation. 3. Both primiparas and multiparas thought equally that physical and psychological care, nursing skills and attitudes were important during labor and delivery, but did not relate basic nursing care directly to normal delivery. Need for nursing care was rated more highly by primiparas (2.83-3.48) than by multiparas (2.51-3.17) (p〈0.05). 4. There was no difference in need for nursing care according to the educational level of the women nor according to whether they had a religious affiliation or not (p〉0.05). 5. There was no difference in the reported nursing care given regarding of the educational preparation of the nurses (p〉 0.05). 6. There the reported nursing needs of the women and the reported nursing care given were compared, physical and psychological nursing care directed toward protecting the mother and fetus and a safe do]ivory were considered important by both groups. Neither group related simple nursing care directly to protection of the mother and fetus or to a safe delivery. The women rated highly their needs for nourishment (3.05) and having a relative with them (2.90) for emotional support but there was little evidence (2.39) that the nurses provided care to meet these needs (p〈0.05). In conclusion, the nursing needs of the women during the three stages of labor and the nursing care given were generally similar. The women had more psychological needs than physical needs but in comparison, nurses gave a little more physical than psychological care. The results point up the need to make adjustments in labor and delivery room nursing care the nurse should Prepared to pay more attention and bigger consideration in psychological comfort care than physical care.

• Journal of Korean Academy of Nursing
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• v.29 no.3
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• pp.507-517
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• 1999

The purpose of this study is to understand home care needs for parturient women and neonates up to the postpartum period. Methodology : The design of this study is a cross-sectional survey study. The subjects of this study are 88 postpartum mothers who delivered a first baby during the period from December 1996 to July 1997. Data collection was done with a structured questionnaire by mailing. Data were collected at the point of six months after delivery. A structured questionnaire composed of items related to home care needs. Data analysis was done with descriptive statistics. The study results are as follows : .The highest need was personal hygiene(93.2%) for the parturient women, and the peak period was the two week period after delivery. .The most frequent maternal needs regarding neonates were cord care (72.4%) during the first week, elimination(67.9%) during the first two weeks, baby crying(88.3%) and sleeping pattern(71.5%) at one month after delivery, and baby temperament(30.4%) at sixth months after delivery. .The mothers requested home care methods such as written material for self health care (35%) and counseling(34%) and direct home visits (5%) for neonate care. - Conclusion : The most important period for home health care needs was one week after delivery, and the health care needs for neonate temperament, behavior and sleeping pattern rose rapidly at the period of 6 months after delivery. Therefore it could be concluded that the postpartum home care should be done by those, written material should be enhanced for parturient women care, and counseling enhanced for neonate care.

• Women's Health Nursing
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• v.7 no.1
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• pp.67-79
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• 2001

This study was designed to verify the effect of Doula-type-delivery nursing care on plasma $\beta$-endorphin, serum cortisol, related to delivery stress during labor, and postpartum anxiety of primipara by a quasi experiment(nonequivalent control group pretest-posttest design), from December, 1999 to August, 2000. The subjects of this experiment consisted of sixty eight primipara, with single gestation, full term, uncomplicated pregnancies, thirty three for the experimental group and thirty five for the control group. Their mean age was 26.1 years for the experimental group and 25.5 years for the control group. Their mean gestation period was 39.7 weeks for the experimental group and 40.1 weeks for the control group. As treatment, Doula-type-delivery nursing care was given for the experimental group. Data assessed plasma $\beta$-endorphin, serum cortisol during labor, and anxiety during postpartum. Plasma $\beta$-endorphin, serum cortisol were measured in the latent phase before treatment(pre-test) and the transition phase after treatment(posttest). Also, anxiety was measured in the latent phase before treatment(pre-test) and 24 hours postpartum after treatment(posttest). Data was analyzed by t-test, $x^2$-test, Repeated measures ANOVA with SAS Program. The results of this study were as follows; 1. Plasma $\beta$-endorphin was significantly elevated in the experimental group who were cared for with Doula-type-delivery nursing care during labor(P=.0463). 2. No significant group effects were found, but significant time effects were found for serum cortisol. 3. The postpartum anxiety of the experimental group was significantly lower than the control group(P=.0110). In conclusion, these findings indicate that Doula-type-delivery nursing care during labor could be effective in increasing maternal plasma $\beta$-endorphin and decreasing postpartum anxiety. Doula-type-delivery nursing care during labor could be applied as an effective nursing treatment for primipara.

• Health Policy and Management
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• v.8 no.2
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• pp.1-24
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• 1998

There exists a general consensus in Korea that patients tend to concentrate in large hospitals and this tendency is partly responsible for inefficiency in health services. The process of choosing a medical care provider for health care services and evaluating the provider after utilization seems to involve many diverse factors to become very complex. Therefore a systemsatic study is needed to achieve sufficient understanding of the proeess. For this point of view, this study investigates patient's selection of medical care institution for delivery care services and their evaluation of the institution after delivery. In more specific, the objectives of the study are twofold: 1) to identify the factors associated with expectant mothers' choice of type of medical care institution for delivery among tertiary hospitals, general hospitals, small hospitals, and clinics: and 2) to understand the factors affecting patient evaluation of the medical care institution after delivery. The data used for the analysis were collected through face-to-face interviews with those women who had childbirth during the period from January 1, 1996 to the date of interview in February 1998. The survey was conducted using preqared structured questionnaire in Seoul. The sample was drawn from each of arbitrarily defined four regions of Seoul, Northeast, Northwest, Southeast and Southwest, in proportion to the number of births reported in 1996 in each of them. The distribution of the interviewed women by educational level was made similar to that of mothers of new babies reported in 1996. The sample size was planned to be about 300, but ended up with analytical sample of 319. Major conclusions emerged from the analysis can be summarized as follows: 1) Large hospitals were evaluated as much better for technical quality than other types of institutions, whereas they were compared similar to or worse for other attributes. And it was found that technical quality of care is considered as the most important condition of medical care institution for delivery, while the amount of direct cost is considered as the least important one. Taken together, the utilization of large hospitals is not likely to decrease even though they cannot give satisfaction to patients in other aspects than technical quality. 2) The activeness in the search for information affected the respondents' evaluation of medical care institutions, which would influence their later decision or recommendation to other persons as to the choice of source of health care services. Therefore, increased efforts should be directed to improving availability of useful and correct information for patients in relation to the utilization of health care services. 3) Since the findings of this study were obtained from the analysis of delivery care services, their applicability to other kinds of services may be limited. Thus it would be useful to conduct a comparative study of several kinds of services explicitly taking into account the characteristics of those services in the analysis.