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Treatment Result in Advanced T3 and T4 Glottic Carcinoma: YUMC Experience (T3, T4병기 성문암의 치료성적)

  • Shin Hyun Soo;Lee Hyung Sik;Chung Eun Ji;Kim Gwi Eon;Loh Juhn Kyu;Suh Chcng Ok;Kim Kwang Hoon;Hong Won Pyo
    • Radiation Oncology Journal
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    • v.9 no.1
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    • pp.73-79
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    • 1991
  • Between January 1980 and September 1988,08 patients with advanced T3 & T4 glottic carcinoma were treated with RT and surgery/RT in the Department of Radiation Oncology, Yonsei Cancer Center and ENT, Yonsei University College of Medicine. The mean age was 60 years old (range 33 to 79 years old). The 34 patients were treated with irradiation alone, and the remaining 34 patients with surgery and irradiation. Initial nodal presentation was $37\% (25/68);\;31\%$ (l1/34) in RT alone group and $41\%$ (14/34) in combined treatment group. The minimum follow-up was 2 years. The local control rate after treatment was $47\%$ in RT alone group and $65\%$ in combined treatment group; $57\%$ for node negative and $27\%$ for node positive patients treated with RT alone; $65\%$ for node negative and $54\%$ for node positive patients treated with combined treatment. The treatment failure was observed in 30 patients; 14 patients for primary local failure, 6 patients for regional nodal failure,5 patients for local and regional failure, 26 patients for primary failure and/or distant metastasis, and 2 patient for regional failure and/or distant metastasis. The overall 5-year suwival rate was $57\%;\;37\%$ in RT alone group and $70\%$ in combined treatment group; $55\%$ for node negative and $20\%$ for node positive patients treated with RT alone; $73\%$ for node negative and $77\%$ for node positive patients treated with combined treatment. In conclusion, the combined treatment groups in the treatment of advanced 73 and 74 glottic cancer showed the better results in local control rates and S-year actuarial survival rates than RT alone group. We suggest that total laryngectomy and postoperative RT in the most patients of advanced glottic cancer were performed. However, in cases of node negative patints, RT alone is prefer as a treatment modality over combined surgery and RT since the treatment results were comparable and furthermore functional preservation could be achieved.

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The Characteristics and Medical Utilization of Migrant Workers (외국인 노동자의 특성과 의료이용 실태)

  • Ju, Sun Me
    • Korean Journal of Occupational Health Nursing
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    • v.7 no.2
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    • pp.164-176
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    • 1998
  • This study deals with the current medical utilization for migrant workers and the characteristics of them. The purpose of this study is to provide the basic information to establish proper medical policy. For the study self-made questionnaire was used, which was answered by 453 migrant workers working in the area of manufacturing and non-technical work in 10 cities like Seoul, Inchon, Namyangju, Sungnam, Kwangju, Pyungchon, Kunpo, Kimpo, Masuk in Kyungki-do and Chunan in Chungchungnam-do. Besides, 303 medical records of those who had visited free medical check-up center were analyzed. The period of accumulating data is 6 months, from November 1st, 1996 to April 30th, 1997. The characteristics of migrant workers and current medical utilization are analyzed by percentage and the relation between characteristics and current medical utilization were analyzed using ${\chi}^2$-test, t-test, ANOVA. The finding of this study was as follows : 1) The number of nationality was 16. The first majority was Philippians as 32.0%. Among 16 nationalities Southeastern and Northern Asians were 48.9%, Southwestern Asian was 46.5%, the rest was 7.3%. Men were 81.0%, those who are aged from 26 to 30 were 39.0%, Graduatee from high school 92.7%, Christians 56.3%, unmarried 55.4% and salary from 600,000 Won to 800,000 Won 53.8% averaging monthly payment 669,810 Won. As for their residence, those who resided over 3 years were 31.9% and the illegal residence reached 77.4%. As for Korean language, those who speak in middle level were 5.6%. 2) As for kind of work and circumstances, manufacturing was 81.1%, 4 off-days per month 72.2% and 9-10 working hours per day 42.1%. As for accommodation, residence in fabric was 62.6% and one or two members as roommate 40.2%. 3) The characteristics of health behavior showed that 89.4% of migrant workers had 3 meals, 70.9% of them did not drink alcohol, 73.5% of them did not smoke. 4) As a characteristic of health status, 71.8% of them perceived of their health. 76.1% thought that they had no illness before coming Korea. Among them who recognized their illness, those who had problem in circulatory system was 35.3%, respiratory system ENT 19.1% and nervous system 19.1%.66.2% of those having illness had already had sickness when coming to Korea. 5) During last one month, 79.2% of them were known as ones having no illness. Among the sick, those who had problem in circulatory system was 31.6%, nervous system 23.7% and respiratory system 21.1%. 60.3% of the sick were not cured at that time. 6) Sorting the symptom of those who visited free medical check up, dental care was 24.2%, orthopedic 14.0% and digestive system 13.8%. Teethache was 34.4%, stomach problem 11.6%, upper respiratory inflammation 10.2% and back pain 5.9%. Averagely they visited free medical check up 1-2 times. According to symptom, epilepsy 25.5 times, heart and vascular disease 9 times, constipation 2.8%, neurosis 2.38 times and stomach problem 2.34 times. 7) The most frequently visited medical service by migrant workers was hospital. The most mentioned reason was good healing as 36.3%. The medical service satisfied migrant workers mostly was hospital as 64.3%. The reason of satisfaction was also good healing as 45.9%. 8) 77.2% of respondents did not spend money for medical check. Average monthly medical cost was 25,100 Won, 3.7% of income. Those who had no medical security was 73.4%. In their case, 67.7% got discount from hospital or support from working place and religious organization. 9) As for the difference of medical utilization according for the characteristics of migrant workers, legal workers and no-Korean speaker used hospital more frequently. 10) Those who were satisfied most of all with the service of hospital were female workers, hinduists and buddhists, legal workers or manufacture workers. 11) Christians, those who have 3 meals or recognize themselves as healthy ones mostly had no illness. As a result, the most of migrant workers in Korea are from Asia. They are good educated but are working in manufacturing and illegal. Their average income is under 700,000 Won which in not enough for medical cost. They have no medical security and medical fee is supported by religious organization or discounted. Considering these facts the medical policy by government is to be established.

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Praziquantel($Distocide^{\circledR}$) in Treatment of Clonorchis sinensis Infection (국산 Praziquantel($디스토시드^{\circledR}$)의 간흡충증에 대한 효과)

  • 서병고;이순형금종일홍성태
    • Parasites, Hosts and Diseases
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    • v.21 no.2
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    • pp.241-245
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    • 1983
  • PraziquantEI ($Distocide^{\circledR}$), the KcrEan product, was tEstEd for its safety and Efficacy in treatmEnt of Clonorchis sinensiJ infccticn during the period from April to SeptembEr, 1983 in Korea. A total of 55 egg positive cases were selected and treated with the regimen of 25 mg/kg t.i.d. for 1 day (total 75 mg/kg). The follow-up stool examination was done in 47 cases by cellophane thir;k smear and Stoll's egg counting techniques. The 8 uncured cases were treated again with the same regimen. The laboratory tests for blood picture and liver function were done in 27 cases and compared before and after the treatment. The results obtainEd are as follows: 1. After single course treatment, the cure and egg reduction rates were 83.0 and 99.1% respectively. With the second treatment, excellent results of 100% in both rates were obtained. 2. Several kinds of side effects such as dizziness, headache, etc. were complained by 29 cases (61.7 %), however, those were so mild and transient that no special treatment was necessary. 3. No significant change in laboratory findings was recognizable before and after the treatment. From the above results, it is concluded that $Distocide^{\circledR}$ is as effective and safe as $Biltricide^{\circledR}$ and highly recommendable in treatment of C. sinensis infection.

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A Study on the Development Method of e-Learning Contents by the Level of Demand for Landscaping Practical Education - Development and Reuse of Modular Learning Objects - (조경실무 교육수요 수준별 이러닝 콘텐츠 개발 방법론 - 모듈형 학습객체 개발과 재사용을 중심으로 -)

  • Choi, Ja-Ho
    • Journal of the Korean Institute of Landscape Architecture
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    • v.46 no.3
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    • pp.1-13
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    • 2018
  • Landscape Architecture is a minority manpower field that requires wide knowledge and experience. Therefore, the service market is narrower than other fields, and education service for practitioners is lacking. The purpose of this study is to propose e-learning content development methodology that can provide customized landscaping practical education according to the level of education and increase the economic efficiency of the development process. First, in theoretical review, the ADDIE model was modified to select the curriculum development model that pursues efficiency and introduced the concept of reusing learning objects in the SCORM-based model. In particular, to overcome the problems presented in the precious studies, the analysis and design stages have been strengthened and faculty designers with integrated knowledge of Landscape Architecture and ICT have led the overall phase. The actual development process is based on a step by step procedure--analysis of landscaping practitioners needs and environments, etc., teaching and learning procedures and the design of activities considering contents reuse, the first development such as actual shooting and editing, and the second development reusing the first development content--and was done in the order of evaluation and revision of professionalism and satisfaction. As a result of the study, the space-based courses composed of modular learning objects were first developed as 216 courses in 8 subjects, as 208 courses in 3 subjects in total, in which the modularized learning object are crossed and combined in units and difficulty-based courses were second developed in 216 courses with 3 subjects in total. As a result of the evaluation the satisfaction assessment of the overall satisfaction was 4.20 and the average value of the eight measures was 3.97, both being close to 4.0. For the professional assessment, the scores of 8 subjects were very high at 84.8 to 96.4 points. in context, the scores of 5 subjects were equal to from 89.9 to 96.4 points. In conclusion, as the study was conducted based on a clear understanding of the digital characteristics of e-learning contents and general characteristic of the landscaping industry, it was possible to develop a curriculum by developing a course composed of modular learning objects and reusing learning objects by unit. In particular, it has been proven to be effective in conveying professional knowledge and experiences via general procedures and provided an opportunity to overcome some analog problems that may occur in offline education. In the future, further studies need to be done by expanding the content and by focusing on segmented subjects.

Comparison of the Awareness of Garden Functions (정원 기능에 대한 인식 비교)

  • Park, Mi-Ok;Choi, Ja-Ho;Koo, Bon-Hak
    • Journal of the Korean Institute of Landscape Architecture
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    • v.48 no.2
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    • pp.34-44
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    • 2020
  • The purpose of this study was to investigate the difference in perceptions between gardens and park functions as recognized by two groups, Group A and Group B, in order to confirm the distinction between concepts and functions and then establish the importance of individual functions. The AHP was used to analyze the importance of each group's perceptions by dividing them into garden and park, Group A and non-Group A, respectively. In Group A, the importance of garden functions were considered in descending order of importance to be cultural function, ecological function, and social function. In the general group, ecological function, cultural function, and social function also appeared, but in a different order of importance. As for the park functions, Group A recognized the importance of functions in a similar order of importance to the gardens: cultural function, ecological function, and social function. Group B thought that social function, ecological function, and cultural function have the same significance. At the major classification level, Group A and Group B emphasized the social function of the parks. Group A recognized the importance of the garden's cultural function as the most important, whereas the general group emphasized the importance of the garden's ecological function. As for the mid-class level, Group A recognized the aesthetic beauty, health, ecological environment protection, and water circulation as important functions of the garden. For Group B, the ecological environment protection, aesthetic beauty, water cycle, and health were important. The concepts and functions of gardens and parks are still largely mixed but are gradually becoming differentiated. As a follow-up study, it is important to systematically manage the functions of gardens by establishing design, construction, and monitoring DB techniques for the garden type and examine the hierarchy of various other gardens.

A Study on Satisfaction level with Herbal Public Health Services and its Improvement Plans (한방공중보건서비스 만족도와 개선방안)

  • Lee, Jae-Won;Koo, Jin-Suk;Seo, Bu-Il
    • Korean Journal of Oriental Medicine
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    • v.18 no.2
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    • pp.65-89
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    • 2012
  • Objective : In order to investigate and improve public Korean medical health service satisfaction level, this study was designed. Method : A questionnaire has been conducted on 212 patients who received treatments at six public health centers in the northern part of Gyeongbuk during 15 days between Sep. 24 and Oct. 8, 2011. Result : 1. An Investigation on the usage of herbal clinics in public health centers reveals that 63.7% have received three times or more medical treatments previously and 61.8% have had their illness treated at other medical institutions. In regard to illness 32.1% have had arthritis or muscle aches. 50.9% have taken insurance medication after having had treatments at the public health centers. 66% have assessed acupuncture and moxa cautery the most satisfying. 2. To a question regarding whether herbal health treatment costs higher than that of physician's, the highest response at 31.6% is 'No'. And to a question regarding whether herbal medicines administered at public health centers have more side effects than that of physician's, the highest response at 39.6% is 'No'. 3. To a question regarding whether herbal treatment of public health centers has little effect against acute disease, 48.1% of responses are 'Fair'. To a question regarding whether herbal treatments, when compared with physician's treatments, boost better recovery of patients, 48.1% of responses are 'Fair'. To a question regarding whether herbal medicine is unscientific, when compared with that of western medicine, 38.2% of responses are 'Fair', To a question regarding whether herbal medicine has faster effect on disease than western medicine, 41.0% of responses are 'Fair'. To a question regarding whether herbal medicine is more effective on disease prevention and promotion of health than disease treatment, 38.2% of responses are 'Fair'. And to a question regarding whether the lack of various types of physical therapy devices in herbal medicine, when compared with western medicine causes inconvenience in herbal treatment, 42.0% of responses are 'Fair'. Those responses take up highest portion at each questionnaire. 4. A comparative study between herbal treatments and physician's treatments has also been conducted. To questions regarding which one of the two considering types of disease is the better, responses are the latter accounted for 43.9% against 'Cancer', the latter accounted for 45.3% against 'Endocrine disorders', the former accounted for 30.7% against 'Psychiatric disorders', the latter accounted for 38.2% gainst 'Otolaryngological(ENT) disease', the former accounted for 47.6% against 'Post traumatic stress disorder', and the former accounted for 52.4% against 'Muscle-skeletal disease'. 5. An investigation on frequency of patients' visits via (p<0.05) of subjects show a statistically significant difference. 6. First, an investigation on frequency of reasons of medical treatments reveal that age, occupation, monthly income, and insurance type (p<0.05) of subjects show a statistically significant difference. Secondly, an investigation on frequency of subjects taking insurance medicines after herbal health treatments reveal that monthly income (p<0.05) of subject shows a statistically significant difference. 7. First, an investigation on frequency of a claim that herbal treatments of public health center does not have great effect on acute disease reveals that age, education, and insurance type (p<0.05) of subjects show a statistically significant difference. Secondly, an investigation on frequency of analysis that herbal treatments has faster effect on disease compared with western treatments reveals that education level, religion, monthly income, and insurance type (p<0.05) of subjects show a statistically significant difference. 8. When herbal clinics of public health centers and general herbal medicine institutions are compared, a survey on additional treatments that herbal clinics need the most reveals that education level, monthly income, and insurance type (p<0.05) of subjects show a statistically significant difference. Secondly, an investigation on frequency of subjects who want various forms of herbal medicines reveals that occupation and insurance type (p<0.05) of subjects show a statistically significant difference. Conclusion : In order to improve efficiency of treatments and enhance patient's satisfaction level, this study suggests measures such as providing a differentiated acupuncture treatments as a whole, streamlining an reception procedure, adopting more elaborated computer system for a patient to get proper medical attention, standardizing a treatment duration in order for a maximum result, keeping regular office hours, and optimizing a consultation time for a patient.

The Vogue about Outwearization of Underwear in a Tendency to the Century-end (세기말 현상으로 본 속옷의 겉옷화 현상)

  • 이상례
    • Journal of the Korean Society of Costume
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    • v.35
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    • pp.325-341
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    • 1997
  • One of the noticeable trends of female wear in 1990s is the Outwearization of Underwear as it is called 'Lingerie look' This trend meaned 'Exposure Fashion' raised splendidly its head to the whole stage of fashion destrying the tradional concept having divided the fashion between outwear and underwear by Madonna an Americal populer singer showed up in front of the audience wearing the corset-dress as a stage custome. This corset-dress which can not be recognised whether it is underwear or outwear has been diffused into the mass as a fashionable trend re-gardless of any reason; therefore discrimi-nation of wear by space by far that is underwear should have the sstandard telling between private and public sector has been gradually tumbled. By the way what has propelled desigers to introduce the style continuously having the underwear motive such as outwear almost as same as underwear or underwear worn on out-wear etc. and has made it a fashion trends? How do we accept this "Ligerie look'fashion" The rearch on vogue of outwearization of underwear started by the questions above can be summarized as the followings The division between the sprit and the ma-terial-economic shrinkage by the collapse of the bubble economy in the late of 20 century and expectation for the next century doubt by changes of international politics dynamics for the next century and increasement of psycho-logical tention by the environmental destruc-tion etc, has been extended to break the sense of value down These frustration of the tra-ditional values and dissatisfaction on the pres-ent have reflected on the fashion pursuing some more sensational style to increase the ex-posure of the body. The revolution of wearing bouncing the con-servatismhas outwardly expressed underwear of the private sector. Therefore the spatial concept of wear which for the public sec-tor has been fallen into pieces and has broken the wall of the concept fixed by outwear on underwear. in addition the stage costome for the popular people like Madonna has not been limited by the specularity any more and has been assimilated with the normal wear on the street to take the distinction for away. The circumstances of the late of 20 century pursuing sensation and making sex commer-cialized have accordance with the outweari-zation of underwear. there it is on the basis of Minimalist's dogmatism has been expressed the maximization of expoure in the pubric space to popularize bra pants(knickers) as outwear. The reaction on the attribute of hiding and shanding has brought 'See-Through fashion' with the transparent materials, The contemporary doubt recalling the mem-ory of the past has sublimated corset which was an instument of toture for women into Romanticism to introduce it to fashion with the development of a new material not to be a tool of any oppression and maltretment any longer. The popularization of outwear like underwear what's more has brought high quality of underwear. There it has called for the variety of materials such as knit demin and velvet etc, and has urged the famous designers to enlarge their working boundaries to underwear designs, Besides outwearization of underwear has been popular even in the Orient which has the con-servative opinions on exposure ; so changes of the thoughts can be seen among the establish-ment generation on exposure of the body. As the more high tech information publi-cized and the more technology and media digitalized the more expression being analog the pursue for the new in fashion with vision never been seen and even though it is imprac-tical the experimental designers have drived the freedom beyond the traditional roles of the previous century. Consequently outwearization of underwear may be viewd as a trial as an expression responded the contemporary background. This trend in my opinion will have been lasted for a while by being proliperlated among lasted for a while by being proliperlated among the pub-lic who has the century-end anxiety and doubt and expectation for the next century.

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The Clinical Considerations of Serous Otitis Media and Ventilation Tube (삼출성중이염과 중이내 통기관 유치술의 임상적 고찰)

  • 김영명;박인용;장태영;심형보
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1982.05a
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    • pp.14.2-15
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    • 1982
  • Serous otitis media (SOM) is one of the most common otologic diseases which was first discribed by Politzer in 1869. Currentely, among many methods introduced to treat SOM, ventilation tube insertion is considered to be the most popular and standard method being used. However due to complication of it, there remains many disputable various problems. In order to review the clinical aspect of SOM and search for the effects and safety of ventilation tube, we studied 97 SOM patients, who had performed V-tube from Jan. 1981 to Feb. 1982 at ENT dept. of Severance Hospital. Analizing the clinical symptoms, age distribution, associated disease, otoscopic findings of ear drum, degree of hearing loss, hearing gain after insertion of V-tube and complications, following results were obtained. 1) As a subjective symptom, among 29 cases all patients had hearing loss, 19 cases (65.6%) had tinnitus, 12 cases (44.4%) had autophony and 10 cases (34.5%) of the patients had sensation of ear fullness. 2) In age distribution, 6 to 10 year old group was most numerous up to 42 cases (43.3%) and 20 years and over was 23 cases (23.5%) 3) In adult group SOM tend to be involved unilaterally whereas young child group had tendency involving bilaterally. 4) 49 cases (50.05%) were associated with tonsillitis and adenoid vegetation, 15 cases (15.5%) were associated with sinusitis, 4 cases (4.1%) had nasal allergy. 5) In preoperative otoscopic findings, 62 ears (47.7%) had retraction, 37 ears (23.6%) had bulging, 34 ears (21.7%) had color change, and 29 ears (19.7%) had no significant findings. 6) In characteristics of middle ear fluid, child group was tend to have mucinous content (84.2%) while adult group had serous content (62.5%). 7) Average preoperative air-bone gap of pure tone was 25.3 dB. 8) 24 ears (72.7%) had over 10 dB of postoperative hearing gain and average hearing gain was 17.2 dB. 9) There were 44 ears (28.1%) of complications. Among them 37 ears (23.6%) had infection, 3 ears had atelectasis, 2 ears had granulation tissue, 2 ears had permanent perforations. 10) Among 37 ears suffered from post-op. infection, 19 ears (51.4%) had initial infection just after insertion of ventilation tube, 18 ears (48.6%) were infected during the course of post-ventilation tube. Of 37 infected ears, 26 ears (70.3%) responded to conservative care, while 11 ears (29.7%) was cured after removal of ventilation tube.

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A Study of Deconstruction in Clothing -Comparison of Clothing with Architecture- (복식에 나타난 해체주의 양식연구 -건축과 복식의 비교-)

  • 전혜정
    • Journal of the Korean Society of Costume
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    • v.32
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    • pp.293-312
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    • 1997
  • Deconstructionism is a philosophical stream in the latter half of 20'th century which goes against western metaphysics and tries to deconstruct the dualism e.g. eastern/west-ern man/woman. Its main concepts are 'indi-vidual' 'other' 'difference' 'restoration of the repressed' 'decentralization' 'Today it shows strong influences in literature art, and other social fields. This study investigated inner meanings and exterior forms represented in clothing on the base of Jacques Derrida's theory in order to re-search modes of deconstruction in is. And it compared clothing with architecture among other genres of art in order to discover similarities between through and modes of art in a certain period. For illuminating concept of deconstruction I referred to the literatures of preceding studies and for deconstruction's characteristics in both clothing and architec-ture I referred work's collection book $\ulcorner$collec-tions$\lrcorner$ and other related books dealing from 1960's to this point. As a rsult there are four modes of decons-truction in both clothing and architecture as follows; 1) Differenance which is a concept of the dif-ference in time and space as being trace. 2) In termeaning of meanings which is not present in reality but re-interpreted a new in the future. 3) Interxtuality in which a texte is not alone but with others 4) Dis.De phenomenon in which distortion and fragmentation forms occur as the result of the denial of perfection and reson. There are characteristics of modes of de-construction in clothing as follows; 1) Differance; R.Gigli, P. Rabanne. G.Bersace, V.Westwood are representatives of the cloth-ing which is combined with the past the pres-ent and the future or is re-viewed as the clothing of the past in the present point of view. J. Watanabe R. Dawakubo I miyake are representatives of the clothing which is out-date but re-viewed in the sense of recollec-tion and re-usage. 2) Intermeaning of meanings: R. kawakubo I, Miyake Y,Yamamoto are representatives of the clothing which is incomplete but re-interpreted in the future and appears to be new-fashioned according to ways of bnding wearing throwing on and tying J.C. Castel-bajac K.Hamnett S.Sprouse are representa-tives of the clothing which is made up of ab -stract forms scribbling or symbolic letters which appears to be different according to view-point of observers. 3) Intertextuality ;J.P.Gaultier K.Hamnett, Comme des Gar ons are representatives of intertextuality of gender which avoids the 여-ality of man/woman J.P Gaultier G,Versace J. galliano are representatives of the intertex-tuality of time place and occasion which mixes temporality extensity and purposiveness. J.P Gaultier G,Versace are representatives of the intertextuality of coordination which combines items different in image purpose and use. P.Rabanne A,Courr ges R,Gernreic I,Miyake are representatives of the intertextuality of mat-ter which uses heterogeneous matter different from cloth. 4) Dis.De-phenomenon: R, Kawakubo I.Mi-yake J.P.Gaultier are representatives of the de-composition which discloses distortion and exag-geration of form through destructing the estab-lished way of construction J.Galliano R.Kawa-kubo Devota Y Lomba arte representatives of the decentring which restores the repressed and the alienated on the one hane and shows front-centrality on the other. Comme des Gar ones is representative of the discontinuity because of which right and left up and down are not in har-mony with one another. J,Galliano J.P,Gaultier T,Mugler are representatives of the disruption by way of which one makes one's body exposed through intentional slashes or holes. As a consequence deconstructionism enabled us to investigate similarities between through of deconstruction and modes of art interms of diffrance Intermeaning of meanings intertextuality and Dis De-phenomenon. And we found that deconstruction was a phase of development in that it as a all-comprising and multiple concept tries to pursue the new through deconstruction.

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Medical Care Utilization Pattern of Medical Aid Program Beneficiaries (의료보호대상자(醫療保護對象者)의 의료이용(醫療利用) 양상(樣相))

  • Kim, Ju-Ho
    • Journal of Preventive Medicine and Public Health
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    • v.17 no.1
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    • pp.37-45
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    • 1984
  • This study was conducted to identify the problems in the medical aid program by reviewing the medical care utilization pattern of the beneficiaries. The data were abstracted from the monthly bills and vouchers for medical care of the whole benefi챠aries(17,527) in Gyeongsan Gun submitted by the physicians to county government for the period of 1 calendar year from October 1981 to September 1982. The number of medical aid beneficiary accounted for 12.7% of the total county population, a higher proportion than the national average-9.5%. Monthly primary care utilization rate per 100 beneficiaries was 9.3 persons with 14.0 visits and 42.9 medication days. for the 2nd and 3rd care, there were 1.7 admissions and 9.3 OPD visits per 100 beneficiaries per year. The beneficiaries of the first class medical aid program had a higher utilization rate of both the primary and secondary/tertiary care facilities. Females utilized more the primary care facilities than males while males utilized more the secondary/tertiary care facilities than females. A significantly lower utilization rate was observed in January than in the other months and this was seemed due to the renewal process of the medical aid certificate. Among 1,931 patients utilized the 2nd/3rd care facilities 84.4% was out-patients and the lowest ratios were in the minor specialties including ENT, ophthalmology, dermatology and urology. The average hospital days per in-patient were 21.2 days and OPD days per out patient were 4.7 days. The average hospital days for a psychiatry in-patient was 74.4 days which was the longest average hospital days among all the specialties. Average medical care cost per beneficiary in a year was W9,821:W24,240 for the 1st class and W7,464 for the 2nd class. The medical care cost for the primary care per patient was W3.901 and W840 per day compared with W49,875 per patient and W5,822 per day for the secondary/tertiary care. From the findings of this study following recommendations were made to improve the medical care program: 1) The renewal process of the medical care certificate should be expedited. 2) Minor specialty clinics should be designated as the primary medical care facility for the medical aid program to reduce the expenses by absorbing more patients referred to the secondary/tertiary care facilities directly. 3) The medical care cost for the primary care facility should be escalated to reduce the differential between the primary and secondary/tertiary care facilities.

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