• 성인간호학회지
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• 제19권5호
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• pp.56-69
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• 2007

Purpose: This study aimed to explore the discourses and the patterns of problem solving behaviors among the nurse managers. The focus of the study was the difficult situations in caring with patients and their families. Methods: Field study was performed at a for-profit hospital from March, 2004 to March, 2007. The participants of the study were 5 head nurses and 2 nurses in charge. The data were collected with iterative interviews and participant-observations. For the analysis of the data, taxonomy and critical discourse analyzing were applied. Results: The nurse mangers who showed wholistic patterns of behavior took the role of a broker among the client system, professional nursing system, medical system, and other allied health system. The nurse managers whose approach was profession-centered took the role of protector of nursing system. The nurse manager who practiced nurse-oriented pattern of behavior tried not to have harm against other members of health system. The experiences of nurse managers were effected from the discourses of patriarchal and market mechanism. Conclusion: The situation that provoke conflict between clients and nurses become more common with the changes to the health care system and to society. Nurse managers take the role of these conflict problems. The successful solving of conflict in a nursing care setting promotes the quality of care and satisfaction of clients. Programs for enhancing nurse's problem solving competency should anchored be in their practices.

• Journal of Preventive Medicine and Public Health
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• 제24권4호
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• pp.485-495
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• 1991

This study examined the effects of referral requirements for insurance patients which have been enforced since July 1, 1989 when medical insurance coverage was extended to the whole population except beneficiaries of medical assistance program. The requirements are mainly aimed at discouraging the use of tertiary care hospitals by imposing restrictions on the patient's choice of a medical service facility. The expectation is that such change in the pattern of medical care utilization would produce several desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities. In this study, these effects were assessed by the change in the number of out-patient visits and bed-days per illness episode and the share of each type of facility in the volume of services and the amount of expenditures after the implementation of the new referral system. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for the patients treated during the first six months of 1989, prior to the enforcement of referral requirements, and those of the patients treated during the first six months of 1990, after the enforcement. The 1989 sample included 299,824 claims (3.6% of total) and the 1990 sample included 332,131 (3.7% of total). The data were processed to make the unit of analysis an illness episode instead of an insurance claim. The facilities and types of care utilized for a given illness episode are defined to make up the pathway of medical care utilization. This pathway was conceived of as a Markov Chain process for further analysis. The conclusion emerged from the analysis is that the enforcement of referral requirements resulted in less use of tertiary care hospitals, and thereby decreased the volume of services and the amount of insurance expenses per illness episode. However, there are a few points that have to be taken into account in relation to the conclusion. The new referral system is likely to increase the use of medical services not covered by insurance, so that its impact on national health expenditures would be different from that on insurance expenditures. The extension of insurance coverage must have inereased patient load for all types of medical service organizations, and this increase may be partly responsible for producing the effects attributed to the new referral system. For example, excessive patient load for tertiary care hospitals may lead to the transfer of their patients to other types of facilities. Another point is that the data for this study correspond to very early phase of the new system. But both patients and medical care providers would adapt themselves to the new system to avoid or overcome its disadvantages for them, so as that its effects could change over time. Therefore, it is still necessary to closely monitor the impact of the referral requirements.

• 한국병원경영학회지
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• 제18권4호
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• pp.78-96
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• 2013

The purpose of this study is to analyze the emergency health care utilization using status according to income class. The target was the 2011 data out Korea Health Panel's raw data. 2011 data composed of total 17,035 people from total 5,741 households. This study set total 1,101 adults over full-20-years old having used an emergency health care utilization as its analysis target. In order to find out the number of emergency health care utilization use according to income class and the influential factors on emergency health care utilization cost, this study conducted the multiple regression analysis. And in order to more accurately analyze the emergency health care utilization use status depending on the income class and the features of emergency health care utilization use status, this study developed Models. As the result, this study found following findings. First, as the income class was lower, the gender was male, the age was lower, and the user has spouse, the user was not a business owner or a paid worker, the user is a house owner, the emergency medical facility type was a clinic, the means of transportation was others rather than 119 ambulance, the reason visiting emergency medical facility was belonged to others rather than accidents or poisoning, then the number of emergency was increased. Second, as the user was in higher income class, received the health insurance benefits, the using medical facility was general hospital, used 119 ambulance more often, stay days in emergency was shorter, then health care utilization cost was increased. In this study investigating the data out of Korea Health Panel, it was found that while the number of emergency health care utilization use was increased in the lower income class, but the emergency health care utilization cost was increased for higher income class. It is considered that this finding was caused from the facts that lower income class was more often exposed to dangers for physical health, so the number of emergency health care utilization use was increased, but their health care utilization cost was decreased because of their economic burdens against various examinations and their difficulties to pay such costs, comparing to that of higher income class. Therefore, in order to solve unequal problem of emergency health care utilization use between lower and higher income classs, it is required to set suitable solutions like the disease prevention effort by facilitating national health check-up programs, the enhancement of public health services in quantity and quality, the emergency health care utilization securing policy at using medical facilities, the promotional, educational activities about emergency health care utilization delivery system, the enhanced accessibility of emergency health care utilizations and emergency medical facilities.

• 한국학교ㆍ지역보건교육학회지
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• 제14권3호
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• pp.67-76
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• 2013

Objectives: This study was intended to provide the base of developing countries' Health Partnership Strategy by investigating the Paraguay's awareness level of health and analyzing the actual state. Methods: The data was collected from 11 government employees, 20 hospital staffs, 26 local residents on Asunci$\acute{o} $n, Paraguay in February, 2012. The method of the study was the questionnaires consisting of 62 questions including 7 questions of general features, 3 questions of awareness on maternal health care, child health care, planned parenthood program, 52 questions of awareness on health. The questionnaires was translated into Spanish which is local language in Paraguay. Results: The results of this study are summarized as follows; 1) The most important awareness on maternal healthcare, child healthcare, planned parenthood program was providing child health care. 2) The most important awareness to prevent non-health behavior was sufficient nutrition. The most important awareness to reduce the rate of chronic disease was diabetes. The most important awareness to eradicate communicable disease was HIV/AIDS. 3) The most important awareness to provide healthcare service was vaccination. 4) The most important awareness on healthcare delivery system was policy. The most important awareness on health education was student's health education. 5) The most important awareness to strength healthcare capacity was developing domestic economy. Conclusion: The results of this study suggest that awareness levels on health are high against low health behavior status in Paraguay. But awareness on health can lead to health behavior by healthcare system. Therefore, it has to induce the healthcare network and system by injecting public health funds, infrastructure, human resources on prevention of disease and healthcare management.

• 보건의료산업학회지
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• 제7권1호
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• pp.119-131
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• 2013

The purpose of this study is to analyze contents on media about the problems of long-term care facilities. For achieving this purpose, we reviewed 'KINDS(http://www.kinds.or.kr/)' from July, 2008 to May, 2012 which was an synthetic newspaper and TV news searching system. Among 320 articles, we finally analyzed 72 articles: 218 articles were duplicated and 30 articles did not directly related or were not objective. The results were divided with seven parts: 'long-term care facilities', 'employee' 'health care and accidents', 'providing and management of service', 'meals related problems', 'maltreatment of client', 'disorders & unfairness long-term care benefit. Among these seven parts, we could confirm specific and major problems, which were lack of safety management, incompleteness facilities & equipments, shortage of long-term care manpower, insufficient service providing low quality of service, hiding money from elderly's accounts, and providing some money to get national subsidies. For resolving these problems, the long-term service guidelines must be prepared and the related facilities must cooperate each other for providing high quality of service. In addition, the efficient systems must be made to find out long-term care problems and unfairness of service providing and strict management rules or sanctions must be needed.

• 한국의료질향상학회지
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• 제9권2호
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• pp.116-133
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• 2002

Background : It is very common in Korea to take care of non-acute patients in an acute setting, due to the lack of long-term facilities. Long term hospitalization increase medical expenses and decreases the bed utilization, which can affect the urgent and emergent admissions, and eventually jeopardize the hospital financially. In this study, strategies for effective transfers to the lower levels of care, and to decrease the length of stay were presented by surveying and analyzing the patient's knowledge of the transfer needs, and the willingness to transfer those whose hospital length of stay was more than 30days. Method : The survey is subject to a group of 251 patients who have been hospitalized over 30 days in a general hospital in Seoul. Excluding those that were in the Intensive Care Unit and psychiatric ward, 214 in-patients were used as participants. They were surveyed from April 9, 2002 to April 17, 2002. One hundred and thirty seven out of 214 were responded which made the response rate 64%. Data were analyzed by SAS and SPSS. Result : Multi-variable Logistic Regression Analysis showed a significant effect in medical expenses, knowledge of referral system and the information of the receiving hospital. The financial burden in medical expenses made the patient 10.7 times more willing to be transferred, knowledge of the referral system made them 5 times more willing to be transferred, and the information of receiving hospital makes 6.5 times more willing to be transferred. Reasons for willing to be transferred to a lower level of care were the phase of physical therapy, the distance from home, the attending physician's advice and being unable to be treated as an out patient. Reasons for refusing to be transferred were the following. The attending physician's competency, not being ready to be discharged, not trusting the receiving hospital's competency due to the lack of information, or never hearing about the referring system by the attending physician. Conclusion : Based on this, strategies for the effective transfer to the lower levels of care were suggested. It is desirable for the attending physician to be actively involved by making an effort to explain the transfer need, and referring to the Healthcare Coordinating Center, which can help the patient make the right decision. Nationwide networking for the referral system is the another key factor that may need to be suggested as an alternative to decrease the medical expenses. Collaborating with the Home Health Agency for the early discharge planning and the Social Service Department for financial aid are also needed. It is recommended that the hospital should expedite the transfer process by prioritizing the cost and the information as medical expenses, knowledge of referring system and the information of the receiving hospital, are the most important factors to the willingness to transfer to a lower level of care.

• 보건행정학회지
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• 제9권2호
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• pp.55-76
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• 1999

In order to understand the local council members' attitudes to the health policy, we conducted mail surveys using self-administered questionaire for 2 months(February and March. 1995). The study subjects were 2.312 local council members in Korea, but only about 11% among whom. 257 persons, responded to 2 times mail survey. This response rate revealed that the local council members was not interested in health care fields. The main results were as follows; The respondents thought that the economic and income development was most important among 15 regional policy agendas and the health care was the 5th or 7th important agenda. They. who had more health needs of and poor access to health care, tended to think that the health care was more important. They considered lobbying to and persuading the civil servants as the best method to tackle the local health care policy agenda. The respondents, who had poor access to health care facilities. tended to set the highest priority for the expansion of public and private health care resources. They expected that the election of local governor would activate the public health program more than thought that the program was implemented more actively than other region. The main opinion of respondents was that the central government had to take over planning and financing for the public health program, and the basic local government had to implment the program and budgeting. The majority of respondents agreed the private dominant medical care delivery system and nation-wide uniformed financing mechanism. Over 60% of them suggested that they were ready to suffer environmental pollution inducing health hazards for the purpose of regional economic and income development. About 75% of them favour the campaign for antismoking regardless of reducing local government's revenue from sale tax.

• 한국가톨릭병원협회지
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• 제13권
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• pp.31-36
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• 1982

• Child Health Nursing Research
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• 제3권1호
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• pp.42-51
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• 1997

Although a family-centered approach to health care for developmentally disabled children has been advocated, existing systems of care have not adequately addressed the support needs of the family system and the essential role that parents play in the daily care of these children. The overall purpose of this research is to examine family system adaptation to the care of a developmetally disabled child using the Resiliency Model of Family Stress, Adjustement, and Adaptation Framework. Relationships among family system demands (stressors, strains, transitions, child's illness factors) and family system strengths and capabilities(resource of social support) were examined to determine their separate and combined contribution to explanining the variability in family system outcomes (family system coping ). The subject for this study was 46 families who have a child with developmental disabilities(mental retardation and / or autism) from three special educational programs in Seoul, Korea. Results from correlation and hierachial regression analysis revealed that perceived social support operated as a resiliency factor between family stress and coping. Child and family characteristics appeared to be important predictors of perceived social support and coping. In summary, there is evidence that the resource of social support as a family strength and capability was found to improve the family coping. These findings also must be viewed within the context that sample of families of children with disabilities was relatively small and eligible families from support group of special educational program.

• 보건행정학회지
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• 제16권4호
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• pp.48-67
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• 2006

The aim of the study was to examine levels of satisfaction with health care in North Korea and to identify factors associated with it using a convenience sample of North Korean refugees in China. Data from the 2004 Survey of Health Seeking Behavior of North Korean Households conducted by the Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health were used. The study subjects were 273 North Korean refugees whose length of stay in China was less than 3 months. Factor analysis was used to extract factor dimensions from the 12 satisfaction items. Bivariate (t test and ANOVA) and multiple regression analyses were used in examining factors associated with satisfaction with health care use in North Korea Overall, satisfaction level was low ($2.36{\pm}0.36$, score range: 1-5). Of the three-factor dimensions, physician skills scored the highest $(2.93{\pm}0.36)$, followed by drug availability $(2.51{\pm}0.07)$ and general cleanliness $(1.66{\pm}0.55)$. In the multiple regression analysis, having a usual source of care was significantly associated with patient satisfaction. Respondents who identified primary care (section) doctors as their usual source of care tended to be less satisfied than those with the city or county hospital as their usual source of care. County residents tended to report a lower degree of satisfaction with general cleanliness than city residents. Among socioeconomic characteristics, the number of household assets positively predicted satisfaction with drug availability. North Korean residents appear to be dissatisfied with their medical care. It may reflect some inadequacies in the North's universal health care system to meet the healthcare needs of its people.