• Health Policy and Management
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• v.24 no.1
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• pp.71-84
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• 2014

Background: Informal care is increasingly recognized as placing a significant burden on the lives of family caregivers. The purpose of this study is to investigate factors related to family caregivers' burden with the community-dwelling disabled elderly under the long-term care insurance system, using the Stress Process Model developed by Pearlin (1990). Methods: Total 1,233 family caregivers with the disabled elderly, using the long-term care services in their home from May to June 2009, completed questionnaires finally. The questionnaire of this study consists of a total of 32 questions, including 11 questions related to background and context, 17 questions related to objective stressors, and 4 questions related to coping resourses. Family caregivers' burden is measured by the Korean Revised Caregiving Appraisal Scale (K-RCAS, Cronbach's alpha=0.86). To investigate factors related to family caregivers' burden, multiple regression analysis was conducted. Results: The average score of caregivers' burden was 22.0 (${\pm}6.12$). In multiple regression analysis, there were statistically significant factors affecting on the family caregivers' burden, that are related to background and context (region, living status, education level, relationship with beneficiary), objective stressors (duration of caregiving), coping resourses (caregiver's health status). Conclusion: This study found that family caregivers experience a considerable burden. The findings suggest that policies must be taken to relieve family caregivers of their duties temporarily, and to support them with counselling and education.

• Health Policy and Management
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• v.21 no.1
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• pp.44-60
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• 2011

Background : Surgical site infection(SSI) is one of the important nosocomial infections with pneumonia, urinary tract infection. SSI increases mortality, morbidity, length of stay, and costs for postoperative patients. The purpose of this study was to estimate length of stay(LOS) and health care costs from SSI using the large observational data. The ultimate objective was to show the effect of prevention of SSI. Method : This study used antibiotic prophylaxis evaluation data and claims data of the HIRA(Health Insurance Review and Assessment Service). The study population included 18,361 patients who underwent gastric surgery, endoscopic cholecystectomy, colon surgery, hysterectomy, cesarean section in nationwide hospitals from August to October 2007. SSI group and non-SSI group were matched according to propensity score resulted from logistic regression. The paired t-test was used to compare the difference of the LOS and health care costs between SSI group and non-SSI group. Results : The 598 cases of SSI were detected of total subjects, and the crude SSI rate was 3.3%. For each surgery, SSI rates were 5.5% for gastric surgery, 4.7% for cholecystectomy, 6.6% for colon surgery, 2.6% for hysterectomy, and 1.6% for cesarean section. The 596 cases of SSI and the 596 cases of non-SSI were matched by propensity score. The LOS of SSI group was longer than that of non-SSI group, and the difference was statistically significant. Health care costs of SSI group was more than that of non-SSI group which was significant. Conclusions : SSI increased apparently the LOS and healthcare costs. The economic loss might affect the cost of national healthcare as well as patients and hospitals. This study provided the evidence that the healthcare expenditure could be reduced by preventing SSI.

• The Korean Journal of Health Service Management
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• v.11 no.2
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• pp.65-79
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• 2017

Objectives : This study aimed to investigate the types of unmet health care needs of the elderly and factors affecting them. Methods : This study used data from the 2012 Community Health Survey. Multinomial logistic regression analysis was conducted to identify the relevance between each type of unmet health care needs and predisposing, enabling, and needs factors, based on the cases without unmet health care needs. Results : Persons with unmet health care needs were 4,460 (9.5%) of the total sample. By types of unmet health care needs, 1,171 (2.5%), 1,026 (2.2%), and 2,263 (4.8%) persons reported inaccessibility, non-accommodativeness, and unaffordability respectively. It was concluded that the there were differences in the associated factors according to the types of unmet medical needs. Conclusions : It is suggested that unmet health care needs in the elderly should be examined from diverse angles rather than from a single aspect of partial limits. In particular, diverse types of unmet health care needs for health care in the elderly according to limited accommodation shoulder be examined. Finally, strategies to decrease unmet health care needs that reflect the associated factors should be developed.

• The Korean Journal of Health Service Management
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• v.8 no.4
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• pp.209-220
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• 2014

This study found a relationship between the characteristics of the elderly with disabilities and extra health care monthly costs caused by disability and suggests methods for effectively managing health care spending of the elderly with disabilities. This study used data from the 2011 Survey on the Disabled conducted by the Ministry of Health and Welfare and the Korea Institute for Health and Social Affairs. The results of the analysis indicate that the relations between the socio-demographic characteristics of the elderly with disabilities and extra health care monthly costs caused by disability of the elderly are influenced by factors such as gender, age, members of the household, average monthly income and type of health insurance. Elderly people with disabilities spend too much for their medical care. To solve this problem, the government needs to find a variety of policy approaches to improve administrative procedure, establish a medical delivery system and enhance health care services.

• The Korean Journal of Health Service Management
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• v.8 no.4
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• pp.199-207
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• 2014

Family type is not only an important sociodemographic variable for health studies but also influences the health behavior and health condition of individuals. This study assessed a representative sample to see whether family type is associated with health behavior in Korean adults age 65 and older. This is a cross-sectional study of 9,535 Korean elderly who participated in the 2010-2012 Korean National Health and Nutrition Examination Survey. The subjects were classified as couple cohabitation, couple-offspring cohabitation, alone, or alone-offspring cohabitation. We assessed the relationship between family type and six health behaviors (smoking, high risk drinking, walking, oral examinations, health screenings, and influenza vaccinations) after controlling covariates. The "alone" classification had a significantly higher risk of no health screening, but was more likely to have an influenza vaccination than couples. Significant interactions between family type and healthy behavior were observed with oral health screening, influenza vaccination, and smoking {Odds ratio (95% confidence interval), 1.452 (1.066-1.980), 1.375 (1.083-1.747), 2.246 (1.604-3.146)}. There is a significant association between family type and healthy behaviors.

• The Korean Journal of Health Service Management
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• v.12 no.2
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• pp.89-99
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• 2018

Objectives : To compare the degree of achievement of Universal Health Coverage (UHC) among 39 developing countries in Africa and to investigate the correlation between health care financing and the UHC index. Methods : For data, 14 UHC indexes were used in 2015 supplied by the World Health Organization (WHO). In addition, this study used a 10% of threshold point corresponding to the catastrophic health expenditures and a 25% of threshold points as a health care financing index. Results : It was found that there were significant difference among Least Low Developed Countries (LLDCs), Other Low Income Countries (Other LICs), Lower Middle Income Countiies (LMICs), Upper Middle Income Countires (UMICs) to compare the average value by nation on the UHC index. This study showed that the UHC index of LLDCs was lowest, but the average value was higher as it moved towards LMICs and UMICs. In addition, it was found that there was an average value difference among the groups like LLDCs, Other LICs, LMICs and UMICs. As a result of comparison, it was found that the spending of household health expenditure increased as LLDCs moved towards UMICs when the burden of household health expenditure was 25%. Conclusions : This study aimed to compare the UHC indexes of African nations and to investigate the correlation between the degree of spending of total expenditure on health and burden of household health expenditure and UHC, and its effect.

• The Korean Journal of Health Service Management
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• v.11 no.4
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• pp.105-114
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• 2017

Objectives : The purpose of this study was to investigate the relationship between dietary pattern and the Community Periodontal Index in elderly people who live alone in rural areas and to provide necessary data to strengthen nutrition education about the oral health of elderly people who live alone. Methods : Dental examinations and questionnaires were conducted with 380 elderly people who live alone in rural areas of Gyeonggi-do. Results : The Community Periodontal Index was higher when the elderly people who live alone had a low intake of vegetables and fruits, a high intake of sugars, a low number of breakfasts, a high frequency of overeating and a high frequency of instant ingestion. Conclusions : It is necessary to provide nutritional management services for the elderly people who live alone in rural areas and to provide preventive centered comprehensive oral care.

• Korea Journal of Hospital Management
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• v.5 no.1
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• pp.200-231
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• 2000

The price systems of the hospital drug services play key roles in the provision of quality services and the development of pharmacy service technologies. Under the premises, this study attempted to determine the costs of hospital drug service, to compare the costs calculated with the fees publicly fixed by the Government, and based on the results of the analysis, to propose directions for the improvement of the price systems. A Costing model for the study was developed based on the cost-fee relationship analysed of the Korean fee-for-service systems. Data on costs and workloads of the 25 hospitals were collected through survey forms designed for the costing' and analysis for the duration of 12 months of 1998. The results of the analysis show that a tremendous unbalance between cost and price levels of the drug services, and that overally the price level of the services is extremely low when compared to the costs of services. Based on these findings, this study suggests that unfairly high or low price level be corrected, and that service items newly developed and being practiced at tertiary hospitals, such as TDM and TPN consultation services, be compensated by fixing a proper level of price.

• The Korean Journal of Health Service Management
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• v.12 no.3
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• pp.1-11
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• 2018

Objectives: The purpose of this study is to evaluate patient experience assessment of inpatients, and to prepare measures to improve the quality level of medical services and guarante patient rights. Methods: The study was conducted among 199 patients admitted to hospitals and general hospitals in the metropolitan area. The analysis method used was crossover analysis, including a comparison of means, and logistic regression analysis. Results: The overall average score of satisfaction with healthcare service was 3.39 for nurses, 3.35 for hospitals and 3.42 for general hospitals. Age at the time of hospitalization affected satisfaction. The overall average score of healthcare service satisfaction was 3.09 for doctors, 3.14 for hospitals, and 3.04 for general hospitals. The factors affecting hospital satisfaction were gender and subjective health status. The factors affecting satisfaction in general hospitals were education, medical department, and hospitalization route. Conclusions: Hospitals should also introduce a systematic management system of general hospitals and strengthen the guarantee of the rights of patients who can improve the quality of medical care through positive communication between medical personnel and patients.

• Perspectives in Nursing Science
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• v.7 no.1
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• pp.10-22
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• 2010

Purpose: Through a thorough examination of the CCSC (Community Comprehensive Support Center) system in Japan, this study suggests a scheme to provide community-based preventive health care services for the elderly in Korea. Methods: The study inquired into the applicability of the Japanese model by reviewing the data related to the CCSC project, aided by both in-depth interviews with staff in the field and consultations with specialists. Results: Rearrangement of the Visiting Health Management Project system is needed to manage the collective or individual visiting care management for frailty prevention of the elderly in communities. The delegated service system for preventive care in the community, including direct management by one of the public health centers, also needs to be reviewed and the application of stricter standards for the selection of the agency or corporation to run the delegated service is necessary. Long-Term Care Insurance, along with national and local grants, is to be considered as a financial resource for the community-based preventive health care model for the elderly. By making active use of education rooms at district offices, senior citizen centers in neighborhoods for the elderly with easy access can be created. The project needs to raise active supports from communities, develop programs which can be absorbed into particular local cultures, and promote the understanding of the preventive project in local communities. The preventive program should focus on first solving the problems of depression, seclusion, and lack of mobility of the elderly. Second, the program should instruct physical self-management for exercise-nutrition-dental maintenance, and third, the program should strengthen the cognitive abilities of the elderly. In addition, it is necessary to systematize and implement counter-plans of the family and community to protect the elderly who has mental and cognitive problems. Finally, by establishing a network of public health welfare resources based upon research on a community level, assessment and planning for the health of the elderly should be one with their family, and comprehensive consultation and recommendations should be provided to the family. Conclusion: Taking into consideration the experience Japan has had with respect to a similar project, it is appropriate to develop and implement a service system which would combine the Visiting Health Management Project system which has already been established and a preventive health care model for the elderly on a community level.