• 보건행정학회지
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• 제24권4호
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• pp.304-311
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• 2014

This manuscript treats a new paradigm for the Korean health care system. We give an account of innovative health care delivery and payment models widely discussed in the contemporary US accountable care organization and coordinated care organization. In doing so, we explore a new health care model amenable to foreseeable changes to the health care system. We propose creating an integrated health care system in which the network of health care providers delivers coordinated and comprehensive care for enrolled patients residing within the geographic boundaries served by the provider network; providers may participate voluntarily in one or more networks and assume shared responsibility for patient care and cost; provider networks compete with each other based on cost and quality; and consumers are allowed to choose a network. We expect that the new paradigm will create a financially-sustainable system that assures quality of care and improves patient experience, minimizing the existing system-wide inefficiency through cross-network competition and within-network care coordination.

• 성인간호학회지
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• 제23권6호
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• pp.554-563
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• 2011

Purpose: The purpose of this study was to investigate factors associated with drug misuse behaviors among polypharmacy elderly. Methods: This was a cross-sectional survey. Participants consisted of 116 polypharmacy elderly who were taking 5 or more medications each day. Data were collected via face to face interviews. Data were analyzed using the PASW 18.0 program. Data concerning predisposing factor (knowledge, benefit), enabling factor (communication with health care provider), and need factor (perceived health status, number of disease) were collected. Results: The total mean score of drug misuse behaviors among polypharmacy elderly was 3.04 out of 10 points. Communication with health care provider, perceived health status, and knowledge were found to be significantly correlated with drug misuse behaviors. In stepwise multiple regression analysis, a total of 42% of the variance in drug misuse behaviors was accounted for communication with health care provider, perceived health status, and knowledge. Conclusion: Therefore, education program for improving communication with health care provider, and knowledge should be designed and provided for polypharmacy elderly.

• 대한간호학회지
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• 제34권8호
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• pp.1460-1467
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• 2004

Purpose. This study examined the predictive factors enabling access to children's oral health care at the level of financial barriers, beliefs, and the provider. Methods. In-depth interviews were conducted with 320 immigrant mothers of low-income families regarding their use of oral health services for children aged four to eight years old. Access to oral health care was measured with frequency of planned dental visits, continuity of care, and age at first visit to dentist. Results. The mother took her child to the dentist at a younger age if she received referrals to a dentist from pediatrician. Regular dental visits were significantly related to household income, provider availability on week-ends, and insurance coverage. The extended clinic hours in the evenings, and the belief in the importance of the child's regular dentist visits increased the likelihood of continuing care. The mothers perceiving a cost burden for the child's dental care were also less likely to return to the dentist. Conclusion. The available care delivery system, coordinated medical care, and health beliefs were among important predictors of the health service use. The study findings suggest need for culturally competent dental health interventions to enhance access to oral health care among particularly vulnerable populations such as low-income children in Korean communities.

• 한국콘텐츠학회논문지
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• 제15권9호
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• pp.541-554
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• 2015

본 논문에서는 첫째, 스마트헬스케어서비스(Smart Health Care Services)의 수용의도에 영향을 미치는 요인들을 규명하였고, 둘째 스마트헬스케어서비스의 수용의도에 대한 영향요인들의 영향력이 의료인과 비의료인에 따라서 어떻게 달라지는지 살펴보았다. 연구모형의 독립변수로는 개인혁신성, 자기효능감, 촉진조건, 보안성을 적용하였으며, 매개변수로는 인지된 용이성과 유용성을, 종속변수로는 수용의도, 조절변수로는 사용자유형(의료인 vs. 비의료인)을 적용하여 연구가설을 수립하여 데이터를 수집하고 분석하였다. 분석결과, 스마트헬스케어서비스 사용자들의 자기효능감은 인지된 용이성과 유용성에 유의한 영향을 미쳤으며, 그 영향력은 의료인과 비의료인 사이에 유의한 차이가 없었다. 스마트헬스케어서비스에 대한 촉진조건은 인지된 용이성과 유용성에 유의한 영향을 미쳤으며, 용이성의 경우 그 영향력은 비의료인이 더 민감하였다. 스마트헬스케어서비스의 보안성은 인지된 용이성에 유의한 영향을 미쳤으며, 그 영향력은 의료인이 더 민감하였다. 스마트헬스케어서비스의 용이성과 유용성은 각각 수용의도에 유의한 영향을 미쳤으며, 용이성의 영향력은 비의료인이 더 민감하였고 유용성은 의료인이 더 민감하였다.

• 보건행정학회지
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• 제28권3호
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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.

• 대한예방한의학회지
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• 제10권2호
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• pp.147-158
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• 2006

The purpose of this paper is to review the empirical study results of conversion factors(unit prices) for relative values of health care services in the national health insurance system and establish optimal classification of health care institutions for feasible contract of conversion factors between National Health Insurance Corporation(NHIC) and provider groups, based on legal backgrounds and types of health care service delivery system. some empirical research evidences shows the validity of applying multiple conversion factors to annual contract for reimbursement in the national health insurance. Policy recommendations suggest that clinic, hospital, general hospital, tertiary hospital, dental clinic, oriental medical clinic, pharmacy, and public health centers would be a basic category of provider groups for a meaningful price contract between the NHIC and providers.

• 한국보건간호학회지
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• 제18권1호
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• pp.178-186
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• 2004

The purpose of this study was to analyze the work of visiting health care providers in public health centers. A descriptive analysis of self-records for work data from 875 visiting health care providers working in 242 public health centers in South Korea was done. The results of the study are as follows: 1. The number of households for each visiting health care provider ranged from under 100 households to over 500 households. 2. Low performance was found for several items on the work list for visiting health care providers. 3. There were significant differences in the work performance of visiting health care providers between nurses and nursing assistants. 4. There were significant differences in the work performance of visiting health care providers according to region. In conclusion. work performance of visiting health care providers was low and differed according to type of occupation and region. This study suggest the need for further studies which analyse the quality of visiting health care providers and services, and the visiting health care system.

• 품질경영학회지
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• 제41권4호
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• pp.527-539
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• 2013

Purpose: Methods for increasing health-care service quality are considered for a women-centered hospital located on a local city. A walk-through audit is applied to uncover areas for improvement. Methods: A survey questionnaire with 25 questions is constructed based on a service blueprint for a walk-through audit, and a survey is conducted both to patients and service providers to assess a health-care service quality. Frequency analysis, statistical tests and customer-provider analysis are used to analyze surveyed data. Results: According to customer-provider analysis, 6 attributes belong to 'problem unawareness' zone in which they are rated high by service providers but low by patients, and another 6 attributes belong to 'problem awareness' zone in which they are rated low by both groups. These attributes are considered to be improved with priority. Conclusion: Both patient group and service provider group have lots of different perceptions on most attributes that are examined, and the hospital to be studied is, in general, competitive in technical quality and less competitive in functional quality.

• 보건행정학회지
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• 제8권2호
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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.

• 한국직업건강간호학회지
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• 제17권2호
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• pp.166-179
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• 2008

Purpose: This study was conducted to understand the situation of general hospital worker's health management and health promotion. Methods: To investigate the current situation of health management in the hospital, structured questionnaires were sent to 122 occupational health providers by post. About 79% hospitals returned questionnaires. The data were analyzed using descriptive analysis, ${\chi}^2$-test by SPSS 12.0 program. Results: A quarter hospitals responded set up separated health care office for workers, 87.5% provided health educations, and 56.5% operated health promotion projects. In the contents of health promotion program embraced both health behavior practice and disease prevention, musculoskeletal disease control, infection control, smoking cessation, and exercise program were most commonly provided to the workers in order. Occupational health care provider chose the item such as budget limitation, manager's apathy, lack of employee's participation, cooperation provider, and so on as the reason of difficulty to run health promotion program in the hospital setting. Conclusion: Hospital managers need to construct infra to manage and promote worker's health. For example, establishing Industrial safety and health committee in hospital and arranging nurses who being fully responsible to worker's health. And occupational health care provider should advertise health promotion projects both managers and workers actively.