• 재활간호학회지
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• 제2권2호
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• pp.215-224
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• 1999

This study was designed to compare care needs of patients with cancer and family members in inpatient and outpatient settings. The questionnaire was a Likert type 5 point scale with 57 items on four need categories; informational, physical care emotional care and socioeconomic care. There were significant differences between inpatient and outpatient settings. Also, there were significant differences in degree of care need according to gender, religion, marital status, economic status, public insurance status, and the past regimen. In conclusion, emotional needs perceived by patients with cancer and family members were higher than the others. Based upon the result, it is recommended that the research to compare needs between cancer patients who have a same illness and family member are necessary.

• Physical Therapy Rehabilitation Science
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• 제8권2호
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• pp.67-73
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• 2019

Objective: The purpose of this study was to compare the differences in the length of hospital stay between hemorrhage stroke survivors with health insurance and those with medical care after controlling all factors except for the type of medical insurance by using the propensity score matching (PSM) method. Design: Retrospective cohort study. Methods: Data from the Korean National Centers for Disease Control and Prevention's In-Depth Discharge Injury Survey between the years 2006 and 2012 were used for analysis. A total of 4,538 cases were defined as persons with hemorrhagic stroke (I60-I62) based on the block of categories in the International Classification of Diseases (10th). In order to analyze the inpatient period differences depending on the type of health care, which reflects one's socio-economic level, the chi-square and t-test was conducted. Results: Frequency and percentage were presented, and regression analysis was used to determine the factors affecting the inpatient period. Age, severity of disease, treatment outcome, and post-discharge status were no longer statistically significant after matching. The inpatient period of the persons receiving medical aid benefits was found to be significantly longer than those with national health insurance (p<0.05). Conclusions: The factors influencing the inpatient period of hemorrhagic stroke survivors were treatment outcomes, severity of disease, hospital admission process, and the type of health care. It is necessary for systematic and comprehensive governmental management for persons with hemorrhagic stroke to be transferred to long-term care facilities.

• 보건행정학회지
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• 제28권4호
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• pp.339-351
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• 2018

Background: The purpose of this study is to estimate empirically whether there is a difference in medical use among income groups, and if so, how much. This study applies econometric model to the most recent year of Korean Medical Panel, 2015. The model consists of outpatient service and inpatient service models. Methods: The probit model is applied to the model which indicate whether or not the medical care has been used. Two step estimation method using maximum likelihood estimation is applied to the models of outpatient visits, hospital days, and outpatient and inpatient out-of-pocket cost models, with disconnected selection problems. Results: The results show that there was the inequality favorable to the low income group in medical care use. However, after controlling basic medical needs, there were no inequities among income groups in the outpatient visit model and the model of probability of inpatient service use. However, there were inequities favorable to the upper income groups in the models of probability of outpatient service use and outpatient out-of-pocket cost and the models of the number of length of stay and inpatient out-of-pocket cost. In particular, it shows clearly how the difference in outpatient service and inpatient service utilizations by income groups when basic medical needs are controlled. Conclusion: This means that the income contributes significantly to the degree of inequality in outpatient and inpatient care services. Therefore, the existence of medical care use difference under the same medical needs among income groups is a problem in terms of equity of medical care use, so great efforts should be made to establish policies to improve equity among income groups.

• 대한간호학회지
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• 제35권3호
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• pp.535-545
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• 2005

Purpose: This paper reports a study exploring factors related to patient satisfaction and dissatisfaction with inpatient care. Method: A cross-sectional study design was used, employing data from the National Health and Nutrition Survey conducted in 2001. Socio-demographic factors, utilization, self-rated health status, and disease characteristics were assessed by employing univariate comparisons and multivariate logistic regression analyses. Result: Out of 37,769 respondents, 1,043 aged 20 years and over had been admitted to a hospital or clinic at least once during the past year. About a quarter of the respondents were discharged from tertiary hospitals and $21\%$ from clinics. The majority of patients ($58\%$) were satisfied with inpatient care received, whereas $11\%$ were dissatisfied. Greater satisfaction was found in patients aged 45-64 years and those having formal education, discharge from tertiary hospitals, national health insurance as a payer, medical expenses not being burdensome, good self-rated health status, and neoplasm. Living in non-metropolitan urban areas, shorter length of stay, and musculoskeletal diseases were associated with greater dissatisfaction. Conclusion: Different factors were related to patient satisfaction and dissatisfaction with care. Those factors need to be taken into account when evaluating and comparing satisfaction levels between health care institutions.

• 한국병원경영학회지
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• 제7권4호
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• pp.123-151
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• 2002

The objective of this study is to analyze the causal relationship of hospital inpatient's perceived quality, overall satisfaction, service value, and future intention to revisit. To carry out this objective, first we analyzed the dimensions of inpatient care service quality using SERVQUAL scale. The SERVQUAL scale is based on the gap theory, that is, the difference of patients' expectations and the actually received medical care service in hospital. On the basis of this theory, we measured the inpatient's perceived service quality and overall patient satisfaction. Data was gathered from a self-administered questionnaire at a 980 bed university hospital in Inchon City. These questionnaire measuring the service quality were distributed to 250 inpatients. The response rate was 66.4%. A total of 166 questionnaires was finally analyzed. To categorize medical service quality, the factor analysis was performed on 42 items. The reliability and validity of these items was evaluated. Finally to test 6 hypotheses, we analyzed the causal relationship of service quality, overall satisfaction, service value, and intention to revisit through the structural equation modeling(SEM). The major results of this study are as follows. First, the dimension of inpatient service quality was categorized into 7 dimensions, that is, personal caring, communication, access, physical environment, facilities and equipment, cleanliness, appropriateness and health status. Second, the reliability and validity of inpatient service quality items was satisfied. Third, as a result of structural equation modeling, the effect of inpatient's perceived service quality on overall satisfaction, service value, and intention to revisit was statistically significant. And total effect on intention to revisit as the core endogenous variable was perceived service quality(1.100), patient satisfaction(0.006), and service value(0.605).

• 디지털정책학회지
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• 1권1호
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• pp.21-26
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• 2022

본 연구에서는 요양병원이 입원비 지출 발생에 기여도가 큰점을 주목하여, 요양병원의 입원정책을 살펴보고, 불필요한 입원비발생을 유발한 점이 있다면, 해외사례를 참조하여 개선방안을 제안하고자 한다. 본 연구는 건강보험공단과 건강보험심사평가원에서 발행한 건강보험통계연보, 건강보험 주요통계를 주로 활용하여 연구를 진행하였다. 이를 바탕으로 요양병원이 입원비 발생에 가장 큰 기여를 한다는 것을 추론하였다. 본 연구 결과 요양병원의 입원규정이 명문화 되지 않았다는 문제점을 발견하였고, 명문화 되지않은 입원 기준이 불필요한 입원비 발생해 기여 할수 있다는 점을 발견하였고, 이를 극복하기 위한 개선방안을 우리보다 먼저 고령화를 경험한 미국의 사례에서 제안해보았다. 본연구를 시작으로 요양병원에서의 불필요한 입원비 지출을 줄인 보다 많은 외국의 사례들을 찾아야 할 것이다.

• Journal of the Korean Data and Information Science Society
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• 제26권3호
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• pp.715-727
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• 2015

본 연구는 우리나라 요양병원의 간호인력 확보수준과 간호결과의 관련성을 파악하고 간호에 민감한 환자 결과를 알아봄으로써 요양병원의 적정 간호인력 확보에 대한 근거를 제공하기 위해 시행되었다. 자료는 건강보험심사평가원의 2012년 '요양병원 병원평가정보'를 바탕으로 분석하였다. 연구결과, 간호사 1인당 환자 수가 평균보다 많은 그룹에서 유치도뇨관 비율 (고위험군/저위험군)이 통계적으로 유의하게 높았다. 간호인력 1인당 환자 수가 평균보다 많은 그룹에서 일상생활수행능력이 감퇴한 환자비율 (치매환자군/비치매환자군), 요실금, 욕창이 새로 발생한 환자 (고위험군)비율이 통계적으로 유의하게 더 높았다. 그리고 요양병원의 등급이 향상될수록 입원환자의 간호결과가 더 좋아지는 것으로 나타났다. 이는 간호인력 확보수준이 높을수록 그리고 요양등급이 높을수록 환자의 간호결과에 긍정적인 영향이 나타난다는 결과이다. 따라서 요양병원에서 간호인력 수를 적정화시킬 수 있는 보다 강력한 정책적 접근이 필요하다는 것을 제안하는 바이다.

• 간호행정학회지
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• 제10권1호
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• pp.1-9
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• 2004

Korean health insurance has adopted preliminary DRG payment system through 8 DRGs from 1997. But present DRG payment system gives economic incentives for hospitals to hire less nurse. This study was attempted to develope DRG adjust index to differentiate DRG price by nurse staffing level for nursing care quality. Method: We analyzed inpatient care cost by medical institute and developed DRG adjust index to differentiate DRG price by nurse staffing level. Results: Among same medical institute, inpatient care cost are very different according to hospital's nurse staffing level. In the case of casarean section, inpatient care cost of the 1st grade general hospital are more expensive 85,732won than the 6th grade hospital. The cost difference are 8.24% of total casarean section DRG price and 16.48% of DTG variable price. We developed DRG adjust index-a to apply DRG variable price and index-b to apply DRG total price for compensation cost difference of hospitals. Conclusions: DRG price adjust index will give economic incentive for hospitals to hire more nurse and improve nursing care quality.

• 한국병원경영학회지
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• 제23권1호
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• pp.87-106
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• 2018

Purpose: 본 연구는 미국 캘리포니아와 플로리다에 위치한 의료기관을 대상으로 급성심근경색증, 심부전, 폐렴을 주진단으로 받은 메디케어 입원환자들에게 제공된 의료서비스의 과정적 질과 잠재적으로 예방이 가능한 30일 이내 위험 보정 재입원율과의 관계를 살펴보았다. Methods: 본 연구의 종속변수는 잠재적으로 예방이 가능한 30일 이내 위험 보정 질환별 재입원율이며 3M PPR 소프트웨어를 이용하여 재입원의 예방 가능 여부를 결정하였다. 미연방 의료 비용 및 이용 프로젝트 데이터베이스, 미국병원협회의 병원조사 자료, 미연방 보건복지부소속 메디케어 및 메디케이드 서비스 센터의 병원비교 자료를 이용하였다. 자료의 위계적 구조를 고려하여 다수준 로지스틱 회귀분석을 이용하여 분석하였다. Findings: 의료서비스의 과정적 품질과 퇴원 후 30일 이내 잠재적 예방 가능 위험도 보정 재입원율과의 관계는 질환별로 차이를 보였다. 폐렴의 경우 의료서비스의 과정적 질은 30일 이내 잠재적 예방 가능 보정 재입원율과 유의한 부(-)의 관계를 보였으나, 급성심근경색증과 심부전의 경우 대체로 유의한 관계를 관찰할 수 없었다. Practical Implications: 잠재적으로 예방 가능한 급성심근경색증, 심부전 재입원율을 줄이기 위해서는 의료기관에서 가이드라인으로 따를 수 있는 더욱 다양한 근거 중심의 과정적 질 지표의 개발에 대한 정부와 보건의료계의 노력이 필요하다.

• 한국산학기술학회논문지
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• 제15권11호
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• pp.6746-6755
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• 2014

본 논문은 기초생활보장수급자를 대상으로 장기요양서비스 이용 여부가 의료 이용에 미치는 영향을 파악하기 위한 서술적 연구이다. 연구 대상은 장기요양 1등급 판정을 받은 기초생활보장수급자 5,834명을 대상으로 하였다. 기초생활보장수급자의 의료 이용에 미치는 영향을 다중회귀분석으로 분석한 결과 2007-2009년 총 진료비 변화량을 설명하는 $R^2$은 22.6%이었으며, 장기요양 서비스 이용자에 비해 미이용자는 8,297,329원 증가하였다(${\beta}=.29$, p< .001). 입원일 변화량의 $R^2$은 22.4%이었으며, 서비스 이용자에 비해 미이용자는 119.013일 증가하였다(${\beta}=.33$, p< .001). 총 진료비와 입원일 변화량에 영향을 미치는 요인은 장기요양서비스 이용 여부, 수발자 여부, 2009년 일상생활수행능력, 간호처치, 재활기능이 유의한 영향을 미치는 것으로 나타났다. 따라서 장기요양 서비스 미이용자의 의료 이용이 높게 나타남에 따라 미이용자에 대한 적정 의료와 요양서비스 이용을 지원할 수 있는 정책 마련이 필요로 된다.