• Journal of Korean Academy of Nursing Administration
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• v.6 no.2
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• pp.211-225
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• 2000

With the drastically changing healthcare market, the adoption of DRG system and the use of Critical Pathway will be increased gradually in order to care hospitalized patients qualitatively and manage cost-effectively in Korea. The purpose of this quasi-experimental research is to apply and analyze the developed critical pathway to the patients with Cesarean section. 35 eligible subjects for the control group were chosen from postpartum patients who has delivered at H-hospital in Kwang-ju, and were questioned after appling previous care plan from May to December, 1998. For the experimental group, 37 subjects were chosen and questioned after applying Critical Pathway service from January to June, 1999. The instruments are a critical pathway for the patients with Cesarean section developed by chung(1998) and a questionnaire that evaluate patients and family members' satisfaction level. Also, educational materials were used to inform them in the process of Critical Pathway application. As a result of chi-square test on general characteristics, there is significant difference between control group and experimental group only in terms of room size(p= .010). There are no significant differences in the average length of stay in the hospital between control group and experimental group(t=.078). Also, the average medical consult fee has no difference significantly between two groups(t= .105). The findings showed that the experimental group with critical pathway service scored significantly higher than control group on the satisfaction level toward care services(p=.000). The items are post-operative care, postpartum exercise technique, breast feeding and breast manage through educational materials. In conclusion, the research indicates that the application of planned Critical Pathway can have a positive impact on satisfaction level of inpatients with Cesarian section.

• Perspectives in Nursing Science
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• v.7 no.1
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• pp.23-35
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• 2010

Purpose: The purpose of this paper is to analyze the demand and supply of advanced practice nurses and suggest alternative benefit strategies in the Korean national health insurance. Methods: A revised demand & supply model was used to estimate the excess supply of APNs, and policy making process and key actors in the Korean health insurance were considered to develop a political approach to the APN issue. Results: The social demand for APNs is currently estimated to be less than 50% of its supply and the APN education program fell into difficulties in recruits. No reimbursement mechanism for APN's services in the national health insurance has given no economic incentive to hospital managers who have monopsony power in nursing labor market, which has caused the demand shortage of APNs in hospital industry. Payment for APN's services recognized as one of the most significant strategies to booster the social demand for APN's services should be carefully designed and implemented in the national health insurance. In line with this, key actors in health insurance policy decision-making include government, national assembly, labor unions, NGOs, civic groups, medical associations, and academia. Conclusion: The basic researches for APN's activities and cost-effectiveness analysis in clinical settings are required to support the strategies aforementioned. Constructing a policy network among key actors is able to make the payment strategy feasible, which will increase the socal demand for APNs.

• Journal of Society of Preventive Korean Medicine
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• v.16 no.2
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• pp.41-52
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• 2012

Objectives : This study aimed to analyze the trend of financial balance of Korean medicine clinics during 20 years, and to provide basic information for adjusting the fee schedule of Korean medicine procedures in national health insurance(NHI). Methods : We collected 6 financial analysis reports for Korean medicine clinics from the Association of Korean Oriental Medicine(AKOM). The data on incomes, costs and EBIT(earning before interests and taxes) of subject clinics were abstracted, and their long-term trends were evaluated. Results : The proportion of insurance income in total income increased from 23% to 56% during 20 years. Among 5 treatment groups, 'non-insurance medication' took up 65~67% of total incomes in 1997, but its proportion decreased to 42.4% in 2007. 'medical procedure, physical therapy and others' increased from 12.4% in 1987 to 29.2% in 2007. The labor cost was major part of total cost and its proportion maintained from 52% to 54%. Cost of 'non-insurance medication' was on the decline from 41% in 1996 to 31.6% in 2007. EBIT were -17.4 million won in 1996, and 18.4 million won in 2007. Conclusions : Financial balance of Korean medicine clinics improved until early 2000, but it became worse in 2007. Though deficits from NHI procedures has been covered up by profit from 'non-insurance medication', health insurance became a major source of income during last two decades.

• Quality Improvement in Health Care
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• v.12 no.2
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• pp.75-83
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• 2006

Background : Utilization review has been adopted as a vehicle for cost and utilization control of health care services. Its role was further stressed and expanded through the establishment of Health Insurance Review Agency in 2001. This article is to introduce concept, activities, and effect of utilization review based on the experiences of U.S. and to suggest important characteristics for ideal utilization review activities at the national level in Korea. Method : Twenty-five articles related with utilization review were reviewed after being selected through web site search through Med Line and Richis. Result : Utilization review was introduced mainly for health care expenditure control either by insurer, provider or the third parties under the pressure of increasing health care cost. It's activities can be categorized to prospective, concurrent and retrospective review according to the time of service provision. Based on most of studies, utilization review has been effective in controling rising health care cost and utilization. However it's effectiveness assumes a reimbursement structure of managed care like capitation payment. More worse, it is still unknown it's effectiveness on quality of care. Conclusion : Utilization review should be employed to increase the cost effectiveness of medical care by optimizing quality and patient's outcomes while also attempting to reduce the use of resources. So, it should consider outcomes before expenditures, check for both under and over-use, and construct an structure in which consumption is reduced equitably. Aggressive adoption of utilization review in Korean health care setting with fee-for-service reimbursement structure might not be a cost-effective approach before adoption of prospective payment system such as D.R.G. and capitation.

• Health Policy and Management
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• v.12 no.1
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• pp.21-53
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• 2002

The purpose of this study is to measure the resource use of the elderly in long-term care services and to examine the effects of patient and facility characteristics on their use of resources. The data were collected from 510 old people over sixty years of age, residing in five long-term care hospitals and two skilled nursing homes during the period between December 1, 2000 and February 28, 2001. For a full sample, when the first level of RUG(Resource Use Group)-III categories were employed as the proxy of patient severity, facility characteristics, such as location, size and ownership, have large effects on the resource use measured by service intensity, whereas patient characteristics such as severity have little or no effect. The resource use is significantly high if the facility: (1) is located in rural areas (gun): (2) has mare than 200 beds; (3) is a long-term care hospital; (4) is private; and (5) has a low percentage of medical aid patients. The analysis of the resource use in each RUG-III categories, for which ADL(Ability of Daily Living) were employed as the prosy of patient severity, shows a similar result. The loose relationship between the needs of residents and the resource use seems to be closely associated with the ineffective reimbursement system for providers. The current reimbursement system has no provision for quality improvement and reimburses facilities simply according to their types: fee-for-service for long-term care hospitals, and monthly-flat-rate or full-coverage-national-aid for skilled nursing facilities. It will be necessary to develop a more reasonable reimbursement system that takes patient's severity into account and gives incentives for long-term care providers to offer cost-effective services.

• Health Policy and Management
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• v.13 no.3
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• pp.104-128
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• 2003

Equity in health care has taken priority in the Korean government's policy agenda after the government-led national health insurance achieved universal coverage in 1989 along with the final inclusion of the self-employed as beneficiary. The purpose of this study is to examine the extent to which there exists difference or inequality in the utilization of health care, especially cancer inpatient services among income classes. We analysed the utilization of cancer inpatient services of residents in Jeju Island for a year of 2000, using the national health insurance data for qualification of beneficiaries and utilization of health care. The independent variable are 10 income classes based on the national health insurance fee imposed on each household for a year of 2000. The dependent variables of this study are an amount of cancer inpatient health care utilization measured by cancer admission days and cancer treatment costs. Also, cancer inpatient health care utilization is analysed by three categories divided into utilization in medical care institutions (1) within Jeju Island, (2) outside Jeju Island, and (3) all within and outside Jeju Island. We measured concentration index of cancer inpatient health care utilization. This analysis showed negative concentration index within Jeju Island and positive outside Jeju Island, and positive in all within and outside Jeju Island. This results suggest inequality against the relatively poor income groups in utilization of cancer inpatient health care services. Especially, inequity of cancer inpatient health care would be more serious in Jeju Island of Korea, considering that lower income groups reportedly have higher incidence rates in most of cancer and thus use more health services.

• Research in Community and Public Health Nursing
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• v.18 no.2
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• pp.252-265
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• 2007

Purpose: This study was attempted to provide basic data required to develop community-base rehabilitation program for disabled persons at home by investigating their characteristics. ADL, and perceived health status. Method: The subjects were 146 disabled persons at home in rural areas. Data were collected from January 22 to January 31, 2004. Data were analyzed using frequencies, percentages, means, standard deviations, minimums, maximums, $\chi^2$-test, Fisher's exact test, t-test, one-way ANOVA, Scheffe test, Contingency coefficient, Pearson's correlation, Stepwise multiple regression. Results: The average score of ADL was $5.51{\pm}1.92$: sphincter control $(5.85{\pm}2.10)$, communication $(5.66{\pm}2.02)$, transfers $(5.67{\pm}2.21)$, self care $(5.44{\pm}2.05)$, social cognition $(5.33{\pm}2.08)$, and locomotion $(4.85{\pm}2.32)$. This means that the respondents were in the state of dependence. The main items requiring others' help were 'bathing' (57.7%) and 'going up and down stairs' (51.1%) ADL was significantly different according to age, sender, occupation, medical fee payer, type, severity and duration of disability, BMI, and alcohol drinking. Among the respondents, 82.8% perceived that their health status was bad. Main factors influencing the perceived health status of disability were age and ADL$(R^2=.343)$. Conclusion: Perception of health status among the disabled is related to their characteristics and ADL, so it is necessary to develop community-base rehabilitation programs in order to improve ADL and the perception of health status.

• The Journal of Internal Korean Medicine
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• v.18 no.1
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• pp.156-174
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• 1997

This study is investigation of clinical statistics toward to old patients of 164 persons over full 65 years old to go to hospital in 5 internal medicine department of the Dongguk University Oriental Medicine Hospital for full one year from 1995. 8 to 1996. 7. The results are followings ; 1. The ratio of male and female was 1:1.6, and in offspring figures five persons or more(60.3%) was most. A couple(32.3%) was extremely much in residing forms, but in accordance to sexual distinction in male a couple(51.7%), in female solitude(31.0%) and an eldest son couple(30.0%) was far much. 2. An attack time, first cure was most in western hospital(59.2%), 81.1% of them desired western-oriental medicine cooperation, in a medical fee charging, themselves(50.7%) were far much, and most were affirmative(76.8%) against aging prevention of restorative. 3. Main diseases were cerebral nerve(41.5%) and circulatory system(25.6%), hypertention (23.8%, 9.8%) was most in complication and the past. In defecation constipation(31.7%), in urination frequence(46.7%) was far much. 4. In preventive measures of diseases invigorant(25.6%) and nothing(24.3%) was far much and in a person tending the sick a mate in male(16.7%), a son in female(13.0%) was extremely much. 5. In sexual life most of(91.5%) didn't act, a mate death was 53.1% and female was far much. And paralysis attack was extremely much in 65-74 years old(76.5%).

• Journal of Biomedical Engineering Research
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• v.28 no.1
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• pp.36-45
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• 2007

Today Human Personal Trainers are becoming very famous in this health conscious world. They teach user to achieve fitness goals in managed way. Due to their high fee and tight schedule they are unavailable to mass number of people. Another solution to this problem is to develop digital personal trainer portable instrument that may replace human personal trainers. We developed a portable digital exercise trainer device - BIOFIT that manages, monitors and records the user's physical status and workout during exercise session. It guides the user to exercise efficiently for specific fitness goal. It keeps the full exercise program i.e. exercises start date and time, duration, mode, control parameter, intensity in its memory which helps the user in managing his exercise. Exercise program can be downloaded from the internet. During exercise it continuously monitors the user's physiological parameters: heart rate, number of steps walked, and energy consumed. If these parameters do not range within prescribed target zone, the BIOFIT will alarm the user as a feedback to control exercise. The BIOFIT displays these parameters on graphic LCD. During exercise it continuously records the heart rate and number of steps walked every 10 seconds along with exercise date and time. This stored information can be used as treatment for the user by an exercise expert. Real-time ECG monitoring can be viewed wirelessly (RF Communication) on a remote PC.

• Health Policy and Management
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• v.20 no.1
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• pp.19-36
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• 2010

Fee for long-term care insurance in Korea are determined in proportion to resources utilized according to severity rather than based on categorization of beneficiaries in consideration of the characteristics of resource utilization. This adoption is based on the assumption that as beneficiaries of long-term care insurance, characteristically, demands social services rather than needs medical treatments, the characteristics of beneficiaries and the quality of utilized resources are comparatively homogenous. Therefore, the proposition is that the size of resource consumed by beneficiaries in the same grade is identical. However, even in the same grade, the level of utilized resources is different depending on the characteristic of beneficiaries. In this regard, this study is to examine whether there are differences in the volumes of utilized resources depending on the characteristics of beneficiaries even in the same grade. We analyzed time study data for 2003, 2005, 2006 which conducted by the Korea Institute for Health and Social Affairs. To look at differences in the volumes of utilized resources, we identified characteristics of beneficiaries that influence utilized resource volumes and categorized services provided by facilities into the rehabilitation treatment category, the problematic behavior category, and the physical malfunction category. Then, we examined each service in consideration of service difficulty levels and wage weights. The result of examination showed that differences in utilized resource volumes exist in all three grades depending on the characteristics of beneficiaries. Especially, in the first grade with a high level of seriousness, utilized resource volumes were different for those three service categories and the problematic behaviour category considered dementia was found to consume the largest volume of resources. Moreover, there was the inversion phenomenon of utilized resources volumes between the grades. This result indicates that utilized resource volumes are different even in the same grade depending on the characteristics of beneficiaries and it is required to consider case-mix for reflection of the volumes of utilized resources depending on the characteristics of beneficiaries.