• Quality Improvement in Health Care
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• v.10 no.2
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• pp.154-163
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• 2003

Purpose: The aim of this study is to develop and apply the critical pathway to the nasal bone fracture patients and to elucidate its effect. Methods: Critical pathway (CP) sheet and questionnaire were developed by a team approach. Critical pathway were applied to 30 nasal bone fracture patients (CP group) from June 2001 to November 2001. Length of hospitalization, cost for hospitalization and bed turnover rate of CP group were compared to those of the 30 patients who had same disease entities and treated by conventional regimen (control group). Results: Length of hospitalization in the CP group (4.20 day) were significantly shorter than that of control group (6.21 day). Mean cost for hospitalization of the CP group (492,106 won) were significantly lower than that of control group (678,376 won). Bed turnover rate in CP group (2.5) were higher than that of control group. The patients satisfaction for the medical personnel, explanation regarding operation procedure, therapeutic operation fee, and length of hospitalization were all affirmative. Conclusion: Critical pathway that we developed for nasal bone fracture definitely improved the quality of treatment and lowered cost of medical service. Furthermore, other critical pathways should be developed for another facial trauma patients.

• Health Policy and Management
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• v.17 no.1
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• pp.1-27
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• 2007

This study is designed to estimate an appropriate level of patient's cost-sharing for oriental medical services in the Korean National Health Insurance. The findings of this study can be summarized as follows: 1) The current co-payment system for oriental medical services does not reflect its cost structure in clinical practice due to inconsistency of cost-sharing plan in the NHI. 2) Both oriental medical institutions and their patients, as a result, are at a relative disadvantage in financial burden, compared with other services. 3) The substantial proportion of patients' cost-sharing depends on the amount of co-payment and the range of medical cost that a flat rate is applied to. 4) The extension of the range doesn't make any substantial decrease in patient's cost-sharing. 5) The fixed amount of co-payment is more sensitive than a range to total variations of patient's cost-sharing. Based on the above, the budget impacts of a new co-payment system were estimated for each co-insurance rate, according to given scenarios. The results range from -59 billion Won (-8.5%) to 16 billion Won(2.3%).

• Journal of agricultural medicine and community health
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• v.44 no.1
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• pp.28-38
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• 2019

Objectives: We searched and reviewed the literature including the laws or acts, statistics, guidelines, papers and conference proceedings related to home visit nursing care in South Korea. Method: We searched and reviewed the literature including the laws or acts, statistics, guidelines, papers and conference proceedings related to home visit nursing care in Korea. Results: There are three types of home care nursing in Korea. Public health center provides home visit nursing to vulnerable population by registered nurses for free, based on community health act in public health center. As of 2017, 1,261,208 people were enrolled in the visiting health program of public health center. Health behavior and disease management has been improved and showed having cost-benefit effect among the enrolled people in visiting health program. Visiting nursing care in long-term care services is provided by registered nurses or nurse aid, based on long-term care act. The cost is paid as the unit price according to service time. 1,095,764 older people used long-term care services in 2017, only 0.2% of total cost used for home visiting nursing. Even though the number of user of home visiting nursing, it was reported that users spent less medical cost and hospitalized shorter. Hospital-based home care nursing is provided to patients and their families under the prescription of a doctor by family nurse specialists who are employed by medical institute based on medical law. Four hundred sixty family nurse specialists worked for hospital-based home care nursing and hospital-based home care services accounted for 0.038% of total medical expenses in 2017. Conclusion: Even though home visit nursing care services are different in aspect of legal basis, personnel, running institutes, and cost basis, home visit nursing care showed cost-benefit effect and good health outcomes. In order to advance home visit nursing care, the integrated home visiting care, improvement of working condition, and revision of legal basis should be considered.

• Women's Health Nursing
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• v.18 no.3
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• pp.200-208
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• 2012

Purpose: This study was aimed to examine the gap between predicted cesarean section rate and real cesarean section rate and it's determining factors of 44 tertiary hospitals. Method: This study is a cross-sectional analysis using the data of 25,623 deliveries in 2009 drawn from homepage of Health Insurance Review and Assessment Service. Data were analyzed with t-test, F-test, Scheff$\acute{e}$ test, and logistic regression. Result: There were statistically significant differences in the gap of cesarean section rate (more gap indicates higher quality of delivery) by grade of nurse staffing and delivery cases. Hospitals with nurse staffing grade 1 to 2 had more possibility to be classified into higher grade in quality of delivery (OR 5.67, 95% CI 1.07-30.08). Also hospitals with over 500 delivery cases had more possibility be classified into higher grade in quality of delivery (OR 4.92, 95% CI 1.14-21.23, respectively). Conclusion: The finding suggests that grade of nurse staffing may influence the real cesarean section rate because nurses do a vital role to prevent unnecessary cesarean section. Further study is required to provide evidence that nurse staffing influence on patient outcome and cost-effectiveness in order to obtain adequate number of nursing staffs.

• Journal of Korean Clinical Nursing Research
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• v.19 no.3
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• pp.321-332
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• 2013

Purpose: Korean health insurance extended application of the Diagnosis Related Groups (DRG) payment system to tertiary and general hospitals from July, 2013. This study was done to develop a DRG fee adjustment mechanism applied to levels of nurse staffing to assure quality nursing service. Methods: Nurse stafffing grades among hospitals in Korea were analyzed. Differences and ratio of inpatient costs by nurse staffing grades in DRG fees and differences of DRG fee between tertiary and general hospitals were compared. Results: In 2013, nurse staffing grades in tertiary and general hospitals had improved, but other hospital nurse staffing grades remained at the 2001 level. Gaps of inpatient costs between first and seventh nurse staffing grades were over 10% in 4 out of 7 DRG diagnosis; However differences of DRG fee between tertiary and general hospitals were only 4.51% and 4.72% respectively. A DRG fee adjustment mechanism was developed that included nurse staffing grades and hospitalization days as factors of the formula. Conclusion: Current DRG fees motivate hospitals to decrease nurse staffing grades because cost reduction is bigger than compensation. This DRG fee adjustment mechanism reflects nurse staffing supply to motivate hospitals to hire more nurses as a reasonable compensation system.

• 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.

• Clinical Nutrition Research
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• v.13 no.2
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• pp.108-120
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• 2024

The study aimed to investigate the basic data to derive plans for snack provision to improve the nutritional status of older adults living in long-term care facilities (LFs) or long-term care hospitals (LHs). The 252 respondents (118 from LHs and 134 from LFs) were included in the study. The questionnaire of nationwide cross-sectional survey was developed by the authors and registered dietitians. The written questionnaire was sent to the food service managers across 800 LFs or LHs. The online survey was introduced using the online platform and network site for dietitians. More than 70% of live-in and non-live-in LFs provided snacks, which were mainly provided one to two times a day. Most institutions provided fruits one to three times a week. The main considerations when providing fruit were in the order of residents' preference, cost, and ease of consumption. The reasons for not serving fruit included cost and differences in the residents' eating and mastication abilities. Most institutions also provided dairy products at a frequency of one to three times a week. The reasons for not serving dairy products included cost and the lack of awareness of the need to provide them. To improve the quality of life and the offer benefits of fruits and dairy products to older people, efforts are needed to propose a plan to expand the provision of snacks in appropriate quantities and varieties.

• Journal of Korean Academy of Nursing
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• v.24 no.4
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• pp.545-556
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• 1994

Medical insurance and health care delivery system enabled Korean people to get the necessary medical service, but it caused increased needs for medical service, and resulted in the occurence of some problems such as a lack of manpower and medical facilities. In order to solve these problems, many countries, which already had medical insurance system had developed home care system and it has been regarded effective both in reducing costs and in increasing the rates of turnover of bed. Recently, Korea has included home nursing care in its health care delivery system, and some models of the hospital based home nursing care had been tried and its effects had been evaluated. So, author tried to run a home nursing care for the Cesarean section mothers and evaluate Its effects both in the mother's health and costs. This study was designed as a Quasi-experimental study. Subjects were thirty mothers who got Cesarean section operation in hospital in Seoul. Experimental group consisted of 15 volunteers, and control group were selected by means of matching technique. Data were gathered from February 1st to March 26th by two assistants who were trained by author. Experimental group were discharged on the 4th day after their operation, and got nursing care and assessment about their home three times on the 5th, 6th, and 7th day. Control group stayed in the hospital until 7th day as usual and were checked on the same day as above mentioned To evaluate the state of physiological recovery, vital signs, H.O.F, presence of edema in the legs, bathing, appetite, sleep, presence of pain or discomfort in the breasts, amount of lochia, color of lochia, defecation urination. To compare incidence of complication in experimental group with that in control group, specific assessment was done such variables as smell of lochia, presence of inflammation of operation wound, dizziness, and presence of immobilization in the extremities. The activities of daily living were checked Satisfaction of nursing were checked To calculate costs, author asked subjects to specify expenditure including hospital charge, traffic enpenses, and food expenses. The results were as fellows. 1. On effectiveness of home nursing careThere were n significant differences between experimental and control group in incidence of abnormal symptoms and any complication. The number of taking a bath [POD #5 P=0.001, #6 P=0.0003, #7 P=0.001] and the degree of appetite [POD #5 P=0.03, #6 P=0.02, #7 P=0.013] were significantly higher in experimental group than in control group. Contrary to author's expectation, the degree of the activities of daily living in experimental group was not higher than that of control group. All of the experimental group said they were satisfied with the home nursing care. 2. Cost analysis 1) Hospital charge of experimental group was lower than that of control group. ［P=0.009］ By taking home nursing care, average period of hospitalization was shortened to 3.1 days, and family members could save 22.8 hours. Total amount of money saved by early discharge was 3,443,093 Won. It is estimated that total amount of money saved by early discharge in a year will be 40,398,956 Won. 2) Home nursing care charge of 15 mothers was 1,781,633 Won. It is estimated that total amount of money Saved by it in a year Will be 20,904,493 Won. It was lower altogether than hospital charge of the three days which is 5th, 6th, 7th day of operation. The average cost of single home visit was calculated 10,940 Won. It took 87 minutes per round and it costed 1,017.3 Won. The average hour of home care was 39.0 minutes. 3) It is expected that early discharge can bring forth the increase of hospital income. On the condition that the rate of running bed is 100%, the expected increase of hospital income will be 202,374, 026 Won in a year. Suggestions for further study and nursing practice are as follows : 1. For the welfare of patients and the increased rates of running bed, home nursing care system should be included in the hospital nursing care system. 2. Studies to test effect of home nursing care on the patients with other diseases are needed. 3. Establishment of law on the practice of home nursing care is strongly recommended.

• Journal of Korean Public Health Nursing
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• v.31 no.1
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• pp.5-18
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• 2017

Purpose: This study was conducted to suggest a method for financial projection of health insurance expenditures that reflects future changes in demographic structure. Methods: Using data associated with the number of patients and health insurance cost per patient, generalized linear models (GLM) were fitted with demographic explanatory variables. Models were constructed separately for individual medical departments, types of medical service, and types of public health insurance. Goodness-of-fit of most of the applied GLM models was quite satisfactory. By combining estimates of frequency and severity from the constructed models and results of the population projection, total annual health insurance expenditures were projected through year 2060. Results: Expenditures for medical departments associated with diseases that are more frequent in elderly peoples are expected to increase steeply, leading to considerable increases in overall health insurance expenditures. The suggested method can contribute to improvement of the accuracy of financial projection. Conclusion: The overall demands for medical service, medical personnel, and relevant facilities in the future are expected to increase as the proportion of elderly people increases. Application of a more reasonable estimation method reflecting changes in demographic structure will help develop health policies relevant to above mentioned resources.

• Journal of Korean Public Health Nursing
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• v.18 no.1
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• pp.154-166
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• 2004

The purpose of this study was to design and implementation of database for school health activity. This database system was designed stand-alone application for college school health center without a hospital affiliation and the database system was made of relational database management system, Microsoft access 2000 to be made GUI (Graphic user interface) type design and made up 7 tables: patients. symptoms. departments, income and outgo. medical cures. and medicine. The construction of this database system was patient management. code management. medicine management. and statistics management. The results of the database system were as follows; 1) This database system could be used for college school health center. 2) This database system could be made correct statistic data. 3) This database system could be managed income and outgo. 4) This database system could be changed for the better activity of community health service. 5) This database system could be simply attired administrative system. This database system will be used for students and employees to protect and promote health to measure for health level and quality of health service. In conclusion. this database system can be applied for unit health center to manage the college school health activity and advanced data management can be applied for health profession to do quality improvement. cost containment. management information system. and decision support system.