This study attempts to analyze some determinants of consumers' medical service quality and their complaining behavior. The results can be summerized as follows: 1. The determinants of consumers' perceived medical service quality could be categorized as five factors; i.e. nursery, hospital environment, medical doctors, other staffs service fee. Among them nursery sector consists of 32% variance. 2. According to the discriminant analysis, those determinants are of great value to distinguish between satisfied/unsatisfied group. The hit ratio was 85.4% which is relatively high score. 3. The type of complaining behavior could be grouped into no action, private and public complaining behavior. Most of respondents belonged to no action group and a few showed private complaining behavior. Any respondents who were willing to show public complaining behavior could not be found out. 4. These variables which influence complaining behavior were preconception toward hospital, barrier to complaining process and expected complaining behavior. Among them the first one was most influential variable. 5. In order to distinguish between complaining/non complaining behavior group, discriminant analysis was done. The result showed the above three variables had a significantly discriminatory power, the hit ratio reaching above 70%. In summary, we can see that consumers' evaluation on the whole medical service depends on the external factor such as staffs' attitude or hospital facilities due to the lack of their ability to evaluate highly specialized service like doctor's treatment.
In this study we analyzed the insurance claims data to investigate the medical care utilization pattern of tuberculosis patients in private sector. We selected the claims of principal or secondary diagnosis with tuberculosis from claims database of National federation of Medical Insurance, from December 1995 to November 1996. Both spell-based analysis and person-based analysis were carried out. In spell-based analysis, type and location of treatment facilities, distribution of diagnoses, number of outpatient/inpatient treatments were analyzed. Additionally in person-based analysis, number of tuberculosis patients, demographic characteristics, number of treatments per person, frequency and pattern of change in source of care were analyzed. The results were as follows 1. The number of treatments with tuberculosis was 863,641 from 1 December 1995 to 30 November 1996. The number of patients was 313.964. 2. Most of tuberculosis patients in private sector were treated in general hospital (45.8%) and clinics(42.2%) 3. About 77.7% of tuberculosis patients who were treated more than two times did not change the source of care. 18,9% of tuberculosis patients changed source of care only once. Even when we limited tuberculosis patient to those who were treated more than five times and whose treatment period were longer than six months, 94.7% of patients did not change source of care at all, or changed treatment facility only once. 4. The probability of change in source of rare was higher in pulmonary tuberculosis, in twenties, and in rural area respectively than other tuberculosis. In conclusion, healer shopping of tuberculosis patients was not serious as expected. However special attention is needed to pulmonary tuberculosis in twenties and rural area.
At this point in time South Korea is rapidly metastasizing to a aging society. A major cause of aging can be summarized as increased life expectancy, decrease of nuclear family and birthrate, and South Korea's progress is faster than any other country. From the 1970s, western society has changed social welfare to deinstitutionalization and community care because of problems about economic reason and facilities protection, so the type of elderly social service has also changed from the facility welfare service which is accommodated old people in certain facility to community welfare service which provides various welfare services with living together. Public facilities for low income group which are supported by government are lower, 6.6%, than the United States or Japan, 50%. They are divided into private manage facilities and subscription elderly facilities. These subscription elderly residential facilities show poor administration because of focusing on development and market analysis for investment returns. Therefore, in order to vitalize the elderly welfare residential facilities in Korea, we need plans about systematic services facilities for welfare and phased medical treatments. Therefore, the purpose of this study is that (1) the types and functions of residents for community elderly residential facilities in elderly welfare policies of U.S., and supported policies are researched as a transcendental model, (2) data about operating system with the principles of the market is analyzed, and (3) basic data about welfare facility plan for community residential elderly people is provided.
Assessment of perceptions of the community, the determinants and development of their behavior regarding common malignancies, helps in establishing evidence-based activities for prevention and early diagnosis of cancer. However information on this important aspect is lacking in our country. Qualitative methods were here used to obtain information through in depth interviews and Focus Group Discussions (FGDs) with all categories of identified stakeholders. Most were unaware of the activities of the cancer control program. Even the providers were not fully conversant. All respondents mentioned lack of diagnostic and treatment facilities in government, primary and secondary level facilities. Perceptions of different categories of stakeholders regarding why many community members did not attend screening camps and other services reflect the determinants of community behavior, acting independently as well as in combination. The cancer control program was thought to be restricted only to some private facilities and overcrowded government tertiary care facilities where the visits were time consuming. Almost all the facilities were considered curative oriented. Issues of supervision, monitoring and feedback were inadequately addressed by providers who were inadequately trained in many program activities. The program lacked effective planning, coordination and appropriate implementation at the grass roots level in Delhi. Social mobilization was grossly inadequate, as most of the community members were unaware of the existence of the program. Misconceptions about the risk factors, signs and symptoms, diagnosis, and treatment were common amongst community members as well as many of the providers. Thus the national cancer control program in our country needs further community participation and social mobilization. Accessibility, availability, acceptability and affordability of various preventive, curative and rehabilitative activities, as well as intersectoral coordination, training, supervision and monitoring of program activities, all need to be addressed to ensure the success of this important public health program.
This study focuses on making recommendations for the improvement of poor emergency medical services or EMS in Korea. Problems of the current EMS system is widely reviewed. As an alternative of the current system, a franchises system is introduced to EMS. A feasibility study of the new system is carried out as follows. 1) The current EMS system shows such problem as; - Inadequacy of emergency medical fee schedule, - Shortage of emergency medical resources, - Concentration of emergency medical facilities in metropolitan area, - Unestablishment of training program for emergency personnel, - Inappropriateness of patients' behvaviro pattern in emergency care system. 2) Recommendations for the improvement of EMS are as follows: - Well organized communication and transportation system needs to be established by utilizing all the availabl EMS is to be devised for the provision of appropriate emergency care. - A franchises system can be widly adopted so that private organizations are willing to establish a free standing emergency center. - Emergency care fee schedule of the franchises system needs to be appropriate for the system to provide high standard medical services.
Few public health researchers have paid research attention to the location of medical institutions in Korea. Previous studies were published in geography journals, and relied on limited data in terms of geographic regions and the type of medical institutions. This study utilized nationwide data covering 8 types of medical institutions. We obtained data from Health Insurance Review and Assessment Service and National Population and Housing Census. The correlation coefficients of resident, daytime, university-graduate population, and the population of different age groups (fewer than 15, 15~64, 65 or more) were compared to understand their relative association with the location of medical institutions. Medical clinic, dental clinic, oriental medical clinic, and pharmacy, all of which are almost completely operated by private sector, showed strong positive correlation with population. Hospital-level medical institutions, which are operated by both public and private sector, had moderate positive correlation. Daytime population and university-graduate population, rather than resident population, were more correlated with the location of medical clinics. The correlation coefficients of the population of 15~64 age group and the location of medical institutions were greater than that of other age groups. The results showed that daytime and university-graduate population are more important than resident population to explain the location of medicalrelated facilities. The results also suggests that the population of age groups (especially, 15~64) might be one of important influence factors in the location of medical institutions.
The purpose of this study is to analyze local-based social welfare facilities to respond to secular change of the UR rental housing estates in Japan. The selected case studies for the analysis are Hibarigaoka, Hamakousien, Turumai UR rental housing estates constructed around 1960's. The analysis was done through UR website, MLIT (Ministry of Land, Infrastructure, Transport and Tourism) and MHLW (Ministry of Health, Labour and Welfare) policy report, and related literature. These case studies are connected with housing policy as well as welfare policy and performed to Stable Living Creation Project by Business Entry System for Stable Living. The types of local-based social welfare facilities are classified by welfare corporation and medical corporation. The results are as follows: 1) The implementation of cooperative and participative system not only the private sector (welfare and medical Corporation, etc.) but also the public (MLIT, MHLW, UR Renaissance Agency, Local government, etc.). 2) Repurposed of land through rent and transfer of land for local-based social welfare facilities in the process of housing stock renewal utilization. 3) The pursue of regional revitalization through attached to multi-generation facility or local community space for elderly in local-based social welfare facilities.
Hospice is the wholistic caring service for terminally ill patient and his family so that he can live in dignity and maintain the quality of life until he passes away peacefully. The purpose of this study is to compare the development of hospice movement in UK, USA, Japan and Korea, to analyze space configuration characteristics of facilities built between 1980-2009 through case study. The result is as follows. First, The modern hospice started in England and it has spread around the world rapidly. In Korea, hospice service was introduced even prior to US and Japan and developed in spite of poor medical environment. The application of health insurance subsidies were late compared to other countries, but the hospice and palliative care system was quickly set on the basis of precedent cases. Second, the number of hospital beds per facility is decreasing, and it has been divided into smaller clusters for the residential atmosphere. The controversy between private rooms and multi-patient room is still ongoing, and increasing facilities without in-patient service. Rather than establishing uniform and absolute regulations, it is necessary to design a flexible space which can cope with various situations such as patients' needs, service changes, and manpower status. Third, the spaces for family members and friends to stay in both private rooms and communal spaces are increasing. Forth, Facilities for patients with different needs, such as children and adolescents and AIDS patients, have been developed in UK and USA. Further research on of patients' diverse needs and customized environmental support is necessary.
As the result of a survey conducted by the author on the status of tile 12 educational institutions for mentally retarded children in Korea and their quartering facilities as well as on 934 children accommodated in such institutions, the following conclusion has been reached: 1) More than a half (approximately 58 percent) of the facilities for mentally retarded children are concentrated in Seoul. About eighty-three percent of these facilities are private establishments, of which 70 percent have their proprietors concurrently as their superintendents. Although these facilities were first established as many as 22 years ago, it has been only five or six years since education was actually started for mentally restarted children. 2) Out of a total of 179 employes, teachers number 99, there by constituting approximately 57.6 percent. Out of them, however, only 32 teachers or 2.8 percent have special teachers licenses. Thus, each teachers has to take care of an average of 29 children. This is excessive a number of children per teachers in view of the special nature of this education, there by indication how urgent it would be to secure more teachers lot this field. 3) Out of the mantally retarded children investigated 57.6 percent suffer from physical disorder in addition to mental retardation, 53.0 percent from mental alienation illnesses besides retardation, and 25 pent from physical, mental disorders in addition to retardation. It is therefore necessary to maintain medical and nursing facilities together with educational facilities. however, two places have no medical facilities at all, and four other places, without medical personnel, have to receive medical support from nearby hospitals or clinics. 4) The total number of children in the surveyed facilities is 934, who can be broken down into 58.7 percent boys and 41.3 percent for girls. They are classified into 12.5 percent for idiot, 37.7 percent for imbeciles, 32.7 percent for morons, and 17.3 percent for thoes children on borderline. Their average age is 13.9 years. 5) As the result of education, the illiteracy rate of mentally retarded children has decreased from 78.1 percent to 32.1 percent while the percentage of those taking the primary school course has increased for 12.2 per cent to 33.5 percent. As a result, it has been learned that education is definitely necessary for Retarded children though it may be a difficult task. 6) The children who have mentally retarded children among their brothers or sisters constitute 6.3 percent of the total number. The corresponding rate for boys is 3.5 percent while that for girls is a remarkably higher rate 10.6 percent. Through studies on the causes of their mental retardation, it has been learned that 39.6 percent of them is of the inherent type and 35.3 percent is of the environmental type. Control and improvement of health of mothers and children, early diagnosis and early treatment are believed to be very important because they could prevent or alleviant much of these conditions. 7) The storage age of teachers and employes is 35.3 years, an indication that a great proportion of them is experienced in a way or another as their major difficulty or problems in serving with these special school, 22.5 percent cited inadequate payment 24.5 gave the inadequate public understanding, and 22.5 percent pointed out the lack of understanding on the part of give parents.
Objectives : To evaluate the annual visit days, the annual prescription days and the medical costs of hypertensive patients. Methods : The medical insurance records of 40,267 incident patients with the diagnostic code of hypertension from September 1998 through August 1999 in Daegu city were reviewed. Results : The proportion of the most proper medical care pattern group (Group VIII) who visited for 6-15 days with 240 prescription days or more a year was only 6.2%. The proper care group (Group IX) who visited for more than 16 days with 240 prescription days or more a year was 9.3%. The overall proper care group (Group VIII+IX) was therefore 15.5%. The proportion of the insufficient care group (Group I, IV) in both the number of visiting days and prescription days was 57.4%. The mean prescription day of the most proper group (Group VIII) was 29 days; the mean annual medical expenses,453,587won; the mean annual amount paid by patients, 218,013won; and mean medical expenses per prescription day, 1,483won. The proportion of the overall proper care group (Group VIII+IX) was significantly higher in adults aged 50-59, those who were enrolled in industrial workers health insurance as well as government employees and private school teachers health insurance, and those who made a higher contribution per month (p<0.01). According to the type of medical facilities, the proportion of the most proper medical care pattern group was highest in the general hospitals (9.3%) but the overall proper care group was higher in the public health centers (22.1%) and private clinics (17.1%). Conclusions : The management system of hypertension should be reinforced urgently. Therefore, it is necessary to develop guidelines including the number of visiting days per year and prescription days per visit day, and make the system provide medical facilities to more properly care for hypertensive patients.
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