• 한국의료질향상학회지
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• 제2권2호
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• pp.112-129
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• 1996

Background : A small number of high cost patients usually spend a larger proportion of scarce health resources. Aged, long-term care and readmitted patients usually belong to these high cost patient group. Among others, long length of stay and readmission can be reduced by checking its cause, and these are the areas needed most of quality improvement activity. Characteristics of high cost medical users between health insurance program and medical assistance program were reviewed. Methods : The inpatient claims of health insurance and medical assistance program were analyzed. Patients were divided by 6 groups; long-term, mid-term, short-term, readmitted, cancer and aged. We defined high cost patients as those who had spent one and half million won and over per 6 months. Characteristics of high cost patients for each group were reviewed. Results : medical assistance patients used much more resources than the insured members in the average hospital cost per case but less in daily hospital cost. The former had a longer length of stay and had much heavier diseases. Major diseases of both group were cancer, diseases of circulatory system and chronic degenerative diseases. Gallstone and schizophrenia were more in the insured program. However, pulmonary tuberculosis, asthma were more common among the medical assistance patients. Early readmission before 2 weeks were 28-30% of the total readmission. Readmission rate in the malignat neoplasm and renal failure were 80% and more. Q.A program should be installed to prevent unnecessary readmissions. Conclusion : Almost 30% of early readmissions and admissions due to complications and long length of stay should be reviewed carefully to keep cost down and to enhance the quality of hospital care.

• International Journal of Advanced Culture Technology
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• 제10권2호
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• pp.79-85
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• 2022

Article 10 of the Constitution All citizens have dignity and values as humans and have the right to pursue happiness. There is a need for support measures such as a means to realize the respect of dignity and values as humans, and how to efficiently maintain policies on welfare for the elderly classified as the socially disadvantaged. It was considered necessary to develop an elderly-friendly city for economic, physical, and social life. Dasan Jeong Yak-yong's respect for adults was to practice the ideology of Confucianism, so this was the most important thing in the past Joseon Dynasty. In particular, it was considered important to think of adults first in practicing filial piety.This study focuses on the long-term care insurance system for the elderly, one of the welfare policy measures for the elderly. The significance of implementing the long-term care insurance system for the elderly is to benefit not only the elderly, but also all generations, including the middle-aged and children who were in charge of long-term care. To this end, the government should properly manage the factors of the social insurance financial crisis caused by the low birth rate and aging population.In addition, concerns about health insurance are high, so it is necessary to secure an appropriate level of government budget for health insurance financial management and minimize unnecessary non-benefit. In addition, it is necessary to induce appropriate medical use through connection with construction medical insurance.

• 한국보건간호학회지
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• 제24권2호
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• pp.285-301
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• 2010

Purpose: The study was aimed at qualitatively enhancing and promoting a home visiting nursing program established in Korea on July 1, 2008, as part of the Long-Term Care Insurance for the Elderly program. Methods: Structural, procedural and consequential aspects of home visiting nursing care wereclassified on the horizontal axis by applying the standard notions for the evaluation of medical care (Donabedian, 1998). At the same time, the home visiting nursing care service support system and the service provision system weredivided on the vertical axis with reference to the accreditation standards for home visiting nursing care organizations suggested by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO, 2008). The data were collected from June 4, 2008 to October 27, 2008, and were analyzed using SPSS ver. 15.0. Results: Twenty-two (proposed) standards, centered on the standard elements under the conceptual framework of the study, were developed, and comprised structural aspects (n=10), procedural aspects (n=6) and consequential aspects (n=6). Those criteria and indicators underwent two content validity surveys among groups of home visiting nursing care research and training experts. The research produced 22 proposed standards, 50 proposed criteria and 166 proposed indicators. Conclusion: The home visiting nursing care standards developed pursuant to the Long-Term Care Insurance for the Elderly Act and the applicability of these standards need to be verified by home visiting nurses. These proposed standards should prove useful in developing an assessment tool to encourage the qualitative enhancement of visiting nursing care in Korea.

• 보건행정학회지
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• 제24권4호
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• pp.349-356
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• 2014

Background: This study aimed to explore factors associated with the non-use of beneficiaries of long-term care insurance services for the elderly in Jeollanam-do Province by analyzing a dataset obtained from National Health Insurance Service. Methods: The study sample consists of 1,663 individuals who were evaluated as eligible for long-term care insurance services in Jeollanam-do Province during the period of July 1, 2008 through June 30, 2009. As a dependent variable, the non-use of the service was defined as one when a beneficiary had used it once or more times during one year after he or she was evaluated as eligible and as zero otherwise. A proportion analysis was conducted to describe characteristics of study sample. Chi-square tests were used to compare general characteristics between beneficiaries who had used the services and those who had not used them. Multiple logistic regressions were performed by three models including additional sets of explanatory variables such as socio-demographic characteristics, health conditions, and economic status. Results: Main results are summarized as follows. The proportion of beneficiaries who had not used the service was 14.5% of all beneficiaries. According to the results from the model using all explanatory variables, the factors associated with the non-use of the services were residence location, dwelling place, type of desired service, level of care needs, and instrumental activities of daily life limitations. Conclusion: In particular, regarding the type of desired service, the cash benefit showed a high likelihood of the non-use of the service; it had an odds ratio (OR) of 50.212 (95% confidence interval [CI], 24.00-105.04) compared with home service. In case of dwelling place, a hospital showed also a high likelihood of the non-use with an OR of 20.71 (95% CI, 10.12-42.44) compared with home.

• 응용통계연구
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• 제26권5호
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• pp.725-736
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• 2013

최근 노년기의 삶에 대비하기 위한 은퇴자금 마련이 중요한 개인적, 사회적 문제로 부각되고 있다. 특히, 앞으로 노년인구의 비율이 지속적으로 상승할 것이라는 전망과 더불어 이러한 개인의 재무설계 및 그와 관련한 리스크와 관련한 문제는 그 중요성이 날로 커질 것이다. 노년기의 질병에 따른 의료비 지출은 특히 재무적인 리스크와 밀접한 관련이 있는데, 유병 기간이 상대적으로 긴 질병의 경우에는 수발비용을 포함한 장기적인 의료비 지출로 인하여 재무적인 위험을 증가시키고 노년기의 삶의 질을 크게 떨어뜨릴 수 있다. 따라서, 각 개인이 장기적인 비용 지출을 요하는 질병에 대하여 예상되는 비용의 규모를 파악하고 이를 사전에 대비할 수 있는 방안을 모색하는 것이 필요하다. 본 연구에서는 노인장기요양보험의 실적 자료와 다중상태모형을 토대로, 노년기에 노인장기요양보험을 통하여 장기요양보호가 필요한 기간과 이에 따른 비용 규모의 추정을 통하여, 각 개인이 장기간병을 위해 준비해야 하는 필요금액을 도출하여 보았다.

• 보건행정학회지
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• 제27권2호
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• pp.103-113
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• 2017

There have been many achievements for 40 years since the introduction of compulsory health insurance. Despite many achievements, it has many challenges in health insurance. Aging, non-communicable disease, and low growth economy are threatening the sustainability of health insurance, and it is time to reform the health insurance. A long-term reform plan will be an absolute necessity for reform of health insurance and health care system. Health insurance and health care reform should be an extremely revolutionary content that completely changes the framework. This reform should deal with the philosophy of health, approach of medical education and doctor training, changing supply of medical service, the innovation of primary medical care, reform of public health system, the management of medical utilization, the integration of medical cure and care services, enhancing the benefit coverage, prohibition of covered and non-covered services, etc. Therefore, it is urgent to form a consensus on the necessity of reform, to establish the health insurance plan on this consensus, and to make efforts to make health insurance sustainable.

• 한국산학기술학회논문지
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• 제13권12호
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• pp.5976-5985
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• 2012

본 연구는 장기요양서비스의 질 제고를 위해 장기요양서비스 이용 노인들의 신체적 및 정신적 기능 상태를 평가해 보고, 그에 영향을 미치는 관련 요인을 규명하고자 시도하였다. 조사대상은 대전지역에 거주하는 65세 이상 노인 중 장기요양서비스 이용자 350명(재가급여 178명, 시설급여 172명)으로 하였으며, 자료 수집은 2011년 2월 16일부터 3월 31일까지의 기간 동안에 표준화된 무기명식 면접조사용 설문지를 사용하여 면접조사를 통해 이루어졌다. 연구결과, 재가급여 노인의 IADL과 MMSE-K는 시설급여 노인보다 유의하게 높았으나 ADL과 CES-D는 유의한 차이를 보이지 않았다. ADL, IADL, CES-D 및 MMSE-K 상호 간의 상관관계를 보면, 재가 및 시설급여 이용노인 모두 ADL은 IADL 및 MMSE-K와 양의 상관관계를 보인 반면, CES-D와는 음의 상관관계를 나타내었다. IADL은 MMSE-K와 양의 상관관계를 보인 반면, CES-D와는 음의 상관관계를 나타내었다. 다중회귀분석 결과 재가 및 시설 급여 이용 노인 모두 ADL과 IADL에 유의하게 영향을 미치는 변수로는 건망증 증상 유무, 규칙적 운동 및 MMSE-K가 선정되었다. 또한 CES-D와 MMSE-K는 주관적 건강상태, 건망증 증상 유무 및 IADL이 유의하게 영향을 주는 것으로 나타났다. 이상과 같은 결과는 장기요양서비스 이용 노인들의 신체적 및 정신적 기능은 개인의 건강상태나 건강관련행위 특성과 밀접한 관련성이 있음을 시사하고 있다.

• 한국노년학
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• 제29권1호
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• pp.177-194
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• 2009

본 연구는 일차적으로 노인장기요양보험 급여방식 중 현물급여와 현금급여의 선택에 있어서 비공식 가족수발자들의 현금급여 선호도를 알아보고, 이에 영향을 미치는 요인을 파악함으로써 현금급여 도입의 필요성을 인식하는데 목적이 있다. 이차적으로는 조건부 가치측정법을 이용하여 비공식적 가족수발에 대한 적정 현금급여액을 추정함으로써 미래 현금급여 도입 시 수가산정을 위한 기초 자료로 제시하고자 한다. 본 연구를 위한 조사는 서울시 소재 3차 의료기관 3곳에서 현재 환자를 돌보고 있는 환자의 보호자 300명을 대상으로 하였다. 경증과 중증 두 가지 유형의 가상의 시나리오 및 구조화된 설문지를 제시한 후 현금급여를 수용할 최소한의 보상금액(Willingness-To-Accept, WTA)을 이중경계 양분선택형 질문으로 구하였으며, 일대일 직접 면접법을 이용하였다. 연구결과, 경증노인에 대해서는 52.7%가, 중증노인에 대해서는 26.0%만이 현금급여 서비스를 선호하였다. 경증노인에 대한 적정 현금급여액은 월 평균 62.8만원, 중증 노인에 대한 적정 현금급여액은 월 평균 107.2만원인 것으로 나타났다. 본 연구는 비공식적 수발자가 직면하는 각기 다른 상황에 대한 실제 현금급여 선호도를 확인함으로써 현금급여 도입의 필요성을 인식하였으며, 잠재적 가족수발자들의 시간손실 보상액으로서 수발자가 받아들일 수 있는 주관적 수발비용을 적정 현금급여액으로 추정함으로써 현행 특별현금급여액의 적정성을 평가하는데 보다 현실적인 기준을 마련하였다는데 함의가 있다고 하겠다.

• 보건의료산업학회지
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• 제8권1호
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• pp.51-64
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• 2014

The purpose of this study was to investigate the relationship among staffing, occupancy rate, upward level change of long-term care need, and evaluation grade of facility. Data were obtained from National Health Insurance Corporation Database. Occupancy rate and evaluation grade were highest in National/public operating facilities, while they were worst in individual operating facilities. The percents of A or B grade in evaluation grade (by newly enforced law) is highest in National/public operating facilities. Multiple regression analysis showed that upward level change of care needs was very weakly associated with the number of doctors. Evaluation grade showed a weak and significant association with occupancy ratey(by old-version law)(r=.20, p<.01), upward level change of care need in group home(r=.23, p<.01) Staffing in facility did not show significantly consistent association with upward level change of care needs, evaluation grade, and occupancy rate.

• 한국노년학
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• 제30권3호
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• pp.855-869
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• 2010

본 연구는 노인장기요양보험 도입이후 장기요양시설과 요양병원의 효율적 연계방안을 모색하기 위한 기초조사 연구이다. 본 연구는 문헌고찰을 기반으로 국민건강보험공단 노인장기요양운영센터를 이용 장기요양시설 192곳과 요양병원 168곳 시설관계자(시설장, 병원장 및 이용자 등)에게 운영현황과 효율적 연계방안에 대해 면접조사를 실시 분석하였다. 자료분석은 기술통계, χ²검증 등을 SPSS 13.0으로 분석하였다. 연구결과 운영현황에서는 요양시설과 요양병원 모두 본인부담의 차이가 미미하나 식대에 대한 편차가 크게 나타났다. 경영수지적자에 대해서는 양 기관 모두 수가보전에 문제점을 지적하고 있으며, 교통과 환경요인이 입지조건을 좌우하는 것으로 파악되었다. 둘째 이용행태면에서는 양 기관 모두 비용할인 경험이 높은 것으로 나타났고, 면회를 오지 않는 경우가 많은 것으로 파악되었다. 반면, 요양시설이 사망 시까지 있는 경우가 요양병원에 비해 더 높게 나타나고 있다. 셋째, 기관의 서비스제공문제점으로는 일률적인 서비스제공, 가족의 지지나 방문 부족 등을 들 수 있다. 끝으로 양 기관의 효율적 연계방안으로는 수가현실화, 간병비 지급, 복합시설 허용, 판정기준 강화, 주치의, 요양병원의 장기요양보험 관리 방안 등을 제시하였다.