• 대한예방의학회:학술대회논문집
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• 대한예방의학회 2000년도 제52차 추계학술대회 연제집
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• pp.173-174
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• 2000

• Journal of Preventive Medicine and Public Health
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• 제21권2호
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• pp.419-430
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• 1988

This study was performed in a rural community, Kanghwa county which was introduced to a regional medical insurance pilot program in 1982. The purposes of this study were, firstly, to observe the changes in ambulatory care utilization in the three years 1982, 1983 and 1987 : secondly, to analyse factors which convert perceived medical care needs to effective medical care demand. During the three periods, a serial interview survey was performed to determine the changes in medical utilization before and after the regional medical insurance program implementation. The number of subjects was 3,356 persons in the year 1982, 3,705 in 1983 and 2,745 in 1987. The results of the study were as follows : 1. Total ambulatory care utilization rates per 100 persons during a 2-week period were 23.6 in the year 1982, 21.8 in 1983, and 29.3 in 1987; and physician visit rates were 6.1 in 1982, 11.7 in 1983, and 14.9 in 1987. Thus, compared to the total utilization rate there was a definite increase in physician visit, and during the study periods there was a decrease in drug store visits whereas an increase in hospital or clinic visits was noticed. 2. The rates of effective demand for medical care need were 70.7% in 1982, 70.5% in 1983 and 75.9% in 1987 : and the rates of patients who visited physicians were 20.2% in 1982, 42.8% in 1983 and 35.6% in 1987. Thus, physician visits increased sharply by introducing the medical insurance program, but after the latent medical care demands were fulfilled, there was a slight decrease in the physician visits. 3. The number of acute symptoms and the number of chronic symptoms were common determinants of total ambulatory care utilization and physician visits. Besides the medical care need factors, age in 1982, sex and accessibility in 1983, and accessibility in 1987 were statistically significant determinants of the total utilization ; sex and accessibility in 1983, and education in 1987 were also statistically significant determinants of the physician visit. 4. For persons with perceived acute symptoms during the 2-week periods, accessibility in total utilization and age in physician visits were common discriminating factors of ambulatory care utilization in the three years, and education and income were also statistically significant variables. For persons with perceived chronic symptoms, occupation and income were statistically significant discriminating variables commonly observed in total utilization and physician visits.

• 보건행정학회지
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• 제22권1호
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• pp.85-108
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• 2012

One of the ways to achieve the principle of equal access for equal needs, availability and geographical accessibility of health care resources regardless of resident sites is important. The purpose of this paper is to measure socioeconomic inequities in distribution of health care resources among regions in the Republic of Korea (hereafter Korea). Data were extracted from regional statistics of National Health Insurance, Community Health Survey, Korea Social Science Data Archive, and Korean Statistical Information Services at the same period of 2009. The dependent variables were the number of health workforce and health care facilities in each region. The proxy indicator of regional socioeconomic status was local tax per person. To identify whether inequalities among regions, we examined the concentration index(CI) and indirectly standardized CI by controlling each region's demographics and need factors. Total observations were 232 districts in nationwide, and we analyzed separately Seoul(25 districts) and non-Seoul areas(207 districts). The standardized CI values of health care resources were positive(favoring the rich region) across the nation in almost all kinds of resources. Especially the number of specialist, dentist, dental clinics, clinics, oriental medical clinics, pharmacists, and pharmacies were statistically significantly favoring the rich region. But the CI for the number of long-term care hospitals, public health centers were negative(favoring the poor region). The tendency of CI presenting positive values were increased in Seoul area. But in the case of non-Seoul, the CI indexes were nearly zero. The results suggest that except the Seoul area, little regional socioeconomic-related inequalities were observed in the distribution of health care resources in Korea.

• Journal of Preventive Medicine and Public Health
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• 제52권1호
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• pp.21-29
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• 2019

Objectives: The Regional Cardiocerebrovascular Center (RCCVC) Project designated local teaching hospitals as RCCVCs, in order to improve patient outcomes of acute cardiocerebrovascular emergencies by founding a regional system that can adequately transfer and manage patients within 3 hours. We investigated the effects of RCCVC establishment on treatment volume and 30-day mortality. Methods: We constructed a panel dataset by extracting all acute myocardial infarction cases that occurred from 2007 to 2016 from the Health Insurance Review and Assessment Service claims data, a national and representative source. We then used a panel fixed-effect model to estimate the impacts of RCCVC establishment on patient outcomes. Results: We found that the number of cases of acute myocardial infarction that were treated increased chronologically, but when the time effect and other related covariates were controlled for, RCCVCs only significantly increased the number of treatment cases of female in large catchment areas. There was no statistically significant impact on 30-day mortality. Conclusions: The establishment of RCCVCs increased the number of treatment cases of female, without increasing the mortality rate. Therefore, the RCCVCs might have prevented potential untreated deaths by increasing the preparedness and capacity of hospitals to treat acute myocardial infarction patients.

• 대한간호학회지
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• 제47권5호
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• pp.676-688
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• 2017

Purpose: The purpose of this study was to analyze the migration patterns of new nurses and experienced nurses and to identify the factors influencing inter-regional migration for solving regional imbalances of clinical nurses in South Korea. Methods: This study involved a secondary analysis of data from the Health Insurance Review and Assessment Service (HIRA). Data were analyzed using descriptive statistics and multiple logistic regression analysis. Results: New nurses tended to migrate from Kyunggi to Seoul. However, experienced nurses tended to migrate from Seoul and Chungchung to Kyunggi. Significant predictors of inter-regional migration among new nurses were location and nurse staffing grade of hospitals. Significant predictors of inter-regional migration among experienced nurses were location, hospital type, nurse staffing grade, ownership of hospitals and age of nurses. Conclusion: Inter-regional migration occupied a small portion of total hospital movement among clinical nurses. The regional imbalances of nurses were not caused by the migration from non-metropolitan areas to Seoul. Nurse shortage problems in the small and medium hospitals of the non-metropolitan area can be solved only through improvement of work environment.

• 보건행정학회지
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• 제31권1호
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• pp.91-99
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• 2021

Background: The Korean government introduced National Cancer Control Program and strengthening national health insurance coverage for cancer patients. Although many positive effects have been observed, there are also many concerns about cancer management such as patient concentration or time-to-treatment. Thus, we investigated the association between the time-to-treatment and survival of cancer patients, and compared regional differences by time trend. Methods: The data used in this study were national health insurance claims data that included patients diagnosed with lung cancer and received surgical treatment between 2005 and 2015. We conducted survival analysis with Cox proportional hazard model for the association between time-to-treatment and survival in lung cancer. Additionally, we compared the regional differences for time-to-treatment by time trend. Results: A total of 842 lung cancer patients were included, and 52.3% of lung cancer patients received surgical treatment within 30 days. Patients who received surgical treatment after 31 days had higher 5-year or 1-year mortality compared to treatment within 30 days (5-year: hazard ratio [HR], 1.566; 1-year: HR, 1.555; p<0.05). There were some regional differences for time-to-treatment, but it was generally reduced after 2010. Conclusion: Delayed surgical treatment after diagnosis can negatively affect patient outcomes in cancer treatment. To improve cancer control strategies, there are needed to analyze the healthcare delivery system for cancer care considering the severity and types of cancer.

• 보건행정학회지
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• 제19권2호
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• pp.127-134
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• 2009

It is known that socioeconomic status(SES) of the cancer patient is associated with survival in recent studies, performed in other countries. The purpose of this study was to determine whether the association between status of national health insurance and survival is also present in a community in Jeonnam province, South Korea. The Gwangju-Jeonnam Cancer Registry, a population-based cancer registry, provided information to identify the cancer cases of study community diagnosed from 1998 to 2007. Total of 2,046 cases were identified during the period. There were significant associations between the status of national health insurance and survival for total cancer after adjusted by age, geographic accessibility to health care, and stage at diagnosis. However, this differences were not found in the analysis using only stomach and colorectal cancer cases. Despite of some limitations, this results suggest that the policy for reducing the difference according to the SES is required in national cancer management program.

• Journal of Preventive Medicine and Public Health
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• 제34권3호
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• pp.219-227
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• 2001

Objectives : To understand the current status of the opening, closing and relocation of primary medical institutes in Korea and identify the underlying decision factors. Methods : Sources of analyzed data included the medical institutional master file at the National Health Insurance Corporation(1998, 2000) and Regional Statistic Annual Bulletins. To investigate changes including the opening, closing and relocation, a total of primary medicalinstitutions(16,757 in 1998, 19,267 in 2000) were analysed. Results : Between 1998 and 2000, there was a 15.0%(2,510) increase in the number of primary medical institutions and the rate of increase in the rural area was higher than the urban area, and higher for specialty clinics than primary practice. However, these findings did not suggestany improvement in the maldistribution of primary medical institutions. During the time period studied, newly opened and closed primary medical institutions numbered 4,085 and 1,573, respectively. Additionally, institutions thatrelocated numbered 2,729, or 16.3% of all primary medical institutions in operation in 1998. These openings and closings were more frequent among young doctors. As a result of our analysis on the underlying regional factors forrelocation, the factors that were statistically significant were local per capita tax burden and the number of schools per ten thousand persons. !n, the case of institutional factors, movements were significantly associated with gender and the location of primary medical institutions. Conclusions : In order to establish effective long-term intervention for primary medical institutions, further study and monitoring of primary medical institutions and the identification of factors influencing opening location and relocation is necessary.

• 농촌의학ㆍ지역보건
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• 제2권1호
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• pp.30-35
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• 1977

Health care conditions in Korea are gradually improving along with the economic and social development. However, the volume of disease is still great, especially in rural areas. This study attempts, therefore, to initiate a comprehensive proposal of rural health care delivery system. The proposal is constructed three parts, problem of health care system, medical cost, medical education system. The proposal consist of the following components: I. The health care system 1. health sub-center is required to be locate in "Myun" the basis administrative unit of local government for delivering primary health care. But, in the viewpoint of medical economics, the primary health care is operated cautiously. 2. Health center is desirable to provide health services in coordinating the health sub-center and other private health institution. 3. The secondary health care is performed in regional combination hospitals, and the attitude that doctors accomodate this system is required. II. The medical cost, Insurance In the expenditure of medical care, the method of a third person's payment is required absolutely. III. The medical education system. 1. The medical education system (process) is changed from the medical education to regional doctor education. 2 In the nurse education system. nursing technical high school is resurrected.

• 디지털융복합연구
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• 제16권11호
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• pp.401-409
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• 2018

본 연구는 서울 및 강원지역 만 65세 이상의 노인을 대상으로 노인틀니 건강보험 급여화에 따른 지역간의 차이와 틀니이용실태에 영향을 미치는 요인을 분석한다. 자료는 '2015 지역사회건강조사'를 사용하였다. 연구결과는 다음과 같다. 1)서울지역 노인과 강원지역 노인의 틀니이용행태에 유의한 차이가 있었다. 2) 성별에 따른 틀니이용행태는 강원지역 노인에게서만 유의한 차이를 보였으며, 연령, 가구소득, 기초생활수습여부, 직업, 교육수준, 주관적 구강건강에 따라 서울지역과 강원지역 모두 유의한 차이를 보였다. 3) 치과진료미수진 경험여부에 서울지역 노인의 16.6%, 강원지역 노인의 22.3%가 예라고 응답하였으며, 필요치과진료 미수진 사유로는 서울지역과 강원지역 모두 경제적인 이유가 가장 높은 것으로 나타났다. 이에 다각적 측면을 고려하여 노인틀니 건강보험 급여화 사업이 확대될 수 있도록 노력과 대책이 필요하다.