• 제목/요약/키워드: School health services

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방사선사 직무에서 조영제 정맥 주입 행위에 대한 인식도 분석 (Analysis Perceptions of Intravenous Injection Behavior of Contrast Medium in Radiological Technologists' Task)

  • 강중호;성열훈
    • 한국방사선학회논문지
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    • 제18권1호
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    • pp.53-63
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    • 2024
  • 본 연구의 목적은 방사선사의 조영제 정맥확보 및 주입에 대한 직무 인식도를 분석하여 미래인력 대응안의 기초자료로 활용하고자 하였다. 임상의 방사선사 총 172명을 대상으로 인구학적 특성, 직무 우선 순위, 방사선사의 조영제 정맥확보 및 주입에 대한 인식도로 구성된 측정도구로 설문조사하였다. 통계분석은 기술통계, 빈도 분석, 독립표본 T-test 검정, ANOVA 분석으로 실시하였다. 그 결과, 첫째 현재 임상 방사선사는 방사선사의 미래인력 대응안으로 정맥확보 및 조영제 주입 행위에 대한 필요성을 높게 인지하고 있었으며, 이로 인한 업무 가중성은 낮게 평가하였다. 둘째, 정맥확보 및 조영제 주입 행위에 대한 두려움은 유의한 차이를 보여 모든 방사선사의 직무보다는 선택적인 직무 행위로 수행하는 것이 유용할 것으로 판단된다. 셋째, 방사선사의 정맥확보 및 조영제 주입 행위에 대한 교육과정 및 면허증 필요성이 제기되고 있어 이에 대한 구체적인 추가 연구가 요구된다. 넷째, 방사선사의 정맥확보 및 주입에 대한 긍정적 인식은 국민 의료서비스 향상과 방사선사 전문성 강화 및 직무 확장의 토대로 기대할 수 있다.

Dosimetric Comparison of Three-Dimensional Conformal, Intensity-Modulated Radiotherapy, Volumetric Modulated Arc Therapy, and Dynamic Conformal Arc Therapy Techniques in Prophylactic Cranial Irradiation

  • Ismail Faruk Durmus;Dursun Esitmez;Guner Ipek Arslan;Ayse Okumus
    • 한국의학물리학회지:의학물리
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    • 제34권4호
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    • pp.41-47
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    • 2023
  • Purpose: This study aimed to dosimetrically compare the technique of three-dimensional conformal radiotherapy (3D CRT), which is a traditional prophylactic cranial irradiation method, and the intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) techniques used in the last few decades with the dynamic conformal arc therapy (DCAT) technique. Methods: The 3D CRT, VMAT, IMRT, and DCAT plans were prepared with 25 Gy in 10 fractions in a Monaco planning system. The target volume and the critical organ doses were compared. A comparison of the body V2, V5, and V10 doses, monitor unit (MU), and beam on-time values was also performed. Results: In planned target volume of the brain (PTVBrain), the highest D99 dose value (P<0.001) and the most homogeneous (P=0.049) dose distribution according to the heterogeneity index were obtained using the VMAT technique. In contrast, the lowest values were obtained using the 3D CRT technique in the body V2, V5, and V10 doses. The MU values were the lowest when DCAT (P=0.001) was used. These values were 0.34% (P=0.256) lower with the 3D CRT technique, 66% (P=0.001) lower with IMRT, and 72% (P=0.001) lower with VMAT. The beam on-time values were the lowest with the 3D CRT planning (P<0.001), 3.8% (P=0.008) lower than DCAT, 65% (P=0.001) lower than VMAT planning, and 76% (P=0.001) lower than IMRT planning. Conclusions: Without sacrificing the homogeneous dose distribution and the critical organ doses in IMRTs, three to four times less treatment time, less low-dose volume, less leakage radiation, and less radiation scattering could be achieved when the DCAT technique is used similar to conventional methods. In short, DCAT, which is applicable in small target volumes, can also be successfully planned in large target volumes, such as the whole-brain.

Quality and Sensory Characteristics of Yanggaeng, a Healthy Snack Added with Pinus Koraiensis Needle Extract Powder for the Elderly

  • Eunbin Park;Soo In Ryu;Minho Lee;Hyo-Jeong Lee;Jean Kyung Paik
    • Journal of Food and Nutrition Research
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    • 제10권3호
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    • pp.228-234
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    • 2022
  • Korea has entered the aged society, with those aged over 65 years accounting for 14~20% of its population. Interest in the quality of life, nutrition, and health of the elderly is increasing. Since the energy intake of the elderly is lower than the estimated required amount, nutrient intake ratio of the elderly is related to mastication. Yanggaeng is a high-energy food made from agar, sugar, and red bean paste. Since it has a soft texture, it is highly utilized as a snack for the elderly who have inconvenience in mastication. Pinus koraiensis needle is known to possess antioxidant and antibacterial effects. The purpose of this study was to develop a functional snack added with Pinus koraiensis needle extract powder known to possess anti-inflammatory, anti-cancer, and antibacterial effects for the elderly that would be easy for them to chew. In this study, yanggaeng was manufactured with 0%, 2%, 4%, 6%, or 8% of Pinus koraiensis needle extract powder, white sediment, and agar. In the experiment, moisture contents, color values texture characteristics, antioxidant activities, and sensory preference results were evaluated. Moisture content was the highest in the group added 6% of the extract powder. It was the lowest in the group added 8% of the extract powder, showing a significant (p < 0.001) difference between the two. Hardness, cohesiveness, and springiness of texture characteristics were decreased significantly (p < 0.001) while the adhesiveness and chewiness of texture characteristics were increased significantly (p < 0.001) as the amount of addition increased. Regarding antioxidative activity measurements, levels of polyphenols were the highest (p < 0.001) in the group added with 8% of the extract powder. DPPH and ABTS radical scavenging activities were increased as the amount of addition increased (p < 0.001). Overall sensory preference was the highest for the 2% addition group. It decreased as the amount of addition increased (p < 0.001). Results of this study indicate that Pinus koraiensis needle extract powder with antioxidant and antibacterial effects can be used to manufacture yanggaeng to make functional snacks with improved quality characteristics for the elderly.

의료기관 QI 담당자의 목표추구몰입에 관한 연구 (A Study on the Goal-Orientation of QI Performers in the Medical Centers)

  • 김미숙;박재성
    • 보건의료산업학회지
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    • 제2권1호
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    • pp.105-124
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    • 2008
  • The purpose of this research is to provide the data base for the activation of Quality Improvement operation through investigating the status of Quality Improvement operation, and finding out factors influencing on the goal-orientation of QI performers in the medical centers of more than one hundred beds where are practicing Quality Improvement operation. In order to reach the purpose, document study was carried out grounded on the proceeding researches and formulated statistical data in relation with the status of Quality Improvement performers, and proof study was carried out through questionnaire survey. The subjects of the survey were the Quality Improvement performers working in seventy three medical centers in Pusan-Gyeongnam, Daegu-Gyeongbuk, and Ulsan. Among eighty three Quality Improvement performers, fifty, five were questionnaire surveyed, on the result of which Reliability Analysis, Factor Analysis, and Multiple Regression Analysis were made, using statistical program. The the results of the proof analysis on this research are as follows. First, in the factors influencing the devoting to goal pursuit of QI performers, organization-goal contribution(0.44) had significant positive effects, while organization conflict(-0.25) had significant negative effects. In other words, the higher the organization-goal contribution was, the higher the devoting to goal pursuit was, while the less the organization conflict was, the higher the devoting to goal pursuit was, which was statistically significant.(p<0.05). Second, in the aspect of goal performance types of QI performers, the process-centered type showed high level of the devoting to goal pursuit, which was statistically significant.(p<0.05). Third, in the aspect of QI performance degree, the higher the devoting to goal pursuit was, the higher the QI performance degree was, which was statistically significant.(p<0.05). In addition, the performers who perceived their workplaces organic structure showed much higher QI performance degree, which statistically significant.(p<0.05). Generalizing the results of this research, it is possible to offer a few suggestions as follows. First, as the competition among the medical centers is more severe recently owing to medical center evaluation system, medical centers are practicing various Quality Improvement operation in all of medical services such as clinical performance and management performance, to reach the purpose of both cost-cutting and medical quality improvement. Thus in order to practice Quality Improvement operation more efficiently in medical centers, it is essential to nuke use of problem-solving methods and statistical members. This as the willingness of chief executives and positive attitude and recognition of organization members. This requires the installation of divisions in charge and disposition of persons in charge, not to speak of persistent training of Quality Improvement. Second, the divisions in charge of QI carry out Quality Improvement operation at the medical center level, and take the role of generalizing and adjusting QI performances of various departments. Owing to this role, the division in charge of QI is considered indispensable organization in the QI operation of medical centers along with medical QI committee, while it contributes to the government's goal of reducing quality level gaps among medical centers. Therefore it is necessary for government and QI organizations to give institutional support and resources for the sake of QI operation of medical centers, besides to supply systematic trainning and informations to the divisions and persons in charge of QI. Third, it is certain that disposition of persons in charge should be determined in view of the scale and the scope of QI operation in medical centers.

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위절제술환자의 간호실무표준 사용이 간호의 질에 미치는 영향 (A study of the impact of using a nursing care standards on the quality of nursing care in gastrectomy patients)

  • 우영자
    • 간호행정학회지
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    • 제2권2호
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    • pp.97-107
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    • 1996
  • Nursing standards determine the type and extent of services that are delivered to the patients and define quality care and communicate the institution's expectations of care. Thus, taking the standard of care and incorporating it into a welldefined indicator of excellent patient care becomes one of the first activities in setting up the nursing service's quality assurance process. The purpose of this study was to determine the impact of using a nursing care standards for the quality of nursing care in gastrectomy patients. The subjects were composed of fourty-two under going gastrectomy patients with stomach cancer in general surgery nursing care unit of K University Hospital in Pusan. The data was collected from January 3 to April 13,1996. The subjects were divided into a control group - those admitted from Jan.3 to Feb.12 and an experimental group those admitted from Feb.18 to April 13. The instruments used for this study were a nursing care standards in gastrectomy patients developed by the investigator and an evaluation tool for the quality of nursing care in abdominal surgery patients developed by Byoung-Sook Lee in 1995. The data was analized by means of chi-square test, t-test and Cronbach-alpha test with the SAS System. The result was as follows : The hypothesis, that scores of the quality of nursing care in the experimental group would be higher than that of the control group. was supported(t=-6.12, p=0.00). The detailed results of each standards of evaluation tool were as follows : The mean score of the experimental group was significantly higher than that of the control group in audit standard 1:'Collection of basic data of the patients', (t=-3.76, p=0.00). The mean score of the experimental group was significantly higher than that of the control group in audit standard 2 : 'Defining nursing diagnoses(or nursing problems)', (t= (-), p= (-) ). The mean score of the experimental group was significantly higher than that of the control group in audit standard 3:'Estabilishment of nursing care plan according to nursing diagnoses(or nursing problems)',(t= (-), p= (-) ). The mean score of the experimental group was significantly higher than that of the control group in audit stndard 4:'Implimentation of nursing care plan', (t=-2.38, p=0.01). The mean score of the experimental group was significantly higher than that of the control group in audit standard 8 : 'Increase of the knowledge of health related to surgery',(t=-2.40, p=0.01). No significant differences between the mean scores of the experimental group and that of the control group in audit standard 5 : 'Recover and maintain of the physical function', audit standard 6:'Prevention of the post-operative complication', audit standard 7 : 'Decrease of discomfort caused by operation', and audit standard 9 : 'Patient satisfaction in nursing care' were found. The standards of evaluation tool were devided into two dimension. One was process dimension which contains four standards(audit standard 1 to 4), the other was outcome dimension which contains five standards(audit standard 5 to 9). The mean score of the experimental group was significantly higher than that of the control group in process dimension (t=-12.30, p=0.00), but no significant difference between the mean scores of the experimental group and that of the control group in outcome dimension was found. From these results, it is concluded that using a nursing care standards in gastrectomy patients promotes quality of nursing care and nursing care standards of various fields are necessary for effective nursing care.

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e헬스케어 비즈니스모델에 관한 연구: 비즈니스생태계 접근 중심으로 (A Study on e-Healthcare Business Model: Focusing on Business Ecosystem Approach)

  • 김영수;정재진
    • 벤처창업연구
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    • 제14권1호
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    • pp.167-185
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    • 2019
  • 대부분의 G20 국가에서 향후 수십 년 동안 의료 지출이 급격하게 성장할 것으로 예상하고 있듯이, 고연령 인구와 만성질환자의 증가로 인해 전 세계적으로 의료비 부담은 지속적으로 늘어나고 있으며 의료서비스의 지속적인 질 개선도 해결해야 할 과제로 대두되고 있다. 그러나 헬스케어와 IT 융합의 급변하는 기술 환경 하에서 이런 변화를 제대로 인식하지 못하고 적절한 대비를 하지 않는데서 그 문제가 더 커질 수 있다. 패러다임 변화와 의료 분야 문제 증대 상황에서 기술적, 제도적, 사업적 측면에서의 복합적인 대응이 절실히 필요하다. 핵심은 의료분야에 IT를 융합한 사업에 적합한 비즈니스모델의 도출이라 할 수 있다. 4차 산업혁명시대의 도래와 함께 사물인터넷 등의 신기술이 e헬스케어에 적용되면서 새로운 비즈니스모델의 필요성이 대두 되었다. 기존 인터넷 시대의 e헬스케어에서는 전통적인 조직 기반 (Firm-centric) 비즈니스모델이 되었으나 사물인터넷 시대에는 사물인터넷의 역동성 (Dynamics) 및 복잡성 (Complex)의 특성으로 인하여 단위 조직 (Firm-Centric)보다는 비즈니스생태계 (Business Ecosystem)기반의 접근이 필요하다. 본 논문에서는 사물인터넷 등 이머징 기술 (Emerging Technology)기반의 e헬스케어의 비즈니스생태계에 대한 연구 결과로 e헬스케어 비즈니스생태계의 3-레이어 (Layer) 구조에 기반한 생태계의 주요 발전 인자를 분석 제시한다. 3-레이어 비즈니스생태계는 (1) 인프라 스트럭처 레이어 (Infrastructure Layer), (2) 특성 레이어 (Characteristics Layer) 및 (3) 이해당사자 레이어 (Stakeholder Layer)로 정의하여 분석하였다. e헬스케어 비즈니스생태계의 주요 발전 인자측면에서는 (1) i헬스케어 개념의 도입, (2) 비즈니스생태계의 확장, (3) 비즈니스생태계 변화 프로세스 혁신, (4) 비즈니스생태계 리더쉽 혁신의 4가지 인자를 제안한다.

의료시장 개방에 따른 국내병원 대응에 대한 치위생과 학생들의 견해에 관한 연구 (A Study on the Outlook of Dental Hygiene Students on the Possible Countermeasure of Domestic Hospitals for the Opening of the Medical Market)

  • 윤현서;김동열
    • 치위생과학회지
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    • 제9권4호
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    • pp.443-451
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    • 2009
  • 부산지역에 소재한 2개 대학 치위생과 1, 2, 3학년에 재학 중인 학생 269명을 대상으로 의료시장 개방에 따른 국내 병원의 대응 방안에 대한 조사 분석의 결과는 다음과 같다. 1. 찬반의견과 대응방안에서 고객만족 병원마케팅의 수립(p=0.023), 해외의료시장 분석 및 진출 모색(p<0.000), 의료서비스의 질 개선 및 다양화(p=0.025)에서 통계적으로 유의한 차이를 보였다. 2. 치과 병 의원 실습 및 아르바이트 경험 유무와 대응 방안은 경험이 있는 경우 병원이미지 차별화(p=0.01), 국민건강보험 수가 현실화(p=0.004), 보험 급여대상 확대(p=0.012)평점이 높고 통계적으로 유의하였다. 3. 학년과 대응방안은 학년이 높을수록 병원이미지 차별화(p=0.009), 국민건강보험 수가 현 실화(p=0.004), 보험 급여대상 확대(p=0.045) 평점이 높고, 통계적의로 유의한 차이를 보 였다. 4. 보건/의료관련 기사에 대한 관심 유무와 대응방안은 관심이 있는 경우 경영의 합리화 (p<0.000), 중소병원과 대형 병원간 협력관계 구축(p=0.027), 고객만족 병원마케팅의 수립 (p<0.000), 의료시장 변천에 따른 정책 개발(p=0.001), 해외의료시장 분석 및 진출모색(p=0.001), 의료서비스의 질 개선 및 다양화 (p<0.01), 직원 친절서비스교육 및 훈련 (p=0.01), 병원의 이미지 차별화(p=0.012), 진료예약제의 개선(p=0.025), 병원 부대시설 의 개선(p=0.029), 의사들의 의식 개혁(p=0.007)에서 평점이 높았으며 통계적으로 유의한 차이를 보였다. 5. 외국 병원 이용의사에서는 진료비와 상관없이 이용 (p<0.000), 국내병원 진단 후 외국병 원에서 재 진단 유무(p<0.000), 거주지와 거리부분(p=0.05), 의료서비스가 진료비와 진료 비(p=0.005), 통역사의 도움부분(p=0.023)에서 통계적으로 유의하였다. 외국 병원 선호 국 가에서 1위 미국(41.9), 2위 호주(19.9), 3위 캐나다(14.2)순으로 나타났다.

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패스트푸드점 아르바이트생과 그 외 음식관련 서비스업 아르바이트생의 식습관, 패스트푸드에 대한 인식 및 섭취빈도 비교 (Comparison of dietary habits, perception and consumption frequency of fast foods between youths working part-time at fast food restaurants and other food-related services)

  • 조미양;현태선
    • Journal of Nutrition and Health
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    • 제47권3호
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    • pp.206-213
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    • 2014
  • 본 연구에서는 패스트푸드점 아르바이트생 118명과 패스트푸드점 외의 음식 관련 서비스업에서 일하는 아르바이트생 115명을 대상으로 설문조사를 실시하여 식습관과 패스트푸드에 대한 인식 및 패스트푸드 섭취 빈도 등을 비교하여 두 집단 간에 차이가 있는지를 남녀별로 나누어 파악하고자 하였다. 남자의 경우 패스트푸드점 아르바이트생과 그 외 아르바이트생에 있어서 연령, 신분, 주거형태, 용돈, 음주, 흡연, 일하는 시간 및 시급에는 차이가 없었으며, 음주횟수에 차이가 있었다. 여자의 경우 패스트푸드점 아르바이트생은 그 외 아르바이트생에 비해 20세 이상의 대학생이 더 많았고, 6시간 이상으로 일하는 학생이 많았으며, 시간당 급여가 더 높았다. 여자의 경우 패스트푸드점 아르바이트생이 그 외 아르바이트생에 비해 식사 횟수는 적고, 간식으로는 패스트푸드를 먹는다고 한 사람이 더 많았으며, 남녀 모두 야식을 더 자주 먹는 것으로 나타나 식습관이 더 나쁜 경향이 있었다. 또한 패스트푸드점 아르바이트생은 그 외 아르바이트생에 비해 남자의 경우 과일류의 섭취빈도, 여자의 경우 콩 및 콩제품의 섭취빈도가 유의적으로 낮았다. 또한 패스트푸드점 남자 아르바이트생은 패스트푸드의 장점에 대한 인식 점수가 더 낮았다. 패스트푸드점 아르바이트생은 남자의 경우 햄버거류, 피자류, 탄산음료, 여자의 경우 햄버거류, 감자튀김, 도넛, 탄산음료에서 그 외 아르바이트생보다 유의적으로 섭취빈도가 높았으며, 연령, 신분, 주거형태, 용돈, 음주, 흡연, 일하는 시간, 시급 등으로 보정한 후에는 남녀 모두 햄버거류, 피자류의 섭취빈도가 유의적으로 높았다. 총 섭취빈도도 패스트푸드 아르바이트생의 섭취빈도가 더 높았으며, 연령, 신분 등으로 보정한 후에도 여전히 유의적인 차이를 나타냈다. 이와 같이 패스트푸드점에서 일하는 아르바이트생은 그 외아르바이트생보다 식습관이 더 나쁘고, 패스트푸드를 더 자주 섭취하고 있었다. 따라서 패스트푸드 아르바이트생은 결식하지 않고, 다양한 식품을 충분히 섭취하도록 노력하는 등의 좋은 식습관을 갖도록 더 노력해야 할 것이며 이를 도울 수 있는 영양교육이 요구된다.

제주지역 젊은 성인의 배달음식 섭취실태와 식생활 및 비만과의 연관성 (Association of delivered food consumption with dietary behaviors and obesity among young adults in Jeju)

  • 고민정;하경호
    • Journal of Nutrition and Health
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    • 제57권3호
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    • pp.336-348
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    • 2024
  • 본 연구는 제주지역 20-30대 성인 312명의 배달음식 섭취 실태를 파악하고, 이에 따른 식생활 및 비만과의 연관성을 규명하고자 하였다. 조사참여자의 배달음식 섭취 빈도는 '주 1-2회(32.37%)'가 가장 높았으며, 다음으로 월 1-3회 (32.05%)', '주 3-4회 (20.51%)순으로 높았다. 아침식사 섭취빈도가 높을수록 배달음식 섭취 빈도가 낮게 나타났으며, 평소 짜게 먹을수록 배달음식 섭취 빈도가 높게 나타났다. 조사대상자의 비만 여부에 따른 배달음식 섭취빈도 분석 결과, 비만한 그룹에서 배달음식을 주 3회 이상 섭취하는 비율 (40.00%)이 비만하지 않은 그룹 (23.38%)에 비해 높았고, 배달음식을 주 1회 미만 섭취하는 비율은 비만하지 않은 그룹(45.02%)에서 비만한 그룹 (28.00%)에 비해 높았다. 배달음식 섭취빈도와 비만과의 연관성을 알아보기 위해 다중 로지스틱 회귀분석을 실시한 결과 배달음식을 주 1회 미만 섭취하는 경우에 비해 주 3회 이상 섭취할 경우 비만의 교차비가 2.4배 더 유의하게 높았다. 이상과 같은 결과를 토대로 할 때 제주지역 젊은 성인에서 배달음식을 자주 섭취할수록 아침결식, 평소 짜게 먹는 등 식생활이 바람직하지 않았고, 비만의 위험이 높았다. 본 연구의 결과는 배달음식 소비자 측면에서 건강한 음식 선택 및 섭취를 위한 영양지식 증가의 필요성을 시사한다. 배달시장 측면에서는 배달음식의 종류가 다양화됨에 따라 건강식에 대한 수요가 높아지고 있으므로 건강 고려사항에 대한 옵션 강화가 요구되며, 배달음식 영양표시를 위한 정부 및 지자체의 지원이 필요할 것으로 사료된다.

환자들의 의료시장개방에 대한 인식도와 외국병원 선택요인 - S대학교병원 외래환자들을 대상으로 - (Attitudes on Medical Market Opening and Factors for Selecting a Foreign Hospital of Korean University Hospital Outpatients)

  • 윤여룡;유승흠;김유영;오현주
    • 한국병원경영학회지
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    • 제8권3호
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    • pp.32-48
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    • 2003
  • Korea is to open its medical markets to foreign hospitals starting in the year 2006 regardless of our will(DDA, Doha Development Agenda). To accurately understand the characteristics of Korean medical users, their detailed and various needs, their attitudes toward the opening of Korean medical markets, and factors affecting these users in choosing foreign medical service providers would be first step needs to be taken by the Korean medical facilities that need to survive and develope through the fiercely competitive era coming with the opening of Korean medical markets to foreign medical service providers and would be very important in hospital management. The subjects of this study were 500 patients randomly selected from the outpatients who visited one of university hospitals in Seoul on the 14th-16th days of April 2003, and conducted a self-completion questionnaire. The answers of 463 respondents among the selected patients(93% of a responding rate)were analyzed through the Excel and statistics programs. The attitudes on the opening of the medical markets were shown in agreement 56.5%(247 persons), disagreement 6.9%(30 persons), and no idea 36.6%(160 persons). In consideration of only the answers as agreement and disagreement exclusive of the answer as no idea, 89.2% of the respondents agreed to the opening of the medical markets while 10.8% objected to the opening. The approval rate was higher with the higher education and income levels. Moreover, The approval rate for the opening of the medical markets was relatively high regardless of the satisfaction in the medical service, and the most important reason of the agreement was the guarantee of the patients(national)option. The main reason of the disagreement was high medical fee(50.5%), and the other reasons showing low rates were outflow of the domestic fund to the foreign countries(13.6%), damage of medical influences on the public(11.4%), lack of competition of the domestic medical industry(9.1%)and so on. As for the factors of selecting the foreign hospitals in the opening of the medical markets, the patients considered the authority(competency)of doctors firstly, and the other principal factors were worldwide fame and reliance, specific explanation of doctors, modernized medical instruments, convenient consultation procedure, etc. The patients agreed to the opening of the medical markets at a high rate regardless of the satisfaction in the medical service, and the most principal reason of the agreement was the guarantee of the patients(national)option for the medical care. Connected with the factors to select the hospitals, the approval reasons for the opening of the medical markets were the authority(competency)of the doctors as the first one, and then fame and tradition, reliance, overall diagnosis and modernized medical instruments, doctors specific explanation, and so on. However, these factors are actually associated with the Quality of the medical care, and consequently the approval reasons for the opening of the medical markets are connected with the security of the medical care. Accordingly, the guarantee of the patients(national)option answered as the main reason of the agreement can be also understood as the awareness of the right to have a variety of options for the security of the medical quality.

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