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The Effects of Government Intervention on Health Care System -1970-1990 in Korea- (정부개입이 의료제도에 미치는 영향 -1970-1990년을 중심으로-)

  • 이은표;문옥륜
    • Health Policy and Management
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    • v.4 no.2
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    • pp.77-110
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    • 1994
  • This study is an empiriacl analysis of effects of government intervention on the health care delivery system in Korea. The purposes of this study are to find out the effects of government intervention on the per capita national health expenditure(per capita NHE), crude mortality rate(CMR), and institutional efficiency. Here, the institutional efficiency is defined as a formula shown below: log$\frac{100-curde mortality rate }{per capita NHE}$$\times$100. The formula indicates that the instiutional efficiency increases if the CMR and/or per capita NHE goes down. In the meantime the government intervention is measured by six independent variables: I) the degree of social developments, ii) the numberr of physicians per 100, 000 population, iii) the proportion of specialists among the total physicians, iv) the proportion of public expenditure among the NHE, v) the proportion of public beds to the total number of beds, vi) the proportion of physicians working at the public sector to the total number of physicians. In the above six independent variables iv), v) and vi) are the ones that reflect the degree of government intervention. In actual calculation, the two independent variables v) and vi) are integrated into a new variable based on one to one correspondence. The materials used are the time-series data from 1970 through 1990 in Korea. A path analysis and the time-series regression analysis were adopted to estimate and examine the causal relationship between variables involved. And decomposition of the effect of causal relationship is made to find net effect, direct and indirect effect. The major findings are as follows; 1. The effect of public expenditure, number of physicians per 100, 000 population, the proportion of specialists among the total physicians and social development shows a positive relationship with per capita NHE. Only if the government intervention would be counted, the effects of the number of physicians and the proportion of specialists succeed in containing per capita NHE. 2. In additionn to the above four variables, one additional variable, per capita NHE, was also responsible for the reduction of CMR. The factor of social development found to be the most potent predictor of the CMR reduction. However, the CMR reduction due to government intervention was negligible. 3. Meanwhile, the above four variables were found to was have negative effects on the institutional efficiency. The reverse is true when the government intervention is counted. For example, the number of physicians and the proportion of specialists have played a positive role in raising institutional efficiency via goverment intervention. This comes from the factual effect that the increment of institutional efficiency via the reduction of per capita NHE is bigger than via the reduction of CMR.

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Species Composition of Fishes in Eelgrass Bed of Geoje Bay on Geoje Island, Korea (거제도 거제만 잘피밭의 어류 종조성)

  • Lee, Dae-Hee;Kim, Tae-Jin;Choi, Byung-Eon;Lee, So-Jeong;Gwak, Woo-Seok
    • Korean Journal of Ichthyology
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    • v.22 no.3
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    • pp.179-185
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    • 2010
  • This is a study of the fish assemblages in eelgrass beds of Geoje Bay on Geoje Island, Korea. Samples were collected by surf net monthly from June 2006 to May 2007. A total 26 species, 1,825 individuals, and 4,483.1 g of fishes were collected. The dominant species were Acentrogobius pflaumii, Aulichthys japonicus, Gymnogobius heptacanthus, Rudarius ercodes, Chaenogobius annularis, Gymnogobius urotaenia, Syngnathus schlegeli, Pterogobius elapoides, Zoarchias glaber, Takifugu niphobles, Zoarchia suchidai. These species accounted for 90.6% of the total number of individuals and 76.2% of the biomass of the fishes collected. The fish assemblages in the eelgrass beds showed clear seasonal changes; the number of fish species and individuals increased in March and were highest in September, whereas the biomass attained its highest level in May and subsequently decreased. Meanwhile the species diversity indices showed their highest value in December.

Analysis of influencing factors on self-employed physician's income (개원 전문의 소득에 영향을 미치는 요인분석)

  • Park, Woong-Sub;Kim, Han-Joong;Sohn, Myong-Sei;Park, Eun-Cheol
    • Journal of Preventive Medicine and Public Health
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    • v.31 no.4 s.63
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    • pp.770-785
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    • 1998
  • This study describes the relation of physician's income and price of medical service and social welfare through microeconomic view, reviews the literature of influencing factor on physician's income, and it describes general distribution of physician's income, and analyzes influencing factor of physician's income. A total of 844 persons responded to the mail survey, through stratified sampling by 23 branches of medical society in Korean RBRVS study. The design of the study is cross sectional study, and the unit of analysis is a physician. To examine the change of average income per month, multiple regression was used to test the change according to physician's characteristics, demographic characteristics, scale of clinic, average intensity of ordinary work, and specialty. The major findings of this study are as follows; 1. As for self-employed physicians, the difference of average income per month among specialties was mcreased \4,850,000, but the difference was \6,020,000 under the control of control variables. 2. The number of average out-patients per month and number of nurses and nursing aides significantly positively associated, and average income per month was significantly higher for physicians who had sick-beds than physicians who had no sick-beds. In conclusion, the number of out-patient and number of nurses and nursing aides is the major influencing factor, and the difference of average income per month among specialties existed in self-employed physicians. So this study suggests basic hypothesis that the price of medical service and supply of physician by specialties are not pertinent. Being a cross-sectional study, this study can not suggest causal explanations. In the future, further study is needed for causal explanations.

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Study on Quality Improvement Activities in Korean Hospitals (국내 의료기관의 질 향상 사업주제)

  • Chae, Yoo Mi;Lee, Sun Hee;Choi, Kui-Son
    • Quality Improvement in Health Care
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    • v.8 no.2
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    • pp.232-243
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    • 2001
  • Background : the hospitals in Korea are in a situation of a severe competition than the past. This situation was resulted from the increase in the number of hospitals and also from the government policy controlling the medical insurance fee. Moreover, consumer's desire for the high quality medical service g\has been significantly increased. Many programs to improve the quality of medical services are being performed in hospitals since the middle of 1990's. Studies up to now reported that more than 10 programs are being performed per hospital in Korea. So far studies have been performed to measure only the number of such programs in a hospital. The purposes of this study are to examine a specific area involved in the programs designed to improve the medical service quality and to suggest a future direction of the such programs. In addition, we hope that the results from this study could assist the programs for the medical service quality. Methods : A mailed questionnaire survey of the QI staffs at hospitals with 400 beds or more was conducted between September 15 and October 30, 2000. Of the 108 hospitals eligible for inclusion in our study, 69 participated, yielding a response rate of 63.9%. Excluding 7 hospital which are not responsed about activities of hospital then 62 hospitals were used for the analysis. Result : The total number of programs was 1,081 from the 62 hospitals participated in the survey. The highest number (24.8 programs) was found in the hospital having more than 800 beds and performing the programs more than 5 years. The 1,081 programs were consisted of 445 from the medical examination area, 343 from the medical examination support area, and 296 from the management area. Conclusion : This study showed the present situation of hospitals in Korea regarding to the quality improvement programs. The results from this study suggest that the pattern of the program for the medical service improvement is being changed to service process and result-centered programs from the structural area.

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Predictors of Total Quality Management in Health-Care Organizations (의료기관에서의 종합적 품질경영과 관련된 변인분석)

  • Tak, Ki-Chun;Yoo, Kyu-Soo
    • Korea Journal of Hospital Management
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    • v.6 no.3
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    • pp.46-68
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    • 2001
  • The study was to examine the relationships among those variables related to total quality management and to reveal those variables affecting total quality management in Health-Care Organizations. To study the relationship, a questionaire was designed and sent to 220 hospitals of which the number of beds is over 200 beds. Out of 660 questionaire, 263 questionaire were collected. Data analysis were conducted by using t-test, ANOVA, Pearson correlation coefficients and stepwise multiple regression. The result were as follows: 1. TQM was significantly different according to activities of QI, department of QI, age, and position. 2. Leadership was significantly different according to activities of QI, department of QI, age, and position. 3. Significant differences in the level of satisfaction of employee were found according to activities of QI, department of QI, age, position, and duration of employ. 4. Significant differences in the level of participation of employee were found according to activities of QI, department of QI, and position. 5. Education trainning was significantly different according to amount of bed, activities of QI, department of QI, level of education, kind of job, and position. 6. Medical technique was significantly different according to activities of QI, department of QI, and position. 7. Quality of work was significantly different according to activities of QI, department of QI, age, and position. 8. Significant differences in the level of investigation's system in satisfaction of client were found according to activities of QI, department of QI, kind of job, and position. 9. Positive correlations were observed between TQM and those variables related to TQM. 10. TQM was significantly predicted by the level of satisfaction of employee(40.9%), participation of employee(7.0%), investigation's system in satisfaction of client(2.7%), leadership(1.4%), and medical technique(1.1%), respectively.

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A Study on the Factors to be Considered before Drug Utilization and the Prescribing Behavior of Antibiotics (처방전 고려사항과 항생제 처방행위에 관한 연구)

  • Moon, Sun-Soon
    • Korea Journal of Hospital Management
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    • v.4 no.2
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    • pp.286-304
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    • 1999
  • The purpose of the study was to analysis physician's prescribing behavior. Data was collected from 320 medical doctors of 10 general hospitals from August to September in 1996. The major findings are as follows; 1) Prescribing dosage: 74% of total selected middle dosage. Resident doctors used maximum dosage. 2) The number of similar antibiotics: 72.4% of total used 1 antibiotic. Surgery depts. and resident doctors selected 2, 3 antibiotics. Physicians to consider of insurance benefit or non insurance benefit used the number of antibiotics less than not to consider. Physicians to think over patient's economic state used less the number of antibiotics than that not to consider. 3) Used term of antibiotics: Total mean was 7.39 days. medical parts had 9.11 days but surgery used 6.41 days. Specialists consumed 6.57 days and residents applied 7.80 days. Physician to reflect result of claim used short term of antibiotics than that don't reflected. 4) Optional order of antibiotics: First antibiotics were selected 68% of total respondents, by medical depts, but secondary, tertiary antibiotics was used surgery depts. Tertiary antibiotics was used residents doctors, universal hospitals, fill beds and over. 5) The number of the items of oral drug : 3-4 the items of oral drug were used 76% of respondent Surgery parts selected 1-2 the items of oral drug, medical depts. selected five and over. Physician to reflect result of claim used less the number of the items of oral drug than that don't reflected. Physician to prescribe different of class of insurance used less the number of the items of oral drug than that don't prescribe different.

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Species Composition of Fishes in the Eelgrass Bed of Jangpyeong in Tongyeong, Korea (통영 장평리 잘피밭에 출현하는 어류의 종조성)

  • Choi, Hee Chan;Park, Jong Hyeok;Baeck, Gun Wook
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.51 no.3
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    • pp.278-285
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    • 2018
  • Monthly variation in species composition of fishes in the eelgrass bed of Jangpyeong in Tongyeong, Korea was determined using monthly samples from a seine net from May 2016 to April 2017. A total of 32 species, 2,042 individuals and 3,991.1 g of fishes were collected during the study period. The dominant species were Takifugu niphobles, Rudarius ercodes, Gymnogobius heptacanthus, Zoarchias glaber, Pholis nebulosi and Leucopsarion petersii. These species accounted for 79.5% of the total number of individuals. The fish assemblages in the eelgrass bed showed clear seasonal changes: the number of fish species increased in March and was highest in October, while the number of individuals increased in December and was highest in July.

A Study to define the range of sample size for setting Intensive Care Unit(ICU) facility guidelines - Focused on analysis of guidelines and present of ICUs facilities by general hospitals size (중환자실 시설기준 작성을 위한 기본시설 수준 설정 연구 - 국내·외 시설기준 및 국내 종합병원 병상규모 별 시설 현황분석을 기초로 하여)

  • Yoon, Hyung Jin;Cho, Jun Young
    • Journal of The Korea Institute of Healthcare Architecture
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    • v.23 no.3
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    • pp.47-56
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    • 2017
  • Purpose : This study is a basic research to establish guidelines for healthcare facility in Korean healthcare market. As a first step, it is a main purpose for making beginning point of ICU guideline to set a basic level of ICU facility size and quality by analysis current ICU facilities and existed domestic guidelines : law, criteria of healthcare insurance review and assessment service, credit of Korea institute for healthcare accreditation. Methods : First of all, the all requirements of existed guidelines are put together and summarized. The summary is compared with that of US, UK, and Australia to know its quality difference with international market. In addition, all hospitals in Korean market are classified based on total bed number and ICU bed number to know the most occupied facility size range in the market. Second of all, by comparing 15 ICUs' current setting of the public general hospital, a general condition of ICU facility would be extracted based on function, floor area per bed, services Results : 72.8% of hospitals in Korea are belonging below 500 beds hospital. Among them 200-299 beds hospitals occupied 35.3% and are shown as the most occupied hospital size. As 15 public general hospitals are analyzed, it is clear that the more bed size and services the more ICU area per bed. As a result it is sure that the 300~500 bed may be a clear line as a general ICU condition whose function and bed number relatively consistent in the range. Implications : to keep the qualified medical environment and contemporary hospital trend, the guideline as a minimum requirement keep naturally out from current healthcare settings and should reflect their limit to reconcile with the new trend in the market.

Factors Affecting the Operating Performance of General Hospitals (종합병원 수익성에 미치는 영향요인 분석)

  • Kim, Ji-Hyoung;Ha, Ho-Wook;Lee, Hae-Jong;Sohn, Tae-Yong
    • Korea Journal of Hospital Management
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    • v.10 no.3
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    • pp.45-66
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    • 2005
  • The purpose of this study was to analyze related factors affecting profitability on general hospitals(300-499 beds). The data were derived from survey by the Korean Hospital Association on 33 hospitals during 10 years (from 1993 to 2002). Profitability was measured by 3 ratios - net profit to total assets, normal profit to total assets and operating margin to gross revenue - as dependent variables. Independent variables were classified by general factors (ownership, number of bed, period of establishment, region), financial factors (total asset turnover, current ratio, liabilities to total assets, personnel costs per operation profit, material costs per operation profits), productivity index(number of daily patient per nurse), the score of quality assurance activity and the time lag score. Multiple regression model was used in this study. First, Number of bed, region was not statistically significant for profitability. But ownership was affect positively to normal profit to total assets and operating margin to gross revenue. Private hospitals had higher profitability than that of public hospitals Second, the score of quality assurance activity was not statistically significant to profitability. Third, Those hospitals having more daily patient per nurse had significantly higher profitability than the others. Fourth, Those hospitals having higher proportion in total asset turnover had significantly higher profitability than other hospitals. But liabilities to total assets and liquidity ratio had no difference to the profitability. Those hospitals having higher proportion in personnel costs and material costs per operation profits had significantly lower hospital profitability than others.

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A Study on the Nurses' Contingent Employment and Related Factors (간호사의 비정규직 고용실태 및 관련요인에 관한 연구)

  • Choi, Sook-Ja
    • Journal of Korean Academy of Nursing Administration
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    • v.5 no.3
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    • pp.477-500
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    • 1999
  • Korean labor market has showed remarkable change of the increase in the amount of unemployment and contingent employment since IMF bailout agreement. There is a theoretical position to explain this increase in contingent employment at hospitals with the notion of flexibility. The high flexibility of employment due to the increase of contingent employees is becoming very important part in new business strategy of hospitals. The types of contingent employment of the nurse are part-time employment temporary employment, fixed-term employment, and internship which was introduced in early 1999. Recently, Korean health care industry managers have paid attention to the customer oriented service, rationalization of business administration, service quality control so that they can adjust their business to outer environment. Especially their efforts concentrate on the wage reduction through efficient and scientific control of man power because wage shares about 40% of total cost. This dissertation aims at verifying the phenomena of the contingent employment of the nurse and analyzing the related factors and problems. To rephrase these aims in ordinal: First, verifying the phenomena of contingent employment of the nurse. Second, verifying the problems of that phenomena. Third, analyzing the related factors of the contingent employment of the nurse. To accomplish these research goals, a statistical survey was executed. in which 384 questionnaires-66 for manager nurses, 318 for contingent nurses - were given to nurses working at 66 hospitals-which have at least 100 beds-in Seoul. Among them, 187 questionnaires-38 from manager nurses, 149 from contingent nurses'- 'were returned. Then, the data coded and submitted to T-test, $X^2$ -test, variance analysis(ANOVA), correlation analysis, multiple regression analysis, Logistic Regression with SAS program. The research results of the contingent nurses are followings: 1. The average career term at the present hospital 8.4 months: duty-on days per month are 24.2 days: working time per day is 7.9 hours. These results showed little difference from regular nurses. 2. Their wage level is about 70% of regular nurses except for internship nurses whose wage level is 41% of regular nurses. To break down the wage composition, part-time nurses and internship nurses get few allowance and bonus. And contingent nurses get very low level of additional pay except for fixed-term nurses who are under similar condition of employment to regular nurses. These results show that hospital managers are trying to reduce the labor cost not only through the direct way of wage reduction but through differential treatment of bonus, retirement allowance, and other additional pay. 3. The problem of contingent employment: low level of pay; high level of turn-over rate: weakening of union; low level of working condition: heavy burden of work; inhuman treatment. The contingent nurses consider these problems more seriously than manager nurses do. What manager nurses regard problematic is the absence of feeling-belonged and responsibility of the contingent nurses. 4. The factors strongly related with the rate of the number of contingent nurses for the number of regular nurses; gross turn-over nurses; average in-patients per day; staring wage of graduate from professional college: the type of hospital ownership; the number of beds; the gap between gross newcomer nurses and gross turn-over nurses. The factors related with their gross wage per month; the number of beds; applying of health insurance; applying of industrial casualty insurance; applying of yearly-paid leave; the type of hospital ownership; average out-patients per day; gross turn-over nurses. The meaningful factors which make difference by employment type: monthly-paid leave; physiological leave. The logistic regression analysis using these two factors shows that monthly-paid leave is related with the type of hospital ownership; the number of beds; average out-patient per day, and physiological leave is related with the gross newcomer nurses; gross turn-over nurses; the number of beds.

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