• KDI Journal of Economic Policy
• /
• v.30 no.2
• /
• pp.99-128
• /
• 2008

Nearly all Koreans are insured through National Health Insurance(NHI). While NHI coverage is nearly universal, it is not complete. Coverage is largely limited to minimal level of hospital and physician expenses, and copayments are required in each case. As a result, Korea's public insurance system covers roughly 50% of overall individual health expenditures, and the remaining 50% consists of copayments for basic services, spending on services that are either not covered or poorly covered by the public system. In response to these gaps in the public system, 64% of the Korean population has supplemental private health insurance. Expansion of private health insurance raises negative externality issue. Like public financing schemes in other countries, the Korean system imposes cost-sharing on patients as a strategy for controlling utilization. Because most insurance policies reimburse patients for their out-of-pocket payments, supplemental insurance is likely to negate the impact of the policy, raising both total and public sector health spending. So far, most empirical analysis of supplemental health insurance to date has focused on the US Medigap programme. It is found that those with supplements apparently consume more health care. Two reasons for higher health care consumption by those with supplements suggest themselves. One is the moral hazard effect: by eliminating copayments and deductibles, supplements reduce the marginal price of care and induce additional consumption. The other explanation is that supplements are purchased by those who anticipate high health expenditures - adverse effect. The main issue addressed has been the separation of the moral hazard effect from the adverse selection one. The general conclusion is that the evidence on adverse selection based on observable variables is mixed. This article investigates the extent to which private supplementary insurance affect use of health care services by public health insurance enrollees, using Korean administrative data and private supplements related data collected through all relevant private insurance companies. I applied a multivariate two-part model to analyze the effects of various types of supplements on the likelihood and level of public health insurance spending and estimated marginal effects of supplements. Separate models were estimated for inpatients and outpatients in public insurance spending. The first part of the model estimated the likelihood of positive spending using probit regression, and the second part estimated the log of spending for those with positive spending. Use of a detailed information of individuals' public health insurance from administration data and of private insurance status from insurance companies made it possible to control for health status, the types of supplemental insurance owned by theses individuals, and other factors that explain spending variations across supplemental insurance categories in isolating the effects of supplemental insurance. Data from 2004 to 2006 were used, and this study found that private insurance increased the probability of a physician visit by less than 1 percent and a hospital admission by about 1 percent. However, supplemental insurance was not found to be associated with a bigger health care service utilization. Two-part models of health care utilization and expenditures showed that those without supplemental insurance had higher inpatient and outpatient expenditures than those with supplements, even after controlling for observable differences.

• Korea Journal of Hospital Management
• /
• v.10 no.1
• /
• pp.93-114
• /
• 2005

The prenatal care is the preventive medical service to help the pregnant mother deliver the healthy baby. It's regular examines give some chances to check-up the healthy conditions. This thesis concentrates on the CRM system to support an effective prenatal care system and prove the effectiveness of it. As CRM is the adapted management related to the customer's own information, it is important to develop the CRM model classified by the patients characteristics. A general hospital in Busan operated the CRM system to carry out the effective prenatal care and there is an analysis to ensure the effectiveness of CRM system for the pregnant women in our maternity ward. The results can be summarized as follows: 1) According to the comparisons with the CRM system, we can conclude the system is desirable. (1) Maternal Age : In the age distribution, the prenatal visit frequency, triple marker freqency, oral GTT and targeted ultrasonography in the experimental group in 30 to 34 years old is higher on the whole. For over 35 years old group, the higher frequency comes out in the oral GTT and targeted ultrasonography and for 25 to 29 years old group the different figure shows just in the targeted ultrasonography. (2) Area of residence: There is a clear difference in all the items in Busan and near area but no sign of difference in prenatal visits and oral GTT in other residencial area. Especially in the targeted ultrasonography the higher figure shows in the experimental group located in the both areas. The targeted ultrasonography is known as the specific examination which should be examined by the specialists, on the contrary the other examinations can be operated in the small clinic. So the public information and seminars related with ultrasonography increases the check-up frequency. The clinic requests some ultrasonographical examinations to the specialists in general hospital. (3) Parity: The clear difference shows that the CRM system causes the prenatal visit frequency to become higher in experimental group. The figure is 9.7 times and 8.6 times each. This is opposite that the past study said multiparity reduced the average prenatal visits. But the result of CRM is considered as the method to help the multiparity understand the importance of the prenatal care. (4) Obstetrical history: In the experimental group of the spontaneous delivery group, the figure is higher in the prenatal visit frequency, triple marker, oral GTT and targeted ultrasonography but the Caesarean section delivery group has higher figure in targeted ultrasonography. (5) In the first check-up, the rate of targeted ultrasonography in under 16 week pregnancy, in the 16 week pregnancy to 32 week pregnancy and the over 32 week pregnancy in the experimental group is upper than the compared one. For the oral GTT, there is a difference in under 16 week pregnancy but no difference in prenatal visits and triple marker. 2) The analysis of characteristics of prenatal care through the decision tree resulted in the fact that the most important variable is the residential area. After the delivery frequency is following, the obstetrical history and maternal age are in order. It is the same result in the triple marker and oral GTT. Consequently it is the same order of important variables in CRM system. The effectiveness of CRM system is proved in this study. The CRM system is a marketing method to control and lead the customers through the segmentation of customer data. It increases the new customer aquisition, maintenance of loyal customers, augmentation of customers value, activation of potential customers and creation of life time customers. So eventually it can enlarge the customers value. The medical institution should make efforts to establish the data base enforced by the customer's information on the underlying ordinary data system to carry out the CRM system effectively. In addition, it should develop the a variety of marketing strategy in order to set up one to one marketing satisfying the needs of individual patients.

• Tuberculosis and Respiratory Diseases
• /
• v.56 no.5
• /
• pp.485-494
• /
• 2004

Background : To assess the effects of mDOT implementation on sputum smear conversion for AFB (Acid fast bacilli) positive pulmonary tuberculosis patients, modified Directly Observed Treatment (mDOT) was started on October $8^{th}$ 2001 at a health center in Seoul. mDOT was defined through weekly interviewing and supervising of a patient by a supervisor (doctor, nurse, or lay health worker). The sputum smear conversion of a mDOT group was compared with that of a self-medication (self) group. Methods : This study included 52 AFB positive pulmonary tuberculosis patients registered at a health center in Seoul between October $8^{th}$ 2001 and April $23^{rd}$ 2002. 24 and 28 patients were enrolled in the mDOT and self medication groups, respectively. Paired (1:1) individual matching, by gender, extent of disease, relapse and age-matching variables, was performed between the two groups, resulting in 20 paired matches. This prospective study was planned as an unblinded, non-randomized quasiexperimental pilot project. Outcomes were identified from results of sputum smear examinations for AFB in both groups at 2 weeks, and 1 and 2 months. The paired matching data were analyzed using the SAS program version 8.1 by McNemar test. Results : At the end of 2 weeks of treatment, the sputum smear conversion of the mDOT group was somewhat higher than that of the self medication group (78.57 vs. 50%, p-value=0.289), and after 1 month of treatment no statistically significant difference was shown between the two groups (83.33 vs. 50, p-value=0.125). At the end of 2 months of treatment (initial intensive phase), the sputum smear conversions of the mDOT and self groups were 95 and 75%, respectively (p-value=0.219). Conclusions : The implementation of mDOT did not result in clinically significant increases in the sputum smear conversion at 2 weeks, and 1 and 2 months compared with that of the self medication group. However, the increases experienced might contribute to diminishing the infectious period of AFB positive patients, and this approach may act as a guide for a specific group of patients. In this study, mDOT was performed for one hundred percent of the intensive treatment phase. It can also be an effective treatment for pulmonary tuberculosis patients, and may be useful for some high risk tuberculosis patients.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.18 no.7
• /
• pp.162-174
• /
• 2017

This study is descriptive research conducted to determine the levels of depression, emotional intelligence, and psychological well-being of nurses employed in small-and medium-sized hospitals, as well as to identify the correlations of these variables, predict factors influencing nurses' psychological well-being, and finally, test the mediating effects of emotional intelligence in the relationship between depression and psychological well-being. The subjects of the study included 336 nurses employed in small-and medium-sized hospitals located in the Daegu-Gyeongbuk region. Using a structured questionnaire, a sample was taken from December 17, 2016 to January 8, 2017. The results that the nurses showed an average level of depression with a mean score of 1.55 points, while their mean scores of emotional intelligence and psychological well-being were above average (3.05 and 3.51 scores, respectively). Depression exhibited negative (-) correlations with emotional intelligence and psychological well-being, whereas emotional intelligence had a positive (+) correlation with psychological well-being. The significant predictors of psychological well-being were found to include sleep hours (${\beta}=0.111$), working department (${\beta}=0.236$), and depression (${\beta}=-0.245$). Moreover, evaluation of the mediating effects of emotional intelligence revealed significant relationships between depression and regulation of emotion (${\beta}=0.527$) and between depression and emotional utilization (${\beta}=0.167$). In conclusion, the work environment and depression were predicted to be major factors influencing psychological well-being, while emotional intelligence was found to be a partially mediating factor. Overall, these results demonstrate that easing depression and improving emotional intelligence can be very positive countermeasures in revitalizing the hospital organization, as well as in ensuring the happiness of individual nurses. Therefore, interventions aimed at improving work environments and easing depression are required to improve nurses' psychological well-being.

• Journal of Nutrition and Health
• /
• v.40 no.4
• /
• pp.334-346
• /
• 2007

The present study examined the reproductive factors and food intake pattern which influence on the breast cancer risk in Daegu${\cdot}$Gyungbuk area. The case subjects were 103 patients newly diagnosed as breast cancer at Kyungpook National University Hospital. The control subjects were 159 healthy women selected by frequency matching of age and menopausal status in the same community. The survey was conducted by individual interviews using questionnaires which include general and reproductive characteristics, dietary habits, and food frequency. The odds ratios were calculated by using unconditional logistic regression after adjusting for confounding variables. The mean age of the subjects was 50 yrs, and mean body mass index was significantly high in the patient group than in the control. The patient group had a significantly higher familial history of breast cancer and a significantly shorter breast-feeding period compared to the control group. It has been found no significant relationship between extrinsic hormone use such as oral contraceptives or estrogen replacement therapy and breast cancer risk. In regard of food habits, a high preference for the cooking method of steaming rather than frying, panbroiling or roasting was significantly associated with lower relative risk of breast cancer. The higher intake frequencies of fruits for all subjects, and seaweeds only for postmenopausal subjects were related with a significantly lower relative risk of breast cancer. The results of the study suggest that the possible risk factors for the breast cancer occurrence include high BMI, family history, less breast feeding experience, preference for the cooking method of frying, and less consumption of fruits and seaweeds. This study provides an useful data for nutrition education to prevent breast cancer for the residents in Daegu${\cdot}$Gyungbuk area.

• Sleep Medicine and Psychophysiology
• /
• v.4 no.1
• /
• pp.57-65
• /
• 1997

As jet lag of modern travel continues to spread, there has been an exponential growth in popular explanations of jet lag and recommendations for curing it. Some of this attention are misdirected, and many of those suggested solutions are misinformed. The author reviewed the basic science of jet lag and its practical outcome. The jet lag symptoms stemed from several factors, including high-altitude flying, lag effect, and sleep loss before departure and on the aircraft, especially during night flight. Jet lag has three major components; including external de synchronization, internal desynchronization, and sleep loss. Although external de synchronization is the major culprit, it is not at all uncommon for travelers to experience difficulty falling asleep or remaining asleep because of gastrointestinal distress, uncooperative bladders, or nagging headaches. Such unwanted intrusions most likely to reflect the general influence of internal desynchronization. From the free-running subjects, the data has revealed that sleep tendency, sleepiness, the spontaneous duration of sleep, and REM sleep propensity, each varied markedly with the endogenous circadian phase of the temperature cycle, despite the facts that the average period of the sleep-wake cycle is different from that of the temperature cycle under these conditions. However, whereas the first ocurrence of slow wave sleep is usually associated with a fall in temperature, the amount of SWS is determined primarily by the length of prior wakefulness and not by circadian phase. Another factor to be considered for flight in either direction is the amount of prior sleep loss or time awake. An increase in sleep loss or time awake would be expected to reduce initial sleep latency and enhance the amount of SWS. By combining what we now know about the circadian characteristics of sleep and homeostatic process, many of the diverse findings about sleep after transmeridian flight can be explained. The severity of jet lag is directly related to two major variables that determine the reaction of the circadian system to any transmeridian flight, eg., the direction of flight, and the number of time zones crossed. Remaining factor is individual differences in resynchmization. After a long flight, the circadian timing system and homeostatic process can combine with each other to produce a considerable reduction in well-being. The author suggested that by being exposed to local zeit-gebers and by being awake sufficient to get sleep until the night, sleep improves rapidly with resynchronization following time zone change.

• Asia-Pacific Journal of Business Venturing and Entrepreneurship
• /
• v.17 no.6
• /
• pp.105-114
• /
• 2022

The purpose of this study is to analyze the influence of the nation's institutional environment on start-up intention of employees and the mediating role of risk-taking propensity in the relationship between these variables. This study classified the institutional environment into institutional profile regulation, institutional profile norms, and institutional profile recognition. The research data were collected through questionnaires for office workers belonging to domestic companies, and 322 copies of questionnaire data were used for hypothesis verification, except for questionnaires that were omitted or unfaithful. The results of this study are as follows. First, institutional profile regulations and norms were positively related to start-up intention of office workers, while institutional profile cognition had no significant effect on the start-up intention. Second, institutional profile regulations and norms were positively related to risk taking, while institutional profile cognition had no significant effect on risk taking. Finally, risk taking was found to partially mediate the relationship between institutional profile regulation and start-up intention, and completely mediate the relationship between institutional profile norms and start-up intention. The theoretical implications of this study are as follows. First, this study makes a theoretical contribution in that it revealed that the country institutional profile regulation and norms are important prerequisites for start-up intention and risk taking. Next, unlike previous studies, this study makes a theoretical contribution by presenting a start-up intention model of office workers consisting of perception of the institutional environment and risk taking, which is the individual characteristic of entrepreneurs. The practical implications of this study are as follows. First, the government and local governments should strengthen regulations on institutional profiles so that start-ups can be activated. Second, the government and local governments should strengthen the norms for institutional profiles so that start-ups can be activated. Finally, the government, local governments, and educational institutions should devise measures to strengthen the risk taking of start-ups.

• Journal of Korean Society of Environmental Engineers
• /
• v.34 no.8
• /
• pp.574-582
• /
• 2012

This study presents the concentrations of the polycyclic aromatic hydrocarbons (PAHs) listed as priority pollutants by United States Environmental Protection Agency (US EPA), in 98 sludges from 54 industrial wastewater treatment facilities of South Korea. The mean concentrations of ${\Sigma}_{16}PAHs$ were ranged from 32.5 ${\mu}g/kg-dw$ to 1189.3 ${\mu}g/kg-dw$ by industries, and the highest content was found in the petrochemical industry, followed by chemical, clothing manufacturing and dying, pulp and papermaking, secondary wastewater treatment, and food/beverage producing industries. Comparisons to the EU and Danish standards of ${\Sigma}_{16}PAHs$ in sewage sludge for land application showed only two samples (one from petrochemical, and the other from chemical industry) exceeded the limits. ANOVA test with PAH concentrations as variables revealed no statistically significant influences by industrial types and sampling time (i.e., seasonal variations). Pearson correlations between individual PAHs showed strong relationships (r>0.7) among 4-ring PAHs. Concentrations of acenaphthylene, anthracene, fluoranthene, benzo(a)anthracene, benzo(f)fluoranthene, benzo(k)fluoranthene, benzo(a)pyrene presented strong correlations to ${\Sigma}_{16}PAHs$. Principal component analysis discriminated entire samples into three groups by two principal components (PC1 and PC2) with 70% of data variations, in which industrial types were not of importance, but a dominance of certain PAHs. Samples in group-I, which is high PC1 and low PC2, were characterized by a dominance of 2-ring PAHs, and in group-II, PC1 and PC2 showed a linear relation, was dominant 4-ring PAHs. Group-III with low PC1 and high PC2 includes 17 samples showing a noticeably high contribution of 3-ring PAHs to ${\Sigma}_{16}PAHs$. This study provides concentrations of PAHs in industrial sludges collected from a wide variety of sources (six industrial types) and two seasons of sampling events, and the comparison of ${\Sigma}_{16}PAHs$ with other studies are also discussed.

• Korean Journal of Occupational Health Nursing
• /
• v.7 no.2
• /
• pp.143-154
• /
• 1998

The purpose of this research is to suggest basic materials for the practical infection precaution program to protect health care workers from hospital infection by grasping their compliance level of Universal Precautions and examining the factors affecting them. The number of the health care workers we studied were 486, including the doctors, the nurses, and the lab technicians who were working in a university hospital. The period of this research was from Aug. 18th, 1997 to Aug. 30th, 1997. The method of the study was to measure the compliance level of Universal Precautions with the item of "Universal Precautions" established by CDC in 1987, and examine the questionnaire of 52 questions dividing related factors into socio-populational, individual, socio-psychological and organizational management ones. The data was analyzed by t-test. ANOVA, and chi-square test. The results were as follows : 1. An the compliance level of Universal Precautions, hand washing had the highest score(85.4%), and doctors(18.9%), nurses(44.0%), and lab technicians(7.6%), had a low compliance level in the safe handling of an injection syringe, and item not to handle patients and their samples when the subject suffered from dermatitis or injury had the lowest score of 17.1%. 23.3% of them said that they wear protection gown, goggles and mask. 2. Female's Compliance level of Universal Precautions Was higher than male. 3. The health care workers who had high recognition on Universal Precautions got significantly higher compliance level of Universal Precautions than those have low recognition on Universal Precautions(P<0.001). 4. The health care workers experienced a needle stick injury had a significantly higher compliance level of Universal Precautions than those who had not(P<0.000). 5. The health care workers who had infection protection education got a significantly higher compliance level of Universal Precautions than those who didn't(P<0.000). 6. The health care workers who had a firm belief in the effect of Universal Precautions got a higher compliance level of Universal Precautions than those who didn't. 7. The health care workers who had less conflicts between treating patient arid protecting them-selves got a higher compliance level of Universal Precautions than others with many conflicts. 8. The health care workers who had a high score in organizational management factors got a significantly higher compliance level of Universal Precautions than those with a low score(P<0.000). 9. Only 16.9 percent of the all respondents(82 in number) answered that they knew well or a little about the Universal Precautions, which is very low rate of recognition. 10. The variables which affected the score in organizational management factors were age, sex, education period, work experience, the kind of work, recognition on Universal Precautions, the experience of needle stick injury, revealing dangerous circumstance related to infection, and training on precaution again infection. According to the result above, compliance level of Universal Precautions showed high correlation with sex, the recognition on Universal Precautions, the experience of needle stick injury, training on precaution against infection, the belief in the effect of Universal Precautions, the recognition degree of conflicts and organizatinal management factors. These results could be used as the basic materials for the developing infection protection programs. Also, There should have a systematic training course to elevate a effective compliance level of Universal Precautions as well as the manageeent of infection protection programs.

• Korean Journal of Psychosomatic Medicine
• /
• v.11 no.2
• /
• pp.118-136
• /
• 2003

Objective: This study is to examine the neuropsychological and developmental characteristics of the Computerized Neurocognitive Function Test among normal children in elementary school. Methods: K-ABC, K-PIC, and Computerized Neurocognitive Function Test were performed to the 120 body of normal children(10 of each male and female) from June, 2002 to January, 2003. Those children had over the average of intelligence and passed the rule out criteria. One-way ANOVA and Bonferroni were used for statistical analysis. Results: In sampling of normal children in elementary school, the control of intelligence level and strict rule out criteria were applied. As a result, although 21.1% were excluded from of total participants, the children that passed the rule out criteria had over the average of intelligence and not differ in the intelligence level among the graders. Comparing Computerized Neurocognitive Function Test results among the graders, almost of variables had significant difference among the graders and especially between the 1st to 2nd and the 5th to 6th graders. In the attention tests, as rising the graders, the performance of tests were improved. In the short-term memory tests, the difference between forward and backward tests were same as the previous research result. The verbal auditory learning test composed of recall task and visual figure memory test composed of recognition task were same as the previous research result using the individual power or achievement test and also as rising the graders, the performance of those tests were improved. The higher cognitive function tests had the same results with other tests. Conclusion: The Computerized Neurocognitive Function Test devised for adult can be used of assessing child neuropsychological characteristics. For this objective, more strict sampling criteria, control of the intelligence and psychopathology were needed.