• 한국사회복지학
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• 제60권3호
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• pp.129-150
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• 2008

본 연구는 노인장기요양보험제도 2차 시범사업 결과를 바탕으로 우리나라 노인의 요양시설 서비스 이용에 영향을 미치는 요인을 탐색해 보고자 하였다. 이론적 모형으로는 앤더선과 뉴만(Andersen and Newman)의 행동주의 모델을 토대로 하여 영향요인을 구분하였으며, 연구방법은 의사결정분석을 이용하였다. 분석결과 서비스 이용에 가장 큰 영향을 미치는 것은 대상 노인의 서비스 이용의향이었으며, 이러한 선행요인 다음 중요한 요인으로 자원 요인(수발자 있음 및 동거가족 여부)으로 나타났다. 욕구요인으로는 인지장애가 있는 경우, 치매로 인한 문제행동이 있는 경우, 기본적 일상생활수행능력에 있어 완전도움을 받아야 하는 경우로 나타났다. 이러한 분석결과는 앤더슨과 뉴만의 행동주의 이론의 과정을 그대로 보여주고 있음을 알 수 있는데, 즉 선행요인과 자원요인에 의해 서비스 이용형태가 달라지며, 이러한 선행요인과 자원요인은 욕구요인과 결합하여 실제 서비스 이용에 영향을 주는 것으로 나타났다. 이를 통해 본 연구는 시설 서비스 이용 대상자의 욕구요인을 정확히 파악하여 이에 적절한 서비스 내용을 구축하고 지역사회 내 시설서비스 이용노인을 선별하는데 기초 자료를 제공하는데 기여하고자 한다.

• 보건행정학회지
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• 제22권4호
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• pp.497-521
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• 2012

Objectives This study aimed to investigate the effect of social capital, health risk behavior and health status on medical care utilization by the elderly. The data and Research method Data were obtained from the 4th wave survey of the Korea Welfare Panel Study. 4,087 household members aged 65 years and over were subject to analysis. Descriptive statistics are used to describe the basic features of the data in a study. we performed a structural equation modeling(SEM) analysis to evaluate the effect of social capital and mediating effect of health risk behavior and health status. Results Results showed that factors related to medical care utilization of the elderly were different depending on types of service (inpatient and outpatient service) except health status. Age, higher social capital, more health-risk behavior and poorer health status were associated with increased use of inpatient service. Social capital was found to have a positive direct effect on it. Also, social capital had an indirect effect on reducing use of inpatient services by improving health status. On the other hand, lower age and higher household income tended to increase use of outpatient service, while higher social capital and higher health status were inversely related. Social capital had a direct effect and an indirect effect on reducing use of outpatient service and, at that time, health status played a mediating role. Conclusions Social capital may contribute to improve health status and indirectly reduce medical care utilization of the elderly by enhancing their health status. These results provide evidence that more policy and strategy considerations should be needed for the elderly to strengthen their social capital in order to enhance their levels of health and more efficient utilization of medical care.

• 보건교육건강증진학회지
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• 제29권2호
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• pp.1-12
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• 2012

Objectives: Several practice guidelines recommended both medication and behavior modification to control hypertension. The objective of this study was to analyze ambulatory care utilization pattern and related factors. Methods: A retrospective cohort study was conducted among 45,267 new users who initiated treatment with hypertensive drugs in 2003. Korean National Health Insurance Claims Data was used to study the medical care utilization behavior and related factors after treatment initiation for up to four years. Taking prescription was considered as medical care utilization. Results: More than 20% of patients discontinued visiting physicians for prescription after initiating antihypertensive drug therapy. The average number of institutions visited by patients was about 1.3 annually. Clinic was the most frequently visited institution by patients. In GEE analysis, probability of continuous visit one institution after initiating antihypertensive drug treatment increased in patients who were women, old, have comorbidity, visited clinic or hospital mainly in previous year. Conclusions: Young hypertensive male patients who have no major comorbidity showed high possibility to discontinue medical service utilization. It is necessary to educate these targeted patients about importance of hypertension management in early stage after treatment initiation.

• 한국농촌간호학회지
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• 제8권1호
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• pp.5-12
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• 2013

Purpose: This research was a survey to ascertain whether there are differences in opinion about designated doctors and hospitals, type of health care service utilized and health behavior between people who have applied to be Medical Aid Beneficiaries, but not using the Designated Doctor System. Method: The participants were from three groups, application for two years, one year and non-appliers. Data collection was done by Medical Care Client Managers through in-depth interviews using a structured questionnaire. Results: The participants expressed no negative effect of the designated doctor system in relation to designated doctor, hospital or health behavior but there was a significant effect in type of health care service utilized. Conclusion: In the future, the commitment of Medical Care Client Managers is important, but the role of health care providers will be emphasized in order to sustain the effectiveness of the health care system under the Designated Doctor System.

• 보건의료산업학회지
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• 제8권2호
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• pp.115-125
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• 2014

This study tries to investigate inequity in supplementary private health insurance insured in terms of the analysis of insurance insured general characteristics and to analyze the influence of supplementary private health insurance on their admission and their outpatient medical utilization behavior. As a result of the analysis of the general characteristics of supplementary private health insurances insured, it has turned out that men, persons at low ages, people with a spouse and chronic diseases, and persons with a high income have applied such insurances more. We can also tell that low-income classes have difficulty in applying private health insurances as people in the fifth income quintile have applied such insurances about 9 times as much as those in the first income quintile. The analysis of supplementary private health insurance insured health care utilization behavior has revealed that both male and female insured aged less than 55 and without chronic diseases have increases the number of their use of health care, their patient charge, and their medical cost per visit.

• The Korean Journal of Pain
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• 제12권1호
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• pp.101-107
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• 1999

Background : In order to improve the quality of life of dying patients, they need to receive not only the physical, psychological, social, and spiritual care, but also systematic and continuous care to die with dignity. However, no adequate medical services are available for these terminal cancer patients. We studied their behavior patterns of health care utilization to understand more of their medical and social needs. Methods : We investigated 108 bereaved families through the telephone interview with structured questionnaires. They were randomly selected through the retrospective chart review of the terminal patients who passed away due to cancer. Results : Most of the terminal cancer patients received their care from proper medical services including admission to hospital (45.4%), outpatient clinic (22.2%), emergency room (16.7%), and oriental medicine (12.0%). But during the terminal phase of their illness, 32.4% of patients never received medical care including oriental medicine, and 28.7% received alterative natural care. 26 bereaved families (24.1%) pointed out the indifference of medical staff as a problem receiving proper hospital care, and 22 (20.4%) emphasized emotional strain of their helplessness with the patients' suffering as a problem of caring at home. Over 90% suggested availability of continuous care, hospice care, home care, and 24 hour telephone service to be improved. Conclusions : Due to various reasons, adequate medical care is not delivered to the terminal cancer patients in our present medical system. These problems can be approached with the establishment of proper education and medical delivery system. The role of comprehensive medical specialty cannot be overly emphasized to accomplish this most effectively.

• 한국사회복지학
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• 제56권4호
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• pp.123-147
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• 2004

본 연구에서는 노인요양보험제도의 도입을 앞두고 재가 요보호 노인 가족의 재가복지 및 재가보건서비스의 이용의향을 유형별로 알아보고, 이에 관련된 요인을 행동주의모델을 이용하여 검토함과 동시에 서비스를 이용하지 않는 이유를 분석하는 것을 목표로 하였다. 각 서비스 이용의향에 관련된 요인을 로지스틱 회귀분석을 통해 분석한 결과, 선행요인으로는 재가복지와 재가보건 서비스 모두 연령이 낮은 사람이 이용의향이 높았다. 서비스 이용촉진 및 저해요인 중에는 경제적인 여유가 있거나 부부양자가 있는 사람, 혹은 부양과 관련된 정보를 제공해 줄 사람이 있어, 물적 자원이 있거나 비공식적 지원을 받고 있는 사람이 재가복지와 재가보건 서비스에 대한 이용의향이 모두 높게 나타났다. 욕구요인에서는 예상과는 달리, 노인의 증상이 심각하거나 거동불편 정도가 심한 사람, 혹은 요보호 노인 외에도 요보호 가족이 있어 서비스에 대한 이용 욕구가 높은 집단이 오히려 이용의향이 낮게 나타났는데, 서비스의 유료화를 위해서는 경제적 자원과 같은 촉진요인을 가지고 있지 않으면 서비스에 대한 욕구(필요도)가 높아도 서비스 이용으로 연결되지 못할 위험이 있는 것으로 해석된다. 한편 서비스를 이용하지 않는 이유로는 경제적인 부담 이외에 '가족이 돌봐야 한다'. '노인이 싫어한다'와 같은 전통적인 부양의식이 차지하는 비율이 높았다. 요보호 노인의 증가로 서비스에 대한 이용 의향이 이전에 비해 높아지고 있지만, 서비스에 대한 욕구가 높음에도 불구하고 서비스 이용의향이 없는 사람이 적지 않았다. 본 연구를 통해 재가복지 서비스에 대한 이용의향과 재가보건 서비스에 대한 이용의향을 나타낸 집단의 특성이 유사한 것이 확인되었고, 향후 클라이언트 위주의 서비스 제공을 위해서는 보건복지 서비스의 연계를 통한 서비스 제공의 필요성이 재확인되었다.

• 한국농촌간호학회지
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• 제18권2호
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• pp.80-91
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• 2023

Purpose: The purpose of the study quantitatively investigates the experience of unmet healthcare service utilization by rural populations in vulnerable areas during the COVID-19 pandemic based on Andersen's behavior model. At the same time, this study attempts to describe the experiences of unmet healthcare service utilization among participants in vulnerable rural areas by analyzing qualitative contents through open-ended question. Methods: Data were collected from October to November 2022 using Qualtrix, a web-based survey platform. A total of 863 participants completed an online survey. Quantitative data were analyzed using 𝑥² test and logistic regression analysis. Qualitative data were analyzed using content analysis. Results: The factors affecting participants' unmet healthcare service utilization were type of residential area and underlying disease. The qualitative analysis identified; four categories and nine sub-categories. Conclusion: Based on these findings, it is necessary to develop a disaster nursing response model according to the type of residential areas and the number of people.

• 한국실내디자인학회논문집
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• 제19권6호
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• pp.224-232
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• 2010

This paper aims to identify the characteristics and the current situation of the architectural characteristics, children's characters using facilities, and status of management and utilization by surveying 'Day Service for Children' in Tokyo-do. First, About the status of management and utilization, 'Day Service for Children' is operated by a local government, NPO corporate group and social welfare corporate. There are not big differences of the care program or running hours depending on operating principals but there are differences depending on staff organization, number of children and space constitution. Also, infants ratio at 'Day Service for Children' is high for the purpose of detecting disability early and supporting their development early. They have diverse disabilities but developmental disabilities' ratios high and most children are using both this facility and normal nursery centers together. Samples for proper child care based on status of space constitutions were installing lock, raising door knobs and using softer floor materials which are for children's safety. For the problem of space utilization, most comments were about lack of space which is not enough for teaching and training materials. Therefore, as an example, observation rooms for parents and teachers were sometimes used as storages and it changes teachers' moving direction, staying area and behavior zone. The programs of 'Day Service for Children' are divided to group teaching and private one. It will be the best if they have separate spaces such as group class room, private class room and play room. When they were operated by NPO corporate group or Social welfare corporate, there are many cases that their space was not properly zoned for each activity.

• 한국사회복지학
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• 제53권
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• pp.105-128
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• 2003

본 연구는 65세 이상 노인을 모시고 있는 가족부양자를 대상으로 재가복지서비스에 대한 이용의사와 이에 영향을 미치는 요인을 분석함으로써 향후 노인부양의 사회적 지원방안을 보다 효과적으로 마련하는데 연구의 목적이 있다. 서비스 이용의사에 영향을 미치는 요인을 선행요인, 가능태 요인, 욕구요인으로 구분하여 이용행위를 분석한 Anderson-Newman 모델을 기반으로, 총 230명의 가족부양자가 분석에 포함되었다. SAS 6.12를 이용하여 빈도분석, 교차분석과 함께, 서비스 이용의사에 있어 다양성이 포함될 수 있도록 다중명목 로지스틱 분석(Multinominal logistic analysis)을 실시하였다. 연구결과, 재가복지서비스를 이용하겠다는 의향은 85.9%로 나타났으며 시설보호서비스도 비슷한 수준인 86.9%이었다. 그러나 재가복지서비스는 무료 또는 유료라도 사용하겠다는 의사가 각각 50%씩 나타난 반면, 시설보호서비스는 유료라도 사용하겠다는 의사가 91.1%로 상대적으로 높게 나타났다. 또한 장기요양 발생시 대처방안에 있어서도 가족이 전담하기보다는 장기요양보험제도나 사회적 고용지원제도와 연결시키려는 욕구가 높았다. 재가복지서비스 이용의사에 영양을 미치는 요인을 분석해보면, 서비스를 이용할 의사여부는 연령, 부양자와 노인간의 우애관계, 노인부양 가치관과 같은 선행요인(predisposing factors)이나, 노인부양의 경제적 혹은 심리적 부담, 가족내 추가로 돌봐야 할 가족원 유무 등과 같은 서비스 이용의 직접적인 욕구와 연결된 요인(need factors)들이 주요한 영향력을 보이고 있다. 반면 서비스를 이용하겠다는 사람들 중 무료 옥은 유료 이용의사를 주요하게 구분하는 것은 가능태 요인(enabling factors)으로, 소득수준이 높을수록, 주부양자를 대체할 부부양자가 없을수록 유료라도 사용하겠다는 의향이 높은 것으로 나타났다. 이와 같은 연구결과에 기초하여 향후 노인부양을 위한 사회적 서비스의 지원 방향성과 대책이 제시되었다.