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Incidence and magnitude of out-of-pocket payment and factors influencing them in Industrial Accident Compensation Insurance (산재환자의 진료비 본인부담 발생 및 크기와 이에 영향을 미치는 요인)

  • Park, Bo-Hyun;Lee, Tae-Jin;Lim, Wha-Young
    • Health Policy and Management
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    • v.20 no.1
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    • pp.103-124
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    • 2010
  • Objectives: The out-of-pocket payment (OOP) of the Industrial Accident Compensation Insurance (IACI) in Korea was investigated empirically in terms of its incidence, magnitude and factors influencing them. Methods: The subjects were sampled with stratified, randomized methods among medical institutions of which the number of monthly IACI claims exceeded its median as of May 2008. Out of 204 institutions selected, 118 institutions (57.8%) responded to this survey. A total of 24,826 episodes(2,457 inpatient and 22,369 outpatient episodes) were included in this analysis. The incidence and magnitude of OOP of IACI were calculated by characteristics of institution as well as patient. Factors that affected the incidence and magnitude of OOP were investigated through multi-level analysis. Results: The overall incidence of OOP of IACI was 9.9% (25.6% for inpatient and 8.2% for outpatient) and the percentage of OOP among total expenditures was 8.3% on average (7.6% for inpatient and 26.8% for outpatient); 25.2% at traditional oriental medicine hospitals, 9.5% at general hospitals and 2.5% at the industrial-accident-designated medical institutions. The incidence of OOP of IACI was influenced by hospital size, ownership, longer duration of designation (over 5 years) and length of stay. On the other hand, its magnitude was influenced by medium-sized hospital, public hospital, location of large city and length of stay. Extra charges for upper grade room which accommodates less than 4 patients and treatment by specialists were the leading contributors to the magnitude of OOP of IACI. Conclusion: The incidence and magnitude OOP of IACI varied in institution type and were influenced by both institutional and patient's factors. In order to achieve the goal of Industrial Accident Compensation Insurance, appropriate level of compensation, that is, no incidence of OOP, for accident and disease of workers, it is necessary to take measures to reduce incidence and magnitude of OOP.

Characteristics of Obstructive Sleep Apnea Syndrome Patients Proven with Nocturnal Polysomnography as Correlates of Age and Gender (야간 수면다원 기록으로 확진된 폐쇄성 수면무호흡증 환자의 특성: 연령과 성별에 따른 차이)

  • Lee, Ju-Young;Kim, Seog-Ju;Lee, Jung-Ho;Jeong, Do-Un
    • Sleep Medicine and Psychophysiology
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    • v.16 no.2
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    • pp.65-73
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    • 2009
  • Objectives: The purpose of this study was to assess the clinical and polysomnographic characteristics of Korean patients with obstructive sleep apnea syndrome (OSAS), especially in relation to differences due to age and gender. Methods: All subjects were consecutive patients who were proven to have OSAS with nocturnal polysomnography. They were interviewed with a structured interview format including sociodemographic information, past medical history, medication, and sleep-related history. Simultaneously, they were also given Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) to answer in order to check subjective sleep quality and subjective sleepiness. Results: Mean age of the 308 subjects was $49.5{\pm}$13.3 years, with 77.6% of the subjects being males and 22.4% of the subjects being females. The aging effects on the sleep architecture in Korean OSAS corresponded with normal aging, but with the effect of OSAS itself superimposed, the extent of aging effects was more marked than that of normal aging. The severity of Korean patients of OSAS was not correlated with age. When divided into age subgroups, significant correlation was found between RDI and BMI in patients of each subgroup of those in the 4th to 7th decades. The oldest subgroup (>70 years) described their subjective sleep quality as poorer than any other age subgroups, despite of less subjective drowsiness. The severity of OSAS and the change of sleep architecture of male subjects turned out to be severer than those of female ones. The female/male ratio of the subjects tended to increase with aging. Conclusions: The aging effect on the sleep architecture in Korean OSAS seems to be a mixture of the changes by normal aging and sleep disorder per se. The severity of OSAS was not correlated with age, but highly correlated with BMI. The severity of OSAS and the change of sleep architecture of male patients were severer than those of female ones.

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Performance Test of Hypocenter Determination Methods under the Assumption of Inaccurate Velocity Models: A case of surface microseismic monitoring (부정확한 속도 모델을 가정한 진원 결정 방법의 성능평가: 지표면 미소지진 모니터링 사례)

  • Woo, Jeong-Ung;Rhie, Junkee;Kang, Tae-Seob
    • Geophysics and Geophysical Exploration
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    • v.19 no.1
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    • pp.1-10
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    • 2016
  • The hypocenter distribution of microseismic events generated by hydraulic fracturing for shale gas development provides essential information for understanding characteristics of fracture network. In this study, we evaluate how inaccurate velocity models influence the inversion results of two widely used location programs, hypoellipse and hypoDD, which are developed based on an iterative linear inversion. We assume that 98 stations are densely located inside the circle with a radius of 4 km and 5 artificial hypocenter sets (S0 ~ S4) are located from the center of the network to the south with 1 km interval. Each hypocenter set contains 25 events placed on the plane. To quantify accuracies of the inversion results, we defined 6 parameters: difference between average hypocenters of assumed and inverted locations, $d_1$; ratio of assumed and inverted areas estimated by hypocenters, r; difference between dip of the reference plane and the best fitting plane for determined hypocenters, ${\theta}$; difference between strike of the reference plane and the best fitting plane for determined hypocenters, ${\phi}$; root-mean-square distance between hypocenters and the best fitting plane, $d_2$; root-mean-square error in horizontal direction on the best fitting plane, $d_3$. Synthetic travel times are calculated for the reference model having 1D layered structure and the inaccurate velocity model for the inversion is constructed by using normal distribution with standard deviations of 0.1, 0.2, and 0.3 km/s, respectively, with respect to the reference model. The parameters $d_1$, r, ${\theta}$, and $d_2$ show positive correlation with the level of velocity perturbations, but the others are not sensitive to the perturbations except S4, which is located at the outer boundary of the network. In cases of S0, S1, S2, and S3, hypoellipse and hypoDD provide similar results for $d_1$. However, for other parameters, hypoDD shows much better results and errors of locations can be reduced by about several meters regardless of the level of perturbations. In light of the purpose to understand the characteristics of hydraulic fracturing, $1{\sigma}$ error of velocity structure should be under 0.2 km/s in hypoellipse and 0.3 km/s in hypoDD.

Classification of Quercus mongolica Stand Types at Mt. Joongwang, Kangwon-Do and Determination of Proper Future Tree Density for Forest Tending Work (중왕산(中旺山) 지역(地域) 신갈나무림(林)의 임분형(林分形) 구분(區分) 및 육림작업(育林作業)에 적절(適切)한 미래목(未來木) 본수(本數)의 결정(決定))

  • Choi, Seon Deok;Lee, Don Koo;Ma, Sang Kyu
    • Journal of Korean Society of Forest Science
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    • v.87 no.4
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    • pp.631-641
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    • 1998
  • The objectives of this study were 1) to classify the types of Quercus mongolica stands at Mt. Joongwang and compare their quality, and 2) to determine the proper future tree number of Q. mongolica per ha and the appropriate distance between the future trees. The results from this study were as follows : Q. mongolica stands at Mt. Joongwang was classified into four types, pure Q. mongolica stand as stand type I, Q. mongolica - hardwood stand as stand type II, Q. mongolica - Pines densiflora stand as stand type III, Hardwood - Q. mongolica stand as stand type IV, according to mixture rate in stand volume. Stand type IV showed the best quality stem of Q. mongolica among the stand types, and the stem quality of Q. mongolica in Q. mongolica stand mixed with hardwood as stand types II and IV was better than those in pure Q. mongolica stand as stand type I and in Q. mongolica - P. densiflora stand as stand type III. If the management goal for Q. mongolica stand is to produce its high quality-timber, it is desirable to sustain proper mixture rate of Q. mongolica with another hardwoods. The proper number of future trees in pure Q. mongolica stand as stand type I was 122trees/ha and reasonable distance between the future trees was 9.15m. The distance between future trees in other stand types was 7.2m to 9.3m for stand types II and IV, while 8.0m for stand type III. Thus, the classification of Q. mongolica stand type based on stand character and maturity, and proper stem number of future tree and optimum distance between future trees would be a useful forest tending work.

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Microarray Analysis of Gene Expression in Rat Glioma after Ethanol Treatment (에탄올 처리에 의한 흰쥐 신경아교종(Glioma) 세포에서의 유전자 발현 - DNA 칩을 이용한 분석 -)

  • Lee, So Hee;Oh, Dong-Yul;Han, Jin-Hee;Choi, Ihn-Geun;Jeon, Yang-Whan;Lee, Joon-Noh;Lee, Tae Kyung;Jeong, Jong-Hyun;Jung, Kyung Hwa;Chai, Young-Gyu
    • Korean Journal of Biological Psychiatry
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    • v.14 no.2
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    • pp.115-121
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    • 2007
  • Objetives : Identification of target genes for ethanol in neurons is important for understanding its molecular and cellular mechanism of action and the neuropathological changes seen in alcoholics. The purpose of this study is to identify of altered gene expression after acute treatmet of ethanol in rat gliom cells. Methods : We used high density cDNA microarray chip to measure the expression patterns of multiple genes in cultured rat glioma cells. DNA microarrays allow for the simultaneous measurement of the expression of several hundreds of genes. Results : After comparing hybridized signals between control and ethanol treated groups, we found that treatment with ethanol increased the expression of 15 genes and decreased the expression of 12 genes. Upregulated genes included Orthodenticle(Drosophila) homolog 1, procollagen type II, adenosine A2a receptor, GATA bindning protein 2. Downregulated genes included diacylglycerol kinase beta, PRKC, Protein phosphatase 1, clathrin-associated protein 17, nucleoporin p58, proteasome. Conclusion : The gene changes noted were those related to the regulation of transcription, signal transduction, second messenger systems. modulation of ischemic brain injury, and neurodengeneration. Although some of the genes were previously known to be ethanol responsive, we have for the most part identified novel genes involved in the brain response to ethanol.

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Reducing error rates in general nuclear medicine imaging to increase patient satisfaction (핵의학 일반영상 검사업무 오류개선 활동에 따른 환자 만족도)

  • Kim, Ho-Sung;Im, In-Chul;Park, Cheol-Woo;Lim, Jong-Duek;Kim, Sun-Geun;Lee, Jae-Seung
    • Journal of the Korean Society of Radiology
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    • v.5 no.5
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    • pp.295-302
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    • 2011
  • To n the field of nuclear medicine, with regard to checking regular patients, from the moment they register up to the doctor's diagnosis, the person in charge of the checks can find errors in the diagnosis, reexamine, reanalyze the results or save images to PACS. Through this process, the results obtained from the readings are delayed due to checks and additional tests which occur in hospitals, causing patient satisfaction and affected reliability. Accordingly, the purpose is to include visual inspection of the results to minimize error, improve efficiency and increase patient satisfaction. Nuclear medicine and imaging tests from examines at Asan Medical Center, Seoul, from March 2008 to December 2008, were analyzed for errors. The first stage, from January 2009 to December 2009, established procedures and know-how. The second stage from January 2010 until June 2010 conducted Pre-and Post-filtering assessment, and the third stage from July 2010 until October 2010 consisted of cross-checks and attaching stickers and comparing error cases. Of 92 errors, the 1st, 2nd and 3rd stage had 32 cases, and there were 46 cases after the 4th stage, with the overall errors reduced by 74.3% from 94.6%. In the field of general nuclear medicine, where various kinds of checks are performed according to the patient's needs, analysis, image composition, differing images in PACS, etc, all have the potential for mistakes to be made. In order to decrease error rates, the image can continuously Cross-Check and Confirm diagnosis.

Oral Health Behavior Changes Based on Oral Health Education of Mental Disabilities (정신지체 장애인의 구강보건 교육에 따른 구강보건 행태 변화)

  • Choi, Ju-Hyun;Lee, Myeng-Hee;Seo, Hwa-Jeong
    • Journal of dental hygiene science
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    • v.12 no.4
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    • pp.404-412
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    • 2012
  • The main object of this study is to render a better dental education to mental disabilities, teachers, and their parents. By providing a better dental education to them, mental disabilities would understand the importance of their oral hygiene. The study was held in Seoul at two different locations, named H and E mental welfare facilities. Ninety Three mental disabilities were studied by observing their oral behavior, simple oral hygiene index and plaque index prior and post to dental education. At the end of education, following result were gathered from two mental facilities. First, the level of oral behavior in Class 1,2, and 3 mental disabilities were observed prior and post to the dental education. Overall, there was no significant difference among Class 1 mental disabilities with the dental education. Second, in simple oral hygiene index, the severity of mental illness has affected on their oral behavior (F=6.322, p<.001). Third, in simple oral hygiene index, the frequency of dental education, regardless of severity of mental illness has affected on their oral hygiene (F=5.961, p<.01). Fourth, the plaque index also illustrated that the frequency of dental education, regardless of severity of dental illness has affected on their oral hygiene (F=5.126, p<.05). Finally, the general characteristics of mental disabilities according to changes in oral health awareness to gender, age, disability type, educational level do not statistically significant in all variables. Their simple oral hygiene index and plaque index advanced, although after a while they started to lose focus, which brought back their old habits. Nevertheless, in conclusion I believe that helping mental disabilities more frequently to constant reminder, will not only keep them entertained, but help them realize how important oral hygiene practice is, hopefully increasing and benefiting those with mental disabilities for future reference.

Patient Satisfaction and Perception on Nutritional Counseling Services Quality (영양 상담서비스 품질에 대한 환자의 만족도와 인식조사)

  • Choi, Ki Bo;Lee, Song Mi;Lee, Seung Min;Lee, Eun;Park, Mi Sun;Park, Yoo Kyoung;Cha, Jin A;Lyu, Eun Soon
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.46 no.2
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    • pp.251-258
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    • 2017
  • The objective of this study was to analyze patient satisfaction and perception of nutritional counseling services quality. A patient satisfaction and perception survey was conducted for 1,095 patients from 43 tertiary hospitals and 20 general hospitals. The number of returned questionnaires was 656 (response rate: 60.0%). Data from 633 questionnaires were analyzed after the questionnaires with unanswered items were excluded. Five domains were identified from the result of the factor analysis using the maximum likelihood and oblique rotation. The five domains were named empathy, responsiveness, tangibles, reliability, and skill and specialty. Patient perception mean score of nutritional counseling was 4.54/5.00. Patient satisfaction scores were significantly higher in empathy (P<0.001), responsiveness, and skill and specialty (P<0.01) with a college or graduate school education than in patients with a middle school education. There was no statistically significant difference between satisfaction scores in tertiary hospitals and those in general hospitals, but patients in capital hospitals reported significantly higher scores than their local counterparts in empathy, responsiveness, reliability, skill and specialty (P<0.001), and tangibles (P<0.05). In responsiveness, significantly higher (P<0.01) scores were observed in patients who received nutritional counseling only once compared to patients who received counseling two times. Patients perception of nutritional counseling services was significantly correlated with their satisfaction of five domains, reliability (r=0.721), responsiveness (r=0.697), empathy (r=0.690), skill and specialty (r=0.678), and tangibles (r=0.622).

Analysis of Coexistence Rates of Attention Deficit/Hyperactivity Disorder Symptoms in Patients with Depression (우울감을 주소로 내원한 환자들에서 주의력 결핍/과잉행동장애 증상의 공존율 분석)

  • Jeong, Mi Young;Park, Seo Young;Kim, Jung Ho;Im, Woo Young;Lee, Yeon Jung
    • Korean Journal of Psychosomatic Medicine
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    • v.27 no.2
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    • pp.147-154
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    • 2019
  • Objectives : Cognitive dysfunction, including inattention, is often observed in patients with depression. Inattentive symptoms in patients with depression is similar to those among attention deficit/hyperactivity disorder (ADHD) patients. It is important to diagnose the two diseases accurately, because the treatment varies depending on the cause of inattention. This study aimed to investigate the coexistence rate of ADHD and the correlation between ADHD symptoms and depression in patients with depression. Methods : Participants in this study were 158 outpatients presenting with depression, who visited the psychiatric department from March 2015 to July 2018. Participants divided into a depression and a non-depression group according to the Korean version of the Center for Epidemiological Studies-Depression Scale (CES-D) score and were administered the following : a sociodemographic variables form (age, sex, academic background, occupation), the self-reporting test for adult ADHD (Adult Attention Deficit/Hyperactivity Disorder self-report scale-V 1.1; ASRS V1.1), and the Korean version of the Connors adult ADHD rating scale (K-CAARS). Descriptive statistical analysis, crossover analysis, t-tests, and Pearson's correlation coefficient were conducted on the data. Results : The coexistence rate of adult ADHD symptom was as high as 36.7% in patients with depression (p<0.001). In K-CAARS, the depression group (Inattention=1.80, Hyperactivity=1.92, Impulsivity=1.56, Self-concept=2.06) showed higher average scores on ADHD symptoms than the non-depressive group (Inattention=1.28, Hyperactivity=1.25, Impulsivity=1.09, Self-concept=1.42, p<0.001). Conclusions : This study confirmed that ADHD symptoms coexist in the depression group. When evaluating the symptoms of patients who complain of depression, it is suggested that they should be accurately diagnosed and appropriately treated with interest to the coexistence of ADHD symptoms and the possibility for ADHD diagnosis.

Multinational Corporate Linkage Stability in the Canadian Urban System (캐나다 도시체계에서의 다국적기업 연계패턴의 안정성)

  • Kee-Bom Nahm
    • Journal of the Economic Geographical Society of Korea
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    • v.1 no.1
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    • pp.151-172
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    • 1998
  • Over the past two decades, the process of globalization of multinational corporations has increased at a rapid rate. One manifestation of this process is the establishment of corporate head offices in a variety of international centers to administer and coordinate, the day-to-day operations in the host countries. In establishing a subsidiary overseas a firm creates a direct link between the operations of the domestic corporate center and the foreign host center This paper investigates elements of stability and change in the international linkage patterns among domestic parent corporations and host subsidiaries over the past several decades. In particular, it seeks answers to a number of question related to stability and change in linkages among foreign centers of control and those Canadian centers selected to administer the subsidiary operations from 1970 to 1991 over the four primary sectors, namely, resources, manufacturing, services, and finance. By confirming the core stability and dispersed linkages hypotheses, the papar offers some generalizations with respect to the location and stability of subsidiary headquarters centers in Canada and their respective subsector specialties. Finally, it addresses further research avenues fer the quaternary place study.

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