• 보건행정학회지
• /
• 제3권2호
• /
• pp.81-99
• /
• 1993

The purpose of this research is to assess the geographical distribution of physicians and dentists and the degree of maldistribution of the physician. Data were obtained form the Korean Medical Association's report on physicians registry and census for 1990. To assess the degree of disparity in the rural-urban distribution of physician manpower and to identify changes in the distribution pattern, the Gini index of concentration was used. Major findings are as follows; 1. Urban-rural disparity in the distribution of physician manpower exists in all categories of manpower, i.e. physician, dentist, oriental medical doctor, general practitioner, medical specialist, practitioner, public health physician and public health dentist. Urban area which had 74.4% of nation's population, accounted for over 90% of all physician manpower. 2. In terms of the ration of physician manpower per 10, 000 population, in urban area, they were 8.2 physicians, 2.7 general practitioners, 5.5 specialists, 3.0 practitioners, 1.8 dentists and 1.3 oriental medical doctors. In rural area, the ratios were 1.4 physicians, 0.6 general practitioners, 0.9 specialists, 1.0 practitioners, 0.4 dentists and 0.4 oriental medical doctors. 3. Gini indicies computed to measure inequality of physician manpower distribution were 0. 3675 for physicians, 0.3372 for general practitioners, 0.3338 for specialists, 0.2263 for practitioners, 0.3132 for dentists and 0.3293 for oriental medical doctors. 4. Inspite of increase in the number of physician manpower, urban concentration of physician manpower intensified from 1980 to 1990. However, the Gini index for all physician manpower fell by 18.3~36.7% from 1980 to 1990, indicating more even distribution. 5. In rural area, the public health physicians and dentists had increased the ratios of physicians, general practitioners, practitioners and dentists per 10, 000 population remarkebly, and had decreased the Gini indicies of physicians, general practitioners, practitioners and dentists. Thus, public health physicians and dentists contributed to improve the distribution of physician manpower in rural area. Based on the results of this study, long-term and rational manpower policies should be developed to solve the problem of geographical maldistribution of physician manpower as well as short-term policy for inducing physicians to the rural areas.

• 보건행정학회지
• /
• 제3권2호
• /
• pp.159-176
• /
• 1993

The utilization of outpatient care services involves two steps of sequential decisions. The first step decision is about whether to initiate the utilization and the second one is about how many more visits to make after the initiation. Presumably, the initiation decision is largely made by the patient and his or her family, while the number of additional visits is decided under a strong influence of the physician. Implication is that the analysis of the outpatient care utilization requires to specify each of the two decisions underlying the utilization as a distinct stochastic process. This paper is concerned with the number of physician visits, which is, by definition, a discrete variable that can take only non-negative integer values. Since the initial visit is considered in the analysis of whether or not having made any physician visit, the focus on the number of visits made in addition to the initial one must be enough. The number of additional visits, being a kind of count data, could be assumed to exhibit a Poisson distribution. However, it is likely that the distribution is over dispersed since the number of physician visits tends to cluster around a few values but still vary widely. A recently reported study of outpatient care utilization employed an analysis based upon the assumption of a negative binomial distribution which is a type of overdispersed Poisson distribution. But there is an indication that the use of Poisson distribution making adjustments for over-dispersion results in less loss of efficiency in parameter estimation compared to the use of a certain type of distribution like a negative binomial distribution. An analysis of the data for outpatient care utilization was performed focusing on an assessment of appropriateness of available techniques. The data used in the analysis were collected by a community survey in Hwachon Gun, Kangwon Do in 1990. It was observed that a Poisson regression with adjustments for over-dispersion is superior to either an ordinary regression or a Poisson regression without adjustments oor over-dispersion. In conclusion, it seems the most approprite to assume that the number of physician visits made in addition to the initial visist exhibits an overdispersed Poisson distribution when outpatient care utilization is studied based upon a model which embodies the two-part character of the decision process uderlying the utilization.

• Journal of Preventive Medicine and Public Health
• /
• 제26권4호
• /
• pp.661-671
• /
• 1993

In order to compare the geographical distribution of physician by level of medical care and specialty, a log linear model was applied to the annual registration data of the Korean Medical Association as of the end of December, 1991 which was supplemented from related institutions and adjusted with relevant sources. Those physicians in primary and secondary care institutions were not statistically significantly unevenly distributed by province-level catchment area. There were some differences in physician distribution among big cities, medium and small-sized cities, and counties; however, those physicians for primary care level were equitably distributed between cities and counties. Specialties for secondary care physicians were less evenly distributed in county areas than in city areas, and generalists are distributed more evenly in cities and counties than in big cities. There is a certain limitation due to underregistration in the annual physician registration to the Korean Medical Association; however, the geographical distribution of physicians has been improved quantitatively. It is strongly suggested that specialties and the level of medical care should be considered for further physician manpower studies.

• 유통과학연구
• /
• 제19권2호
• /
• pp.5-14
• /
• 2021

Purpose: We examined informational justice, cognitive trust, and satisfaction in healthcare distribution market and their associations within the physician-patient (provider-purchaser) relationship. Methodology: 253 valid survey samples collected from patients and used structural equation modelling for analysis. Findings: We postulated that (1) physicians' informational justice has a positive impact on patients' cognitive trust, (2) patients' cognitive trust has a positive impact on satisfaction, and (3) patients' perceived informational justice has a positive impact on satisfaction. Participants were 253 people who had visited a hospital in South Korea in the past year. Results confirmed that the presence of informational justice has a positive impact on patients' cognitive trust and satisfaction in the physician-patient relationship. Additionally, once cognitive trust was built, it positively influenced patients' satisfaction. We discussed the concept and the impacts of informational justice in light of our analyses regarding patients' perceived cognitive trust and their satisfaction in the physician-patient relationship. Implications: These results emphasize the importance of ethics in healthcare, particularly physicians' frankness and honesty when providing information to patients. Further, these findings present implications for physician education, as part of their training must involve building their patients' cognitive trust as a prerequisite for developing patient satisfaction.

• 보건행정학회지
• /
• 제9권3호
• /
• pp.1-20
• /
• 1999

This study reviews the literature of influencing factor on hospital-employed physician's income, and it describes general distribution of hospital-employed physician's income, and analyzes influencing factor of hospital-employed physician's income. A total of 1.795 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 hospital. average intensity of ordinary work. and specialty. The major findings of this study are as follows; 1. As for physicians working in first referral hospital. the average income of neurosurgeon per month was the largest. being 1.34 times larger than that of the family physician, and that of the emergency physician was the smallest, being 0.78 times smaller than that of the family physician, but that of the ophthalmic and Orthopaedic physician was significantly larger than that of the family physician under the control of control variables. And average income per month was significantly larger for physicians who worked in Seoul metropolitan area than physicians who worked in rural area. 2. The year of physician's career, number of average out-patients per month significantly positively associated, but the number of hospital beds and average intensity of therapy significantly negatively associated with average income per month. 3. As for physicians working in second referral hospital. the average income of the psychiatric physician per month was the largest, being 1.33 times larger than that of the family physician, and that of the emergency physician was smallest, being 0.74 times smaller than that of the family physician., but no significant difference was seen under the control of control variables, and average income per month was significantly larger for physicians who worked in Seoul metropolitan area than physicians who worked in large municipal area. 4. The year of physician's career and number of hospital beds significantly positively associated, but average working hours per month significantly negatively associated with average income per month. In conclusion, the year of hospital-employed physician's career is the largest influencing factor on hospital-employed physicians. But the difference of average income per month according to working regions and to number of hospital beds existed in employed physicians under the control of control variables. So this study has implementation that we must consider the influence of working regions and the number of hospital beds on the income of hospital-employed physicians in making policy for hospital. Being a cross-sectional study, this study can not suggest causal explanations. In the future, experiment or cohort study is needed for causal explanations.

• 보건행정학회지
• /
• 제9권3호
• /
• pp.21-32
• /
• 1999

The purpose of this study is to assess individual decisive factors for distribution of medical specialists in Korea. A data set was constructed using several published data sources. including the Korean Medical Association's physician master file as a principal source for physician information. Linear logistic regression analysis was performed to assess the relationship between the location of private specialist clinic for practice with six variables related with individual characteristics: age. sex. location of postgraduate training hospital. location of medical school graduated, size of hospital for training, and specialty. Analysis showed that location of practice. classified into urban and rural areas, was significantly associated with the variables of sex. location of postgraduate training hospital. location of medical school. In addition, significant association was found between the location of practice which was categorized into "near-Seoul area" and others, and sex, location of postgraduate training hospital. and location of medical school. We could conclude that to improve area maldistribution of physicians locations of hospitals for training and medical schools have to have the highest priority in the policymaking.icymaking.

• Journal of Preventive Medicine and Public Health
• /
• 제31권4호
• /
• pp.770-785
• /
• 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.

• 보건행정학회지
• /
• 제32권1호
• /
• pp.73-93
• /
• 2022

Background: Appropriate physician workforce projection through reasonable discussions and decisions with a broad view on supply and demand of the workforce, thus, is very important for high-quality healthcare services. The study expects to provide preliminary research data on the workforce diagnosis standard model for Korean physician workforce policy decision through more flexible and objective physician workforce projection in reflection of diverse changes in healthcare policy and sociodemographic environments. Methods: A low flow rate through the causal map was developed, and an objective workforce demand projection from 2019 to 2040 was conducted. In addition, projections by scenarios under various situations were conducted with the low flow rate developed in the study. Lastly, the demand projection of the physician workforce by region of 17 cities and provinces was conducted. Results: First, demand of physicians in 2019 was 110,665, 113,450 in 2020, 129,496 in 2025, 146,837 in 2030, 163,719 in 2035, and 179,288 in 2040. Second, the scenario for the retirement of baby boomers led to a decrease in the growth rate due to time delay. Third, Seoul and Gyeonggi-do account for a high percentage of demand, a very high upward trend was identified in Gyeonggi-do, and as a result, the projection showed that the demand of the physician workforce in Gyeonggi-do would worsen over time. Conclusion: This study is meaningful in that rational and collective physician workforce supply and demand and its imbalance in workforce distribution were verified through various projections by scenarios and regions of Korea with System Dynamics.

• 지역사회간호학회지
• /
• 제11권2호
• /
• pp.499-512
• /
• 2000

The number of deliveries by cesarean section has increased internationally. However, The cesarean section rate is different by country to country. It is because each country has different social and cultural background and. practices its unique delivery policies. Hence, it is very important to understand the uniqueness that one country faces related with the cesarean section. In Korea, there have been many researches on the clinical. maternal. hospital and community factors and so on. However, few studies have attempted to reveal the physician factors in Korea because it is difficult to approach hospital records. So, in this study, the physician factors that influence the increase of cesarean section rate in Korea was investigated, and preliminary research agenda for policy establishment to keep the cesarean section rate from excessive increase was provided. In this study, all 2744 cesarean section deliveries performed by 36 physicians at the hospital was considered. and detailed delivery records of 12 months selected randomly from January 1996 to August 1998 was reviewed retrospectively. Chi-square analysis is used to examine the homogeneity of distribution of maternal, fetal, and clinical factors. In addition, multiple regression analysis is used to examine the effect of physician characteristics on the cesarean section rate. Physician characteristics as independent variable and the cesarean section rate as dependent variable was put in this analysis. Follows are the results of this study. 1) Total cesarean section rate is 34.8%. primary cesarean section rate is 12.5 % and repeated cesarean section rate is 22.3 %. Among the indications for the primary cesarean section, 15.6 % is for breech presentation. 40.2 % is for dystocia. 7.6 % is for fetal distress. and 36.6 % is for others. 2) There is positive correlation between physician's age and the cesarean section rate (p<0.001). And statistically significant correlation is found between the physician's educational attainment and the cesarean section rate (p<0.001). A physician with Ph.D degree has lower cesarean section rate than a physician with B.A only and M.A. degree (p<0.001). However. physician's gender, location of graduated university. position at the hospital, and the religious belief were not shown statistically significant relations with the cesarean section rate. 3) Among all cesarean sections in this study, only 15.4 % is performed during weekend. While 18.2 % is performed on monday only. This suggests that physicians may not prefer weekend operation of cesarean section. In addition, 86.1 % among all cesarean section operations is performed from 6 a.m. to 6 p.m. So the cesarean section rate could be related with a day of the week and a time of the day. From this results. there is a possibility that the physicians' personal comfort may influence the cesarean section rate.

• 산경연구논집
• /
• 제11권11호
• /
• pp.19-28
• /
• 2020

Purpose: The supply of and demand for medical services continue to increase as the current social environment changes. Consequently, competition among medical institutions is intensifying and hospitals must establish appropriate management strategies to improve the medical services they provide. This study suggests that the authenticity of doctors is a factor in improving medical-service quality and examines the effect authenticity has on the affective trust and satisfaction of patients. Design, methodology, and approach: The study utilized previous studies to examine the significance of potential variables, established hypotheses and used a questionnaire to confirm these hypotheses. The questionnaire was distributed to patients who had visited a hospital in the previous six months. Responses were analyzed empirically using structural equation modeling. Findings: The analysis found that a physician's authenticity has a significant impact on the affective trust of patients. While patients' affective trust does not have a similar strong impact on patient satisfaction, physician authenticity does have a significant impact on patient satisfaction. Conclusion and implications: This study examined the roles of authenticity, affective trust, and patient satisfaction in doctor-patient relationships in the medical services field. The implication of the findings is that physician authenticity is a prerequisite for patient satisfaction of medical services.