• 지역사회간호학회지
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• 제9권1호
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• pp.89-103
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• 1998

The elderly population will increase from 5.8% in 1996 to 12.5% in 2020. The related problems of health will also become a very important issue in the future. Therefore it is important to address the problems of geriatric nursing and geriatric health. 87.6% of the aged were ill with chronic degenerative diseases in 1994. In 1995, hospital admission rates (86.8) for those aged 60 or older were higher than that (56.3) of the total age group. Such high medical utilization will increase national health costs. For the development of geriatric nursing, active nursing intervention in various settings combined with education and research should be developed. Considering the health and welfare of the aged and the present status and views in Korea, I suggest the following: First, the health needs of the elderly in the institution, must be met by a plan that fosters geriatric nurses and programmed service development. Second, health service for the residential elderly must be provided in day care centers, short stays, nursing homes and geriatric hospitals. Geriatric nursing services should be provided in home residential areas, public health centers, public health subcenters as well as having, community health practitioners in primary health care posts and home health nurses. Third, geriatric nursing curriculum must be developed adjust to situations and culture of Korea and be included in the nursing curriculum. And gerontological nurse practitioner or geriatric specialist must be fosteraged to provide the professional care for the aged. Geriatric nursing research should be also achived for geriatric nursing improvements.

• 보건행정학회지
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• 제18권4호
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• pp.23-48
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• 2008

Although the universal health insurance, National Health Insurance (NHI), have improved access to health care and financial burden of health care costs for Koreans, limited coverage of the NHI leads to high out-of-pocket payment for health care. This study examines financial burden of household health expenditures by income level. Data from the Urban Household Expenditure Survey from 1985 through 2005 is analyzed and household expenditure is used as a proxy measure for income. Health expenditures include spending for inpatient care, ambulatory care and pharmaceuticals. If a household spends health expenditure above 40% of household consumption except for foods, that is defined as catastrophic health expenditure. Access to health care for the lowest income group had been improved for two decades relative to other income groups as well as in absolute term. However, both financial burden of health expenditures and the proportion of households that experienced catastrophic health expenditure had been increased in the lowest income group. Study findings have several policy implications. First, in terms of financial burden of health expenditures. the differences among income groups decreased until 2000 but it was worsen in 2005. This suggests that recent policies for extending NHI coverage are not enough to improve the disparity by income level. Second, a differential catastrophic coverage by income level would be an effective strategy that relieves financial burden for low income group. Third, since the catastrophic coverage is applied to only covered services by the NHI, additional strategy for uncovered services should be considered.

• 보건행정학회지
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• 제22권4호
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• pp.467-496
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• 2012

Public participation in the decision making for scarce health resources is important because health policy requires trust based consensus, which can be achieved by public's understanding and involvement of related policies. In the past, opportunities for interaction between health policy decision makers and lay public were rare in Korea. As political impulses towards public participation in health policy have increased, a few of deliberation methods were attempted. However, there is little research, reporting such cases with a critical examination of relevant theories and previous studies. We first critically review the literature on public participation within theories of democracy, governance, and empowerment. Next, we report a case of a citizen council experiment, which was held to examine public's preferences among different benefit options regarding new drugs and medical technologies. Specifically, in an one-day long citizen council with a total of 28 lay public, twelve questions of whether a drug or a technology should be included in the benefit package of health insurance were asked. Pre- and post-surveys investigated participants' perception of public engagement in health policy. Although it was experimental, the citizen council ensured that lay public could be careful enough to rationally compare the costs and benefits of different options and collectively make decisions. Further, results from pre- and post-survey showed a strong willingness of members to be involved in health care decision making. In the conclusion, we emphasize that better theories and methods need to be developed for more cases of citizen participation in health care policy and management.

• Journal of Preventive Medicine and Public Health
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• 제38권4호
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• pp.408-414
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• 2005

Objectives : The purpose of this study was to determine the impact of the sociodemographic and health characteristics on the out-of-pocket health spending of the individuals aged 20 and older in Korea. Methods : We used the data from the 2001 National Public Health and Nutrition Survey. The final sample size was 26,154 persons. Multiple linear regression models were used according to the age groups, that is, one model was used for those people under the age of sixty-five and the other was used for those people aged sixty-five and older. In these analyses, the expenditures were transformed to a logarithmic scale to reduce the skewness of the results. Results : Out-of-pocket health expenditures for those people under the age of 65 averaged 14,800 won per month, whereas expenditures for those people aged 65 and older averaged 27,200 won per month. In the regression analysis, the insurance type, resident area, self-reported health status, acute or chronic condition and bed-disability days were the statistically significant determinants for both age groups. Gender and age were statistically significant determinants only for the non-elderly. Conclusions : The findings from this study show that the mean out-of-pocket health expenditures varied according to the age groups and also several diverse characteristics. Thus, policymakers should consider the out-of-pocket health expenditure differential between the elderly and non-elderly persons. Improvement of the insurance coverage for the economically vulnerable subgroups that were identified in this study should be carefully considered. In addition, it is necessary to assess the impact of out-of-pocket spending on the peoples' health care utilization.

• Journal of Preventive Medicine and Public Health
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• 제40권4호
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• pp.329-335
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• 2007

Objectives : To identify the effects of supplemental private health insurance on health care utilization and expenditure under the mandatory National Health Insurance(NHI) system in Korea. Methods : The data were collected by the National Cancer Center in Korea. Cancer patients who were newly diagnosed with stomach (ICD code, C16), lung(C33-C34), liver (C22), colorectal cancer(C18-C20) or breast(C50) cancer were included as study subjects. Data were gathered using a structured questionnaire from face-to-face interviews, the hospital Order Communication System (OCS) and medical records. Clinical, socio-demographic and private health insurance related factors were also gathered. The differences of health care utilization and expenditure were compared between those who have private health insurance and those who do not using t-test and multivariable regression analysis. Results : Individuals with private health insurance spent larger inpatient costs than those without, but no differences were found in utilization in other service such as hospital admissions, hospital days and physician visits. Conclusions : We found that private health insurance exerts a significant effect on the health care expenditure in inpatient service. These study results can provide a rational basis to plan a national health policy regarding private health insurance. Further studies are needed to investigate the impacts of private health insurance on cancer patients' outcomes and survival rates.

• 보건행정학회지
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• 제29권3호
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• pp.288-302
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• 2019

Background: The one-person households (OPH) are rapidly increasing and vulnerable to socioeconomic and health problems. Because it is predicted to be inequitable to health care utilization, we would like to find out about the equity of health care utilization of the OPH by comparison with the multi-person households (MPH). Methods: This study followed the theoretical framework of Wagstaff and van Doorslaer (2000), O'Donnell and his colleagues (2008), where the horizontal inequity index is the difference between the concentration indices of actual health care utilization and health care needs. This study employed the 9th Korea Health Panel survey, and a total of 10,807 cases were analyzed. Health care needs were measured by age, sex, subjective health status, chronic disease count, Charlson's Comorbidity Index, limitation of activities, and disability. Results: Compared with the MPH, there were pro-poor inequities in hospitalization, emergency utilization, hospitalization out-of-pocket payments, and pro-rich inequities in outpatient out-of-pocket payments for the OPH. The decomposition of the concentration index revealed that chronic disease count made the largest contribution to socioeconomic inequality in outpatient utilization. Age, health insurance, economic activities, and subjective health status also proved more important contributors to inequality. The variables contributing to the hospitalization and emergency utilization inequity were age, education, Charlson's Comorbidity Index, marital status, and income. Conclusion: Because the OPH was more vulnerable to health problems than the MPH and there were pro-poor inequities in medical utilization, hospitalization, and emergency costs, it is necessary to develop a policy that can correct and improve the portion of high contribution to medical utilization of the OPH.

• 보건행정학회지
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• 제13권3호
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• pp.104-128
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• 2003

Equity in health care has taken priority in the Korean government's policy agenda after the government-led national health insurance achieved universal coverage in 1989 along with the final inclusion of the self-employed as beneficiary. The purpose of this study is to examine the extent to which there exists difference or inequality in the utilization of health care, especially cancer inpatient services among income classes. We analysed the utilization of cancer inpatient services of residents in Jeju Island for a year of 2000, using the national health insurance data for qualification of beneficiaries and utilization of health care. The independent variable are 10 income classes based on the national health insurance fee imposed on each household for a year of 2000. The dependent variables of this study are an amount of cancer inpatient health care utilization measured by cancer admission days and cancer treatment costs. Also, cancer inpatient health care utilization is analysed by three categories divided into utilization in medical care institutions (1) within Jeju Island, (2) outside Jeju Island, and (3) all within and outside Jeju Island. We measured concentration index of cancer inpatient health care utilization. This analysis showed negative concentration index within Jeju Island and positive outside Jeju Island, and positive in all within and outside Jeju Island. This results suggest inequality against the relatively poor income groups in utilization of cancer inpatient health care services. Especially, inequity of cancer inpatient health care would be more serious in Jeju Island of Korea, considering that lower income groups reportedly have higher incidence rates in most of cancer and thus use more health services.

• 지역사회간호학회지
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• 제5권1호
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• pp.5-29
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• 1994

In recent years, interests in health promotion have been stimulated by the epidemiological transition from infectious to chronic diseases as lead ing causes of death, the aging of the population, rapidly escalating health care costs, and epidemiologic findings linking individual risk to morbidity and mortality. It is not surprising that the workplace has been targeted as a promising setting for health promotion. In Korea, national attention to the opportunities for workplace health promotion began in the first 1990s. But there is no in depth study to identify the relating factors to the health promotion program in the workplace. The objective of this study is behavioral and physical characteristics to find that in crease the person's risk for a range of health problems and to analysis other characteristics to influence the degree of his/her intention to change health behavior. In addition, this study is purposed to present the process of planning health promotion program in the workplace. To accomplish these objectives, one workplaces was selected. And 363 employees in those workplaces were served as subjects for the study. Major findings in this study are as follows. (1) They have many risk factors such as smoking, drinking, lack of sleep, law rate of regular exercise, irregular eating, stress. (2) Some of the health risk factors such as smoking, drinking, and stress have the negative correlation to the intention to change. (3) Among cognitive and socio-environmental factors, significant predictors to the intention are attitude and social support. (4) In the cluster analysis to segment the target population in to homogeneous unit, three clusters of lifestyle are specified. (5) Smoking cessation and exercise program are planned for the risk group to change their behavior.

• 대한한의정보학회지
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• 제15권1호
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• pp.67-76
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• 2009

Quality management is a recent phenomenon. Advanced civilizations that supported the arts and crafts allowed clients to choose goods meeting higher quality standards than normal goods. There are many methods for quality improvement. Health care, refers to the treatment and management of illness, and the preservation of health through services offered by the medical, dental, complementary and alternative medicine, pharmaceutical, clinical laboratory sciences (in vitro diagnostics), nursing, and allied health professions. Health care embraces all the goods and services designed to promote health, including "preventive, curative and palliative interventions, whether directed to individuals or to populations. The overall impact of managed care remains widely debated. Proponents argue that it has increased efficiency, improved overall standards, and led to a better understanding of the relationship between costs and quality. Practices can solicit feedback from patients in a variety of ways: phone surveys, written surveys, focus groups or personal interviews. What do I do with the results? While you don't have to act on every suggestion that your patients give you, you should take action on the key items that are causing dissatisfaction.

• 지역사회간호학회지
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• 제21권4호
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• pp.439-447
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• 2010

Purpose: This study was to describe the burden of aged parents caring for adult children with disabilities and related factors. Methods: The subjects were 123 caregivers aged over 65 who were caring for 18-year-old or older children with disabilities. The research tool of this study was a structured questionnaire on family burden. Data were collected from June 3 to 25, 2010, and analyzed by Cronbach's alpha, mean, standard deviation, t-test, and ANOVA using SAS 9.2 program. Results: The major findings of this study were as follows. Elderly parents caring for adult children with disabilities perceived a moderate level of burden. The burden from concern over their children's future was highest, and economic and physical burdens were higher when the parents were younger. Burden was significantly different according to parents' characteristics such as gender, perceived health status, disease, the costs of caring for disabled children, and children's characteristics such as disability rating, health status, and ADL. Conclusion: In order to reduce the burden of elderly parents caring for adult children with disabilities, we need to improve their health status and assess comprehensive policies.