• 지역사회간호학회지
• /
• 제26권1호
• /
• pp.11-17
• /
• 2015

Purpose: This study was to ascertain whether there are differences in health care utilization and expenditure for Type I Medical Aid Beneficiaries before and after applying Copayment. Methods: This study was one-group pretest posttest design study using secondary data analysis. Data for pretest group were collected from claims data of the Korea National Health Insurance Corporation and data for posttest group were collected through door to-door interviews using a structured questionnaire. A total of 1,364 subjects were sampled systematically from medical aid beneficiaries who had applied for copayment during the period from December 12, 2007 to September 25, 2008. Results: There was no negative effect of copayment on accessibility to medical services, medication adherence (p=.94), and quality of life (p=.25). Some of the subjects' health behaviors even increased preferably after applying for copayment including flu prevention (p<.001), health care examination (p=.035), and cancer screening (p=.002). However, significant suppressive effects of copayment were found on outpatient hospital visiting days (p<.001) and outpatient medical expenditure (p<.001). Conclusion: Copayment does not seem to be a great influencing factor on beneficiaries' accessibility to medical services and their health behavior even though it has suppressive effects on outpatients' use of health care.

• 지역사회간호학회지
• /
• 제23권4호
• /
• pp.438-445
• /
• 2012

Purpose: Medical Aid Beneficiaries were surveyed to identify differences in health behaviors, adherence to drug regimen, and quality of life between those people in the Designated Doctor System and those who are not. Methods: A total of 1,327 study subjects were separated into three groups: those in the Designated Doctor System for 2 years, those in for 1 year, and those not in the system. Results: After the introduction of the Designated Doctor System, 55.8% and 67.9%, respectively, of the subjects in the Designated Doctor System complained of inconvenience in relation to hospital use and the patient referral process. Also, the rate of emergency room use or hospitalization guided by the Designated Doctor System was only 8.7% and 6.5%, respectively. There were no significant differences in health behaviors and adherence to drug regimens between those in the Designated Doctor System and those who are not. Conclusion: This study was carried out early in the introduction of the system. Therefore, it is necessary to monitor the positive and negative effects of the Designated Doctor System for a full reflection of its impact.

• 기본간호학회지
• /
• 제18권3호
• /
• pp.310-316
• /
• 2011

Purpose: In the present study, the difference in patients' nursing demands and nursing performance as perceived by the patients was examined. Methods: The participants were 272 patients on maintenance hemodialysis at five university hospitals. Nursing need and nursing performance were measured using the tool developed by Lee for this study. Results: The mean score for nursing demand was 3.35 points out of 4. The scores were higher for participants with middle school graduation or less, those not professing religion, and those whose medical insurance was of the medicaid type. The mean score for perceived nursing performance was 3.22 points out of 4. Nursing performance as perceived by hemodialysis patients was lower than nursing demand for 22 of 28 items. The item with the largest difference between nursing performance and nursing demand was 'Give a pain-free injection', followed by 'Explain about insurance benefits and supports' and 'Maintain quiet environment in the hemodialysis unit enabling rest during hemodialysis'. Conclusion: The results show that nursing performance as perceived by hemodialysis patients was lower than nursing demand. This result indicates a need to develop appropriate strategies to enhance nursing performance, especially for items that showed low nursing performance.

• 지역사회간호학회지
• /
• 제32권3호
• /
• pp.382-395
• /
• 2021

Purpose: The purpose of this qualitative study was to explore the transition experiences of the elderly from long-term care hospitals to their homes. Methods: The participants were eight elderly medicaid beneficiaries, who had been the subjects from the community care project in Korea. The data were collected with one-on-one interviews from April to November in 2020, and analyzed by phenomenological steps. Results: The seven themes derived in this study were 'Space to escape', 'Reliable supporter opened the way to discharge', 'Comfortable life at home', 'Obstacles to independent life', 'Struggling to live alone', 'Fence for community life', and 'Energizing in daily life' Conclusion: The results revealed the positive aspects of Community Care program in Korea. However, it is suggested that active communication between hospitals and community care institutions, and improvement of home environment to live in the community before discharge should be required. And system revision is needed to adjust activity in their home and support health problems of the elderly in the early stage of discharge. The results of this study can be referred to as the foundation of transitional care for the elderly.

• 간호행정학회지
• /
• 제4권2호
• /
• pp.351-361
• /
• 1998

The purpose of this study was to explore whether there is a point within the range of physical impairment after which the cost of home care exceeds the cost of nursing home care among the elderly who require long-term care. The provision of long-term care for the elderly is a major health policy issue, in part due to the aging of the American population and dramatic increase in health care costs. The framework for this study was guided by Pollak's(1973)model of costs of alternative care settings for the elderly. This study used a retrospective, descriptive correlational design. Physical impairment was measured by the modified Index of Activities of Daily Living(Katz et al. 1963). Cost of care was measured by the average cost per patient per day. The sample for this study included 67 patients receiving long-term care at home from the Long-term Home Health Care Programs (LTHHCPs) and 67 patients receiving long-term care in nursing homes. Data were collected on patient characteristics. including activities of daily living and cognitive impairment. and on the number of physician visits. emergency room visits. and hospitalization from the patient records. For each patient. Medicaid cost data for home care services/or nursing home services were collected from the financial department of each home care agency or nursing home. The living costs and informal care costs were estimated for home care patients. The results indicated that the home care sample and the nursing home sample were similar in terms of gender. ethnic background. and marital status. The elderly patients in the home care sample were: however. younger and less physically impaired than those in the nursing home sample. The hypotheses of this study were supported: For elderly persons with physical impairment scores below 12(possible range of 0 to 14), cost of care was lower in home care than in the nursing home care setting. However, for elderly persons with physical impairment scores above 12. the cost of care was higher in home care than in the nursing home care setting. Thus. in this sample for elderly patients with extreme physical impairment, the cost of home care exceeded the cost of nursing home care.

• 보건행정학회지
• /
• 제27권2호
• /
• pp.149-156
• /
• 2017

Background: This study was conducted to evaluate the performance of the Hierarchical Condition Category (HCC) model, identify potentially high-cost patients, and examine the effects of adding prior utilization to the risk model using Korean claims data. Methods: We incorporated 2 years of data from the National Health Insurance Services-National Sample Cohort. Five risk models were used to predict health expenditures: model 1 (age/sex groups), model 2 (the Center for Medicare and Medicaid Services-HCC with age/sex groups), model 3 (selected 54 HCCs with age/sex groups), model 4 (bed-days of care plus model 3), and model 5 (medication-days plus model 3). We evaluated model performance using $R^2$ at individual level, predictive positive value (PPV) of the top 5% of high-cost patients, and predictive ratio (PR) within subgroups. Results: The suitability of the model, including prior use, bed-days, and medication-days, was better than other models. $R^2$ values were 8%, 39%, 37%, 43%, and 57% with model 1, 2, 3, 4, and 5, respectively. After being removed the extreme values, the corresponding $R^2$ values were slightly improved in all models. PPVs were 16.4%, 25.2%, 25.1%, 33.8%, and 53.8%. Total expenditure was underpredicted for the highest expenditure group and overpredicted for the four other groups. PR had a tendency to decrease from younger group to older group in both female and male. Conclusion: The risk adjustment models are important in plan payment, reimbursement, profiling, and research. Combined prior use and diagnostic data are more powerful to predict health costs and to identify high-cost patients.

• 보건행정학회지
• /
• 제14권2호
• /
• pp.1-16
• /
• 2004

The study purpose was to find which factors affect selection of hospital network types. This study used the 1998 American Hospital Association Annual Survey Database from Health Forum. Among these U.S. hospitals, the researcher selected hospitals located in Metropolitan Statistical Areas. Therefore the final observation cases for analysis are 1,971 Metropolitan Statistical Area hospitals in the United States. To identify significant variables influencing hospital network types, the study used proportional odds logistics regression model on population size, Health Maintenance Organization penetration rate, and market competition rate of area including a hospital, types of hospital ownership, hospital bed size, proportion of Medicare patients and Medicaid patients in total hospital patients, and occupancy rate. Contrary to conventional wisdom, selection of hospital network types was influenced by population size of area which a hospital located, types of ownership, hospital bed size, and proportion of medicare patients rather than Health Maintenance Organization penetration. Population size 1,000,000-2,499,999 had the highest probability of selecting type IV (clinical-vertical integration) from an independent hospital, and a religious group owned hospitals and for-profit owned hospitals had the highest probability of selecting Type IV (clinical-vertical integration) from an independent hospital. A bed size had positive relation on selecting Type IV (clinical-vertical integration) from an independent hospital. Unlikely general belief that the selecting types of hospital network was determined by the change of health insurance policy such as Health Maintenance Organizations and Preferred Provider Organizations, the types of hospital network were influenced by community characteristics such as population size, and hospital characteristics.

• 한국치위생학회지
• /
• 제14권3호
• /
• pp.353-362
• /
• 2014

Objectives : The purpose of the study is to investigate the xerostomia in the chronic severe psychiatric patients in Korea because there were few reports on xerostomia in the psychiatric patients. Methods : The subjects were 61 psychiatric patients in the mental hospital by convenience cluster sampling. A self-reported symptom questionnaire was filled out by the three researchers on the basis of medical records by the informed consent. The stimulated salivary flow rate of the patients was measured by saliva sampling. Results : The subjects consisted of 45.9% of male and 54.1% of female. High school graduation accounted for 40.0% and 20.0% did not attend the school. The majority of the patients were medicaid recipients. Schizophrenia accounted for 86.9% and most patients were long term care recipients. A total of 68.9% of the patients suffered from salivary dysfunction. The medication in schizophrenia seemed to decrease the stimulated salivary flow rate and made the patients difficult in chewing and swallowing due to xerostomia and low saliva secretion(p<0.05). Conclusions : Medication in schizophrenic patients caused the salivary dysfunction. So the collaboration between the psychiatry doctors and dental hygienists is very important to improve the salivary secretion in the schizophrenic patients. The continuous and long term care of the xerostomia will help the patients maintain the good oral hygiene.

• 한국치위생학회지
• /
• 제13권4호
• /
• pp.693-700
• /
• 2013

Objectives : The purpose of this study was to investigate the number of remaining natural teeth in elderly people visiting dental care services and the factors affecting dental visit. This study will contribute the development of oral health promotion programs for the elderly people. Methods : Subjects were 172 elderly people recruited from 217 senior citizens visiting public oral health care services in 16 districts in Busan. They completed self-Corresponding Author reported questionnaires. Results : Elderly people had less remaining natural teeth (p<0.001). The remaining natural teeth ($15.07{\pm}8.75$) of the health insurance beneficiary were majority than those of the medicaid ($8.78{\pm}8.45$)(p<0.001). The respondents with better oral health condition had more remaining natural teeth (r=0.317, p<0.001), and those who were more worried about oral health had less remaining natural teeth (r=-0.599, p<0.001). Aging accelerates loss of natural teeth (p<0.001) of 3.203. Approximately 2.188 remaining teeth will be preserved by oral health care improvement (p=0.009). Conclusions : Frequent dental clinic visit will prevent natural teeth loss in the elderly people. Toothbrushing is the most efficient method of oral health care in the elderly people. Awareness towards oral health care is the motivation to preserve natural teeth in the elderly people.

• Journal of Preventive Medicine and Public Health
• /
• 제40권1호
• /
• pp.51-58
• /
• 2007

Objectives : The objectives of this study were to estimate the continuity of care for all Koreans with diabetes and to identify factors affecting the continuity of care. Methods : We obtained National Health Insurance claims data for patients with diabetes who visited health-care providers during the year 2004. A total of 1,498,327 patients were included as study subjects. Most Frequent Provider Continuity (MFPC) and Modified, Modified Continuity Index (MMCI) were used as indexes of continuity of care. A multiple linear regression analysis was used to identify factors affecting continuity of care. Results : The average continuity of care in the entire population of 1,498,327 patients was $0.89{\pm}0.17$ as calculated by MFPC and $0.92{\pm}0.16$ by MMCI. In a multiple linear regression analysis, both MFPC and MMCI were lower for females than males, disabled than non-disabled, Medicaid beneficiaries than health insurance beneficiaries, patients with low monthly insurance contributions, patients in rural residential areas, and patients whose most frequently visited provider is the hospital. Conclusions : The continuity of care for patients with diabetes is high in Korea. However, women, the disabled and people of low socio-economic status have relatively low continuity of care. Therefore, our first priority is to promote a diabetes management program for these patients.