• The Korean Journal of Health Service Management
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• v.13 no.4
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• pp.179-190
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• 2019

Objectives: This study aimed to investigate the mediating effects of health promotion behaviors on the correlation between self-perceived health and medical care utilization among older adults. Methods: This study used data from a. Data were analyzed with frequency analysis, descriptive statistics, Pearson's correlation coefficient, and hierarchical multiple regression. Mediation analysis was performed according to the Sobel test. Results: The self-perceived health and some health promotion behaviors in older adults had a statistically significant effect on medical care utilization. Only the nutritional management of health promotion behaviors had a mediating effect on the relation between the self-perceived health and medical care utilization of older adults. Conclusions: The nutritional management of older adults was confirmed as an important factor to health promotion and prevention. This study was meaningful in that it identified the political directions for establishing health care policy for the older adults.

• Health Policy and Management
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• v.5 no.1
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• pp.31-58
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• 1995

The Korean government achieved the universal coverage of health insurance in July 1989, and concomitantly introduced a new measure of regulated health care delivery system in using medical care. There are three reasons why the government took the new health care delivery system. Firstly, there was ample room for improving the allocative efficiency in the use of medical facilities. And the second one was to constrain the dramatic increase of medical demand under health insurance. Thirdly, and the most important reason was to alleviate the patient crowdedness in big general hospitals, particularly tertiary hospitals. There are essentially two different ways to control the use of health care : one is to cut the demand for health care, and the other to regulate behaviors of providers through the use of incentives/disincentives, demand-side approach or supply-side approach. The objective of this study is to examine whether or not medical care utilization behaviors under health insurance scheme have been changed among medical facilities such as clinic, hospital, general hospital and tertiary hospital in comparison with those before and after the introduction, particularly whether the patient crowdedness in tertiary hospitals has been alleviated or not. In order to conduct this study, the insurance claim data during the period of January 1989 and July 1992 were analyzed by focusing on diagnosis of both inpatients and outpatients, and especially the fifteen most frequent diseases in ambulatory care and the seven most frequent diseases in hospitalizatio. In addition, the same analyses were made on the changes in medical care utilization by specialty department. This was because the five departments, such as family medicine, ENT, eye, dermatology and rehabilitation, were exempted from applying the regulated health care delivery system in tertiary hospitals. The study revealed that a remarkable alleviation effect in the crowdness was noted for tertiary hospitals. This effect was most conspicuous for the most frequent mild diseases of both inpatient and outpatient care. For example, the fifteen most frequent OPD care at tertiary facilities have decreased as much as by 40%, of which 34% belonged to the cut in initial visits. Meanwhile, the proportion of those who used general hospitals and private practitioner's clinics have increased due to the shift of patients. The cases from the five special departments were also decreased, but not so much as other departments. A problem was noted that, as time passed by, the decreasing tendencies of crowdness at tertiary hospitals due to the regulated system became slightly smaller. Therefore, through complementary remedies are needed for the future implementation.

• Journal of Society of Preventive Korean Medicine
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• v.16 no.2
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• pp.83-94
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• 2012

Objectives : This study aimed to investigate the use and patterns of health care resources of local patients and to analyze the health seeking behaviors focusing on shopping around phenomenon. Methods : Questionnaires on the use of health institution were developed and administered to the residents in Yangsan city, Korea. We selected patients who were suffering from any diseases two months and over. Patients' health seeking behaviors were categorized, and the factors for selecting health institutions in each visiting stages were analyzed. Results : 139 local patients participated in the survey, and 130 completed questionnaires were analyzed. We found that there were sixty eight different types of medical utilization paths. The most frequent path was 'western clinics ${\rightarrow}$ Korean medicine hospitals or clinics ${\rightarrow}$ western clinics'. Only 6 patients started at Korean medicine, however, 16 patients(12.3%) finalized their treatment at Korean medicine hospitals or clinics. In most health seeking stages, patients tended to select health resources by their own decisions, and the geographic factor was the key reason to select health resources. Conclusions : Patients had not any stable forms to treat with their diseases, and we observed diversified patterns in the health seeking behaviors of patients, a typical shopping around phenomenon.

• Journal of Physiology & Pathology in Korean Medicine
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• v.25 no.3
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• pp.582-588
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• 2011

The objective of this study is to examine the difference about manner of utilization and satisfaction on western and oriental medical care. The data came from the National Health and Nutrition Examination Survey in 2001 and 2005. The Andersen model of health behavior was employed to make this analysis. The major statistical methods used in this analysis are chi-square test and logistic regression. The major findings are as follows; Medical care is totally increased in 2005 in comparison with 2001, but medical care in the oriental side is decreased. There is no significant variables in predisposing factors such as sex, age, education level and spouse. Of health behavior factors, the average persons in health state are more favorable in oriental care rather than western care. Oriental care is favorably taken in health insurance subscribers and residents in a large city of enabling factors. The patients with musculoskeletal disease are more dependent in oriental care than western medical care. In conclusion, the findings show that it is largely related to patients' health state, medical insurance, living area and disease types to take oriental medical care. These characteristics should be considered in establishing policies of the oriental medical care in the future.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.13 no.8
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• pp.3500-3512
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• 2012

The purpose of this study is to conduct a comparative analysis of health behaviors, health status, and health care utilization by the homeland of the internationally married women immigrants living in Korea. The subjects of this study were 171 married women immigrants who are registered at 7 multicultural centers in Chungbuk province. The study was conducted from September 2010 to November 2010 by surveying them with structured questionnaires translated in 7 different languages. In health behaviors the results indicated that there were statistically significant differences in high intensity exercise, walking, weight control, and the number of times having breakfast per week depending on the subject's homeland. In health status, there were statistically significant differences in low back pain incidence and obesity rate by the subject's homeland. In health care utilization, the subjects revealed statistically significant differences in utilizing health screening, in selecting primary medical institutes, and in the reasons for avoiding medical institutes depending on the subject's homeland. Health promotion policies that take the results of this research into account would provide suitable health care services for internationally married migrant women.

• Research in Community and Public Health Nursing
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• v.26 no.1
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• pp.11-17
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• 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.

• Journal of Korean Academy of Rural Health Nursing
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• v.1 no.1
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• pp.11-20
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• 2006

Purpose: To compare of health inequalities between rural and urban areas in term of health status, health behaviors and medical care utilization by using national-wide data. Method: The data came from the 2000 and 2005 census data, 2004 death certification statistics and 2001 national health and nutrition survey. The health indicators used in this study were mortality, perceived health status, health related behaviors, morbidity, accidents and suicides, mental health-related factors, health care accessibility. Korean rural areas have been experiencing a rapid aging process and there are demographic differences between rural and urban populations. Thus, both of crude rates and age-adjusted rates were compared. Result: Although the degrees decreased after adjustment for age, health inequalities between areas still existed. The people who lived in rural areas suffer from higher mortality, morbidity and unhealthy behavior compared to people in urban areas. Especially, regional health inequalities for women were significant. Health care accessibility in rural areas was also lower and medical indirect costs for rural residents were higher than those of urban residents. Conclusion: To reduce health inequalities between geographical areas, political efforts to tackle health inequalities in the rural areas are required.

• Journal of Preventive Medicine and Public Health
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• v.30 no.4 s.59
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• pp.870-883
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• 1997

The health center has to play an important role in promoting community health and satisfying a variety of community health needs and demands in the decentralized Korea. The nearly enacted Community Health Act compels every health center to make its own health plans which intend to deal with local health problems and plan its future health care. This obligation is obviously a big burden to most health centers. They do not have experiences in and abilities of making local health care plans. In order to establish a systematic community health plan, health centers have to concentrate their efforts on enhancing the ability of making health care plan through gathering and analysing the local health informations. However, it is very difficult in reality. This is simply because it will take long time to accomplish these activities. It seems natural that various professionals and researchers participate in carrying out the process of making community health plan in the initial stage. No standardized methodology and analysing framework exist even in the health professional society. Nonetheless, it is common to introduce survey research methodologies in analysing consumer's health care utilization and cost, and in identifying factors influencing health behaviors. Many researchers and professionals have applied social survey methodologies in obtaining information on providers and health policy makers as well. The authors have found that few studies have ever utilized local health data stored at the self-employed medical insurance society as the data source of planning activities. The purpose of this study is to illustrate the usefulness of the data stored at the Sung-Dong Gu Self-employed Medical Insurance Society in establishing the community health plan. The major contents of this study are as follows ; 1. frequency of utilization by age, area, sex, type of medical care institutions, and some major diseases 2. Medical treatment by type of medical care institutions, by classification of 21 diseases, by frequency of three-character categories 3. Medical treatment of major neoplasm and some chronic diseases by age, sex, and area. The conclusion of this study is that it is of great potentiality to find out the local health problems and to use them in blueprinting the community health plan through comparing the frequency of medical utilization analyzed by a variety of variables with NHI health data or the health data from survey research.

• Journal of Korean Academy of Nursing
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• v.15 no.2
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• pp.5-15
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• 1985

This study was conducted for the purpose of fin-ding out the variance explaining the medical facilities utilization behavior, which is defined adaptation behavior Process by focal, contextual, residual stimuli in Roy's Adaptation Model. What kinds of characteristics can explain adaptation behavior in Roy's Model? And which is the relative importance of input variables? For this analysis, stepwise multiple regression and path analysis was used. The data come from the 1981 Baseline Household Interview Survey in remote rural area. The findings of the analysis can be summarized as follows: First, Total variance of independant variables for adaptation behavior, that is medical facilities utilization including clinic, drug store, health center, herb medicine was shown 16.2 percent. The most important variable which explain the dependent variable was the occurance of illness with the Ra of value 0.112. The illness symptom, living level, regular care source was shown important variables with relatively high the R²value and significant beta coefficient. Second, in the path analysis of variables which is selected important variables, the occurance of illness was shown variable which has the highest direct effect which 0.297 path coefficient. Also the education level of household was shown variable which has the highest indirect effect through living level and the occurance of illness in causal model. Third, This analysis suggests that the occurance of illness belonging focal stimuli are more influenced than others. To sum up, It is seem to the occurance of illness, illness symptom belonging focal stimuli have high explanation ability through direct effect, education level of household among contextual stimuli have explanation ability through indirect effect.

• Journal of Society of Preventive Korean Medicine
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• v.22 no.2
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• pp.25-32
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• 2018

Objectives : This study was conducted to investigate the frequent diseases among the people who had been treated by collaborative treatment of Korean medicine and Western medicine, and to compare their medical use behaviors before and after the collaborative first-stage pilot project between Korean medicine and Western medicine. Methods : 4,467 patients were identified as the patients who are participated in the collaborative first-stage pilot project between Korean medicine and Western medicine during the period between July 15, 2016 and March 31 2017. We used 28,480 records of Korean national health insurance claim data from January 1 2016 to March 31 2017 to analyzed present condition of cooperative medical usage. Also we conducted a paired t test to compare the percentage of collaborative treatment days before and after the pilot project period. Results : We found that the most frequent diseases treated in the pilot project were the diseases of musculoskeletal and nervous system and then 10 major diseases such as H, K, J, C (D), N, L, E, A, H and F disease codes in order. Also it was confirmed that 14 major and 53 medium diseases are included from more than 90% of total patients. As a result of high frequency of medical treatment in Western medicine or Korean medicine is "administration of Korean medicine", which is same as before and within the pilot project. The ratio of utilizing both Western and Korean medical care for the same disease on the same day by both general patients and patients in KCD-7 disease code group C, G, I, M and S had been increased significantly. Conclusions : The pilot project might change the behavior of utilizing the medical care service by increasing the ratio of collaborative treatment of Western medicine and Korean medicine for the same disease on the same day.