• 보건행정학회지
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• 제21권4호
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• pp.599-616
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• 2011

This research was performed to investigate the determination factors of medical service to cover the fee for selecting a doctor which is one of the most important causes of debilitating national health insurance in Korea. Data was from Korea Health Panel and analyzed by Dutton(1986)'s medical service model which was an extended Anderson Model and was widely used in the researches on determination factors of medical service. The results were as follows; In the determinants of selecting a doctor in specialized medical institutions and general hospitals, patients with serious diseases selected doctors more often than other patients. By industrial accident compensation insurance law and enforcement ordinances, insurance covers the fee of selecting a doctor in the hospitals appointed by Labor Welfare Corporation for the patients in critical conditions under industrial accident compensation insurance, while health insurance patients pay the fee themselves for selecting a doctor in all cases. It is suggested that patients with serious diseases proved by medical opinion be provided with health care insurance in selecting a doctor and that the health insurance benefit coverage be enhanced by staged lowering of patient's cost-sharing.

• 한국병원경영학회지
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• 제14권3호
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• pp.66-82
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• 2009

The purpose of this study is to investigate the determinants of caregiver's conflict experience in elderly care institutions. This study focused on the three key independent variable groups(e.g., socio-demographic, job-related, and individual personality). The sample used in this study are 311 caregivers who are randomly selected from 21 elderly care institutions in Korea. Data were collected with a structured questionnaire by mail from Oct. 15 to Nov. 30 in 2007. The collected data were analyzed using logistic regression. The major findings of the study are as follows: 1) Nearly 40% percent of the respondents reported that they had experienced conflicts with elderly patients. The conflict with other caregivers ranked as second(20.6%), followed by patients' families(18.6%) and hospital employees(15.1%). 2) The personality, especially uniqueness caused conflict with patients or other caregivers. The professional identity reduced conflict with patients. The negative work experiences caused conflict with patients or family. The service attitude reduced conflict with family. The service-centered culture reduced conflict with hospital employees. Those who lived with the elderly showed lower level of conflict with family or hospital employees.

• 보건행정학회지
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• 제14권2호
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• pp.99-116
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• 2004

This study estimates the determinants of national health expenditures of OECD countries using panel regression method. The data used are OECD Health Data(2003) covering 33 countries and from 1970 to 2001. This study shows several important different results compared to the previous studies. Further this study estimates the determinants of Korean case using data from 1m to 2000, and compare with the results of OECD panel. The main findings are as follows. The income elasticity of health expenditures is estimated below 1.0, but is shown above 1.0 when the different health systems of each country are controlled. The women's labor participation influences strongly positive effect on the health expenditures. The diffusion of new technologies is positively related with the increasing expense. The increasing government expenditures have a tendency not to contain health expenses, but to increase expenses. The expansion of public health insurance holders is containing the expenses, and the increasing number of doctors is pushing expenditures. This implies the health expenditures are influenced more by the induced demand of providers rather than the moral hazard of patients. However, the above result is opposite in Korean case. The existence of primary care doctors affects slightly up warding rather than containing expenditures. Finally the determinants are seriously depending upon which factors are included in the model and which statistical model is chosen. Therefore it must be cautious to interpret the results of statistical model.

• 간호행정학회지
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• 제20권1호
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• pp.10-21
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• 2014

Purpose: This study was done to identify determinants of registered nurse (RN) skill mix and staffing level focused on hospital characteristics. Methods: Data were obtained from health insurance claims data and hospital reporting system in the Health Insurance Review and Assessment Service (HIRA) for the year 2010. Data from 2,998 hospitals were analysed using t-test, ANOVA, Pearson correlation, and regression analysis. Results: The RN skill mix and staffing level were positively related to hospital size and the percentage of inpatients to total patients. RN skill mix and staffing level were statistically different across regions. Including nursing aides (NA), however, there was no difference in staffing levels across regions. Medically vulnerable regions, bed operation rate, and the number of patients per doctor were also related to RN skill mix and staffing level. Conclusion: The statically significant determinants of RN skill mix and staffing level included hospital size, region, bed operation rate, percentage of inpatients, doctor-patient ratio. Further study needs to be done to investigate factors including RN supply and wages.

• 보건의료산업학회지
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• 제10권2호
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• pp.83-97
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• 2016

Objectives : This study analyzed the factors that determine the use and type of medical examination services (MES) to develop a model explaining the use behavior of MES which could consequently contribute to policy implications for medical examinations. Methods : Based on Anderson's healthcare utilization model, the MES utilization model was developed by including the perceived needs for MES. The data were collected from an online survey of a population aged 20-39 years and from a telephone survey of a population aged 40 years or older, respectively. Chi-Square tests and hierarchical logistic regression analyses were done with SAS version 9.3. Results : Generally, as health status became lower, the use of MES increased. However, patients with two or more chronic diseases were less likely to use private MES compared to patients with one chronic disease. The perceived needs for MES were only related to the use of service and not to the choice of the MES type. Conclusions : There were different results for the significant determinants between the use of the MES and the choice of the MES type. The healthcare industry needs to aware of consumer needs to provide MES based on empirical findings.

• Korean Journal of Radiology
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• 제22권6호
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• pp.890-900
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• 2021

Objective: To identify the association between morphological and functional characteristics of the bicuspid aortic valve (BAV) and bicuspid aortopathy and to identify the determinants of aortic dilatation using transthoracic echocardiography (TTE) and cardiac computed tomography (CCT). Materials and Methods: This study included 312 subjects (mean [SD] age, 52.7 [14.3] years; 227 males [72.8%]) who underwent TTE and CCT. The BAVs were classified by anterior-posterior (BAV-AP) or right-left (BAV-RL) orientation of the cusps and divided according to the presence (raphe+) or absence of a raphe (raphe-) based on the CCT and intraoperative findings. The dimensions of the sinus of Valsalva and the proximal ascending aorta were measured by CCT. We assessed the determinants of aortic root and proximal ascending aortic dilatation (size index > 2.1 cm/m²) by Univariable and multivariable logistic regression analyses. Results: Of the 312 patients, BAV-AP was present in 188 patients (60.3%), and 185 patients (59.3%) were raphe+. Moderate-to-severe aortic stenosis (AS) was the most common hemodynamic abnormality (54.8%). The most common type of aortopathy was the combined dilated root and mid-ascending aortic phenotype (62.5%). On multivariable analysis, age and AS severity were significantly associated with aortic root dilatation (p < 0.05), and age, sex, and AS severity were significantly associated with ascending aortic dilatation (p < 0.05). However, the orientation of the cusps, presence of a raphe, and severity of aortic regurgitation were not associated with aortic root and ascending aortic dilatation. Conclusion: BAV morphological characteristics were not determinants of aortic dilatation. Age, sex, and AS severity were predictors of bicuspid aortopathy. Therefore, age, sex, and AS severity, rather than valve morphology, need to be considered when planning treatment for BAV patients.

• 기본간호학회지
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• 제13권1호
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• pp.68-75
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• 2006

Purpose: This study was carried out to obtain basic data for developing effective pain management by identifying the positive and negative determinants for pain management in both cancer patients and their nurses. Method: The participants were 85 cancer patients and 78 nurses at C university hospital in Seoul. Data were collected from December 2004 to March 2005 using structured questionnaires. Results: The level of pain peaked at 5.02 when going into the hospital, and was then lowered to 2.08. The waiting time for analgesics was less than 30 minutes in 81.1% of the patients and for 68.2% answered that they reported their pain when the pain was no more endurable. Just over eighty percent (80.6%) of the patients were satisfied with the pain management. Only 10.3% of the nurses used a standardized tool for assessing patients, pain and 64.1% gave analgesics whenever patients complained of pain, while 19.2% did not when patients complained too frequently. Nurses who were unsatisfied with pain management accounted for 85.4% of the participants. Patients showed higher levels of barriers to pain management than nurses. Conclusion: There is a need to give cancer patients and nurses appropriate information on effective cancer pain management.

• 한국전문물리치료학회지
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• 제16권3호
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• pp.60-68
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• 2009

Psychsocial factors appear to play an important role in the maintenance and development of chronic disability from low back pain. Fear of pain may be more disabling than the pain itself in patients with nonacute low back pain. The purpose of this study was to identify the contribution of gender, age, depression and pain-related fear to pain intensity and disability in nonacute low back pain patients. This was a cross-sectional survey study of eighty four patients who had low back pain for at least 4 weeks. More than moderate correlations were found between pain intensity, disability, fear-avoidance beliefs and depression. Regression analyses revealed that disability ratings and fear-avoidance beliefs for work activities significantly contributed to the prediction of pain intensity, even when controlling for age, gender and pain duration. Also, fear-avoidance beliefs for physical activity, pain intensity, age and depression, significantly contributed to the prediction of disability, even when controlling for gender and pain duration. These findings suggest that disability scores and fear-avoidance beliefs for work activities are important determinants of pain intensity. They also suggest that fear-avoidance beliefs for physical activity, pain intensity, age and depression are important determinants of disability.

• 한국지역지리학회지
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• 제17권5호
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• pp.617-637
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• 2011

본 연구는 충청북도의 사례를 통해서 온라인 협진의 지리적 특성과 환자의 온라인 협진에 대한 결정 요인에 대해서 알아보는 것을 목적으로 하고 있다. 2009년 7월부터 9월까지 심층 인터뷰에 기반한 정성적 기법을 이용하였고, 충청북도에 거주하는 환자 20명을 대상으로 하였다. 이 연구에 의하면 대부분의 환자는 1차적으로 의료 문제가 해결되지 않을 경우, 온라인 협진의 본래 취지와 달리 충청북도 내에서 그것을 해결하는 것이 아니라, 경기 의료권에 위치한 의료 기관으로 방문하는 경향을 보였다. 이와 더불어, 환자의 의무 기록 또한 온라인 시스템을 통해 이들 병원에 전달되어, 온라인 협진의 공간상 네트워크는 경기 의료권으로 집중하게 된다. 이러한 주요 원인은 의료 서비스에 대한 질 혹은 수준에 대한 고려, 개인적인 이해 관계와 신뢰성, 좋은 접근성 등에 기인하는 것으로 밝혀졌다. 이에 반해, 온라인 협진 시스템의 편리성, 유효성 등과 같은 온라인 협진의 기술적 가치나 온라인 협진의 본래적인 목적인 지역의료 향상과 같은 요인은 크게 영향을 미치지 않는 것으로 밝혀졌다. 따라서 우리나라 원격진료의 결정 요인은 환자 개인에 의해서 결정이 되는 바가 크고, 아직 개개인의 인식이 지역 의료 시스템과 크게 밀착되지 않는 형태를 보이기 때문에 경기 의료권으로 원격진료의 선택이 집중된 공간 특성을 보이고 있다고 할 수 있다. 특히, 이는 기존의 의료 제도 및 환자의 행태가 온라인 상에서의 의료 활동에도 그대로 투영되기 때문인데, 가장 이상적인 원격진료의 지리적 담론인 지역화를 실현하기 위해서는 근본적인 지역의 의료 서비스 구조의 개선이 필요할 것으로 보인다.

• 간호행정학회지
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• 제4권2호
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• pp.289-306
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• 1998

For continuous development of professional nursing to the powerful professional organization, it is essential that the public understand and help nursing. This research was done to identify the image of nurses and factors that determine that image. The study subjects were 97 admitted patients 95 family members of patients who were admitted to a university hospital and a general hospital in Seoul and 164 parents of stutents in elemantary, middle, high schools in Seoul. The total numbers of subjects was 356. The researcher collected the data from April 13.1998 to April 20.1998. The Research tool was developed by the researcher following a literature review. Cronbach ${\alpha}$ for the tool of the image of nurses was 0.9397 and Cronbach a for the tool for determinants of the image was 0.8764. The obtained data were processed by SPSS (Statistical Package for Social Science) and the results are as follows : 1. The mean score for the image of nurses was 90.40${\pm}$15.15(range 47${\sim}$138) indicating a positive response. 2. Analysis of the image of nurses : Four factors were identified traditional. social. professional and personal image. The mean score for traditional image was 3.27. the second highest score. and for social image. 2.95. the lowest score. The mean score for professional image score was 3.48. the highest score. and for personal image, 3.20. a lower score. 3. The image of nurses according to respondents There were significant differences for traditional. social, professional. personal factors between subject groups. A more positive responses was found in the patients and patient' families as a compared to the students' parents. 4. Image of nurses related general characteristics : There was a significant difference for age and school graduation. More negative responses were found in the 31${\sim}$40 years old age group and in the higher educated group. 5. Image of nurses related to experience of nurses The respondents showed a more negative image when their experience related to nurses through the mass media, as a compared to the experiences of having talked with patient who had been admitted to hospital. For the social image factor. a more negative attitude was revealed for those who had the experience of patient who had been admitted to hospital as compared to other factors. 6. Determinants of image of nurses : There were three factors that were named subjective. administrative and media . The mean for the subjective factor score was 3.85. the highest score of the three factors. The mean for the administrative factor score was 3.53. And the mean for the media factor score was 3.27. 7. Determinants of image of nurses according to respondents group : There were no significant differences(F= 1.95, P= .14) Consequently the result showed a low social image of nurses. So. nurses must work to improve the social image of nurses through scientific approaches and by monitoring the mass media for correct descriptions of nurses. Also. it is necessary that excellent education for service and politeness be continually provided in order to positively effect the personal image field. It is also importent to raise the expectations of the recipients of nursing care by having a strategy for the determinants of the image of nurses that allows nurses to personnally develop professionally.