• Health Policy and Management
• /
• 제3권2호
• /
• pp.100-129
• /
• 1993

This study is designed to find out some intra-clinic factors affecting the content of practice provided by primary care physicians in Korea, and proposed factors in this study are characteristcs of each private clinc --- physician-related variables(age, sex, specialty), bfed-related variables for inpatient care, laboratory-related variables for precise diagnosis. We have tried to estimate the difference of disease entities cared by each primary care physician according to above factors by analyzin gdisease data claimed during one month(April, 1992) to National Federation of Medical Insurance. The diagnosis codes by ICD-9 in the research disease data were reclassified to 'diagnosis clusters' by virtue of clinical similarities for effective analyses. We have converted frequent-tsing ICD-9 codes to 86 diagnosis clusters, which incorporated 97.4 percents of all ambulatory visits to private clinics. This result means proposed diagnosis-cluster method is effective tool for analysis of the content of ambulatory medical care carried out by primary care physicians. Comparisons and analyses of multiple diagnosis-clusters made on the basis of presented factors were done and the results were as follows; - Major factors affecting the difference between diagnosis-cluster pattern by each variables were phyusician's age, sex, specialty and bed counts of each private clinic for inpatient care and the size of laboratories of each clinic. - Middle aged(30th to 40th) group physicians are providing more comprehensive care than 20th or above 50th aged groups. Male physicians are more adequate for comprehensive care than female physicians, because woman-doctors are providing narrow-spectrum care. The content of practice of obstetricians and gynecologists shows much difference from primary medical practice, and they cannot be included in primary care physician, this study suggested. Pediatricians are also providing short-spectum acre, and nearly all visits to pediatricians were incorporated only 2-3 diagnosis-clusters. General surgeons' practices are very similar to general practioners' or family physicians' practices, the means they are providing primary care rather than special surgical care. And small number of beds(under 5 beds) and only basic(2-3 sorts of)diagnostic apparatuses are sufficient for primary physicians' clinic to carry out primary care. In conclusion, to reinforce primary care department in Korea, there must be support with health policy to expand office-based primary care practice-- with small number of beds for inpatient care and only basic laboratories-- provided by general practitioner of family physician.

• Women's Health Nursing
• /
• 제5권1호
• /
• pp.133-145
• /
• 1999

The purposesof the study are to analyze the community nursing center in U.S.A and to develop the model of nursing care system based on nurse-midwifery clinic in community for women's health in Korea. 1. In America nursing center is defined as nurse-anchored system of primary care delivery or neighborhood health center. Nursing centers are identified the following four types: (1) community outreach centers, which are similar to traditional public health clinics: (2) institutional-based centers following the mission of a large institution, such as a hospital or university: (3) wellness/health promotion centers, which offer screening, education, counseling, triage, and health maintenance services: and (4) independent practice. Nursing centers are a concept of services provided by nurses in practice arrangements in a community. Nursing centers offer a variety of services, ranging from primary care provided by advanced practice nurses with medical acute management and nursing care to the more traditional education, health promotion, screening wellness and coordination services. Some services, such as the care provided by advanced practice nurses are reimbursed under various insurance plan in some instances and states, where as others, such as preventive and educational services, are not. Thus, lack of reimbursement has threatened the survival of some centers. Licensing of nursing centers varies by state and program and accreditation of nursing centers is also limited. 52% of centers are affiliated with another facility and 48% are freestanding centers. The number of registered nurse at the nursing centers ranges from just one to 115, with a mean of eight RNs peragency and a median of three. Nursing centers avail ability varies: 14% are open 24 hours, 27% have variable short hours, 23% are open 6-7 days per week, and 36% are open Monday- Friday. As the result of my visiting three health centers in Seattle and San Francisco, the women's primary care nurse practitioners focus on a systematic and comprehensive assessment of the health status of women and diagnosis and management of common physical and psychosocial health concerns of women in ambulatory settings. Therapeutic nursing strategies are directed toward self-care, risk reoduction, health surveillance, stress reduction, healthy nutrition, social support, healthy coping, psychological well-being, and pharmacological therapy. They function as primary care providers for the well ness and illness care of women from adolescence through the older adult years and pregnant families. 2. In Korea a nurse-midwife practices independently for pregnant women's health including childbearing family at her own clinic in community. Her services are reimbursed under national health insurance but they are not paid on a fee-for-service schedule covering items. Analyzing the nursing centers in America, I suggest that nurse-midwifery clinics offer primary care for women and home care for chronic ill patients. The health law and health insurance policy should be reovised in order to expand nurse-midwife's and home care nurse's roles at nurse-midwifery clinic.

• Health Policy and Management
• /
• 제24권1호
• /
• pp.92-99
• /
• 2014

Background: Korea's primary care clinics are seeking increase in consultation fees by expanding supply within the frame of the health insurance system, but inequality of physician income between regions and individuals is exacerbating. The purpose of this study lies in analyzing the distribution of patients of primary care clinics, their specialized field, and the degree of inequality between medical fee income according to region. Data was acquired from the Health Insurance Review and Assessment Service on charged bills made by clinic-size medical institutions from 2008 to 2011. Methods: By comparing the outpatient number per clinic according to the clinic's specialized field, results showed that ophthalmology, otolaryngology, dermatology, orthopedics, and internal medicine showed high numbers whereas plastic surgery, neuropsychiatry, cardiothoracic surgery had fewer outpatients. The number of outpatients for clinic according to region showed Chuncheonnam-do, Jeju-do, Gangwon-do, Chungcheongbuk-do, Ulsan to have higher numbers of outpatients. For those four years, clinics in the Seoul area had a rather lower number. Results: As a result of comparing the decile hierarchy distribution ratio between specialized fields according to primary care clinics income from National Health Insurance, the inequality degree showed that obstetrics and gynecology and general medicine were each 0.130, 0.280 for the decile distribution ratio, which was the highest degree of inequality within the specialized field. Their Gini coefficient were also relatively high at 0.691, 0.528 respectively. On the other hand, the decile distribution ratio for otolaryngology and orthopedics were 0.510, 0.468, respectively, while their Gini coefficient each at 0.318, 0.314 makes their inequality degree relatively lower than other fields. Conclusion: This study is limited in that the data used was the health insurance charges submitted by clinics, which does not provide total information of the doctors' income. However, because most clinics are largely dependant on their income to come from health insurance reimbursements. Therefore, the results of this study can be used effectively. In the future, research that includes data on non-covered service income should be conducted to closely examine policy plans with a new medical fee policy which can resolve the medical fee income inequality issue between clinics as well as revitalize primary medical care.

• Journal of Korean Academy of Rural Health Nursing
• /
• 제18권2호
• /
• pp.106-112
• /
• 2023

Purpose: This study developed a shelter for dementia programs based on primary health care posts; and examined its effectiveness in rural older adults. Methods: This study used a case report provided by a primary healthcare post in Jeonnam, Korea, in 2023. A single group pre-test post-test design was used; for three months, and 10 older adults participated in the shelter for dementia programs based on the primary health care post. The effectiveness of the intervention was measured immediately after entering the shelter for dementia programs. Results: There were significant differences between the pre-test and post-test on the cognitive impairment screening test (p=.005). Conclusion: The shelter for dementia programs based on primary health care posts was effective in improving cognitive impairments of rural older adults.

• Journal of The Korea Institute of Healthcare Architecture
• /
• 제7권1호
• /
• pp.69-76
• /
• 2001

It is generally said that primary health care is the base of health delivery system. But in Korea, the primary care have not performed its roles well. To resolve these problems, the government has elaborate some policy measures. One of them is 'Attending Hospital System'. The purposes of this study are to understand Attending Hospital System and to anticipate the change of general hospital and clinic by this regulation.

• Health Policy and Management
• /
• 제6권2호
• /
• pp.58-90
• /
• 1996

This study provides an empirical analysis of location competition for demand maximization by central place theory among physicians in nonmetropolitan areas of Korea. The results show that the primary care physicians distribute themselves evenly from urban communities to rural communities. The subspecialists, however, cluster together in major cities rather than decentralize themselves in rural counties. This study establishes the three statistical models : Primary care physicians, subspecialist physicians, and total physicians. Two models of primary care physicians and total physicians have a strong significance in multiple regression analysis (p=-.0001). The primary care model explains approximately 45% of the variation and the total physicians model explains approximately 70% of the variation in physician/1,000 population ratios across national counties. The subspecialist physicians model analysze the tobit regreassion because of the left consored and truncated values(57 cases = 0). In all three models, analysis of the coefficiencts for physician centralization degrees in the 0- to 5- and 5- to 10-km rings around the core county reveals each a positive and negative association betwee these degrees and the physician/1,000 population ratios in the core county. Also, the results provide moderate evidence that the relationship between clinic physicians and community hospitals is competitive, and the relationship between clinic physicians and pharmaceutists is synergistic. This suggests that public policy makers and local self-governing bodies must take an active role to ensure procider availability and the regional health planning in all nonmetropolitan areas of Korea.

• Journal of agricultural medicine and community health
• /
• 제5권1호
• /
• pp.16-27
• /
• 1980

Five hundred seventeen farmers(214 males and 303 females), over age 30 and living in Suh San County, Unsan township, were examined to determine the prevalence of peasants syndrome. Using the health interview questionnaire, the farmers were asked whether they had any of eight subjective symptoms during the past one month before the survey, October 1979. Those symptoms reported were scored based on a pre-determined point system. The farmers with high symptom scores(7 points or more) were further examined by the liver function test. In addition, all the sample(517 cases) were subjected to the examination of urinalysis and blood pressure. The liver function test is also undertaken for those farmers with high symptome scores(7 points or more) and those with abnormal findings in urinalysis and blood pressure. The results are summarized below: 1) 156 out of 517 farmers(30.2%) have had seven points or more of the symptom scores. Among the eight major symptoms, 72% of the farmers complained of lumbago. 2) The prevalence of peasant's syndrome were higher among females and the older age group. The symptom scores of this syndrome were slightly higher among women who have had many children (e. g. 4 or more). 3) The prevalence of peasant's syndrome was also related to the level of one's education-the lower education groups were found to have higher symptom scores of this syndrome. This may be due to the fact that the lower education groups are more exposed to manual labor. 4) The points of the peasants syndrome were higher in hypertensive farmers and those with abnormal findings of urinaly sis. 5) It was reported, in Japan, that those with high scores of the syndrome are more likely to have an abnormal findings in the liver function test. However, in this study it was observed that there was no significant difference between those with high scores of the syndrome (7 points or more) and those with low score of the syndrome(6 points or less) in the prevalence of abnormal liver function. As this study indicates that the point system given for the peasant's syndrome is closely related to the high bleod pressure and abnormal urinalysis(and to some extent to the abnormal liver function), there is a need to study peasant's syndrome more extensively. Such an effort will serve to detect varonic disease conditions among farmer's towards better management of farmer's health, which is vitally important for rural development in Korea.

• Journal of Korean society of Dental Hygiene
• /
• 제4권2호
• /
• pp.165-177
• /
• 2004

The purpose of this study was to analyze the influence of child's general property, mother's social and economic property, mother's knowledge and behavior in oral hygiene upon the appearance and treatment of child's primary tooth decay. For the purpose, oral examination was applied to one hundred three(103) small children who were at the age between four(4) and seven(7) and went to two(2) places of day care centers located in Seoul, and questionnaire was done to their mothers. The results of the study are as follows. 1. The number of children's dt is 1.55, the number of their ft is 1.42, dft index for primary tooth is 2,98, ft rate is 45.61%, and the higher child's age is, the higher their value is. 2. Mother's age, educational background, and occupation does not show significant difference with dft index for primary tooth. The higher mother's monthly average income is, the higher child's ft rate is. 3. dft index for primary tooth does not show significant difference according 10 mother's knowledge in oral hygiene. And, the child of mother using dental floss does show higher it rate in comparison with the one of mother who does not use dental floss, 4. Experience using dental clinic to treatment tooth decay does show significant difference with dft index for primary tooth. And experience using dental clinic for the purpose of oral examination and preventive treatment does show significant difference with ft rate. 5. From the result of multiple regression with dependent variable of dft index for primary tooth, there is no variable having significant influence. From the result of multiple regression with dependent variable of ft rate, explanatory variable is 43%, child's age, mother's occupation, mother's monthly average income, and experience using dental clinic to prevent tooth decay are significant explanatory elements. Through the above results, we can know that mother should practice positive behavior in oral hygiene for child to improve oral health. Under the reason, oral health education should be applied toward mothers as soon as possible, and governmental support should be followed so that mothers can participate in the education.

• Asian Pacific Journal of Cancer Prevention
• /
• 제14권12호
• /
• pp.7451-7457
• /
• 2013

Background: Understanding and enhancing change capabilities, including Practice Adaptive Reserve (PAR), of Community Health Centers (CHCs) may mitigate cancer-related health disparities. Materials and Methods: Using stratified random sampling, we recruited 232 staff from seven CHCs serving Asian Pacific Islander communities to complete a self-administered survey. We performed multilevel regression analyses to examine PAR composite scores by CHC, position type, and number of years worked at their clinic. Results: The mean PAR score was 0.7 (s.d. 0.14). Higher scores were associated with a greater perceived likelihood that clinic staff would participate in an evidence-based intervention (EBI). Constructs such as communication, clinic flow, sensemaking, change valence, and resource availability were positively associated with EBI implementation or trended toward significance. Conclusions: PAR scores are positively associated with perceived likelihood of clinic staff participation in cancer screening EBI. Future research is needed to determine PAR levels most conducive to implementing change and to developing interventions that enhance Adaptive Reserve.

• Journal of the korean academy of Pediatric Dentistry
• /
• 제2권1호
• /
• pp.57-66
• /
• 1975

The study was performed to evaluate the Parent's knowledge and attitudes concerning the dental health of their children. A questionnaire consisting of 17 questions was given to each of the 664 parents by their children who are attending in primary school and was completed by them. The collected information from the questionnaire was analyzed by the visits to dental clinic, age and education. The results obtained from this study are as follows: 1) The more educated parents were more interested to the dental health of children. 2) In the know ledge concerning the dental health of their children, the parents who were more educated and had visited the dental clinic gave the better. responses. 3) There were no clear differences in age groups in the knowledge and attitudes on their children's dental health. 4) The reason for first visiting the dental clinic was dental treatment 43.2%, toothache 35.4%, for the purpose of oral examination 21.2%, and others were 9.2%. 5) 13.1% of the parents who had visited the dental clinic couldn't or didn't follow the recommended treatment because of economic difficulty 53.3%, lack of time 25%, lack of understanding of child's dental needs 18.3%, and other reasons were 3.3%.