• 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 Preventive Medicine and Public Health
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• v.46 no.3
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• pp.147-154
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• 2013

Objectives: Many epidemiological studies have suggested that a variety of medical illnesses are associated with suicide. Investigating the time-varying pattern of medical care utilization prior to death in suicides motivated by physical illnesses would be helpful for developing suicide prevention programs for patients with physical illnesses. Methods: Suicides motivated by physical illnesses were identified by the investigator's note from the National Police Agency, which was linked to the data from the Health Insurance Review and Assessment. We investigated the time-varying patterns of medical care utilization during 1 year prior to suicide using repeated-measures data analysis after adjustment for age, gender, area of residence, and socioeconomic status. Results: Among 1994 suicides for physical illness, 1893 (94.9%) suicides contacted any medical care services and 445 (22.3%) suicides contacted mental health care during 1 year prior to suicide. The number of medical care visits and individual medical expenditures increased as the date of suicide approached (p<0.001). The number of medical care visits for psychiatric disorders prior to suicide significantly increased only in 40- to 64-year-old men (p=0.002), women <40 years old (p=0.011) and women 40 to 64 years old (p= 0.021) after adjustment for residence, socioeconomic status, and morbidity. Conclusions: Most of the suicides motivated by physical illnesses contacted medical care during 1 year prior to suicide, but many of them did not undergo psychiatric evaluation. This underscores the need for programs to provide psychosocial support to patients with physical illnesses.

• 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.

• Research in Community and Public Health Nursing
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• v.13 no.2
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• pp.272-279
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• 2002

Objectives: The purpose of this study was to analyze health service utilization, and its related factors in low income families who earned half of the average Korean household income. Methods: This was a cross-sectional descriptive survey study in which a nationwide randomization sampling technique was used. The data were collected from July 12 to August 7, 1999, and the total sample size was 5,819 individuals, belonging to 1.753 households. Results: 1) In the utilization of health services for the last 3months, the pharmacy was the type of service that was the most utilized (32.0%), and the health center was the one that was the least utilized (10.3%). About 29% (29.2%) of the respondents could not utilize the health service at all. and 19.8% of the respondents terminated their medical treatments half way to completion because of financial difficulty (89.4%). 2) Analysis of the data using logistic regression showed that living with spouse, level of education, occupation, and income had statistically significant effects on health service utilization. Conclusion: The parameters of health care policies are equity and efficacy for health status, and the health service utilization by low income families. The conclusive resolution for these is the improvement of public health centers for an increased utilization rate of their services.

• Research in Community and Public Health Nursing
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• v.21 no.3
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• pp.351-361
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• 2010

Purpose: This study was done to analyze the effects of tele-care case management services using secondary data. Methods: A descriptive research design was utilized, and the participants were 134 medical aid beneficiaries who were in either the high-risk group or the preventive group. Casemanagement services were delivered by 8 care managers. Data were analyzed using PAWS Statistics 17 through descriptive statistics and paired t-test. Results: After the case management intervention, the participants' health quality of life, self-care competency, and reasonable medical care utilization increased significantly for the high-risk group. However there were no significant changes in the preventive group. Conclusion: The results showed that the tele-care case management services were effective for high-risk medical aid beneficiaries. Further studies with controls for constitutional variables and a comparison group are required to validate the robustness of the effectiveness of the case management program in the present study.

• Health Policy and Management
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• v.8 no.2
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• pp.1-24
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• 1998

There exists a general consensus in Korea that patients tend to concentrate in large hospitals and this tendency is partly responsible for inefficiency in health services. The process of choosing a medical care provider for health care services and evaluating the provider after utilization seems to involve many diverse factors to become very complex. Therefore a systemsatic study is needed to achieve sufficient understanding of the proeess. For this point of view, this study investigates patient's selection of medical care institution for delivery care services and their evaluation of the institution after delivery. In more specific, the objectives of the study are twofold: 1) to identify the factors associated with expectant mothers' choice of type of medical care institution for delivery among tertiary hospitals, general hospitals, small hospitals, and clinics: and 2) to understand the factors affecting patient evaluation of the medical care institution after delivery. The data used for the analysis were collected through face-to-face interviews with those women who had childbirth during the period from January 1, 1996 to the date of interview in February 1998. The survey was conducted using preqared structured questionnaire in Seoul. The sample was drawn from each of arbitrarily defined four regions of Seoul, Northeast, Northwest, Southeast and Southwest, in proportion to the number of births reported in 1996 in each of them. The distribution of the interviewed women by educational level was made similar to that of mothers of new babies reported in 1996. The sample size was planned to be about 300, but ended up with analytical sample of 319. Major conclusions emerged from the analysis can be summarized as follows: 1) Large hospitals were evaluated as much better for technical quality than other types of institutions, whereas they were compared similar to or worse for other attributes. And it was found that technical quality of care is considered as the most important condition of medical care institution for delivery, while the amount of direct cost is considered as the least important one. Taken together, the utilization of large hospitals is not likely to decrease even though they cannot give satisfaction to patients in other aspects than technical quality. 2) The activeness in the search for information affected the respondents' evaluation of medical care institutions, which would influence their later decision or recommendation to other persons as to the choice of source of health care services. Therefore, increased efforts should be directed to improving availability of useful and correct information for patients in relation to the utilization of health care services. 3) Since the findings of this study were obtained from the analysis of delivery care services, their applicability to other kinds of services may be limited. Thus it would be useful to conduct a comparative study of several kinds of services explicitly taking into account the characteristics of those services in the analysis.

• 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.

• Tuberculosis and Respiratory Diseases
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• v.81 no.2
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• pp.116-122
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• 2018

Background: Chronic obstructive pulmonary disease (COPD) is a serious chronic condition with a global impact. Symptoms of COPD include progressive dyspnea, breathlessness, cough, and sputum production, which have a considerable impact on the lives of patients. In addition to the human cost of living with COPD and the resulting death, COPD entails a huge economic burden on the Chinese population, with patients spending up to one-third of the average family income on COPD management in some regions is clinically beneficial to adopt preventable measures via prudent COPD care utilization, monetary costs, and hospitalizations. Methods: Toward this end, this study compared the relative effectiveness of six indices in predicting patient healthcare utilization, cost of care, and patient health outcome. The six assessment systems evaluated included the three multidimensional Body mass index, Obstruction, Dyspnea, Exercise capacity index, Dyspnea, Obstruction, Smoking, Exacerbation (DOSE) index, and COPD Assessment Test index, or the unidimensional measures that best predict the future of patient healthcare utilization, cost of care, and patient health outcome among Chinese COPD patients. Results: Multiple linear regression models were created for each healthcare utilization, cost, and outcome including a single COPD index and the same group of demographic variables for each of the outcomes. Conclusion: We conclude that the DOSE index facilitates the prediction of patient healthcare utilization, disease expenditure, and negative clinical outcomes. Our study indicates that the DOSE index has a potential role beyond clinical predictions.

• Journal of Preventive Medicine and Public Health
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• v.19 no.1 s.19
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• pp.137-145
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• 1986

A Nationwide health care utilization survey was conducted from March 11 to September 19, 1985 to assess the level of illness and the magnitude of medical care utilization. A probability sample of 15,427 persons was taken from 180 Enumerated Districts designated by the Economic Planning Board. Of those 4,500 housewives were proxy respondents. A interview was conducted with pre-tested questionnaire schedule which was recorded by well trained interviewers. Age and sex compositions of the study population were similar to those of general population structure in 1985. The major findings of this survey are as follows : 1) A total of 64.5% of the study population lived in city area and 35.5% lived in county area. 2) While no difference was observed in interview rate between city and county area, it showed statistically significant difference in the medical security program coverage rate between the two areas(44.7% and 37.1%, respectively) 3) Morbidity rate was 79 per 1,000 persons during the two week periods. There was difference in age and sex adjusted morbidity rates between city and county area. Furthermore morbidity rates by the status of the program were significantly difference between the two areas. 4) Average ambulatory care utilization rate was 7.2 visits per person per year and average admission rate was 1.8 per 100 persons per year. There was significant difference in average ambulatory care utilization rate by the program. but no significant difference in medical utilization rate between city and country area. 5) The major symptoms of the perceived illness was the respiratory system(44.1%). 6) A total of 50.4% of the perceived illness among the covered group by the program were treated at the hospital and clinics, but those who are not covered used primarily drug stores(61.3%).

• Journal of Preventive Medicine and Public Health
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• v.31 no.4 s.63
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• pp.814-827
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• 1998

In this study we analyzed the insurance claims data to investigate the medical care utilization pattern of tuberculosis patients in private sector. We selected the claims of principal or secondary diagnosis with tuberculosis from claims database of National federation of Medical Insurance, from December 1995 to November 1996. Both spell-based analysis and person-based analysis were carried out. In spell-based analysis, type and location of treatment facilities, distribution of diagnoses, number of outpatient/inpatient treatments were analyzed. Additionally in person-based analysis, number of tuberculosis patients, demographic characteristics, number of treatments per person, frequency and pattern of change in source of care were analyzed. The results were as follows 1. The number of treatments with tuberculosis was 863,641 from 1 December 1995 to 30 November 1996. The number of patients was 313.964. 2. Most of tuberculosis patients in private sector were treated in general hospital (45.8%) and clinics(42.2%) 3. About 77.7% of tuberculosis patients who were treated more than two times did not change the source of care. 18,9% of tuberculosis patients changed source of care only once. Even when we limited tuberculosis patient to those who were treated more than five times and whose treatment period were longer than six months, 94.7% of patients did not change source of care at all, or changed treatment facility only once. 4. The probability of change in source of rare was higher in pulmonary tuberculosis, in twenties, and in rural area respectively than other tuberculosis. In conclusion, healer shopping of tuberculosis patients was not serious as expected. However special attention is needed to pulmonary tuberculosis in twenties and rural area.