• Journal of Preventive Medicine and Public Health
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• 제28권1호
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• pp.153-174
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• 1995

This study was conducted to examine the determinant factors for expenditure of the medical insurance program for self-employeds based on the analysis of 1991 'The Medical Insurance Program for Self-Employeds Statistical Yearbook', and also similar yearbooks in the metropolitan and other provinces. The major findings are as follows : We have divided benefits into these four components such as the utilization rate for out-patients, expenses per claim for out-patients as paid by the insurer, utilization rate for in-patients, and the expenses per claim for in-patients as paid by the insurer, in order to examine the determinant factors for it. The results of the study revealed the following findings, in urban areas, the supply of medical care had more influence on the benefits than other demographic and economic variables, while, in county areas, both the supply of medical care and the rate of those aged over 65 affected the provision of benefits. The determinant factors for financial balance of the medical insurance program for self-employeds are, first, the determinant factor for administrative expenses was the number of households. The more the number of households, the less the administrative expenses per the insured. This shows that the economy of scale is being. And so, the administrative district must be taken into consideration in the incorporation of small regional medical societies and should be re-organized for more efficient management. Second, in urban areas, the supply of medical care had more influence on utilization rate and expenses per claim as paid by insurer, and therefore it is necessary to control it. In county areas, the supply of medical care and the rate of those aged over 65 raised the utilization rate and expenses per claim as paid by insurer. For the financial stability of county areas, a common fund for medical care for the aged and expansion of finance stabilization fund would be necessary. But, in county areas, it would be unnecessary to control the supply of medical care because it was much more insufficient than in urban areas. The vitalization of public health facilities must be carried out in county areas, for they reduced benefits. Sice the more insured in a single household, the less the utilization of the medical insurance program, benefits for habilitation at home should be given consideration. The law of majority and the economy of scale were applied here, and therefore the incorporation of regional medical societies must be taken into consideration. In integrating regional medical societies, it would be absolutely necessary to review the structural differences among all regional medical societies, the medical demand of each region, and also the local characteristics of each region.

• 보건행정학회지
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• 제32권2호
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• pp.205-215
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• 2022

Background: The purpose of this study is to identify the factors infecting the medical care utilization from a new perspective by newly classifying the categories of administrative districts using the urban decline index and medical vulnerability index as indicators. Methods: This study targeted 150,940 people who used medical services using the 2015 cohort database (DB), 2010-2015 urban regeneration analysis index DB, and 2014-2015 public health and medical statistics DB. The decline of the region was classified using the urban decline index typed using k-means clustering and the medical vulnerability index typed using the quantile score calculation. Regression analysis was performed 3 times with medical expenditure, length of stay, and the number of outpatient visits as dependent variables. Results: There were 37 stable region (47.4%), 29 health vulnerable region (37.2%), and 12 decline region (15.4%). The health vulnerable region had lower medical expenditure, fewer outpatient visits, and a higher length of stay than the stable region. The decline region was all higher than the stable region but had no significant effect. Conclusion: The factors that cause the health disparity between regions are not only factors related to individual health behavior but also environmental factors of the local community. Therefore, there is a need for a systematic alternative that properly considers the resources within the community and reflects the characteristics of the population.

• 농촌의학ㆍ지역보건
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• 제20권1호
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• pp.51-60
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• 1995

This study was to examine the awareness of health and the utilization of primary health care in rural areas. The data were obtained from self-administered questionnaire conducted 450 parents of Mi Gum md Su Dong middle school students in Nam yang Ju city, Kyung Gi-Do, Korea, from December 15 to 20 in 1993. The results were as follows : 1) Among the causes of disease, 'insufficient health care' was the highest(39.1%), and 'bad environment'(28.9%), 'complexity of life style'(17.8%) in next order. 2) In the priority between 'daily farm work' and 'primary health care', only 45.6% of respondents answered that primary health care is more important than the daily farm work. The 29.8% of respondents answered 'daily farm work', and the 23.1% answered 'the equal of the both'. 3) The 63.6% of the respondents recognized correctly, the meaning of primary health care. And the rate of information source in primary health care were 'TV and Radio'(42.2%), 'medical facilities'(23.3%), and 'newspaper and magazine'(11.3%) in order. 4) In the choice rate of medical facilities for primary health care, 'drug store' was the highest(34.9%), and 'local private clinic'(34.7%), 'health (sub)center'(15.8%), 'hospital'(10.2%) in next order. 5) The 53.5% of the respondents had experienced to visit the health (sub)center more than once. And the disfavorite reasons of health (sub)center were 'insufficient equipment'(36.7%), 'inavailable time to visit'(26.9%), and 'poor treatment'(9.1%). 6) Among the preference of the physicians for primary health care, 'specialist' was the highest rate of the respondents(54.2%), and 'general practitioner'(32.4%), and 'family doctor'(9.8%) in next order. The major obstacles in utilizing the medical facilities for primary health care were 'daily farm work'(41.6%), 'distance'(21.1%) and 'medical cost'(10.4%) in order. 7) The weakened reasons in health (sub)center function were 'insufficient medical equipment'(44.4%), 'the lack of resident's understanding for health (sub)center'(21.8%), and 'short thought of duty in health (sub)center personnel'(16.9%) in order.

• Journal of Preventive Medicine and Public Health
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• 제39권5호
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• pp.411-418
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• 2006

Objectives: The purpose of this study was to determine whether the disabled have worse access to primary care than the non-disabled. Methods: We used the National Disability Registry data and the National Health Insurance data for the calendar year 2003, and we analyzed 807,380 disabled persons who had been registered until December 2001 and we also analyzed 1,614,760 non-disabled persons for nine ambulatory care sensitive conditions (ACSCs). The rates of physician visits and hospitalizations for the patients with ACSCs were compared between the disabled and the nondisabled. Multiple logistic regression analysis was used to evaluate the association between medical care utilization and disability and to assess the association between hospitalization and the number of physician visits while controlling for potential confounders. Results: The numbers of physician visits per 100 patients were $0.78{\sim}0.97$ times lower for the disabled than that for the non-disabled with five of nine ACSCs. The numbers of hospitalizations per 100 patients were $1.16{\sim}1.77$ times higher for the disabled than that for the non-disabled with all the ACSCs. While the ORs of a physician visit for the disabled were significantly lower than that for the non-disabled with all the ACSCs (OR: $0.44{\sim}0.70$), and the ORs of hospitalization for the disabled were significantly higher (OR: $1.16{\sim}1.89$). The lower physician visit group (number of physician visits ${\leq}$1) was more likely to be hospitalized than the higher physician visit group (number of physician visits ${\geq}$2) (OR: $1.69{\sim}19.77$). The effect of the physician visit rate on hospitalization was larger than the effect of disability on hospitalization. Conclusions: The results suggest that the disabled were more likely to be hospitalized for ACSCs due to their lower access to primary care.

• Journal of Preventive Medicine and Public Health
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• 제23권3호
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• pp.285-295
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• 1990

The utilization of medical care services has been partly regionalized with the implementation of referral requirement by the government since July 1, 1989 when the health insurance coverage was extended to all the people. For the purpose of regionalization, the whole country has been primarily divided into tertiary care regions, and each of them again into secondary care regions. This study investigates the self-sufficiency for in-patient care services of secondary care regions focusing on why it varies among the regions. In doing so, analysis is performed to examine a model which embodies three sets of hypotheses as follows : 1) The regional self-sufficiency for medical care services would be subject to direct influences of regional characteristics, amount of available services and structural properties of regional medical care system ; 2) The regional characteristics would have indirect effects on the self-sufficiency which are mediated by medical care services ; and 3) The amount of available services would indirectly affect the self-sufficiency by influencing the structure of regional medical care system. The results of analysis were generally consistent with the model. The findings have some practical implications. The regional self-sufficiency for medical care services partly depends upon basic properties of each region which cannot be changed in a short period of time. Thus the self-sufficiency for medical care services can be improved mainly by health policy measures. In some of the regions the self-sufficiency for in-patient care services was much higher or lower than can be predicted from the bed-population ratio. Indication is that the allocation of health resources should be made considering a variety of factors bearing upon the supply of and demand for health care ; not on the basis of just a single criterion like the availability. The self-sufficiency of a certain region is related to not only its own characterstics but also the characteristics of neighboring regions. Therefore, attention should be also directed to the inter-regional relationships in health care when the needs for investment of health resources in a region are assessed. However, it should be noted that this study used the data collected before the referral requirement was imposed. A replication of this analysis using recent data would provide an evaluation of the impact on the self-sufficiency of the referral requirement as well as a confirmation of the findings of this study.

• 농촌의학ㆍ지역보건
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• 제28권2호
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• pp.87-105
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• 2003

2002년도 군위군 내 30세 이상 저소득주민을 대상으로 건강검진을 실시한 결과 유소견자로 판정된 263명에 대하여 설문지를 이용하여 추후의료기관 이용여부와 관련요인을 조사 분석하였다. 대상자의 추후의료기관 이용률은 51.0%이었으며, 미이용률은 49.0%이었다. 단순분석결과, 추후의료기관 이용률은 소인성 요인에 있어서는 남자의 경우, 건강관심도가 높은 경우, 질병이 오는 이유가 팔자나 운명적이지 않다는 경우, 검진이 건강에 도움이 된다는 경우, 검진결과를 통보 받을 당시 느낌이 걱정된다는 경우가 의료기관 이용률이 높았다(P<0.05). 가능성 요인에서는 의료보장형태가 의료급여인 경우, 과거 2년간 건강검진 경험이 있는 경우, 단골의료기관이 있는 경우, 검진결과를 인지하는 가족이 있는 경우에 추후의료기관 이용률이 높았다(P<0.05). 필요성 요인에서는 검진결과를 본인이 인지한 경우, 판정결과가 건강에 심각하다는 경우, 검진결과를 통보받는 방법이 우편과 전화통보를 받은 경우, 검진결과에 대한 가족반응이 있는 경우, 보건지도가 있는 경우가 추후의료기관 이용률이 유의하게 높았다(P<0.01). 의료기관 이용여부를 종속변수로 하고 단순분석에서 유의한 관련이 있는 변수를 독립변수로 한 다중 로지스틱 회귀분석 결과, 판정결과를 받을 당시 느낌이 걱정이 된 경우, 의료보장형태가 의료급여의 경우 (P<0.05), 과거 2년간 검진경험이 있는 경우(P<0.05), 검진결과에 대한 가족의 반응이 있는 경우(P<0.01)가 의료기관을 더 이용하였다. 추후 의료기관을 이용한 방문시점은 통보 후 8-15일이 가장 높았고 그 다음이 16-30일 순이었다. 재검결과 당초와 같은 질환이 69.4%, 정상이 23.1%, 당초와 다른 질환이 7.5%이였으며, 정밀검사 후 치료유형에서는 규칙적 치료가 39.6%로 가장 높았으며, 치료하지 않은 경우가 34.4%, 치료중단이 11.8%이었다. 추후의료기관을 이용하지 않은 이유는 가벼운 질환인 것 같아서가 32.4%로 가장 높았으며, 일 때문에 시간이 없어서, 결과가 정상이라서, 이전부터 알고 있는 질병으로 치료 중이어서 순이었다. 이상의 결과, 저소득층의 건강검진 실시 후 의료이용 제고와 사후관리를 위해서는 국가와 검진기관, 보건기관, 가족 등이 연대가 되어야 하겠다. 국가에서는 차상위계층의 의료이용문제점을 해결하여 의료이용의 형평성과 효율성을 높이도록 하여야 하며, 검진기관과 보건기관에서는 건강검진 전에 검진의 필요성, 의의, 올바른 수검지도를 실시하고, 건강검진 통보 시에는 유소견자에 대해서는 방문 등을 통하여 추후관리를 하는 것이 의료기관 이용률을 높일 수 있을 것이다. 그리고 건강검진 결과에 대한 올바른 해석, 의료이용의 필요성, 해당 질환에 대한 정보에 대해 본인 뿐만 아니라 가족을 포함한 보건지도가 있어야 하겠다.

• 대한간호학회지
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• 제25권4호
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• pp.774-789
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• 1995

Due to the rapid socioeconomic development and the introduction of the national health insurance system the general population's need for health care and utilization of health care services have increased dramatically. As a result of this change. Korea is experiencing a shortage of health care facilities and health manpower, and this leads long wailing line at doctor's offices. One of the solutions of this problem could be home health care system for those who have minor health related problems. With this background, this study was conducted to look at the feasibility of a home-based prenatal care system using information superhighway and nursing informatics specialists. With the home-based prenatal care system, the pregnant woman checks her blood pressure, tests her urine for sugar and protein, and measures her body weight at home and sends the information to a hospital computer via the information networks such as public telephone line and information superhighway. Nursing informatics specialist at the hospital will go through each patient record and screen those who have abnormal values and notify them to see a doctor as soon as possible. Besides telemonitoring features, the proposed system will include tole-education capabilities for the patients so that patient can learn whatever they need to know ragarding the prenatal care via information networks. If this system develops and operates, patient can save time in terms of travel to and from the hospital and waiting time in the hospital. And the health care institute can utilize its resource more efficiently.

• Journal of Preventive Medicine and Public Health
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• 제24권4호
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• pp.485-495
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• 1991

This study examined the effects of referral requirements for insurance patients which have been enforced since July 1, 1989 when medical insurance coverage was extended to the whole population except beneficiaries of medical assistance program. The requirements are mainly aimed at discouraging the use of tertiary care hospitals by imposing restrictions on the patient's choice of a medical service facility. The expectation is that such change in the pattern of medical care utilization would produce several desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities. In this study, these effects were assessed by the change in the number of out-patient visits and bed-days per illness episode and the share of each type of facility in the volume of services and the amount of expenditures after the implementation of the new referral system. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for the patients treated during the first six months of 1989, prior to the enforcement of referral requirements, and those of the patients treated during the first six months of 1990, after the enforcement. The 1989 sample included 299,824 claims (3.6% of total) and the 1990 sample included 332,131 (3.7% of total). The data were processed to make the unit of analysis an illness episode instead of an insurance claim. The facilities and types of care utilized for a given illness episode are defined to make up the pathway of medical care utilization. This pathway was conceived of as a Markov Chain process for further analysis. The conclusion emerged from the analysis is that the enforcement of referral requirements resulted in less use of tertiary care hospitals, and thereby decreased the volume of services and the amount of insurance expenses per illness episode. However, there are a few points that have to be taken into account in relation to the conclusion. The new referral system is likely to increase the use of medical services not covered by insurance, so that its impact on national health expenditures would be different from that on insurance expenditures. The extension of insurance coverage must have inereased patient load for all types of medical service organizations, and this increase may be partly responsible for producing the effects attributed to the new referral system. For example, excessive patient load for tertiary care hospitals may lead to the transfer of their patients to other types of facilities. Another point is that the data for this study correspond to very early phase of the new system. But both patients and medical care providers would adapt themselves to the new system to avoid or overcome its disadvantages for them, so as that its effects could change over time. Therefore, it is still necessary to closely monitor the impact of the referral requirements.

• 성인간호학회지
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• 제15권3호
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• pp.432-440
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• 2003

Purpose: The purposes of this study were to examine 1) functional status at 2 months after hip fracture surgery 2) health care utilization after a fall episode and 3) fear of falling experienced during first 2 months after a fall episode. Method: With a convenient sample of 99 elderly from six university or general hospitals with hip fracture from a fall, data were collected at 2-3 days before discharge and at 2 months after hip fracture surgery. Result: 1) At 2 months after hip fracture from a fall, significant proportion (25.3%) of elderly was not able to walk indoors. 2) Average length of hospital stay was 27.6 days with a range of 8 to 86 days. About 51% subjects received physical therapy during hospital stay, and only 6.1% subjects received physical therapy following discharge from the hospital. 3) Significant proportion (72.7%) had fear of falling after the fall episode. About 51% reported that they restricted their activities because they had fear of falling. Conclusion: Fall is a dreaded event which result in loss of independence and restriction of activity. Development and application of fall prevention program is critical especially for those with risk factors of fall.

• 디지털융복합연구
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• 제12권7호
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• pp.327-336
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• 2014

본 연구는 심뇌혈관 환자의 정기적 의료이용에 영향을 미치는 요인을 살펴보는 데 목적이 있다. 2010년 한국의료패널조사 자료를 이용하였으며, 설문에 응답한 응답자 중 심뇌혈관질환자 770명을 대상자로 하였다. 분석대상자의 의료이용 현황을 파악하기 위하여 기술통계를 실시하였으며, 심뇌혈관 환자의 정기적 의료이용에 영향을 미치는 요인을 파악하기 위하여 로지스틱회귀분석을 실시하였다. 연구 결과, 심뇌혈관 환자의 정기적 의료이용에 영향을 미치는 요인은 연령, 교육수준, 가구소득수준, 동반상병지수(CCI), 고위험음주 유무, 비만 유무로 나타났다. 연령별로는 60-69세, 교육수준별로는 고등학교 이상, 가구소득수준별로는 중위수 이상, 동반상병지수(CCI)가 높을수록, 고위험 음주 무, 비만인 환자가 정기적으로 의료를 이용할 확률이 높게 나타났다. 이는 정기적 의료이용이 낮은 중위수 미만 환자와 고위험 음주 유인 환자 등 문제의 원인과 대상에 맞는 구체적인 관리방안을 모색하는 노력이 필요할 것으로 보인다. 이러한 결과들은 향후 보건의료정책 수립에 기초 자료로 의미 있게 활용되어질 수 있으리라 여겨진다.