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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
> Journal Vol & Issue
Health Policy and Management
Journal Basic Information
Journal DOI :
The Korean Society of Health Policy and Administration
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Volume & Issues
Volume 1, Issue 1 - Oct 1991
Selecting the target year
A Study on the Characteristics of Administrating Practice of the Directors of Health Centers in Korea.
Health Policy and Management, volume 1, issue 1, 1991, Pages 3~18
On the stage of transition from highly centralized government to local self-government in Korea, administrating practice characteristics of the directors of Health Centers is essentially required to be found. This study was conducted in order to find the administration patte군 of the directors of Health Centers in Korea and their opinion on the environment of health administration including personnel management regime for them. The materials were collected from 149 directors of Health Centers with a structured questionaire by mailing. The major findings of this study were as follows. 1. About two-thirds of the directors(69.1%) make plan through the consensus between public service perosonnel in programme department and them in budgt control department. And 75.0% of the directors maintain the planed by the predecessor. 2. More than two-thirds of the directors (71.1%) take subordinates opinion into consideration in case of the programmes facing objections. 3. When the directors face obstacles in pursuing health programmes they usually consult other public service personnel than inhabitants. 4. Only 10.8% of the directors were satisfied with the support of the Ministry of Internal Affairs for health administration while more than half of them were satisfied with the support of health institution in higher level. 5. The directors evaluated the job attitude of the public service personnel in low level as more favorable than that of there higher level public service personnel who work for central government. 6. Only 18.1% of the idrectors were satisfied with their saley. And more than half of them expect the promotion of their position. On the ground of this result the administration attitude of the directors of Health Centers would be evaluated as improved and as more positive than that of other public service personnel in health authorities. However, they are required to consult the inhabitants more frequently for health administration. An the public service personnel in high level who work for central government are required to improve their job attitude.
Analysis of the Effects of Demographic Variables on Health Care Services Using the Spline Regression
Health Policy and Management, volume 1, issue 1, 1991, Pages 19~26
Demographic variables have a great deal of impact on the utilization of health services. In this paper, the use of segmented polinomials is shown to be superior to the simple use of dummy variables and simple polinomials in explaining differences in health care utilization with respect to sex and age differences.
Analysis of Institutional Factors Influencing Regional Variations in the Cesarean Section Rate
Health Policy and Management, volume 1, issue 1, 1991, Pages 27~41
The purpose of this study is to estimate cesarean section rate in Korea and analyze characteristics of health care institution which affect regional variation in the rate. We have searched vaginal and cesarean section deliveries among Diagnosis Related Group dat based upon insurance claim bills which have been submitted to Korean Insurance Corporation for two years since March, 1985. The results are as follows: 1. Out of all delivery cases of 87,500, cesarean section rate was 16.3% (14,299 cases). 2. Cesarean section rate varied according to size and ownership of health care institutions. In above 6- bed sized hospitals, the rate was at about 20% higher than small sized institutions, but rather in hospitals that have more than 500 beds, it was somewhat low. Classified by the hospital ownership, the rate was low at 18.4% in hospitals of religious organization and highest at private or corporate hospitals. 3. This study shows large regional variation in cesarean section rate; there are two times differences between region with the highest and lowest rate. Strongly related factors in that variation was the ownership of health care institution and urbanization variables. Low level of cesarean section rate in a region is explained by high proportion of delivery cases at institutions of religious organization and at insitutions in county level site. This result shows that apart from medical conditions of patients, indications of cesarean section differs from health care providers, and especially ownership of institution strongly affect them. Cesarean section rate in Korea is supposed to be at high level and development of utilization review programs to keep appropriate cesarean section rate is needed.
Small Area Variation
Health Policy and Management, volume 1, issue 1, 1991, Pages 42~53
Analysis of health care utilization is very important for health care policy development. Traditional studies of health care utilization were focused on measuring the level of health care utilization and on analyzing the determinants of health care utilization in the defined areas and populations. But there were some limitations in comparing the health care utilizations rates in traditional studies because so many factors were to be considered. Small area analysis is a method used to demonstrate substantial variations in health care utilization with popualtion-base use rates among similar geographic areas. This review discusses the methods, magnitude and trend of geographic variations, factors influencing small area variations, and makes suggestions for further study. Finally, the article discusses the necessity and feasibility of small area analysis in Korea.
Maternal Child Health : Toward Better Performance
Health Policy and Management, volume 1, issue 1, 1991, Pages 54~71
Health of a nation is quite often represented by the statistics such as infant death rate and maternal mortality rate. It is indisputable that maternal child health(MCH) is the basis of health of a nation. MCH is also one of the cardinal component of primary health care. The importance of MCH is conspicuous especially in the developing countries. In Korea, People in the rural communities still have high access barrier to basic health care needs, including MCH services. Access to quality care during pregnancy and delivery seems to be the crucial factor in preventing deaths in women and children. The beneficial effects of prenatal and postnatal care on the outcome of pregnancy for mother and child, and those of health professional-attended institutional delivery on the health of mother and child have been well documented in many studies. Recognizing these effects, the government of Korea received IBRD loan of $30 million in 1979 for th purpose of constructing 89 rural MCH centers. The construction is complete now and all 89 MCH centers are under operation ti imporve primary health care for mothers and children in Korea. However, it has been observed over time that overall performance of public MCH centers is declining. The decline has been attributed partly to low quality services by public MCH centers, poor management by health center mangers, competition with for-profit private clinics, and to the development of national health insurance. This study investigates the utilization by rural communities in Korea of MCH services provided by public sector health centers deemed to be physically and financially accessible to the community but suboptimally used. It seeks also to determine the factors that influence people's utilizations. This study sets out to discover a desirable form of MCH center from among alternative forms of centers, thereby to construct a MCH model.
The Proposal of Reforming for Resolving Medical Malpractice Disputes
Health Policy and Management, volume 1, issue 1, 1991, Pages 72~94
The number of disputes between physicians and patients caused by medical malpractice are showing a sharp increasing over the past several years. The disputes on medical malpractice may be resolved either in court or by direct negotiation between both sides concerned. There are no special acts relating to the civil or penal liability of the physicians in Korea. The medical disputes are decided merely through legal technicalities and without reference to actual medical practice. The current system which does not compensate injured patients adequately or equitably leads to taking a long time consuming for dispute resolution processes. The things make worsed, the problem is due to not being of insurance system or a proper funds for compensation. This research proposes a outline of new and comprehensive alternative for these problems and failure of conventional resolution of medical disputes. So far, we have learned lessons from the excperiencies of resolving medical malpractice disputes of Japan and the United States. The proposal first calls for an administrative arbitration and pretrial screening panels as a condition precedent to trial. The proposal also includes to facilitate with the funds for compensating the injured.
Primary Health Care and Desirable Policy Directions in Korea
Health Policy and Management, volume 1, issue 1, 1991, Pages 95~108
The World Health Organization and its member states, in 1978, declared that primary health care is a key to attain the goal of Health for All by the goal of Health for All by the yeas 2000. As a member state of WHO, the Republic of Korea has participated in the declaration of ALMA-ATA and committed to put national efforts for devedoping and implementing primary health care approach with the spirit and content of this Declaration. Since 1978, to translate the spirit of the Declaration into realization, Korean goverment has developed a new category of health manpower such as Community Health Practitioners serving people living in remote rural areas and Village Health Workers serving voluntarily their own village, strengthened the function of Health Centers and Health Subcenters through their reorientation and improved the infrastructure by their new construction or renovation. While primary health care is viewed as an essential health care in Korea, there are some circles who follow a narrow definition in referring to the health care at the periphey of a health system, which is erroneous. Considering the PHC is accepted as the best alternative approach to health care to solve problems that modern health systems are facing, we propose the followings as desirable health policy directions that modern health systems are facing, we propose the followings as desirable health policy directions which might translate the persopective into action at the national level after reviewing past and current PHC approach in Korea : 1. To improve the equity through the reduction of gaps between those who have access to health care and those who have not. 2. To reinforce multisectoral approach and intersectoral coordination through the re- establishment of the National Health Council or establishment of equivalent organization at the central level. 3. To stengthen community participation through lacal people's empowerment by leadership training, changing planning process from the top-down approach to bottom-up and giving the priority to human resources rater than technology, 4. To reinforce the Ministries of Health and Social Affairs through upgrading its role and function to Coordinate Ministries which involve human welfare policies, and creating a Division which is in charge of PHC in the Ministry.
An Approach to program Design of Management Information Sytems for Health Centers and Subcenters
Health Policy and Management, volume 1, issue 1, 1991, Pages 109~115
We are in the process of developing information systems that can be helpful for the effective management of community health services provided by the health center and subcenters in Hwachon Gun, Kangwon Do. In doing so, we have employed a different program design from those programs of information systems developed in other health centers or subcenters. The main idea of our design is dividing all the programs into two parts. One part is for the control of operation functions such as addding, seeking, editing, and printing needed to all the tasks. The other consists of a set of programs each of which deals with a specific task. It is believed that this program design would result in an information system that is simple to use, easy to modify and expand, and flexible to new computer technologies.
An Analysis on the Utilization Patterns of Health Care Facilities for an Employees Health Insurance Program
Health Policy and Management, volume 1, issue 1, 1991, Pages 116~135
Few studies have been conducted on the detailed routes of medical care utilization under the National Health Insurance. This study was undertaken to identify the utilization patte군 of health care facilities among industrial workers and their dependents. One of the largest health insurance association was purposively chosen for this objective. The association had 345, 757 members as of 31 December, 1990. The study sample of 297, 948 subjects have been drawn from the membership pool on the basis of their continuous membership status during 1 January through 31 December 1990. This study has tried to identify differential utilization patterns between acute and chronic conditions, and among standard income classes. All the diagnoses were recoded in a manner to achieve the objective of this study. As for acute diseases, most age group had used one medical facility as much as by 60% except the age group of 1-4, This young age group had used over three different health facilities as much as by 10.9-15.8%. The finding suggests that some policy measures by sought for remedying the excessive/inappropriate use of services. In addition, mid-income classes(between 17 and 48) were more likely to use multiple sources of care than lower income classes(between 1 and 16) and upper income classes(above 49). This study has revealed that chronic cases are more likely to pursue multiple sources of care, however those with chronic conditions tend to use single health facility more than those with acute conditions(67.9% versus 52.4%). As many as 12.2% have visited more than three health facilities in chronic conditions, but 5.9% for acute conditions. The most likely source of care was primary clinics for both acute and chronic conditions. Compared with the role of general hospital, small-size hospitals found to play a minimal role in the care and referral of patients. This indicates the need of strengthening the function of small-size hospitals. While a minor cross utilization of western medicine and pharmacy was noted, no significant boundary crossing was identified between western medicine and oriental medicine, or between pharmacy and oriental medicine. It is too early to confirm that whether there is substitutability or cross utilization among these alternative sources of care. A further study is needed to identify these relationship.
The Supply and Demand Projection of Physicians in the Medical Service Area
Health Policy and Management, volume 1, issue 1, 1991, Pages 136~152
The study was conducted to project supply and demand of the physicians from year 1991 to year 2010 based on the analysis of supply and demand of the physicians up to year 1989. Results of the study will provide information for the physicians manpower planning of the 7th 5-year Economic Social Development Planning(1992-1996) and contribute to the overall health manpower planning for the 21the century. It is projected that physician will be oversupplied from the very near future based on the current productivity or underestimated based on the optimal productivity. Thus, it is desirable not to change size of training and education during the 7the 5-year planning period and re-examine the status of the physician manpower at the end of the 7th 5-year period taking into consideration medical services utilization pattern, patients' satisfaction, and physicians' productivity.
Nature and Issues of Hospital Management
Health Policy and Management, volume 1, issue 1, 1991, Pages 153~160
Hospital Management, as a branch of science, is now in a formative period in Korea. Proper understanding on the scienctific nature and issues of the subject, therefore, is important for both its developement and education of the students. As an academic subject, Hospital Management can be pointed out to have three characteristics, Firstly, when looking it in teleological viewpoint, it is a branch of health science. Ultimate goal of the hospital lies in promoting and keeping health of the people residing in the catchment area in which it places, Secondly, in terms of its contents, Hospital Management can be divided into tow subsubjects ; hospital administrative management and hospital business management. The former stands at the point of looking the hospital as the object of goverment administration, while the latter as the subject of organizational operation. Flanlly, Hospital Management, in its academic appoach, is a science that adopts management theories, what is called, traditional and/or modern. For the settlement and development of the Hospital Management, four major issues were suggested for discussion now and in the future. They include ; (1) boundary between Hospital Management and its related academic fields (2) subdivision of the subject and its contents, (3) activation of study, theortical and empirical, and (4) distinction of the level of lecture among lecfnical, four-year and gradudate courses.