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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
Editor in Chief :
Volume & Issues
Volume 10, Issue 4 - Dec 2000
Volume 10, Issue 3 - Sep 2000
Volume 10, Issue 2 - Jun 2000
Volume 10, Issue 1 - Mar 2000
Selecting the target year
Health Care Utilization and Its Determinants of Public Officials with Detected Diseases through Periodic Health Examination Program In Health Insurance
Health Policy and Management, volume 10, issue 3, 2000, Pages 1~18
This study was conducted to find medical care utilization pattern and to examine the affecting factors on medical facilities utilization using Andersen's medical care service behavioral model. Three hundreds and five public officials with detected disease through the health examination in 1998 were surveyed using self-administered questionnaire. And 230 data were available and analyzed. The results of this study were summarized as follows: Among variables of predisposing factors, knowledge for disease, confidence about periodic health examination program in health insurance, and the attitude toward medical utilization in the usual showed significant relations with the medical utilization. Other variables were not related with the medical utilization. Variables of enabling factors did not show significant relations with the medical utilization. Recognition of family members for detected disease had significant relations with the medical utilization. Among variables of need factors, absence caused by detected disease was significantly related with the medical utilization. The number of non-occupational diseases detected, but untreated people were 75(32.6%) of total subjects, mainly because detected diseases seemed insignificant to them. With multiple logistic regression analysis, the significant variables having an effect on the medical facilities utilization were 'knowledge for disease', 'attitude toward medical utilization in the usual', 'recognition of family members for detected disease' and 'experience of absence caused by detected disease'. On considerations of above findings, counselling for detected disease and its treatment, health education for individuals and program for family support promotion are needed for health management of public officials with diseases detected in health examination.
Recognition Level of Organization, Motivation and Job Satisfaction Factors of the Staff of Health Centers
Health Policy and Management, volume 10, issue 3, 2000, Pages 19~49
This study was conducted to help staff members of health centers manage personnel by examining the staff members' recognition level of organization structure of health centers, their motivation, their job satisfaction level and its related factors. Data were collected from 471 staff members of 14 health centers from March 3, 1999 to April 30, 1999. The results of this study are summarized as follows. In recognition levels of organization structure of health centers, the recognition level of necessity of discretion right was highest(3.55 points on the base of 5 points), while the recognition level of the location of decision making right was lowest(2.77 points). The general recognition of organization structure of health centers was 3.06 points, the suitability of division of duties was 3.05 points, and the optimum of manpower and budget was 2.93 points. The staff members' general recognition level of the organization structure appeared significantly higher in case of the groups of small and medium sized cities, above fifties, below high school graduate, above the sixth grade, public service experience of above 20 years, service period of below 2 years at present post, and average monthly salary of one million, eight hundred and ten thousand won. In the recognition level of the location of decision making right, the groups of big cities, male, the married, above the sixth grade, health and administration posts, average monthly salary of one million, three hundred and ten thousand won to one million, and eight hundred thousand won were significantly higher than the other groups. The recognition level of necessity of discretion right was higher in case of the groups of the twenties, the unmarried, above college graduate, nursing post, public service experience of below 5 years, service period of below 2 years at present post, and average monthly salary of below eight hundred thousand won. In the recognition level of suitability of division of duties, the groups of small and medium sized cities, the married, medical technicians, public service experience of above 20 years, and service period of below 4 years at present post were significantly higher than the other groups. In the staff members' recognition levels of organization management, the recognition level of opinion response when making decision was highest(2.92 points). The recognition level of rationality of the target amount establishment method was 2.88 points and the recognition level of personnel management was 2.63 points. The recognition level of personnel management was significantly higher in case of the groups of small and medium sized cities, the forties, above the sixth grade, medical technicians, public service experience of above 20 years, service period of below 2 years at present post, and average monthly salary of above one million, eight hundred and ten thousand won. In the recognition level of opinion response when making decision, the groups of small and medium sized cities, female, the eighth grade, health and administration posts, and service period of below 2 years at present post were higher than the other groups. The recognition level of rationality of the target amount establishment method was significantly higher in case of the groups of above fifties, below high school graduate, above the sixth grade, medical service post, and public service experience of 15 to 20 years. The factors significantly influencing sanitation were sex, education level, the period of public service experience, general recognition of organization structure, recognition of necessity of discretion right, recognition of suitability of division of duties, and recognition of opinion response when making decision. The factors which significantly influenced motivation were marital status, grade, recognition of the location of decision making right, recognition of necessity of discretion right, recognition of division of duties, recognition of opinion response when making decision, and sanitation. Sex, education level, recognition of suitability of division of duties, recognition of the target amount establishment method, and motivation influenced job satisfaction significantly. The factors significantly influencing organization culture were age, the period of public service experience, service period at present post, recognition of optimum of manpower and budget, recognition of suitability of division of duties, recognition of opinion response when making decision, and recognition of rationality of the target amount establishment method. In the coming days, the staff members' job satisfaction level must be increased through motivation and efficient conduct of duty must be accomplished through rational organization structure and management. Moreover, change of the staff members' consciousness and administrative system which are suitable for local autonomy system have to be established with increase of local residents' consciousness level and education level. Forming organization culture by reformative idea which fits the new era, public health service by the Community Health Act and health education service by the Health Promotion Act must be carried out efficiently. In doing so, financial support of central government and active efforts and concerns of local governments have to be devoted in order to get public health service in which peculiarity of the community is considered to be pursued well
Estimation of the Consumption of Antibiotics in Korea
Health Policy and Management, volume 10, issue 3, 2000, Pages 50~67
This study aims to estimate the consumption of antibiotics in Korea and to suggest the further studies. To measure the amount of antibiotics consumption, we referred to the statistic of NFHI(National Federation of Health Insurance) and a private institute of pharmaceutical information(Korea Intercontinental Medical Statistics; IMS Korea). There were 1,563 antibiotics produced in Korea in 1997. The total amount of antibiotics production was 1,197 billion won in 1997. Antibiotics accounted for 17.6% of the total pharmaceutical productions in 1997. Cephalosporins have taken the largest part of antibiotics production since 1992. The estimation using NFHI data showed that the total expenditure of antibiotics used in health facilities was 268 billion won, 608 billion won, 911 billion won in 1990, 1994, 1997 respectively. Tertiary hospitals spent 246 billion won, general hospitals 287 billion won, hospitals 78 billion won, clinics 300 billion won in 1997. The amount of expenditure and the intensity of antibiotics consumption in hospitals have increased more steeply than any other health facilities. The total expenditure of antibiotics consumption in health facilities and pharmacies was 778 billion won when estimated using the data from IMS Korea, and 999 billion won from NFHI. Cephalosporins was the fast growing antibiotics group in all of the market- hospitals, clinics, pharmacies since 1991. To measure the amount and patterns of antibiotics consumption more precisely, a pharmaceutical monitoring or surveillance system is needed.
Conceptual Design for Virtual Hospice Center
Health Policy and Management, volume 10, issue 3, 2000, Pages 68~87
This study aims at the operation of the hospice in the virtual space by the use of telecommunication technology. The hospice can be an efficient alternative for the elderly and terminal patients. It can achieve both the quality of life of patients and the conservations of medical resources. The virtualization creates new norms and values which are different from the conventional environments. The concepts and limitations which are crucial to the projection of the existing hospice into the virtual space are discussed. The items ranging from the hospice need to the design criteria of the modules are investigated. The most important point in constructing the virtual hospice center is the human factor, which characterizes the hospice. In addition, the real-world circumstances of the hospice should be considered in the realization of the VHC.
Changes in Self-evaluated Health States after the Participation to the AA Program
Health Policy and Management, volume 10, issue 3, 2000, Pages 88~107
The Alcoholics Anonymous(AA) program has been known to be effective in many countries in helping alcoholics to stop drinking and to change their attitudes, beliefs, and behaviors. In this study, we examined AA activities among Korean AA members and measured the self-evaluated physical, social, and mental changes following the entry into the AA program. Out of identified 300 AA members who were attending 18 different AA group meetings at the time of the survey, 207 completed the self-administered questionnaire(response rate of 69.0%). T-test and ANOVA were used to compare the scores of physica(4-items), social(4-items), and menta(10-items) changes according to the level of AA activities. The proportion of the respondents who practiced the 11th step (meditation) or the 12th step (take alcoholics to a meeting after carrying messages) on the regular basis was 66.6% and 37.2%, respectively. The average time spent in meditation per week was
hours. The length of participation in AA meetings has significantly positive impact on the average score of changes in all the 3 health states; physical(p<.01), social(p<.05), and mental states(p<.01). Also, practicing the 11th step was significantly associated with improvement of social(p<.01) and mental(p<.05), while practicing the 12th step improved only mental states(p<.01). Our findings demonstrated that not only the length of participation in AA meetings but also the practice of regular meditation(11th step) and taking alcoholics to an AA meeting after carrying messages(12th step) are very important for AA members, and lead to great positive changes in physical, social, and mental states following entry into the AA program.
Korean Experiment for the Unification of Multiple Health Insurers : A Road to Success or Failure
Health Policy and Management, volume 10, issue 3, 2000, Pages 108~128
The Korean government has implemented the policy for merging 141 health insurers into Korean Unified Health Insurer (KUHI) in July of 2000. The unification of multiple insurers will definitely effect the stability of financial management, equity of premium burdens and efficiency of administrative management. However, it is difficult to predict what forms the far-reaching effects of the unification would take. Thus, pursuing the unification may be express as a huge policy experiment. In order to lead the unification, which lies on a crossroad between success and failure, to the road of success, we need to infer the problems and obstacles predicted in the step-wise processes of merging organizations, finances and the systems of computing premium, and come up with the effective means to maintain the stability of financial management, to improve the equity of premium burdens and to increase the efficiency of administrative management. Thus, I first described the changes of the Korean medical insurance system, and analyzed the performances of self-employed medical insurance 1 year after the integration of societies in October of 1998. At the base of examining the stability of financial management, equity of premium burdens and efficiency of administrative management, I predicted the problems and obstacles that could occur after the unification of the multiple medical insurers, and proposed a few ways of leading the unification of the multiple medical insurers in Korea to success. The most worried factor is that insurance finance would become unstable since the expansion of premium revenues is not easy because raising the premium for all Koreans is to be difficult. In addition, the unification of insurance finance could weaken the insurer's efforts for declaring real incomes of the self-employed and increasing the collection rate of premiums from them. This weakening would be the decisive factor of lowering the equity of premium contributions between the self-employed and employees. And bureaucratization and rigidity that are unavoidable in a gigantic unified organization could lower the efficiency of administrative management. Furthermore, by having 3 labor unions in the unified organization, it is possible to experience frequent difficulties and discords among the unions and between the unions and organization. Thus, when smooth pursuing of the unification of multiple insurers gets difficult, the social expenses derived from the failure would eventually end up on all Koreans. The unification is to be performed after coming up with the ways to eradicate these worries, so that the unification of multiple insurers would step onto the road of success.
Quality of Life Using WHOQOL-Bref in Taegu
Health Policy and Management, volume 10, issue 3, 2000, Pages 129~154
This study aims at providing the basic data necessary for developing a model of and the policies for the improved quality of life of the adult population by measuring and analyzing factors affecting the quality of life based on a WHOQOL-Bref survey of 1,200 persons above the age of 20 residing in Taegu Metropolitan City area. 1. The factors affecting their quality of life were measured as follows: The physical conditions got the highest point of 3.31 while the psychological conditions got 3.20 and the environmental conditions got the lowest point of 3.09. The overall quality of life was rated to be at 3.11 2. General conditions affecting the quality of life, such as the economic conditions, health conditions and stress all turned out to be variables having significant differences(p〈0.01) in all the factors affecting the quality of life. 3. Through the analysis, we also found out the positive correlation exists among all the factors determining the quality of life(p〈0.01), while the psychological factor turning out to have the highest correlation value(r=0.640) with the overall quality of life. 4. To find out the factors affecting all the aspects of quality of life, we also conducted a multiple regression analysis employing the general characteristics as an independent variable. The health, economic and stress conditions all turned out to be significant in all aspects(p〈0.01). Summarizing the above analysis, the quality of life has a high correlation with the psychological, physical and environmental conditions. It has also turned out that the health, economic and stress conditions have the greatest influence on the quality of life. Therefore, it is believed to be necessary that a comprehensive program be developed to promote the public health and to formulate a model for improvement of the people's quality of life that can enhance their physical, psychological and social health conditions.
Measuring Expectations in Assessment of Consumer Satisfaction by SERVQUAL
Health Policy and Management, volume 10, issue 3, 2000, Pages 155~168
The SERVQUAL scale is based on the gap theory, which indicates the difference between consumers' expectations and their actual performance. In SERVQUAL scale, the expectations are defined as a "feasible ideal point"(ex, An Excellent hospital has up-to-date equipment). But empirical research identified important problems concerning the conceptual definitions of expectations. They suggests the usage of "desired expectations". Desired expectations are defined as the level at which the consumer predict the service that the organization they visited will perform(ex,
hospital has up-to-date equipment). The purpose of this study was to compare the feasible ideal point expectations with desired expectations in assessment of consumer expectations using SERVQUAL scale. We developed two types of questionnaires : (1) to measure feasible ideal point expectations, (2) to measure desired expections. Questionnaire were distributed to ambulatory patients who used the medical service. Total 329 patients participated the hosiptal satisfaction questionnaire(167 for feasible ideal point expectations, 162 for desired expectations). The major finding is as follows: (1) the SERVQUAL scale which was computed by the feasible ideal point showed the higher explanatory power in consumer satisfaction (
=0.26) than the other identified alternatives(desired expectation,
=0.11) The results of a study suggests that the feasible ideal point were more conceptually suitable to assess of consumer satisfaction using SERVQUAL scale.SERVQUAL scale.
Estimation of Productivity Losses due to Smoking
Health Policy and Management, volume 10, issue 3, 2000, Pages 169~187
Cigarette smoking has been identified as the most important source of preventable morbidity and premature mortality (WHO, 1995), The prevalence of smoking among men is very high in Korea. This study estimated productivity losses due to smoking in Korea, 1997. The derivation of cost estimates for mortality, disability, hospitalization and use of physician services related to cigarette smoking is bas 어 on the calculation of attributable fractions suggested by MacMahon and Cole and Smoking-Attributable Mortality, Morbidity, and Economic Cost(SAMMEC) software. To estimate the number of deaths from neoplastic, cardiovascular, respiratory diseases associated with cigarette smoking, estimates for adults(aged 20 years and over) were based on 1997 mortality data, 1995 data on smoking prevalence from Korea Institute for Health and Social Affairs. Smoking-attributable indirect morbidity cost data were obtained from the National Federation of Medical Insurance. As the result of cost estimation, these productivity losses were 336-430 billion won. During 1997, 8,620-10,804 deaths were attributed to smoking. Cigarette smoking resulted in 133,991-169,422 Years of Potential Life Lost (YPLL) to life expectancy. For smoking -attributable indirect mortality costs, the present value of future earnings(PVFE) for the age at death are 299-384 billion won. Smoking-attributable indirect morbidity costs, the costs of lost productivity for persons who are disabled by smoking-related chronic diseases are 37-46 billion won. In this study the productivity losses due to smoking were restricted to the health effects of smoking. It is possible that these costs were underestimated with the limitation of the data. Smoking is the leading preventable cause of illness and death. The results of this study can be used as elementary data for antismoking policy.