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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
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Health Policy and Management
Journal Basic Information
Journal DOI :
The Korean Society of Health Policy and Administration
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Volume & Issues
Volume 14, Issue 4 - Dec 2004
Volume 14, Issue 3 - Sep 2004
Volume 14, Issue 2 - Jun 2004
Volume 14, Issue 1 - Mar 2004
Selecting the target year
A Study on job satisfaction and strategies to improve the system of Public Health Doctors in Charge of Community Health programmes
Health Policy and Management, volume 14, issue 1, 2004, Pages 1~23
DOI : 10.4332/KJHPA.2004.14.1.001
This study was carried out to investigate the activities and job satisfaction of public health doctors in charge of community health programmes. Subjects were 138 public health doctors charged with community health project, registered in the roll of public health doctors, made out by Central Supporting Team for the District Health Work in 2002. Data was obtained from Ninety-six public health doctors. The response rate was 70%. The survey was conducted from March to April in 2003 bye-mail. The items of the questionnaire consisted of general characteristics of participants, understanding of their activities, support system, job satisfaction, and suggestions to improve the system. Collected data was analyzed using PC-SPSS 10.1. Descriptive analysis, t-test, and ANOVA test were used. The results are as follows: Most of the respondents showed a low participation rate in community health services, but they agreed to the importance of their activities and the necessity to modify and improve the system. 70% of the respondents were dissatisfied with their jobs. The participation in health planning and programmes of health center, and the degree of acceptance of their opinion from health center workers were significantly related to their job satisfaction. The participation rate of the public health doctors having specialty, in community health services is higher than that of the others. In terms of the supports for system operation, the reflection of one's intention in job arrangement process, education and public relation of this system, and the administrative and financial supports made significant differences in the job satisfaction and the accomplishment of their duty. The respondents hoped that the administrative and financial supports for public health doctors in charge of community health programmes should be reinforced to motivate them. They also wanted that they could keep from being overloaded with clinical services. They favored to conduct home visit, community diagnosis, health planning, and health promotion programs as their appropriate activities. From these results, we suggest some strategies to motivate and empower the public health doctors in charge of community health programmes.
Trends of Alcohol Attributable Mortality in Korea: 1995-2000
Health Policy and Management, volume 14, issue 1, 2004, Pages 24~43
DOI : 10.4332/KJHPA.2004.14.1.024
Although alcohol misuse contributes substantially to mortality from diseases, injuries and adverse effects, a few attempts have been made to figure out size of adverse consequences attributable to alcohol in Korea. This study was conducted to describe trends of estimated deaths attributable to alcohol in Korea. Estimations were made by employing Korean alcohol aetiological fraction(AEF) into deaths from alcohol-related diseases, injuries, and adverse effects from year of 1995 through 2000. Korean AEF was derived from previous studies on AEF applied to USA and Canada (Schultz et al.,1991; English et al., 1995) with reflecting peculiar drinking patterns in Korea. An average number of deaths attributable to alcohol was 21,123, accounting for 8.76% of all deaths reported to National Statistical Office during the period. Death rates attributable to alcohol tended to decrease from year of 1995 to 1997 and then increased with peak at year of 1999. Sex-age standardized alcohol attributable death rates varied among areas, with those of metropolitan areas being lower than those of non metropolitan areas. Years of potential life lost (YPLL) were estimated to reflect qualitative aspect of deaths attributable to alcohol. Similar change patterns during the year were observed between number of deaths and YPLL. Average YPLL of men was longer than that of women by about 4 years. Some implications for future study have been discussed.
Impact of Korea's reform for separation between prescribing and dispensing of drugs on profits of doctor's clinics and pharmacies
Health Policy and Management, volume 14, issue 1, 2004, Pages 44~64
DOI : 10.4332/KJHPA.2004.14.1.044
As of 1 July 2000 a big reform was introduced into the Korean health care system: the separation between prescribing and dispensing of drugs (SPD reform). There was, however, a big financial stake associated with pharmaceuticals, particularly before the reform, because physicians as well as pharmacists were allowed to purchase drugs at much lower costs than the insurance reimbursement. In this respect, this study focuses on the change in income and profit of both doctor's clinics and pharmacies after the reform. Data from National Health and Nutritional Survey by the ministry of health and welfare were used to estimate the income or expenditure that are financed by out-of-pocket payment of the patients, while national health insurance data etc. were used for the estimation of the income or expenditure that is financed by insurers. Average annual income per doctor's clinic increased from 299 million won to 338 million won for the three years between 1998 and 2001, whereas average annual income per pharmacy increased enormously from 60 million won to 305 million won for the same period. Average annual 'profit' increase per each doctor's clinic caused by the reform itself was estimated to range from 50 to 83 million won, while that per each pharmacy, from 23 to 87 million won. In sum, while both doctor's clinics and pharmacies are beneficiaries of the SPD reform, its positive impact is particularly prominent on the latter.
The Relationship of Organizational and Job Characteristics, Empowerment, Job Satisfaction and Organizational Commitment Perceived by Hospital Administrative Staffs
Health Policy and Management, volume 14, issue 1, 2004, Pages 65~88
DOI : 10.4332/KJHPA.2004.14.1.065
In general, empowerment is defined as the motivational concept of autonomy and self-efficacy. Recently, the concept of empowerment is applied to improve organizational staff's job satisfaction and organizational commitment in many organizations. Empower-ment in service organizations, i.e., hospitals, has certainly generated more publicity than any other organizations. The objectives of this study are, first, to measure the degree of hospital employees' empowerment using Spreitzer(1995)'s empowerment theory, second, to analyze the causal relationship of organizational and job characteristics, a degree of empowerment, and organizational performance(job satisfaction and organizational commitment), and third, to offer the strategy for the improvement of job satisfaction and organizational commitment. Spreitzer insists that the empowerment is composed of 4 dimensions(meaning, competence, self-determination, and impact). And he argues that various work-related characteristics is a direct cause of empowerment and the indirect cause of job satisfaction and organizational commitment, mediated by the empowerment latent variable. In order to perform this study, data were collected by self-administered questionnaires from hospital employees working in administrative department of 3 university hospitals in Inchon and Kyunggi-Do region. The number of cases is 181(response rate; 86%). The Collected data were analyzed with SPSS Ver. 10.0 and AMOSV Ver. 4.0. First, to test validity of variables, the factor analysis was used. Second, to test reliability, Cronbach's alpha coefficients was calculated. Cronbach's alpha of empowerment variable is 0.8323 showing that there's no problem in regard to the internal consistency. Also the Cronbach's alpha of other variables are 0.8301 of the degree of perceived control, 0.6705 of job characteristics, O.8787 of compensation, 0.9254 of job satisfaction, and 0.8389 of organizational commitment, respectively. Among the questions of job characteristics, two survey questions are deleted due to lowering the reliability. Third, to test multicollinearity and correlation of variables, the correlation analysis was performed. There was no problem of multicollinearity. Finally structural equation modelling (SEM) analysis was conducted to find the causal relationship of organizational and job Characteristics, empowerment, job satisfaction and organizational commitment. The 16 variables are included for the SEM analysis. The major results of this study are as follows: First, in the case of model fitness, the condition of x
statistic(92.187) is not fully satisfied, but the indices of GFI(0.912), AGFI(0.863), NFI(0.917) and CFI(0.928) are partially satisfied, which needs to upper 0.90. Second, in the result of hypotheses testing, all hypotheses are accepted and have a positive effect in 95% or 99% confidence interval(P<0.05 or P<0.001) except the effect of compensation variable on empowerment(P=0.082). Third, in regard to the direct, indirect, and total effect of variables, the direct effect of perceived control, task characteristics, and compensation on job satisfaction are 0.728, 2.264, 0.328 and on organizational commitment are 0.094, 1.411, 0.418, respectively. Also the indirect effect of perceived control, task characteristics, and compensation on job satisfaction are 0.311, 0.196, 0.028 and on organizational commitment are 0.210, 0.132, 0.019, respectively. Thus, these findings imply that various work-related factors are direct effect of empowerment and indirect effect of result variables, job satisfaction and organizational commitment. Also These results showed that the workplace empowerment is significant mediating factor of employee's job satisfaction and organizational commitment.
Cost Driver Analysis in General Hospitals Using Simultaneous Equation Model and Path Model
Health Policy and Management, volume 14, issue 1, 2004, Pages 89~120
DOI : 10.4332/KJHPA.2004.14.1.089
The purpose of this empirical study is to test hypotheses in order to identify the cost drivers that drive indirect costs in general hospitals in Korea. In various cases' studies, it has been suggested that overhead costs are driven by volume and complexity variables, how they are structurally related and how the cost impacts of these variables can be A unique feature of the research is the treatment of complexity as an endogenous variable. It is hypothesized that level of hospital complexity in terms of the number of services provided(i.e., “breath" complexity) and the intensity of individual estimated in practice. overhead services(ie., “depth" complexity) are simultaneous determined with the level of costs needed to support the complexity. Data used in this study were obtained from the Database of Korean Health Industry Development Institute, Health Insurance Review Agency and analyzed using simultaneous equation model, path model. The results found those volume and complexity variables are all statistically signi-ficance drivers of general hospital overhead costs. This study has documented that the level of service complexity is a significant determinant of hospital overhead costs, caution should be exercised in interpreting this as supportive of the cost accounting procedures associated with ABC. with ABC.
Refinement and Evaluation of Korean Diagnosis Related Groups
Health Policy and Management, volume 14, issue 1, 2004, Pages 121~147
DOI : 10.4332/KJHPA.2004.14.1.121
Since the pilot program for a DRG-based prospective payment system was introduced in 1997, the performance of KDRGs has been one of hotly debated issues. The objectives of this study are to refine the classification algorithm of the KDRGs and to assess the improvement achieved by the refinement. The U.S. Medicare DRGs version 17.0 and the Australian Refined DRGs version 4.1 were reviewed to identify areas of possible impro-vement. Refined changes in the classification and result of date analyses were submitted to a panel of 48 physicians for their reviews and suggestions. The refinement was evaluated by the variance reduction in resource utilization achieved by the KDRG The database of 2,182,168 claims submitted to the Health Insurance Review Agency during 2002 was used for evaluation. As the result of the refinement, three new MDCs were introduced and the number of ADEGs increased from 332 to 674. Various age splits and two to four levels of severity classification for secondary diagnoses were introduced as well. A total of 1,817 groups were defined in the refined KDRGs. The variance reduction for charges of all patients increased from 48.2％ to 53.6％ by the refinement, and from 65.6％ to 73.1％ for non-outlier patients. The r-square for length of stays of all patients was increased from 28.3％ to 32.6％, and from 40.4％ to 44.9％ for non-outlier patients. These results indicated a significant improvement in the classification accuracy of the KDRG system.
The effects of the parents' social class on the low birthweight among the births, 1995-2001
Health Policy and Management, volume 14, issue 1, 2004, Pages 148~168
DOI : 10.4332/KJHPA.2004.14.1.148
To investigate the effect of parents' social class on birthweight in Korea during the period of transition to a market economy, 1995-2001. Methods: All births resulting from pregnacies reported in 1995-22001(n=4,298,374) were studied with respect to social variation in birthweight. The results were adjusted for maternal age, parity, parents' education, gestational age, total births, the dead births among total births, the number of births in one delivery. Results: Between 1995 and 2001, mean birth weight was 3271g and low birth rate was 3.41%. Maternal education, faternal education, parents' occupation, the number of birth in one delivery, total births, gestational age, and the number of deaths among. total births were all independently related to the birthweight. Parents with lower education showed higher low-birthweight rates compared with parents with university level of education(OR: 2.16 for mother and 1.68 for father). Especially, mother's education showed stronger relationship with birthweight than fathers' education. The differences in birth weight by parents' social class, especially parents' educational level became stronger between 1995 and 2001. Discussion: This study suggests that the social differences of birth weight were increasing in order 1995 to 2001. Especially, this increasing tendency in variation in birth weight by social class was shown after economic crisis, 1998.