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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 19, Issue 4 - Dec 2009
Volume 19, Issue 3 - Sep 2009
Volume 19, Issue 2 - Jun 2009
Volume 19, Issue 1 - Mar 2009
Selecting the target year
Priority Areas for National Health Care Quality Evaluation in Korea
Shin, Suk-Youn ; Park, Choon-Seon ; Kim, Sun-Min ; Kim, Nam-Soon ; Lee, Sang-Il ;
Health Policy and Management, volume 19, issue 3, 2009, Pages 1~26
DOI : 10.4332/KJHPA.2009.19.3.001
Objectives : To identify target areas and set priorities among those areas identified for national quality evaluation. Methods : Target areas were identified from: i) analysis of the national health insurance claims data, mortality and prevalence data ii) various group surveys, including representatives from 22 medical specialty associations, 19 physician associations, QI staffs in hospital, civil organizations, and commissioners of Health Insurance Review and Assessment Service(HIRA) ⅲ) literature reviews and RAM(RAND/UCLA appropriateness method). The priority areas for national quality evaluation represented the full spectrum of health care and the entire life span. The criteria for selecting the priority areas were impact, improvability, and measurability. The priority areas were divided into three categories : short-term, mid-term, long-term. Results: Based on the group surveys and the data analysis, 46 candidates were selected as quality evaluation priority areas. 13 areas were selected as having a short-term priority areas: tuberculosis, community acquired pneumonia, stroke, ischaemic heart disease, diabetes, hypertension, chronic lower respiratory disease(asthma, chronic obstructive pulmonary disease), intensive care unit, emergency room, nosocomial infection, use of antibiotics, multiple medication and renal failure. This results suggested that we need to enlarge the target priority areas to the chronic diseases in short-term. Conclusions: The priority areas identified from the study will assist healthcare quality associated institutions as well as HIRA in selecting quality evaluation areas. It is required to develope and implement strategies for improving the quality of care within the next 5 years.
Patient characteristics associated with length of stay in emergency departments
Chung, Seol-Hee ; Hwang, Jee-In ;
Health Policy and Management, volume 19, issue 3, 2009, Pages 27~44
DOI : 10.4332/KJHPA.2009.19.3.027
The length of stay in emergency departments has been used as a quality indicator to reflect the overall efficiency of emergency care. Identifying characteristics associated with length of stay is critical to monitor overcrowding and improve efficient throughput function of emergency departments. This study examined the level of waiting time for initial assessment by physician and length of stay in emergency departments. Furthermore, we investigated the characteristics of patients' attendance associated with length of stay. An observational study was performed for a sample of 1,526 patients visiting ten nation-wide emergency departments. A structured form was designed to collect information about patients' demographics, route of admission, time and mode of arrival, triage level, cause of attendance, initial assessment time by physician, departure time, and disposition. Multiple regression analysis was performed to determine factors associated with length of stay. The average length of stay was 209.4 minutes (95% confidence interval [CI]=197.1-221.7), with a mean waiting time for initial assessment of 5.9 minutes (95% CI=5.1-6.7). After controlling for emergency department characteristics, increasing age, longer waiting times, attendance due to diseases, higher acuity, multiple diagnoses(
2) and requiring admission or transfer to other health care facilities were positively associated with length of stay in emergency departments. The findings suggest that both patients' characteristics and the flow between emergency departments and parent hospitals should be taken into account in predicting length of stay in emergency departments.
The Study of Health-Risk Perception: Implications for Health Services Research
You, Myoung-Soon ;
Health Policy and Management, volume 19, issue 3, 2009, Pages 45~70
DOI : 10.4332/KJHPA.2009.19.3.045
Outbreaks of health risks such as the Influenza A virus (H1N1) are continuing, which highlights the immediacy of risk control strategies to reduce public's fear and protect the safety of the society. Evidence suggests that success for risk management is basically dependent on the public's willingness to adopt health behaviors recommended by experts, and the behavioral intention relies on their risk perception. Understanding of how individuals think of and feel about health risks is thereby important. This article aims to provide insights for future study on health-risk perception. The main streams and recent developments of theorizing and research on health risk perception are reviewed. The issues, such as (1) health risk perception is an important component for shaping relevant health policies as it reflects public trust of the institutions managing health risks, (2) despite this significance, however, few attempts have been made to address the meaning of 'perceiving health risks' in health services research, are shed light on. On the basis on the critical discussion of the contributions and the limitations of the literature, this article finishes with a few of research agendas by three levels of analysis in risk perception research.
A Comparative Study of the Administrative Behavior of Vaccination and Satisfaction of Physicians according to the National Expanded Programme on Immunization in Korea
Kim, Chun-Bae ; Lee, Sok-Goo ; Lee, Jung-Jeung ; Jeon, So-Youn ; Hyun, Sook-Jung ; Lee, Yeon-Kyeng ; Go, Un-Yeong ;
Health Policy and Management, volume 19, issue 3, 2009, Pages 71~91
DOI : 10.4332/KJHPA.2009.19.3.071
To assess comparatively the administrative behavior of vaccination and satisfaction of physicians by the provision method according to the National Expanded Programme on Immunization (NEPI) between 2005 and 2006 Demonstration Project in Korea. A questionnaire was performed at 582 and 64 physicians in Daegu metropolitan city and Gunpo city on 2005 (a response rate of 39.3%, 45.3%, respectively). Also, we sampled 31, 56, and 28 physicians in Gangneung city, Yangsan city, and Yeongi county on 2006 (a response rate of 35.5%, 98.2%, and 60.7%, respectively). We analyzed these data set using descriptive analysis and
-test through SPSS for Windows (12.0). Most question categories in Daegu metropolitan city and Gunpo city on 2005 were higher than those in the 2006 Demonstration Project regions. These were 'preparing and signing informed consent to vaccination', 'doing physical examination before periodic immunization', 'searching past shot history and inputting the current shot record through the immunization registry management program by physician', 'filing a medical record', 'satisfying the impact of 2005 and 2006 Demonstration Project and achieving the expectation of this Project', and 'improving the immunization coverage rate', et al. In conclusion, we show that the attitudes and practices of physician should be more sensitive to free vaccination services by private clinics and hospitals than public health centers. In the near future, the government must consider the opinion of physicians in implementing the NEPI by the affordable method of the public-private dynamics.
A National Chronic Disease Management Model and Evaluation of Validity of Primary Care Physician(PCP) Model in Korea
Chun, Ki-Hong ; Paek, Kyung-Won ; Lee, Soo-Jin ; Park, Chong-Yon ;
Health Policy and Management, volume 19, issue 3, 2009, Pages 92~108
DOI : 10.4332/KJHPA.2009.19.3.092
This study suggests a model for continuing and comprehensive management of hypertension or Type 2 diabetes mellitus (T2DM) in Korea. Moreover, this paper computed the contribution cost of hypertension or T2DM management using the healthcare medical cost, which could have occurred from stroke, myocardial infarction (MI), and end-stage renal disease (ESRD) that were successfully prevented from the effective hypertension or T2DM management. Additionally, these costs were compared with the cost of implementing the hypertension or T2DM management model suggested in this study. This study used the medical fee summary of the health insurance claims submitted to National Health Insurance Corporation by medical facilities for services provided during the period from January 1st 1999 to December 31st 2006. The prevalence rate with treatment referred to cases in which patients submitted their medical claims at least once during the period, along with an accordant diagnosis. The incidence rate with treatment referred to cases in which patients who never submitted claims for the accordant disease during the five years from 1999 to 2003 submitted claims for the accordant disease in 2004 and 2005. The relative risk of the occurrence of stroke, MI and ESRD was 11.0, 13.6, and 30.3, respectively. The attributable risk of hypertension or T2DM for stroke was 0.730, and that for MI and ESRD were 0.773 and 0.888, respectively. Based on these, the contribution cost of hypertension or T2DM is estimated to be 986.3 billion Korean Won(KRW) for stroke patients, 330.5 billion KRW for MI patients, and 561.7 billion KRW for ESRD patients as in 2005. Hence, the total contribution cost of hypertension or T2DM to stroke, MI, and ESRD is 1.878 trillion KRW. The estimate for operational costs included an annual expenditure of 50,000 KRW per each recipient and an annual subsidy of 0.22 million KRW per person for the 1.6 million low.income individuals with hypertension or T2DM to cover their out.of.pocket medical expenses. Under this assumption, it took approximately 0.6 trillion KRW to manage 5 million high.risk patients in the low. and mid.income range, coverings up to 50% of costs. In conclusion, considering the potential benefits of preventing stroke, MI, and ESRD, the costs seems to be reasonable.
An Empirical Study on General Deterrence Effects of the On-site Investigation System in the Korean National Health Insurance
Kang, Hee-Chung ; Hong, Jae-Seok ; Kim, Se-Ra ; Choi, Jee-Sook ;
Health Policy and Management, volume 19, issue 3, 2009, Pages 109~124
DOI : 10.4332/KJHPA.2009.19.3.109
Background: This study aimed to examine whether cases of punishing false claimants threat general physicians to check their medical cost claims with care to avoid being suspected, and identify empirically general deterrence effects of the on-site investigation system in the Korean National Health Insurance. Methods: 800 clinics were selected among a total of 15,443 clinics that had no experience of on-site investigation until June 2007 using a stratified proportional systematic sampling method. We conducted logistic multiple regression to examine the association between factors related to provider's perception of on-site investigation and high level of perceived deterrence referring to fear of punishment after adjusting provider's service experiences and general characteristics. Results: The probability of high perceived deterrence was higher 1.7 times (CI: 1.13-2.56), 2.73 times (CI: 1.68-4.45) each among clinics exchanging the information once or more per year or once or more for 2-3 months than among clinics no exchanging the information about on-site investigation. Also, the probability of high perceived deterrence was higher 2.27 times (CI: 1.28-4.45) among clinics that knows more than 3 health care institutions having experienced an on-site investigation than among clinics knowing no case. Conclusion: A clinic knowing more punishment cases by onsite investigation and exchanging more frequently information about on-site investigation is likely to present high perceived deterrence. This result will provide important information to enlarge preventive effects of on-site investigation on fraud and abuse claims.
Difference in Outpatient Medical Expenditure and Physician Practice Patterns between Medicaid and Health Insurance Patients
Joo, Jung-Mi ; Kwon, Soon-Man ;
Health Policy and Management, volume 19, issue 3, 2009, Pages 125~141
DOI : 10.4332/KJHPA.2009.19.3.125
The purpose of this study was to examine the role of provider practice patterns in the difference in health expenditure between the two types of patients: Health Insurance and Medical Aid type 1. The study used the outpatient claim data for all Medicaid and health insurance patients of hypertension who received medical services from 8,454 primary care physicians during the first half of 2006. The data were stratified by patient's gender and age for the two groups of patients who received care from the same physician. The dependent variables were the differences in medical expenditure per case, patient days per case and medical expenditure per patient day between Medicaid patients and health insurance patients. Empirical results showed that physician characteristics, such as physicians under age 50, greater proportion of pediatric Medicaid patients, lower proportion of new Medicaid patients and the greater number of comorbidity of Medicaid patients are associated with the greater difference between the two types of patients (i.e., greater expenditure of Medicaid patients relative to health insurance patients). This study shows that factors associated with provider practice patterns need to be taken into account in Medicaid policy.
An evaluation of benefit extension strategies of the Korea National Health Insurance
Huh, Soon-Im ; Kim, Chang-Bo ;
Health Policy and Management, volume 19, issue 3, 2009, Pages 142~165
DOI : 10.4332/KJHPA.2009.19.3.142
Although providing universal coverage for health care through the National Health Insurance(NHI) is a remarkable achievement, the issue of limited benefit coverage of the NHI has been at the core of national debate over how to improve its coverage. This study aims to evaluate benefit extension strategies and implemented policies with regard to the NHI since 1989 using 'policy window theory' proposed by John W. Kingdon. Understanding problem stream, policy stream, political stream, and coupling streams regarding the NHI, in particular benefit extension, would contribute to broaden policy debates and to develop more effective strategies for the future. Historically, political stream had opened policy window in the past two decades and policy streams can be characterized by three waves. Three streams have been coupled since 2003 and the government had a strong will to fulfill better performance of NHI coverage. Study findings indicate that identification of problem structure regarding NHI benefit was not connected with policy stream tightly. In addition, there has been limited discussion on policy goal and principles for extension coverage of the NHI. Policy strategies to improve coverage of the NHI should be linked to characteristics of problem and sought solutions under the principle which is expected to be sustainable through consensus in the society.
The Relationship between Career Decision-Making Self-Efficacy, Social Support, Career Education Experience, Career Attitude Maturity for College students with Major in Health Administration
Cheon, Eui-Young ; Nam, Young-Hee ; Kweon, Hyun-Joo ;
Health Policy and Management, volume 19, issue 3, 2009, Pages 166~182
DOI : 10.4332/KJHPA.2009.19.3.166
Objectives : This study was undertaken to investigate the relationship between career decision-making self-efficacy, social support, career education experience, career attitude maturity for college students with major in health administration. Methods : The subjects were 395 students with major in health administration from 2 universities and 2 colleges located in Incheon city, Gyeonggi province, and Chungcheognam province. Data were collected from June 2 to 20, 2008 using structured questionnaires. Results : For the difference by characteristics of the respondents, the score of career attitude maturity were significantly different according to age(F=3.415), high school style(F=2.661), subject economic status(F=3.627), subject satisfaction of school life(F=7.964), subject health status(F=6.507). For the correlation of major variable, Career attitude maturity was positively correlated with career decision-making self-efficacy, social support from friends, social support from family, social support from professor, career education experience. In a regression analysis, career decision-making self-efficacy(
=.378), social support from friends(
=-.161) significant predictors to explain career attitude maturity(32%). Conclusions : It is necessary to activates the social network from friends and to develop an effective program to improve career attitude maturity of students with major in health administration considering these findings.