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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
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Health Policy and Management
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Journal DOI :
The Korean Society of Health Policy and Administration
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Volume & Issues
Volume 6, Issue 2 - Nov 1996
Volume 6, Issue 1 - Jun 1996
Selecting the target year
Health Care Reform in OECD Countries : A Comparative Policy Analysis
Health Policy and Management, volume 6, issue 1, 1996, Pages 1~28
The paper analyzes OECD health systems from the perspective of historical institutionalism. Criticizing the dependence of Korea's national health program on Pacific countries such as Japan and the U.S., it suggests that European experiences of national health programs can be a model of the Korean health system in the future. Based on an inquiry into Italian and British cases of national health systems, the author emphasizes (1) the role of local governemts in national health programs, and (2) the integration of a national health program with public health programs.
Factors Related to the Output of Health Centers
Health Policy and Management, volume 6, issue 1, 1996, Pages 29~58
This study was conducted to identify the factors that affect the output of health conters. An analystical model employed in this study was developed by modifying 'input-output model' and 'organizational behavior model'. Data were collected form two source; the 1995 report of thealth center which was submitted to the Ministry of Health and Welfare and a mail survey questionary of officers at health center, including 66 directors and 1,768 staffs of the health centers in southern region. The major findings are as follows: That analysis has identified the factors associated with dependent variables: medical services provided by the health center and health program performance(HPP). The number of primary medical facilities was negatively associated with health center performance while the number of staffs, job satisfaction, and professional background of health center directors were positively associated. These independent variables accounted for 40.1% of the variance of dependent variables. The variance of HPP was significantly explained by the number of health subcenter and primary health post, priority level of public health program by hief executive officers(CEOs) and legislator. A significant relationship was found between leadership types of health center directors and the performance of maternal and child health program. Considering these results, the authors suggested that the role in medical care service of health center in the should be rearranged at local level because medical care service of the health center is competing with primary medical facilities in the same region. It is also suggested that educational efforts be made to improve leadership of the health center directors and concern with public health program by the CEOs and legislators of local governments.
Are the nurses overpaid or underpaid\ulcorner
Health Policy and Management, volume 6, issue 1, 1996, Pages 59~84
It is generally believed that the medical profession in Korea is an well-paid field along with legal profession. In this vein, the nursing is regarded one of well-paid profession. The actual data, however, reveals that nurses belong to low income bracket. We carefully compare the nurse's earnings with those of other professions. We selected 58 professions, which are similar in vocational characteristics and education background to nurses and conduct a regression analysis to estimate earning functions. Using the estimated coefficients, we project an optimum salary level for nurse, and compare it with the actual salary level. The estimated results show that the nurses are underpaid : their actual salary is less than the optimum level. We provide several explanations for this phenomenon : a tradition based on Confucian value, wage discrimination for women, and wage inequality among hospitals. Undercompensation will result either ratard professional development, or block the motivation for high quality of nursing care. If the current underpaying situation is not improved, a shortage of nurses along with an noticeable decline in the quality of medical services are expected. Therefore an adequate compensation for nurses must be properly assessed and addresed not only be health care authorities but also by legislators. Further research is needed to explain why there is such as wide salary inequality among nurses, and to find what cause it.
Economic Appraisal of Telemedicine
Health Policy and Management, volume 6, issue 1, 1996, Pages 85~109
Telemedicine can increase accessibility to advance medical technology at the university hospital for community residents living in a remote area. This paper focused on the economic evaluation of telemedicine to identify important factors influencing costs and benefits and to understand how these factors can be changed to improve economic performance of the telemedicine. When the telemedicine project currently operating in Korea was evaluated based on the traditional cost-benefit analysis, the results showed a heavy net loss wiht a B/C ration of 0.56. As several values were added to the analysis based on the Information Economics approach, B/C ratios steadly increased. When the saving of medical expenses from the early detection of diseases was taken into a consideration, the ration exceeded the break-even point. >From the sensitivity analysis, a number of patients and the cost for equipment and communication were found to be the key factors for influencing economic performance of telemedicine.
Equity of Access to Health Services under National Health Insurance System in Korea
Health Policy and Management, volume 6, issue 1, 1996, Pages 110~143
The purpose of this study is to assess the extent of inequality in health outcomes and the distribution of health services according to health need under National Health Insurance System in Korea. For the empirical analysis, data were collected through an interview survey during one month of October, 1994. Interview were conducted with a total of 10, 875 of the employees and the self-employed selected through cluster, systematic sampling. The major findings of this research are as follows: 1. The analysis of the differentials in morbidity rates by socio-economic group showed that health inequality in the pro-higher groups existed in all self-reported morbidity indicators. 2. The findings of the conventional use measures showed that the lower socio-economic groups had more ambulatory and inpatient services than the higher groups. In contrast to the level of the medical care utilization, however, the higher socio-economic groups were more likely to use the high-quality source of care in terms of their treatment place compared to the lower groups. 3. By using the need-based use measures, the results were different from each use-disability ration indicator. Using the use-disability ration measured by physician visits per 100 restricted-activity days in the population, it was found that there was no evidence favoring the higher socio-economic groups. In contrast, the use-disability ration based on physician visits per a chronic patient in one year displayed that there was remarkable relative difference by income group as well as the evidence of the pro-higher income groups. 4. The results of logistic regression analysis and two-stage estimation method indicated that although the utilization is significantly affected by type and duration of insurance coverage, the use or nonuse of service and the volume of physician care consumed is determined by health need and demographic characteristics rater than economic status. In sum, these findings suggest that physician service is equitably distributed according to health need under national health insurance system in Korea. As there were some evidences of inequality including the differential in physician visits of chronic patients by income group, however, the government should strengthen the activities to guarantee the equity of health services utilization.
A Study on the Committees of University Hospitals in Seoul
Health Policy and Management, volume 6, issue 1, 1996, Pages 144~162
This study was conducted to identify the problems related to operation of the committee system in university hospitals and to propose the direction for reforming it. Data were collected by surveying 138 working-level administration managers of committees from 12 university hospitals in Seoul in October, 1995. The results were as follows: 1. The purposes of the committee were to promote the reasonable dicision making in the hospitals, to satisfy the requirement of Hospital Accreditation Program and, to execute the administrational instructions in due order. The sort of job which was charged of chairmen and the majority of committee member was doctor. 2. The committees which were to be held the meeting frequently in a year were general management committees(8.25 times/year). But in case of operation rate, medical care-related committees showed the most frequent meeting(90.15%). Most of committees made the regulations and reported the results of their meeting to the CEO of their hospitals by written documents. 3. Most doctors thought the medical care-related committees useful. Medical technicians regarded education and research-related committees as useful, while administrators favored the general management committees. 4. The factors related to the perceived performance of the committee were the kind of job, the class of job and the kind of committee. Also, the perceived performance of the committee was positively related to the usefulness in efficient management of work, and negatively to uncertainties in responsibility and a nominal role of the committee. 5. Most of the respondnts thought that the concern of the top manager about the committee was the most important factor for the improvement of committee system at hospitals. They also regarded that formalization of the objectives and regulation rule and composition of committees with members which work in various fields as essential. Further studies on the organizational and operational cjharacteristics which include general hospitals in various areas are required.
Strategic Orientation of Rural Hospitals in the U.S.A. -Implications for Korean Rural Hospitals-
Seo, Young-Joon ; Robert L. Ludke ; Ko, Jong-Wook ;
Health Policy and Management, volume 6, issue 1, 1996, Pages 163~190
The applicability of financial indices as a measure of managerial performance of general hospitals
Health Policy and Management, volume 6, issue 1, 1996, Pages 191~210
This study purported to acquire information necessary to improve the operational efficiency of general hospitals. It tried to determine major indices which represent managerial performance of general hospitals and to identify the managerial characteristics of general hospital which affect the major financial indices. 201 hospitals which were subject to standardization audit by the Korean Hospital Association were investigated and 80 hospitals were finally chosen for this study. Their financial and managerial data during the period between January 1991 and December 1991 were collected. Considering financial indices in this study were the ration of net income to total asset, income growth rate, and quick ration. The results of study are summarized as followings. First. The ration of net income to total assets and quick ration were highly related to managerial characteristics of general hospitals. Therefore, the standardization of three financial indices should be needed to systematically check the operational efficiency of general hospitals. Second, the sample hospitals can be classified as four groups on the basis of their financial indices' level. 4 of those hospitals(5.0%) showed high level of performance in terms of three financial indices and 27 of them(33.7%) showed that they are highly related to only two financial indices. 34 hospitals(42.5%) showed they have high level of relationship with only one indices and 15 hospitals(18.8%) showed very weak performance level with three indices. In addition, there is no hospitals to show mid-range level of managerial performance in relation to all three financial indices. Third, there is no significant relationship between three financial indices and the managerial characteristics of hospitals such as the number of beds, type of operation, location of hospitals, and etc. However, in the case of hospitals which have high level of managerial performance, they have more specialists and medical support personnel in comparison to low performance hospitals. They also have high level of bed occupancy rate and average length of stay(ALOS). In conclusion, the study showed the standardization of 3 financial indices are necessary to systematically evaluate the managerial performance of general hospitals and provide more accurate operational information for each hospital. To do so, it is necessary to focus on management side of hospital such as the effective human resource management and quality enhancement of medical treatment.