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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
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Efficiency of Public Hospitals and Their Social Role
Health Policy and Management, volume 6, issue 2, 1996, Pages 1~13
To evalate the efficiency of public and private hospitals, the author used Data Envelopment Analysis(DEA), a mathematical linear programming method calculating the of ficiency of a unity(DMU: Decision Making Unit) in relation to the other units in analysis. DEA was applied to thirty three (10 public and 23 private) general hospitals wiwith 160 to 299 beds. In respect to productivity, public hospitals appeared to be a little more efficient than private ones, even though it's statisticansignificant. However, the efficiency score for profitability conversed that these contrary results were due to the caring of more medical protection patients in public hospitals, who brought less revenlue to te hospital than other patients. Public hospitals' superiority to private counterparts in productivity, which are aguged mainly based on cared patients, suggests that the former contributes so much positively to social utility. In particular, the fact that public hospitals are caring more medical protection patients, namely the poverty group whom the society should bear a burden of by all means, seems to be desirable in respect of role of publi hospitals.
Nature of Competition and Regulation in Health Care Markets : Implications for Public Policy
Health Policy and Management, volume 6, issue 2, 1996, Pages 14~42
On rationale for government intervention is the failure of competition in the market. Health care markets are characterized by such unique aspects as information asymmetry, prevalence of insurance, and cost-increasing competition based on the adoption of costly medical technology. Therefore, government policy to guarantee a sufficient number of providers in markets may not lead to socially beneficisal outcomes such as higher quantity and lower price. This paper examines the unique nature of health services and its implications for competition, the evidence that competition may not reduce health care ex[enditures, and policy tools that government can use to encourage competition which contributes to supporting a sustainable health care system.
A study on the Interdepartmental Conflict in Military Hospitals
Health Policy and Management, volume 6, issue 2, 1996, Pages 43~57
The purpose of this study is to examine the factors influencing interdepartmental confilict in the military hospitals. Relatively little attention has been given to the conflict in the hospitals, especially within military hospitals. Delving into the realities of organizational conflict would provide us an insight of how to handle it. The questionnair survey was conducted for the 254 officers working in 8 military hospitals nationwide. The mean index score of interdepartmental conflict was 14 on the 5-25 point scale, indicating the conflict level was modest. Using t-test and ANOVA, we found that interdepartmental conflict was different by marital status of physicians or educational level of nurses. Next, we examined a causal model using multiple regression method. The personal characteristics of the respondents and the organizational characteristics - intradepartmental relation and interdepartmental relation - were included in the model as the independent variables. From the analysis, we found that working years at the organizations, type of work term, intradepartmental reliance or cooperation, interdepartmental redliance or resource management were significantly related to interdepartmental conflict. The effect from these variables, however, was different across three departments.
An Empirical Analysis on Geographic Distribution of Physicians using the Central Place Theory
Health Policy and Management, volume 6, issue 2, 1996, Pages 58~90
This study provides an empirical analysis of location competition for demand maximization by central place theory among physicians in nonmetropolitan areas of Korea. The results show that the primary care physicians distribute themselves evenly from urban communities to rural communities. The subspecialists, however, cluster together in major cities rather than decentralize themselves in rural counties. This study establishes the three statistical models : Primary care physicians, subspecialist physicians, and total physicians. Two models of primary care physicians and total physicians have a strong significance in multiple regression analysis (p=-.0001). The primary care model explains approximately 45% of the variation and the total physicians model explains approximately 70% of the variation in physician/1,000 population ratios across national counties. The subspecialist physicians model analysze the tobit regreassion because of the left consored and truncated values(57 cases = 0). In all three models, analysis of the coefficiencts for physician centralization degrees in the 0- to 5- and 5- to 10-km rings around the core county reveals each a positive and negative association betwee these degrees and the physician/1,000 population ratios in the core county. Also, the results provide moderate evidence that the relationship between clinic physicians and community hospitals is competitive, and the relationship between clinic physicians and pharmaceutists is synergistic. This suggests that public policy makers and local self-governing bodies must take an active role to ensure procider availability and the regional health planning in all nonmetropolitan areas of Korea.
Measuring production efficiency using Data Envelopment Analysis : The case of public Corporation Medical Centers
Health Policy and Management, volume 6, issue 2, 1996, Pages 91~114
In this research, the Data Envelopment Analysis(DEA) was applied to measure production efficiency of Public Corporation Medical Centers(PCMCs) operating in Korea. The focus of this research is triple. First, identifing convenience and usefulness of DEA to measure the relative efficiency among PCMCs. Second, assessing magnitudes of the relative efficiency for each PCMC. Third, adding insights into some factors resulting inefficiency in PCMCs. Then, in this paper technical efficiency and scale efficiency measured by DEA[introduced by Charnes, Cooper, and Rhoides(1978) and Banker, Charnes, and Cooper(1984)] were analyzed and a new separate variable was introduced which makes it possible to determine whether operations were conducted in regions of increasing, constant or decresing returns to scale(in multiple input and output situations). And a multi-factor Tobit analysis was conducted to see which variables are associated with PCMC's efficiency.
Medical Expenses Structure on Hospitalized Patients of an Oriental Medical University Hospital
Health Policy and Management, volume 6, issue 2, 1996, Pages 115~130
This study was performed to investigate the practical oriental medical expenses by the use of internal data of an oriental hospital due to the bias of medical insurance program data. The purpose of this study was to describe prevalent diseases of clinical department in the studied hospital, to analyze medical expenses structure and to verify the each cost share ration of expenses on insurer to insuree. Under this purpose, we analyzed actual medical expenses data of 1,611 hospitalized patients of the oriental medical university hospital with 150 beds that can be approached to internal data from Jan. 1, 1994 to Dec. 31, 1994. The major findings are as follows : 1. Upper five of most frequent diseases of admitted patients were Joul-Jung-Pung(55.5%), Yoo-Kak-Tong(7.3%), Yoo-/Tong(7.1%), Gu-An-Wa-Sa(2.7%) and sequale of Joul- Jung-Pung(2.4%) 2. In medical expenses structure, hospital ward fee was 47.1%, medication fee 41.3%, fee for procedure(acupuncture, moxibustion, negative therapy, physical therapy, etc) 11.1% and consultation fee 0.5%. In addition to the cost share ration of insuree & that of insurer was 75:25 respectly.
Factors Related to the Medical Service Performace of Health Subcenter Directors
Health Policy and Management, volume 6, issue 2, 1996, Pages 131~148
This study was carried out by using questionnaires with 200 general doctors serving as the director of health subcenter in Kyongsangbuk-do Province as of January 1995. The results are summarized as follows. It was shown that the general characteristics consisted of 53 directors in the lst year(26.5%), 85 in the 2nd year(42.5%) and 62 in the 3rd year(31.0%). The percentage spent on their medical service showed that 73.0% of those directors spent more than 90% on their medical service. Based on their general service attitiude, 0% answered that the director of the health subcenter completes the given duties as the director, and 24.5% did that the director has the sense of responsibility and duty. Multiple answers concerning inconvenience and difficulties of the health subcenter director showed that less monthly salary accounted for 75.5%, no administrative power for 50.0%, insufficient medical instruments for 35.5%, insufficient budget for 30.0%, respect. In conclusion, in order for the health subcenter to meet the function as the primary medical clinic, it is required to arange the plans to inspire the public health doctors' service desire to that they can give the medical service as good as the private primary medical clinics, to convert existing concept of the public health doctors' placement in Myon administrative district into new concept in Gun by breaking from a uniform placement, and to consider an intensive placement according to the relevant projects so that preventive health activities can be planned and carried out.
Factors Affecting Self-Medication
Health Policy and Management, volume 6, issue 2, 1996, Pages 149~189
The aims of this study were to find out present situation of self-medication, and to explicate the factors affecting self-medication propensity. To explicate empirically the factors affecting self-medication propensity, a model containing five groups of determining factors such as attitudinal, behavioral, knowled해, and need of health care factors, and demographic factors were developed. Data were collected from 647 residents in Pusan and Kyungnam using the self-administered questionnaire. The major reslts obtained were as follows: First, self-medication was 32% of all utilization of pharmacy. The drugs used for self-medication most commonly were analgesics(16.2%), followed by antacids and stomachics(14.2%), dermatologic preparations(13.1%), tonics and drinks (12.6%). Second, the sources from which people obtained drug information at self-medication were label of the container(50.8%), pharmacist(32.4%), self-decision or lay person(16.8%). The experience of side effect was 10.6% of all self-medication and how people cope with was withdrawal(59.0%), consultation by pharmacist or doctor(35.9%). Third, the results of ANOVA showed a statistically significant relationship between self-medication propensity and 3 demograpic factors, such as sex(p<0.10), age(p<0.10) and job(p<0.05). Forth, the results of multiple regression analysis showed a statistically significant positive relationship betwee self-medication propensity and satisfaction of previous self-medication, knowledge of drug, drug dependency, the frequency of doctor visiting, confidence in drug advertisement, tendency toward self-treatment of the family, and job. And it showed negative relationship between self-medication propensity and confidence in the medical profession, and health behavior. The model explained 29.5% of the variance in self-medication(p<0.001).