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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
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Volume & Issues
Volume 7, Issue 2 - Oct 1997
Volume 7, Issue 1 - May 1997
Selecting the target year
Health Psdromotion Strategies under Regional Health Planning
Health Policy and Management, volume 7, issue 1, 1997, Pages 1~31
In many people's minds, health promotion is simply a more modern term covering roughly the same field as disease prevention or life style related reduction of the risk factors of chronic disease. A review of the modern literature of health promotion make it clear that there is more to this term than what is involved in functioning as a synonym for disease prevention. Therefore, in order to reach a clear understanding of what health promotion is, this study suggest the concept of the health balance model. Health balance is represented in terms of an equilibrium between physical, social, and life-style-related health challenges on the one hand and health potential on the other hand. Thus, health promotion strategies encompasses both the reduction of health challenges and the strengthening of health potential. Many elements of reducing health challenge are mainly related to the regulation laws. Aspects of strengthening of health potential are related to activities of health center. Therefore, health promotion strategies at a community level should be included in regional health planning which is implemented by health center.
Comparisons of patients' selection and satisfaction between corporate and university hospitals
Health Policy and Management, volume 7, issue 1, 1997, Pages 32~54
The purpose of this study was to identify the reason for patients to choose a hospital. We divided the hospital into two types of hospitals : corporate hospitals and university hospitals. We inverstigated patients' satisfaction according to the image of hospitals. For this purpose, two corporate hospitals and two university hospitals were selected. Data were collected from the self-administered questionnaire for the patients admitted to these four hospitals in April 1996. 772 questionnaires were collected and 55 cases had no answer or insincere answers. So, we used 707 questionnaires for the analysis. Corporate hospitals had modern facilities. However, patients preferred university hospitals because of the reliability of medical staffs and easy accessibility. University hospitals had higher level of satisfaction of medical services, while the corporate hospital had higher level of satisfaction to the friendly atmosphere, and kindness of hospital staffs. When the patients come to hospitals again after discharge, they would consider medical services, hospital atmosphere, and kindness of medical staffs regardless of hospital types. In conclusion, the reasons for patients selecting university hospitals are reliability, history, and tradition of medical services. Instead,, the reasons for patients selecting corporate hospitals are modernization of hospital facilities.
A Study on Demand and Market Segmentation in Nursing Homes
Health Policy and Management, volume 7, issue 1, 1997, Pages 55~72
The purpose of this study is to analyze the consumers' demand pattern and the feature of the market for nursing homes, the number of which is tending upwards. The survey data were obtained from the interview of 500 elderly people living in Seoul and Kyung-Ki provincial area. All respondents were 60 years of age and above. The main findings were summarized as follows: 1. The respondents who are less aged, highly educated comparatively, and living with spouse show positive response for the use of nursing homes. The aged living independently and the aged living with unmarried children show higher demand for this facility. Also, the respondents who prefer independent living away from their childrenn, urban areas as their residence and flat-type housing show more interest for the facility. The respondents who are self- supportive, who has no financial supporter, no caretaker, and no domestic helper demonstrate strong inclination to the use of the facility. The respondents who are interested in this kind of facility, acknowledge the necessity of it show strong intention of moving into it. 2. Logistic regression analysis was conducted to understand factors related to the intention of moving into the nursing homes. The group who wish to live separated from their children in the future give 1.78 times more favorable response than the opposite. The group who have an interest in the facility for elderly has 2.02 times higher intention of moving than the opposite. The group who have an intention of using the facility for elderly it is 7.34 times more likely to move into it. 3. The respondents who are the potential consumers for nursing homes can be subdivided. Within the positive group, it could be divided into the group of living independently with the preference of flat-type housing, the group living independently with the preference of separate housing, and the group wishing to live with their children. Within the negative group, the factor of the division is their concern to the facility. Following this study, it can be said that old age people, who have been regarded as one homogeneous group so far, should be recognized as one characteristic individual. This study also shows that the demand aspect yet in its initial stage shold be researched in anticipation of rapid increase. The understanding of diciding factors, the segmentation of potential market will help work out proper strategy, which will contribute to providers' benefit.
An Analysis on the Effect of Financial Stabilization Program in the Korean Health Insurance
Health Policy and Management, volume 7, issue 1, 1997, Pages 73~99
This study was carried out by using questionnaires with 126 insurance societies from Sept. 30, 1995 to Oct. 18, 1995. The primary data collected bythe survey have been significantly supplemented by secondary data obtained from sources such as health insurance statistical year books and internal data in the Ministry of Health and Wolfare. Major findings were summarized as follows: Two financial coordinating programs have significantly improved financial status of regional health insurance societies: the catastrophic program for high cost medical care that was initiated in 1991 and the program for hospitalization cost of the aged in 1995. Another finding is that there existed ambiguity and inconsistency of equity index that had been used by stabilization programs and its side effects could not be ignored. Regression analyses were made to identify factors that affect financial transfers. Inde pendent variables in the regression include utilization frequency, dependancy ration, insurance contribution per insured and medical expense per insured. All these variables were statistically significant in the equations of applying distribution rate (distribution/contribution) and transfer rate (transfer/contribution) as dependent variables. Policy suggestions for the catastrophic program for high cost medical care are modifying the definition of catastrophic case and setting the maximum amount of subsidies for each society based on distribution rates. To solve the problems of the financial coordinating program for the aged, we could consider reimbursing more than 50% of the copayment incurred by the aged 65 or more and determining the maximum amount of outpatient copayment at 10,000 Won per day or per visit for the elderly. More fundamental improvement could be made by amending the Welfare Benefit Act to establish and expand medical and welfare facilities for the elderly.
Studies on the variations of hospital use and the changes in hospital revenues of 10 KDRGs under the PPS
Health Policy and Management, volume 7, issue 1, 1997, Pages 100~124
In order to suggest the strategies for participation in the PPS(Prospective Payment System), analyses were performed based on variations in utilization pattern and changes in revenues of hospitals in 10 selected KDRGs. The data was collected from the claims data of a tertiary hospital in Kyunggido from September 1, 1995 to August 31, 1996. The studies consisted of 1, 718 inpatients diagnosed for lens procedures, tonsilectomy &/or adenoidectomy, appendectomy with complicated principal diagnosis, Cesarean section, or vaginal delivery without any complications. The resources used in each KDRG were measured including average length of stay, total charges, number of orders, intensity of medical services, frequencies of medical services, the rate of non-reimbursable charges, and the rate of non-reimbursable orders. Then, the changes in hopital revenues due to the composition of medical fee schedules under the PPS were estimated as follows: 1) The variations in average lenght of stay, total charges, number of orders, the intensity of medical services, the frequency of medical services, the rate of non-reimbursable charges, and the rate of non-reimbursable orders among the 10 KDRGs were comparatively small. 2) The average lenght of stay was the longest(6.0 days) for appendectomy with complicated principal diagnosis, while it was the shortest(2.1 days) for two vaginal deliveries. Statistically differences existed in the average length of stay among physicians and among the dates of admission in several KDRGs. 3) The total charges were the highest for lens procedures(1, 716, 000 won), while the lowest charges were for two vaginal deliveries(558, 000 won). Statistically differences in the total charges were found among physicians in several KDRGs: however, there were no differences with the dates of admission. 4) The number of orders was the greatest(155) for appendectomy with complicated principal diagnosis, while it was the smallest(75) for the two vaginal deliveries. Statistical differences in the number of orders did not exist among physicians in the KDRGs. 5) Significant differences were found in the intensity of medical services, and in the frequency of medical services among physicians in the KDRGs. 6) The rate of non-reimbursable charges for each KDRG was not related to the rate of non-reimbursable orders. The rate of non-reimbursable orders was the highest(36.0%) for lens procedures, while the lowest rate(11.6%) was for appendectomy with complicated principal diagnosis. The rate of non-reimbursable charges was the highest(39.4-39.7%) for vaginal deliveries, while the lowest rate(13.1%) was for tonsillectomy &/or adenoidectomy(<17 ages). 7) If the physician's practicing style were not change under the PPS, the hospital revenuses could be increased by 10%, and the portion of patient payment could be decreased by 1.4-22.4%. However, the non-reimbursable charges for showed little change between two reimbursement systems. Based upon the above findings, this hospital could be eligible for participation in the PPS(Prospective Payment Systm). However, the process of diagnosis and treatment should be standardized, inentifying methods to reduce cost and to assure quality of medical care. Furthermore, consideration should be given to finding ways to increase patient volume.
The Effect of Hospital, Department and Physician Factors on Hospital Resource Use
Health Policy and Management, volume 7, issue 1, 1997, Pages 125~154
The hospital, clinical department and the physician factor in explaining variations of hospital resource use in surgically admitted patients was compared. This analysis was based on 6, 361 discharges in 28 hospitals for three surgical conditions - lens procedures anal and stomal procedures, uterine and ovarian procedures using medical insurnce claim data. The results were as follows: 1. Regression analysis indicated that the hospital and clinical department characteristics, such as hospital ownership and size, were more significant predictors of the resource use indicators than the physician and patients' social characteristics. 2. Regarding to the physician factors, the hospital where the physician received the residency training and the medical shool where he/she graduated had less effect compared to the hospitals where he/she currently works. Between the residency trained hospital and medical school, the is more important than the latter. 3. When the hospital charges were divided into type of service provided i. e. room, drug, laboratory & radiologic, procedure & operation, and anesthesic charges, variance due to the hospital factor was larger than that due to the physician factor in each item. In summary, the hospital and clinical departmental factor played an important role than physician factor ; indicating to reduce the variation in hospital resource use, the policy that affects hospital behavior would be more effective than that targets individual physician behavior.
Comparative Study of the Health Status of Two Koreas
Health Policy and Management, volume 7, issue 1, 1997, Pages 155~182
Objectives : This study was designed to compare North Korea and South Korea in measures of the quality of life (physical quality of life index and human development index) and to investigate the impact of selected medical and socioeconomic factors on PQL variables. Data and Methods : The World Bank, the United Nations Development Programme, and Population Reference Bureau were the principal sources of statistical data of 121 countries. Variables included infant mortality, life expectancy at birth, literacy rate, secondary school enrollment (male and female), GNP per capita, population per doctor, daily calorie supply per capita, and a composite PQL index. The Ordinary Least Square model was employed for cross-countries analysis. Findings : Both countries under quite different political and economic systems saw big improvememts in the quality of life, reducing mortality and prolonging life expectancy during the past three decades. In recent decad, however, North Korea has experienced abrupt exacerbation in the quality of life. Significant improvements in infant mortality of the population wer attributable mainly to GNP per capita and the secondary school enrollemt of female. The principal predictors of life expectancy at birth were population per doctor, infant mortality, and literacy rate. The secondary school enrollment of female and population per doctor were significantly associated with improvements in the physical quality of life index (PQLI). Conclusion : The results of this study confirmed a point illustrated by other studies : The association between quality of life as a measure of health status and socioeconomic factors was strong and positive. The important contribution of educational attainment in general, female education level in particular to improvements in the quality of life deserves good news for building an integrated health care system in the reunified Korea, taking into account the high level of education two koreas are enjoying. Meanwhile, when a sharp drop in the quality of life has been observed in North Korea under serious economic difficulties and food shortage in recent decade, the significant contribution of economic development to improvements in the quality of life poses bad nows for reunifying Korean health care in economic terms.