Journal of Preventive Medicine and Public Health

Volume 24(3); September 1991

Original Articles

The effects of insurance coverage on the medical care utilization in public health institutions in a rural area.: Jea Jun Choi; Korean J Prev Med. 1991;24(3):265-278.

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Abstract PDF: This study was to examine the effects of insurance coverage on the utilization of public health institutions and to identify the factors associated with the utilization. The data were obtained from household interview surveys conducted twice in Hwachun Gun, Kangwon Do. The time period covered in the first survey was December 17~31, 1987, before the implementation of regional medical insurance for the self-employed, and that of the second survey was January 28~February 11, 1990, after its implementation. Major findings emerged from the analysis can be summarized as follows. (1) Medical care utilization of rural people markedly increased after they were covered by medical insurance. The insurance coverage increased the utilization of public health institutions as well, and this increase was mainly attributable to the utilization by chronically ill patients. (2) Between 1987 and 1990, the proportion of the utilization of public health institutions over whole medical care utilization decreased. But the proportion increased for chronically ill patients covered by regional medical insurance during the same time span. (3) The results of logistic regression suggested that the rural self-employed utilized public health institutions at an increased rate after they were covered by medical insurance. It was also indicated that the increase resulted from the utilization by chronically ill patients. (4) The relative importance of public health institutions for rural medical care decreased after the implementation of regional medical insurance. But considering that the utilization of public health institutions by chronically ill patients increased after insurance coverage, attention should be directed to improving the capability of public health institutions to control chronic degenerative diseases.; Summary

Health risks related to shift work among female workers of major manufacturing industries in Korea.: Euichul Shin, Kwang Ho Meng; Korean J Prev Med. 1991;24(3):279-286.

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Abstract PDF: Much of the working population in developing countries are engaged in shift work now and the number of shift workers is not expected to decrease in the future mostly because the need for continuity of production is increasing. Therefore, the possible effects of shift work on health are of particular interest, and in fact, there have been many epidemiological studies on shift work since the first world war. However, no studies on health effects of shift work have been reported in Korea, and the existing studies in western world have arrived at quite different conclusions mainly because the conditions of work other than shift work, such as age and selection of workers, work environment, and labor conditions also influence the health of workers. This study was firstly carried out in Korea to investigate the health risks related to shift work with 2,093 female workers randomly selected from three major manufacturing industries in proportion to total number of female workers in those industries. Differences of work conditions other than shift work in this study were adjusted by multivariate analysis. Major findings obtained from this study are as follows: 1. There were significant differences between shift and day workers in the distribution of age, type of industry, condition of noise and dust, regularity of mealtime, working position, and working duration. Shift workers tended to be younger, to have shorter working duration, to have more irregular mealtime, to work in standing position, and to work under more noisy and dusty environment than day workers. 2. Univariate analysis showed that shift work increased the Todai Health Index (THI) scores of digestive tract, respiratory tract, and mental instability symptom categories. Shift work also increased days of sickness absence and number of industrial accident per 100 workers per month. 3. Multivariate analysis that adjusted the differences of demographic, occupational and non-occupational health-related working conditions showed that digestive tract symptoms and mental instability symptom scores were significantly higher in shift workers than those in day workers. Based on those study results, it is concluded that the shift work has significant effects on some psychophysiological conditions of the workers and the effects are also influenced by several other personal and working conditions.; Summary

Metallothionein induction and its protective effect in liver and kidney of rats exposed to cadmium chloride.: Nam Song Kim, Jae Hyung Lee, Dai Ha Koh, No Suk Ki, In Dam Hwang; Korean J Prev Med. 1991;24(3):287-304.

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Abstract PDF: Tolerance to several toxic effects of cadmium, including lethality has been shown following pretreatment with cadmium and zinc. This study was designed to determine if tolerance also develops to Cd-induced hepatotoxicity and renal toxicity. Three groups of rats (A, B, C), each consisting of 16 rats, were studied and each group was divided into four subgroups (1, 2, 3, 4), 4 rats for each subgroup. Rats were subcutaneously pretreated with saline (A), CdCl2(0.5 mg/kg, B), and ZnCl2 (13.0 mg/kg, C) during time periods of 1~6 weeks. At the end of the period, rats were challenged with CdCl2 (3.0, 6.0 and 9.0 mg/kg, ip). After giving the challenge dose, cadmium and metallothionein (MT) concentrations were determined and also observed the histologic change in liver and kidney. The concentration of cadmium in liver and also observed the increased dose-dependently to the challenge dosage. These data indicate the kidney is a major target organ of chronic cadmium poisoning, and suggest that cadmium induced hepatic injury, via release of Cd-MT, may play and important role in the nephrotoxicity observed in response to long-term exposure to cadmium. In addition, histologic examination of group A2, A3 and A4 revealed moderate to severe cadmium toxicity, evidenced by infiltration of inflammatory cells, cell swelling, pyknosis, enlarged sinusoids and necrosis in liver, and tubule cell necrosis and degeneration in kidney. However, MT concentrations in liver and kidney were increased by the pretreatment of CdCl2 and ZnCl2 and their morphological findings were not significantly changed, comparing with control group. Higher MT concentration in liver and kidney observed in the pretreated groups constitutes a plausible explanation of the protective effects of pretreatment against the cadmium toxicity after challenge dosing.; Summary

Industrial fatigue due to banking operations with VDT.: Jung Wan Koo, Seung Han Lee; Korean J Prev Med. 1991;24(3):305-313.

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Abstract PDF: In order to investigated industrial fatigue due to visual display terminal (VDT) work of banking operations, the questionnaires survey for subjective symptoms of fatigue was carried out on 470 bank clerks who had been engaged in VDT work for various length of work hours. The questionnaires comprised three groups of 10 items each, representing dullness and sleepiness (level of cerebral activation), difficulty in concentration (level of motivation) and bodily projection of fatigue. The results were as follows: 1. Of the 30 items of questionnaires, the highest percentage was accounted for by 'eye strain' (51.5%), followed by 'feel stiffness in the neck or the shoulders' (33.4%), 'feel a pain in the low back' (26.8%), 'whole body feels tired' (19.6%) and 'feel headache' (17.9%) in the order of sequence. 2. Ten average weighted score for the first group of questionnaire items (dullness and sleepiness) was the largest among three groups and was followed by the third group (bodily projection of fatigue) and the second item group (difficulty in concentration) in the order of sequence, suggesting the heavier mental stress of VDT work in banking operations rather than physical burden. 3. In terms of the age and sex of workers, work duration and VDT work percentage, the difference in average weighted score was noted only between sex, the score of female being larger than that of male. 4. The complaint rates of subjective symptoms showed close associations with the subjective optimums of room temperature, ventilation, illumination and noise level. 5. The significant correlation was showed between age, work duration and item of 'whole body feels tired', between VDT work percentage and items of 'eye strain' and 'feel stiffness in the neck or shoulders' and between all items of subjective symptoms.; Summary

Hematologic Findings and Urinarysis of Workers Exposed to Mixed Organic Solvents.: K W Jeong, D H Kim, S H Ohm, S J Kim, J H Kim, S S Moon, J H Chun, Y W Kim; Korean J Prev Med. 1991;24(3):314-337.

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Abstract PDF: To evaluate the effects on health by exposure to mixed organic solvents, the author analyzed some labortory findings of blood(hemoglobin, hematocrit, RBC, WBC, SGOT, SGPT) and urine(protein, blood, sugar) that were obtained from 722 workers (male: 446, female: 276) who worked in plywood, painting and shoes factories in Pusan area from January to December, 1990. The result were as follows; 1. The mean values of each hematologic finding were all within normal limit but there were significant differences at hematocrit, RBC, WBC, SGOT, in male and at WBC, SGPT in female at the comparison of the mean values and the distribution according to the normal criteria by type of work. 2. There were no differences in urinalysis (protein, blood, sugar) by type of work. 3. In stepwise multiple regression, analysis of hematologic findings on age, working duration and type of work, regression coefficients on age and type of work were relatively high in male and female subject, respectively. As a result of this study, it is considered that the measurement of WBC with morphology is significant in hematologic findings and instead of spot urine and urinstix, 24 hours urine and quantitative analysis is required in urinalysis in screening test for healthy status of workers who deal with the organic solvents.; Summary

Health status and medical care utilization patterns of rural aged.: Jang Kyun Oh; Korean J Prev Med. 1991;24(3):328-338.

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Abstract PDF: To find out the state of illness, patterns of medical care utilization, and factors which determine medical care utilization for aged we surveyed 679 rural old persons who live in the Chungnam province from Jan. 10 1991 to Jan. 19. The major findings of this study were as follows; 1. The morbidity rate of chronic illness during last 3 months was 56.4% for all surveyed old persons; 58.7% for female and 52.8% for male. 2. As expected, 80 years old or above group showed the highest morbidity rate, 60.2% and the 65-69 years age group was the lowest, 50.5%. 3. Old persons who are householder, whose family income is less than 290,000 won per month, and who receive benefits from the public medical assistance program had relative higher morbidity rate than other groups and the difference was statistically significant (P<0.05). 4. The most frequent chronic illness was musculoskeletal disease, 49.6%; the disease from which the aged had suffered for the longest period was gastrointestinal, 11.6yrs; the cerebrovascular was the disease which inflicts the lowest level of physical ability. 5. 67.1% of 383 persons who were suffering from chronic illness were in need of medical care but unmet; among the remaining 32.9% who utilized medical care, 19.2% utilized it in local clinics or hospital OPD and 15% in the health centers of subcenters. 6. Old person who are married, whose sons are householder and whose family income is 500,000 won or above per month showed relative higher utilization rate than other groups and the difference was statistically significant (P<0.05). 7. The most common reason why the aged did not utilize, in spite of, need medical care was economic problem, 35.4%. For the aged whose family income per month is 500,000 won or above, however the most common reason was tolerable symptom, 46.9% while persons who answered economic problem were 6.1% of them, the lowest frequency.; Summary

Study on the workers' participation in industries.: Jae Wook Choi, Ok Ryun Moon; Korean J Prev Med. 1991;24(3):339-355.

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Abstract PDF: The concept of workers' participation in occupational health was introduced to Korea recently in relation to primary health care in occupational health. But there is confusion and debate about workers' participation concept. The purpose of this study was to review the concepts of workers' participation and to conduct evaluation the workers' participation status in occupational health and safety. 394 workers and 54 employers (5.6%) in north area of Kyunggi-Do, were selected and interviewed with a questionnaire by a trained interviewer from August to September 1990. In general, the concept of workers' participation is based on industrial democratization and Declaration of Human Rights which had been powerful ideologies in labor movement. Contrary to workers' participation, community participation is rooted in the Health Rights. So, it is necessary to consider concept of workers' participation to improve participation. The results of survey were as follows: 1. Most of companies (71.75) carried out occupational health education to workers in study area. 2. The Occupational Safety and Health Committee (OSHC) were set up in 24.1% among the study companies, and 72.7% of workers among respondents thought that OSHC was helpful to workers health. 3. The workers signed his name to personal health report in 43.1% and the rate of participation in occupational environment examination was 54.9%. 4. The workers prefer the OSHC (39.3%), owner (35.1%) and union (25.8%) as a occupation health organization, but owners prefer OSHC (54.5%), manager (43.2%) and union (2.3%). 5. Among the factors of the general characteristics, the existence of labor union was a major determinant of workers' attitude and level of workers' participation. As we have seen, most levels of workers' participation are low in occupational health. The variable of existence of labor union among the factors was a major determinant of workers attitude and level of workers' participation. Therefore, in order to promote workers health, it is necessary to ponder long deeply on occupational health care system under the viewpoint of workers' participation.; Summary

Maternal risk factors associated with the low birth weight.: Hyung Cheol Park, Jong Park, Youn Ji Lee, Gang Moon; Korean J Prev Med. 1991;24(3):356-362.

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Abstract PDF: This study was performed to identify there maternal risk factors for the low birth weight. During the period from February to June in 1991, the medical record review and questionnaire interview were conducted upon the 465 pregnant women who were admitted to and delivered a baby in 3 general hospitals and an obstetric hospital in Kwangju area. The health and other related information from women who bore the low birth weight infant was compared with those from women who bore the normal birth weight infant. The results obtained were as follows: 1. Maternal age, low body weight at term, illegitimate birth, and maintaining work activity during pregnancy were positively associated with low birth weight. 2. The positive association was revealed between low birth weight and the previous abortion, short gestational weeks, anemia, low maternal weight gain during pregnancy, the obstetric present illness and hypertension. 3. Some maternal working conditions were associated with low birth weight although statistically not significant. 4. In multivariate logistic regression analysis, gestational weeks and maternal weight gain during pregnancy were related with low birth weight.; Summary

Leukocyte count and hypertension in the health screening data in some rural and urban residents.: Choong Won Lee, Nung Ki Yoon, Sung Kwan Lee; Korean J Prev Med. 1991;24(3):363-372.

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Abstract PDF: We used the health screening data of some rural and urban residents to examine the cross-sectional association between leukocyte count and hypertension. The 206 male and 203 female rural residents were selected by multi-stage cluster sampling method in Kyungsan-Kun area of Kyungbuk province in 1985 and 600 urban residents were selected by the same sampling method as the rural residents in Daegu city of the same province in 1986 compatible with age-sex distribution of Daegu city of 1985 census, but of whom 384 actually responded. The rest of 600 were replaced by age and sex with those who were members of the medical insurance plan visiting the health management department of the university hospital to get the biannual preventive medical checkups. Excluded in the analysis were those having hypertensive history, diseases and extreme outlying values of the screening tests, leaving 373 rural and 571 urban residents. Leukocyte count was measured with ELT-8 Laser shadow method and the unit cells/mm3. Blood pressures were determined with an aneroid sphygmomanometer with pre-standardized method and hypertensives were defined as those showing systolic blood pressure more than 140 mmHg and / or diastolic blood pressure more than 90 mmHg. Total residents pooled (N=944) showed a significant difference between hypertensives and normotensives (6965.93+/-1997.01 vs 6490.61+/-1941.32, P=0.00) and in rural residents was noted the similar significant difference (P=0.03). None of significant differences were noted in any stratum stratified by residency and sex. Compared to the lowest quintile of WBC, 2/5 quintile showed odds ratio 0.99 (95% CI 0.90-2.21), 4/5 quintile 1.76 (95% CI 1.14-2.72), and highest quintile 1.80 (1.15-2.82) in the total residents. Likelihood ratio test for linear trend for in indicated a significant trend (x2 trend=5.53, df=1, P<0.05). There were no other significant odds ratios compared to the lowest quintile of WBC in strata stratified by residency and sex. The odds ratios in total residents which had showed significant odds ratios became nonsignificant and of reduced magnitude after controlling age, frequency of smoking and drinking with multiple logistic regression. In each stratum, it changed magnitudes of odds ratios slightly and unstably. None of the trend tests showed any significant trend. These results suggest that the Friedman et al's finding of association between leukocyte count and hypertension may be due to an statistical type I error result in from the data dredging in an exploratory study, in which more than 800 variables were screened as possible predictors of hypertension.; Summary

A study on the factors afecting the subjective symptoms of VDT syndrome.: Jai Dong Moon, Min Chul Lee, Byong Woo Kim; Korean J Prev Med. 1991;24(3):373-389.

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Abstract PDF: In order to develop the measuring tool of VDT syndrome and investigate the variables affecting the development of VDT syndrome, a questionnaire study accompanied with the evaluation of working environment was performed with 138 VDT users from six public organs in Kwangju area. The result were summarized as follows: 1. As a result of analysis with data collected by newly developed questionnaire, VDT syndrome included five factors named as eye-related component, psychological component, general body component, musculoskeletal component, and skin-related component and the estimates of the internal consistency of five factors were 0.877, 0.820, 0.796, 0.791, 0.593 respectively. 2. Variables affecting the level of eye-related symptoms were the type of main job using VDT, the total time of VDT operation per day, and the use of external filter on CRT. 3. The level of eye-related symptoms in the group using external filter was higher significantly than that in the group not using filter. 4. The past history of severe illness affected the level of psychological symptoms significantly. 5. Variables affecting the level of general body symptoms were job satisfaction and income satisfaction. 6. Variables affecting the level of musculoskeletal symptoms were the type of main job using VDT, whether majored in EDPS, the level of typewriting, job satisfaction, and the total time of VDT, operation per day. 7. Age and the use of external filter were significantly related to the level of skin-related symptoms. 7. Age and the use of external filter were significantly related to the level of skin-related symptoms.; Summary

A cohort study on the relationship between pesticide use and mortality, and cancer mortality.: Hee Chul Oh, Chung Mo Nam, Sun Hee Lee; Korean J Prev Med. 1991;24(3):390-399.

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Abstract PDF: The purpose of this study is to examine the relationship between pesticide use and mortality, and cancer mortality which are recognized as health hazards of pesticides. Data were analyzed from a cohort of 6,066 people aged fifty-five or over and who have been residing in the main island of Kangwha county. Death certificates, computerized citizenship registers searches, and household interview survey lead to get more than ninety-seven percents follow-up rate for the first five year observation period. Important findings are as follows: 1. Age specific mortality rates of pesticide users are significantly lower than those of pesticides nonusers. The SMR of male is 0.80, and 0.58 for females respectively probably due to healthy worker effects. But, age specific cancer mortality rates are significantly higher than those of pesticide nonusers (SMR=1.59) in males. this finding is not observed in females (SMR=0.85), however. 2. Logistic regression analyses showed that self-reported health status, drinking, and smoking histories in male are significantly associated with total mortality rate. The histories of pesticide use are also calculated to be highly associated with cancer mortality as in univariate analyses in males. In female, self-reported health status, age of first delivery are found to be significantly related to total mortality rate. Only drinking history is calculated to be associated with cancer mortalities in females. Data from further observation of 'Kangwha cohort' and indepth analyses of these are highly expected.; Summary

An analysis of the physician productivity in general hospitals.: Jung Un Lee, Ki Hyo Lee, Ok Ryun Moon; Korean J Prev Med. 1991;24(3):400-413.

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Abstract PDF: The purpose of this paper is to identify factors affecting the optimum mix of required inputs and other relevant factors which account for the variation in physician's productivity in general hospitals, and to find out their implications for the efficient health planning and management. An extended version of Cobb-Douglas production function and cross sectional data of one day patient census from all general hospitals in Korea in 1988 were used in the analysis. Main results of the analysis and their implications could be summarized as follows ; (1) The production function for physician's inpatient service shows the evidence of economies of scale, but the production function for physician's outpatient and adjusted-patient service, which combines both out- and inpatient service, shows that of dis-economies of scale. (2) The physician's role for production for all service is smaller than auxiliary personnel's, which imply that more intensive utilization of nurses, nursing aides and other auxiliary personnel is desirable for improving general hospital productivity. (3) In case of physician's inpatient and adjusted-patient service, nurses is recommended for the efficient operation of general hospitals. (4) The factor of hospital beds plays the leading role among required inputs in the production for physician's in- and adjusted-patient service. (5) The physician's productivity of general hospitals in rural area is lower than that in urban area. And the productivity of teaching hospitals is lower than that of the other hospitals. Further analysis was made in physician production function based upon the size of hospitals, namely those hospitals below 250 beds and those above. Explained variances by the factor of hospital beds was significantly increased in the case of those hospitals above 250. A more detailed and thorough investigation is needed for verifying factors influencing physician's productivity in general hospitals in Korea.; Summary

Assessment of safety of playground equipments in elementary schools in Taegu.: Jung Han Park, Soon Gil Yun; Korean J Prev Med. 1991;24(3):414-427.

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Abstract PDF: To assess the safety of playground equipments in the elementary schools of Taegu, a site visit was made to 117 elementary schools out of 119 schools between 1st and 30th April 1991. Safety criteria were developed on the bases of Massachusetts' Playground Safety Check List, standard height of Korean children of 6-12 years old, and source book for designing playground equipments. There were eleven different kinds of playground equipments installed in 117 schools but the number of equipments was about 50-60% of the minimum requirement set by the Ministry of Education except chin-up bar. Among the installed equipments, 47.3% of swings, 16.6% of parallel bars, 20.0% of monkey bars, and 16.0% of slides were broken down. None of the swings, slides, seesaws, monkey bars, and sandboxes met the safety criteria to the full but 59.0 of chin-up bars, 31.4% of parallel bars, and 13.5% of stumps met the criteria fully. The proportions of equipments that were dangerous for children to play on were 26.4% for slides, 20.0% for monkey bars, 11.6% for seesaws, 10.4% for parallel bars, 9.85 for sandboxes, 7.4% for swings and stumps, and 3.9% for chin-up bars. The rests were either in need of repair of broken down. It was revealed by this survey that the playground equipments were too short in number to meet the minimum requirement, designs and size were not standardized, and many of the equipments were involved with the risk of child accidents. Therefore, a safety standard for the playground equipments should be developed and the existing equipments should be repaired immediately.; Summary

Cytologic screening for cervical cancer and factors related to cervical cancer.: Yong Jae Jeon, Chi Young Lee, Byung Yeol Chun, Sin Kam, Min Hae Yeh; Korean J Prev Med. 1991;24(3):428-440.

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Abstract PDF: This study was conducted to estimate the prevalence rate of cervical cancer and to investigate its risk factors. 5,417 asymptomatic married women were screened from March, 1984 to December, 1990 in Taegu city. Of 5,417 examinees, 3,817 (70.46%) were normal, 1,542 (28.7%) showed inflammatory change, 51 (0.94%) were dysplasia and 7 (0.13%) were carcinoma in situ or invasive carcinomas. The prevalence of abnormal finding (dysplasia, carcinoma in situ or invasive carcinoma) was 1,070 per 100,000 population. The prevalence of dysplasia was 940 per 100,000 and that of carcinoma in situ or invasive carcinoma was 130 per 100,000. Age-adjusted prevalence rate for abnormal finding adjusted with standard population of Taegu city was estimated to be 850 per 100,000. The prevalence of cervical cancer was significantly increased with age (P<0.05). The prevalence of cervical cancer was significantly decreased with age at marriage and educaitonal level (P<0.05). The history of induced abortion and the number of pregnancies were significantly associated with the prevalence of cervical cancer (P<0.05), whereas, the number of parity was not. Age at marriage was significantly associated with the prevalence of cervical cancer after stratification by age (P<0.05). However, the level of education, parity, induced abortion, number of pregnancies were not significant. Inflammation and human papiloma virus infection were associated with cervical cancer with odds ratio of 13.48(95% confidence interval 7.80~23.40) and 474.29 (95% confidence interval 196.80~1143.10), respectively. In conclusion, for early detection of cervical cancer it should be recommended to perform mass cytological screening. In particular, regular and periodic cytologic screening, starting at age 25, for cervical cancer should be recommended for those women who have frequent cervical inflammation and for those women married before age of 20.; Summary

Trend and forecast of the medical care utilization rate, the medical expense per case and the treatment days per case in medical insurance program for employees by ARIMA model.: Kyu Pyo Jang, Sin Kam, Jae Yong Park; Korean J Prev Med. 1991;24(3):441-458.

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Abstract PDF: The objective of this study was to provide basic reference data for stabilization scheme of medical insurance benefits through forecasting of the medical care utilization rate, the medical expense per case, and the treatment days per case in medical insurance program for government employees and private school teachers and for industrial workers. For the achievement of above objective, this study was carried out by Bos-Jenkins time series analysis (ARIMA Model), using monthly statistical data from Jan. 1979 to Dec. 1989, of medical insurance program for government employees and private school teachers and for industrial workers. The results are as follows; ARIMA model of the medical care utilization rate in medical insurance program for government employees and private school teachers was ARIMA (1, 1, 1) and it for outpatient in medical insurance program for industrial workers was ARIMA (1, 1, 1), while it for inpatient in medical insurance program for industrial workers was ARIMA (1, 0, 1). ARIMA model of the medical expense per case in medical insurance program for government employees and private school teachers and for outpatient in medical insurance program for industrial workers were ARIMA (1, 1, 0), while it for inpatient in medical insurance program for industrial workers was ARIMA (1, 0, 1). ARIMA model of the treatment days per case of both medical insurance program for government employees and private school teachers and industrial workers were ARIMA (1, 1, 1). Forecasting value of the medical care utilization rate for inpatient in medical insurance program for government employees and private school teachers was 0.0061 at dec. 1989, 0.0066 at dec. 1994 and it for outpatient was 0.280 at dec. 1989, 0.294 at dec. 1994, while it for inpatient in medical insurance program for industrial workers was 0.0052 at dec. 1989, 0.0056 at dec. 1994 and it for outpatient was 0.203 at dec. 1989, 0.215 at 1994. Forecasting value of the medical expense per case for inpatient in medical insurance program for government employees and private school teachers was 332,751 at dec. 1989, 354,511 at dec. 1994 and it for outpatient was 11,925 at dec. 1989, 12,904 at dec. 1994, while it for inpatient in medical insurance program for industrial workers was 281,835 at dec. 1989, 293,973 at dec. 1994 and it for outpatient was 11,599 at dec. 1989, 11,585 at 1994. Forecasting value of the treatment days per case for inpatient in medical insurance program for government employees and private school teachers was 13.79 at dec. 1989, 13.85 at dec. 1994 and it for outpatient was 5.03 at dec. 1989, 5.00 at dec. 1994, while it for inpatient in medical insurance program for industrial workers was 12.23 at dec. 1989, 12.85 at dec. 1994 and it for outpatient was 4.61 at dec. 1989, 4.60 at 1994.; Summary

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