- Medical Service Utilization and Trends among Korean Elderly in the Last One Year of Life.
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Jee Jeon Yi, Ki Soon Park, Seung Hum Yu, Jeong In Kim, Jae Yong Park, Wang Kun Yoo, Sang Wook Yi
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Korean J Prev Med. 2003;36(4):325-331.
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To analyze medical service utilization and trends among the elderly in the last year of life. METHOD: The subjects of this study were people that had died at the age sixty-five and above between January 1st and June 30th 2000 The names of the deceased and their dates of death were collected from the data of the funeral-expenses-receivers of the National Health Insurance Corporation (NHIC). This data was merged with that of the individual medical expenses of the NHIC. RESULTS: In the first half of 2000, 84.2% of the funeral-expenses-receivers (53, 063) utilized medical services during the year prior to their death; 51.0% (27, 042) were female and 49.0% (26, 021) male. In the last twelve months of life, the medical fees, the number of days receiving medical services and the number of days receiving medicine were 3, 107, 935 Won, 47.88 and 153.21, respectively, for each person. As the age of the groups increased, the level of medical service utilization decreased; the change was more obvious in female group. The level of medical service utilization during the twelve months prior to death drastically increased around the time of death. CONCLUSIONS: This study, from an analysis of the level of medical service utilization prior to death, shows a concentrated volume of medical services during a certain time period prior to death.
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Summary
- Therapeutic Compliance and Its Related Factors of Lung Cancer Patients.
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Si Hyun Nam, Sin Kam, Jae Yong Park, Sang Chul Chae, Moon Seob Bae, Moo Chul Shin, Min Hae Yeh
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Korean J Prev Med. 2002;35(1):13-23.
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To investigate the therapeutic compliance and its related factors in lung cancer patients. METHODS: The subjects of this study comprised 277 patients first diagnosed with lung cancer at Kyungpook National University Hospital between Jan 1999 and Sept 1999. Of these, 141 (50.9%) participated in the study by properly replying to structured questionnaires. The data was analyzed using a simplified Health Decision Model. This model includes categories of variables covering therapeutic compliance, health beliefs, patient preferences, knowledge and experience, social interaction, sociodemographic and clinical characteristics. RESULTS: The therapeutic compliance rate of the 141 study subjects was 78.0%. An analysis of health beliefs and patient preferences revealed health concern (p<0.05), dependency on medicine (p<0.05), perceived susceptibility and severity (p<0.05) as well as preferred treatment (p<0.01) as factors related to therapeutic compliance. Factors from the sociodemographic characteristics and clinical factors that were related to therapeutic compliance were age (p<0.01), monthly income (p<0.05), histological type (p<0.05) and clinical stage (p<0.05) of cancer. CONCLUSIONS: In order to improve therapeutic compliance in lung cancer patients it is necessary to educate the aged, low-income patients, or patients who have small cell lung cancer or lung cancer of an advanced stage for which surgery is not indicated. Additionally, it is essential for medical personnel to have a deep concern about patients who have poor lifestyles, a low dependency on medicine, or a high perceived susceptibility and severity. Practically, early diagnosis of lung cancer and thoughtful considerations of low-income patients are important. By means of population-based education in a community, we may promote attention to health and enhance the early diagnosis of lung cancer.
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Summary
- Short-term Glycemic Control and the Related Factors in Association with Compliance in Diabetic Patients.
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Gui Young Kim, Jae Yong Park, Bo Wan Kim
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Korean J Prev Med. 2000;33(3):349-363.
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Generally, it seemed that the therapeutic result in diabetic patients was changed by compliance. This study was conducted on the basis of assumption that the therapeutic result in diabetic patients could control according to compliance. This study was conducted to analyze the related factors in association with compliance to drug, diet and exercise therapy. METHODS: 224 diabetic patients in Kyungpook National University Hospital were selected through the interviews and HbA1c values from 1 Jan. to 28 Feb. 1997. The drug compliance was tested by regularity of drug administration, the diet compliance was tested by restriction of food, exactly allocation, balance of nutrient, measuring food and the exercise compliance was tested by regularity of exercise per day. We assessed compliance by percentage, X2-test and generalized logit regression model(method:enter). RESULTS: The significant variable was the satisfaction to medical personnels in drug, the knowledge to disease in diet, the participation of the diabetic education in exercise therapy and the satisfaction to medical personnels in HbA1c. Using the generalized logit model(method : enter) in compliance change, the significant variables were the satisfaction to medical personnels and the complication in drug; the significant variables were the age at the first diagnosis, the family history, the concern of health, the knowledge of disease, the self-exertion for therapy and the complication in diet; the only significant variable was the gender in exercise therapy. CONCLUSIONS: The degree of glycemic control in diabetic patients was influenced by compliance. In order to improve patient's compliance, we must foster the knowledge on the diseases, lead participation for diabetic education. Because the satisfaction to medical personnels was the important variables, we must build up good relationship between doctors and patients.
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Summary
- Determinanats of Health Care Utilization of the Physically Disabled.
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Keon Yeop Kim, Young Sook Lee, Ki Soo Park, Jae Hee Son, Sin Kam, Byung Yeol Chun, Jae Yong Park, Min Hae Yeh
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Korean J Prev Med. 1998;31(2):323-334.
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- To investigate determinants of health care utilization of the physically, disabled over 20 years old in age living in Taegu city, a self-administered questionnaire survey was carried out for 337 disabled persons with chronic illness from April to July, 1997. Health care utilization rate was 81.9%(69.l% for hospital or clinic and 12.8% for pharmacy). Marital status, job, health concern, and response to illness showed statistically, significant relationship with health care utilization(p<0.05). By, path analysis, job, economic status, medical security type and response to illness had a significant direct effect on health care utilization(p<0.05), however, health concern and regular source of care had an indirect effect. The reasons of no health utilization were due to economic problem(31.l%), no symptom(18.0%), inconvenience to seek care or no accompanying persons to be helped(14.8%), unseriousness of the severity of the illness(14.8%), too busy to be treated or no free time(8.2%), hopeless prognosis to be treated(6.6%) in order. In conclusion, it is recommended that the program for expanding medicaid, improving socioeconomic status by getting a job and health education to increase the health Concern toward physically disabled should be implemented to increase health care utilization rate.
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Summary
- Knowledge, Attitude and Practice according to Types of Occupational Health Management.
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Sung Hee Kim, Hae Ryeun Shin, Sang Woo Kim, Kuck Hyeun Woo, Wan Seoup Park, Jae Yong Park
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Korean J Prev Med. 1996;29(3):579-596.
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- The first purpose of this study was to compare the mean Knowledge, Attitude & Practice(KAP) scores concerning major occupational Health between two types of occupational health management in small & medium-scale textile factories. Sample number was 1,138 workers. In small & medium factories with 300 workers or less, they have two alternatives for occupational health management; Individual Health Management or Vicarious Health Management. The second purpose was to determine if there was a relationship between duration of Vicarious health management and mean kap scores for 694 workers from the Vicarious Health Management group. We used self-administered questionnaires for measuring KAP. The results of this study were; 1. There was significant difference concerning all socioeconomic & occupational variables(gender, age education level, marital status, Blue/White collar, working duration of present factory, working duration of total factories) except for shift. 2. There was no significant difference of mean scores of Knowledge and attitude between the Individual Health Management Group and the Vicarious Health Management. But, the mean score of Practice was significantly different. 3. According to multiple regression analysis, the mean score of Knowledge significantly increased with age, education level, working duration of all factories increased. The mean score of Attitude significantly increased with age, education level and married. The mean score of Practice significantly increased with age, education level, working duration of all factories, married and men. 4. In conclusion, The type of Health management did not significantly affect the mean KAP scores concerning major occupational Health problems. 5. But, the Duration of Vicarious Health management significantly increased the mean KAP scores.
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Summary
- Drug Abuse Status and Its Determinants of Male High School Students in Taegu.
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Jung Rak Nam, Sin Kam, Jae Yong Park, Chang Hyun Han, Young Ae Ha
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Korean J Prev Med. 1996;29(3):451-470.
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- To identify the drug abuse status and its determinant factors in high school boys in Taegu, the study was performed from April to May, 1995. Study population were selected by cluster sampling method and total 5,665 students replied to the self-administered questionnaire survey(2,207 in academic high school, 3,458 in business high school). The major findings were as follows; The proportion of drinking, smoking experience was 55.0%, 45.8%, respectively, and the proportion of current drinker, current smoker was 27.2%, 27.5%. The drinking, smoking experience rate of second grade students was higher than first grade and it was higher in business high school boys. The proportion of a stimulant, a hallucinogen, hemp leaf cigarets experience was 3.2%, 1.6%, 0.1%, respectively. Drug abuse had significant association with home environment(lower economic status, frequent move, death of father or mother, apart from family), parents environment(parents' indifference, parents' drinking and smoking, etc.), school life(lower school grades, intimate friend's drug abuse, etc.), generous attitude to drug abuse, higher level of stress. Students who replied that the law prohibited immature person(students) from drinking and smoking showed lower drug abuse rate. In multiple logistic regression analysis, second grade students, business high school students, parents' indifference, lower school grades, intimate friend's drug abuse, no recognition of the fact that the law prohibits high school students from drinking and smoking, generous attitude to drug abuse, higher level of stress were significantly related with alcohol abuse and smoking. Other drugs abuse were related with above factors. On consideration of above findings, to prevent students from drug abuse, we have to try together in house, school, and society.
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Summary
- Trend and Prediction of Urban Family Expenditure for Health Care.
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Jae Yong Park, Si Hyun Nam
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Korean J Prev Med. 1995;28(2):347-363.
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- The increase of health care expenditures is an important problem in the almost countries. Also, suppression of the health care expenditures is an important problem in the health field of Korea since the national health insurance for total people in 1989. Thus, it is very important to grasp the change of the health care expenditures of family and proportions of the health care expenditures to total expenditures of family, because they are the basis of national health care expenditures in Korea. While the health care expenditures of urban family were increased during 1980-1993 by 12.8% annually, the total expenditures of urban family were increased by 14.8% annually. consequently, the proportions of health care expenditures to total expenditures were decreased from 5.98% to 4.76%. The proportions of health care expenditure for 3 years to come were predicted to 4.75% in 1994, 4.67% in 1995, and 4.63% in 1996 by the time-series ana]ysis. That is, it was predicted that they would be decreasing slowly. The product elasticity of health care expenditure was less than 1 in the multiple regression analysis, so the health care is normal good rather than superior good. Therefore, it seems that the household economy is able to bear the expense pursuing the improvement of quality of health care by actualizing the medical insurance fee.
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Summary
- Factors Influencing Workers' Perception and Attitude Toward Special Periodic Health Screening Test.
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Si Hyun Nam, Sin Kam, Jae Yong Park
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Korean J Prev Med. 1995;28(2):334-346.
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- To investigate the factors influencing workers' perception and attitude toward special periodic health screening test for workers, a survey with self-administered questionnaires was performed on 279 workers who had special periodic health screening test from september 1 to October 15, 1994. A study model was developed by modifying the health belief model. The end and intermediate response variables of the model were the voluntary participation and necessity perception on the special screening for workers, and The result of analysis was consistent with the study model. Rates for the necessity perception and voluntary participation on the special1 screening for workers were 77.2%, 79.2%, respectively. Factors influencing on the voluntary participation were necessity perception, benefit of special screening for workers, and cue to action. And on the necessity perception were susceptibility and severity to occupational disease, knowledge to special screening for workers, and support of company. General and occupational characteristics influencing on the susceptibility and severity to occupational disease were sex, age, educational level, work duration, and health education. On the knowledge to special screening for workers were age, educational level, work duration, and locus-of-control. On the benefit of special screening for workers were age, locus-of-control, pride on health, and health education. Therefore, to increase the voluntary participation and necessity perception on the special periodic health screening for workers, l) if a worker is judged as occupational disease, the judgment should be widely known in his workplace, 2) the screening result forms should be directly sent to the workers themselves, 3) for the positivity of employers, the campaign and education program subjected to them should be planned, 4) health education should give the first consideration to the younger, lower educational level, and newly employed women, and its frequency should be increased and it should be more frequently dealt with occupation-related subjects, and 5) the employers should have a careful concern in not being disadvantageous to workers due to result of screening.
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Summary
- Determinant Factors for Expenditure of the Medical Insurance Program for Self-Employeds.
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Sin Kam, Jae Yong Park, Min Hae Yeh
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Korean J Prev Med. 1995;28(1):153-173.
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- This study was conducted to examine the determinant factors for expenditure of the medical insurance program for self-employeds based on the analysis of 1991 "The Medical Insurance program for self-Employeds Statical Yearbook", and also similar yearbooks in the metropolitan and other provinces. The major findings are as follows: We have divided benefits into these four components such as the utilization rate for out-patients. expenses per claim for out-patients as paid by the insurer, utilization rate for in-patients, and the expenses per claim for in-patients as paid by the insurer, in order to examine the determinant factors for it. The results of the study revealed the following findings: in urban areas, the supply of medical care had more influence on the benefits than other demographic and economic variables, while, in county areas, both the supply of medical care and the rate of those aged over 65 affected the provision of benefits. The determinant factors for financial balance of the medical insurance program for self-employeds are: first, the determinant factor for administrative expenses was the number of households. The more the number of household, the less the administrative expenses per the insured. This shows that the economy of scale is being. And so, the administrative district must be taken into consideration in the incorporation of small regional medical societies and should be re-organized for more efficient management. Second. in urban areas. the supply of medical care had more influence on utilization rate and expenses per claim as paid by insurer, and therefore it is necessary to control it. In county areas the supply of medical care and the rate of those aged over 65 raised the utilization rate and expenses per claim as paid by insurer. For the financial stability of county areas. a common fund for medical care for the aged and expansion of finance stabilization fund would be necessary. But, in county areas, it would be unnecessary to control the supply of medical care because it was much more insufficient than in urban areas. The vitalization of public health facilities must be carried out in county areas, for they reduced benefits. Since the more insured in a single household, the less the utilization of the medical insurance program, benefits for habilitation at home should be given consideration. The law of majority and the economy of scale were applied here, and therefore the incorporation of regional medical societies must be taken into consideration. In integrating regional medical societies, it would be absolutely necessary to review the structural differences among all regional medical societies, the medical demand of each region, and also the local characteristics of each region.
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Summary
- A study on the repeat tests for diagnosis at a tertiary hospital in Taegu city.
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Jae Yong Park, Gui Young Kim
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Korean J Prev Med. 1993;26(3):457-468.
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- This study was conducted to investigate the repeat test rate for diagnosis at a tertiary hospital for the outpatients who were referred themselves to the hospital by the clinics and other medical facilities. The study population consisted of 498 patients who visited outpatient department of internal medicine, general surgery, orthopedic surgery and neurosurgery in the hospital between March 16 and April 11, 1992. This study was surveyed by the questionnaire about the tests for diagnosis at first level medical facilities, and then, was investigated by the medical record about the tests for diagnosis at a tertiary hospital. The proportion of test among the patients who utilized the first level medical facilities was 20.9% for the X-ray test, 10.6% for the urinalysis, 9.0% for the electrocardiogram, 3.4% for the computer tomogram and 6.4% for the ultrasonogram. At the tertiary hospital, the X-ray test was 45.2%, the liver function test was 24.7%, the urinalysis was 19.1%, and the electrocardiogram was 15.7%. The proportion of patients who possessed results of test for diagnosis at the first level medical facilities was 76.5% for the computer tomogram, and 31.3% for the ultrasonogram. As the repeat test rate between the first level medical facilities and the tertiary hospital, the thyroid function test was the first rank as 71.4%, the second rank was the routine CBC as 67.9%, and the third rank was the X-ray test as 64.4%. But among the patients that brought the result for tests at the first level medical facilities, the repeat test rate was as follow ; the routine CBC was 75.0%, the liver function test was 72.7%, and the computer tomogram was 15.4%.
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Summary
- Recognition and attitude to fundtional division between physicians and pharmacists of practising physicians and pharmacists in Taegu city.
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Moo Sik Lee, Nung Ki Yoon, Suk Kwon Suh, Jae Yong Park
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Korean J Prev Med. 1993;26(1):1-19.
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- Mail questionnaire was administrated to 370 practising physicians and 388 pharmacists in Taegu city selected by systematic sampling to examine utilization states and opinion of pharmacy under medical care insurance programme and the attitude to the functional division between physicians and pharmacists from April to May 1992. Regarding the opinion on the outcome of drug-store under medical insurance, 71.2 percent of practicing physician answered failure but 13.4 percent of practicing pharmacists answered failure in contrast. Fifty percent of practicing physician asserted introducing functional division between physician and pharmacist while 66.9 percent of practicing pharmacist answered drug-store under medical insurance itself is successful programme. Average daily numbers of preparation of medicine was 32.2 case. Percentage of utilization of drug-store under medical insurance to average daily cases of preparing of medicine was 20 percent, percentage of utilization with physician's prescription was 0.7 percent. And 58.7 percent of practicing physician experienced outside the institute prescription. Regarding the opinion on the pros and cons of enforcing functional division between physician and pharmacist, 59.2 percent of practicing physician preferred pros and 17.7 percent cons ,but 38 percent of practicing pharmacist preferred pros and 45.5 percent cons. And pharmacist know better the content of functional division between physician and pharmacist, practicing emphasized to prevent misuse or abuse of medicine but practicing pharmacist emphasized to display physician and pharmacist's professional ability. And as an opinion on implementation style of functional division between physician and pharmacist in pros respondents, practicing physician favored mandatory enforcement (52.3%), while practicing pharmacist favored partial incomplete functional division (81.7%). As the method of prescription if functional division between physician and pharmacist will be enforced, both practicing physician and pharmacist preferred generic name (44.0%, 89%) mostly, but physician preferred brand name (35.3%) secondly. Regarding the reason for not implementing functional division between physician and pharmacist up to date, both physician and pharmacist answered problem of business right between physician and pharmacist, followed by lack of recognition, and interest of people and lack of the governmental willness. Regarding the opinion on prior decision of condition for enforcing functional division between physician and pharmacist, practicing physician and pharmacist named uneven distribution of medical facilities and drug-store between rural and urban, inequality of physician and pharmacist manpower and the problem of manpower demand and supply mostly, and practicing physician pointed out establishing attitude of acceptance on the part of pharmacist and practicing pharmacist favored establishing attitude of acceptance on the part of physician, which was different attitudes between physician and pharmacist. Following conclusion was reached; 1. Current drug-store under medical insurance program yield insufficient outcome, so we should consider program conversion from drug-store under medical insurance program to functional division between physician and pharmacist. 2. There were problem of business right and conflicts between physician and pharmacist at enforcing functional division between physician and pharmacist, so the government should search for formulating plan to resolve the problem and have neutral willness for the protection of the national health.
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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.
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Kyu Pyo Jang, Sin Kam, Jae Yong Park
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Korean J Prev Med. 1991;24(3):441-458.
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- 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.
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Summary
- Morbidity Rate and Medical Care Utilization of Sailors during the Voyage.
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Jae Yong Park, Jung Won Jun
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Korean J Prev Med. 1989;22(1):102-115.
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- The purpose of this study was to find out morbidity rate and utilization pattern of medical services of sailors on a voyage. The subjects of this study were 470 sailors who are sailors' trainee and safety-trainee for embarkation in a ship. Data were collected by means of personal survey conducted from September 5 to October 30, 1988. The subjects were sailed 12.6 months on the average. During the voyage, 49.4% of the sailors had sickness more than once, and 24.7%' was unable to work more than a day because of illness. The average monthly morbidity rate was 85.7 per 1,000 and the monthly prevalence rate of disease that was unable to work more than a day was 21.2 per 1,000. The sailors of 40-49 years old had the highest morbidity rate of 103.6 per 1,000/month. The number of days activity restricted due to sickness was 93.4 days per 1,000 persons, and the average duration of illness was 11.2 days per sickness. The proportion of treatment days to sickness days was 48.8%. Considering morbidity unable to work more than a day, the number of those who had traumatic injury were 17.2%, which revealed the highest rate, influenza or cold were 15.5%, and the digestive disease 11.2%. Less than half(42.1%) of patients were treated with medicine kept in the cabin. However, 2.1% was transferred by helicopter and 29L% was treated at hospitals or clinics in nearby port. In the cabin, 67.4% of patients was cured completely.
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Summary
- Geographic Distribution of Physician Manpower by Gini Index.
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Byung Wook Moon, Jae Yong Park
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Korean J Prev Med. 1987;20(2):301-311.
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- The purpose of this study is to analyze degree of geographic maldistribution of physicians and changes in the distributional pattern in Korea over the years 1980-1985. In assessing the degree of distribution and in identifying changes in the distribution pattern, the Gini index of concentration was used. The geographical units selected for computation of the Gini index in this analysis are districts (Gu), cities (Si), and counties (Gun). Locational data for 1980 and 1985 were obtained from the population census data in the Economic Planning Board and regular reports of physicians in the Korean Medical Association. The rates of physician located countries to whole physicians were 10.4% in 1980 and 9.6% in 1985. In term of the ratio of physicians per 100,000 population, rural area had 9.18 physicians in 1980 and 12.95 in 1985, 7.13 general practitioner in 1980 and 7.29 in 1985, and 2.05 specialists in 1980 and 5.66 in 1985. Only specialists of general surgery and preventive medicine were distributed over 10% in county and distribution of every specialists except chest surgery in county increased in 1985, comparing with that rates of 1980. The Gini index computed to measure inequality of physician distribution in 1985 indicate as follows; physicians 0.3466, general practitioners 0.5479, and specialists 0.5092. But the Gini index for physicians and specialists fell -15.40% and -10.42% from 1980 to 1985, indication more even distribution. The changes in the Gini index over the period for specialists from 0.3639 to 0.4542 for districts, from 0.2510 to 0.1949 for cities, and 0.5303 for countries indicate distributional change of 24.81%, -22.35%, and 10.65% respectively. The Gini indices for specialists of neuro-surgery, chest surgery, plastic surgery, ophthalmology, tuberculosis, preventive medicine, and anatomical pathology in 1985 were higher than Gini indices in 1980.
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Summary
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KSPM
