No abstract available.
Policy Making*

The purpose of this study is to observe the pattern of change in medical care utilization over time in early years of insurance coverage. The source of data is the benefit records file of a voluntary medical insurance society for covering the four-year period, from 1982 to 1985. The measure of medical care utilization used in this study is the age-sex standardized percentage of the enrollee who have visited a physician over total analytical population during a three-month period. For six cohorts by the year of enrollment (1979-1984), the relationship between the utilization and duration of insurance coverage was examined controlling for the calender year and season. In the analysis, logistic multiple regression and residual analysis were employed. It was observed that medical care utilization rapidly increased during the early stage of insurance coverage, and after then increased at a slower rate over time to become almost stable in about twenty months.
Cohort Studies ; Insurance Coverage* ; Insurance* ; Seasons

This paper is an attempt to identify major challenges to be faced by the Korean health care delivery system for about 30 year in the future and to deliberate over possible policy responses to them. It is not intended to make a precise prediction of the future profile of the system, but the focus is given to understanding what we have to do from now on in order to develop health care in Korea toward a desirable direction. Although the discussion has been made in a rather fragmented manner, it would hopefully provide stepping stones for a systematic study of the Korean health care system from a long range perspective.
Delivery of Health Care* ; Korea

The use of communication media suitable for the audience and message is important in conducting effective family planning IEC activities. This study 'intended to assess differential effects of various media used by the Korean program on rural women's family planning knowledge, attitude, and practice. Data for the study were collected originally for the study of family planning mothers' clubs by the School of Public Health, Seoul National University in 1973. The sample was drawn according to the principle usually employed in obtaining a small sample from a large area. Initially, a sample of 25 Gun's was selected from a total of 138 Gun's by systematic random sampling on the basis of the list of number of mother's clubs in each Gun. Secondly, from each of these primary units(Gun) selected, two second stage units(Myon) were drawn by a systematic random sampling method based on the list of the number of Li's -in each Myon. Finally, a sample of nine Li's was drawn by a simple random sampling method from each Myon selected in the second stage sampling. In this way, a total of 450 Li's, 18 Li's from each of 25 Gun's, were selected. In one of thess 18 Li's of each Gun, all the married women with a living husband, up to age 49, were interviewed. out of 1.052 women interviewed, 145 women were naturally sterile or beyond menopause, and were excluded from thib study. Thus, the analytical population consists of 90 fecundable wives, including those with tubal ligation. A series of analyses were made to examine the relationships between family planning status and selected socio-demographic and communication variables. The family planning status was measured by three indicators, one for each of family planning knowledge, attitude, and practice. The variable for family planning knowledge was created by classifying the respondents into two groups: 1) those who professed to know in detail at least one contraceptive method out of a total of five, including the loop, oral pill, vasectomy, condom, and rhythm, and 2) those who had no professed knowledge about any method. The variable for family planning attitude was dichotomized into those who had favorable attitude toward at least one method among the same list of five, and those who did not have a favorable attitude toward any method. Contraceptive status was classified into two categories of current users and non-users. The independent variables, applied to explain the family planning status, include four sociode-mographie variables and six communication variables. The socio-demographic variables are age, education, number of living children and sons, and ideal number of sons. Communication variables are frequency of exposure to family planning messages through each of the following channels: radio and/or TV, newspaper and/or magazine, 'Happy Home' and/or leaflet, public meeting and/or lecture, family planning worker, and neighbor. Major findings obtained from the analysis are summarized as follows: 1. It was observed that about 33% of the eligible women did not want to have additional children but were not practicing contraception(pong-eem). About half of these women were ever-users and the other half were never-users. They have at least perceived the need for family planning, and thus, should be a primary target population for family planning IEC activities. 2. Socio-demographic variables showed a'closer association with practice than with knowledge or attitude. 3. The communication variables affected family planning status over and above the effects of the socio-demographic variables. When the communication variables were added to the socio-demographic variables as independent variables in the multiple classification analysis, the explained variance was increased by 6.3% in knowledge, 8.7% in attitude, and 4.3% in practice. This also suggests that the communication variables exert larger effects on knowledge and attitude than on practice. Family planning adoption decisions may be influenced by many other factors as well as by family planning knowledge and attitude. 4. The Beta-coefficient was computed for each of the independent variables in multiple classification analysis. Among the media considered in this study, 1) neighborhood communication, radio and/or TV, and 'Happy Home' and/or leaflet had significant effect on family planning knowledge:2) public meetings and/or lecture, radio and/or TV, and neighborhood communication had significant effect on family planning attitude: and 3) radio and/or TV, Happy Home and/or leaflet, and home visit had significant effect on family planning practice. Although program media, neighborhood communication, and radio and/or TV appeared to be more effective than other media, no definite pattern emerged. In the interpretation of these data, however, it should be remembered tha t the frequency of contact varies with the media. 5. When women were exposed to family planning messages more frequently, they tended to have more detailed knowledge about, and more favorable attitudes toward family planning, and were more likely to he practicing family planning. 6. Media behavior differed with age and educational level. It was found that the younger the women and the higher their educational level, the more frequently they were exposed to family planning messages through radio, TV, or printed materials. On the other hand, the older the women and the lower their educational level, the more frequently they were exposed to family planning messages through meetings, home visits, and neighborhood communication. This implies that the audiences' characteristics, such as age and educational level, should be taken into account in the selection of appropriate media.
Child ; Condoms ; Contraception ; Surveys and Questionnaires ; Education ; Family Planning Services* ; Female ; Hand ; Health Services Needs and Demand ; House Calls ; Humans ; Menopause ; Mothers ; Newspapers ; Periodicals as Topic ; Public Health ; Residence Characteristics ; Seoul ; Spouses ; Statistics as Topic ; Sterilization, Tubal ; Vasectomy ; Periodicals

No abstract available.
Blood Platelets*

The utilization of medical care services has been partly regionalized with the implementation of referral requirement by the government since July 1, 1989 when the health insurance coverage was extended to all the people. For the purpose of regionalization, the whole country has been primarily divided into tertiary care regions, and each of them again into secondary care regions. This study investigates the self-sufficiency for in-patient care services of secondary care regions focusing on why it varies among the regions. In doing so, analysis is performed to examine a model which embodies three sets of hypotheses as follows: 1) The regional self-sufficiency for medical care services would be subject to direct influences of regional characteristics, amount of available services and structural properties of regional medical care system ; 2) The regional characteristics would have indirect effects on the self-sufficiency which are mediated by medical care services ; and 3) The amount of available services would indirectly affect the self-sufficiency by influencing the structure of regional medical care system. The results of analysis were generally consistent with the model. The findings have some practical implications. The regional self-sufficiency for medical care services partly depends upon basic properties of each region which cannot be changed in a short period of time. Thus the self-sufficiency for medical care services can be improved by health policy measure. In some of the regions the self-sufficiency for in-patient care services was much higher or lower than can be predicted from the bed-population ratio. Indication is that the allocation of health resources should be made considering a variety of factors bearing upon the supply of and demand for health care ; not on the basis of just a single criterion like the availability. The self-sufficiency of a certain region is related to not only its own characteristics but also the characteristics of neighboring regions. Therefore, attention should be also directed to the inter-regional relationships in health care when the needs for investment of health resources in a region are assessed. However, it should be noted that this study used the data collected before the referral requirement was imposed. A replication of this analysis using recent data would provide an evaluation of the impact on the self-sufficiency of the referral requirement as well as a confirmation of the findings of this study.
Delivery of Health Care ; Health Policy ; Health Resources ; Insurance, Health ; Investments ; Referral and Consultation ; Secondary Care ; Tertiary Healthcare

A l3-year-old boy was admitted to our hospital with severe hypertension, visual blurring, excessive sweating, polyuria and polydipsia. On admission, the blood pressure was persistently elevated at 230/180 mmHg. and an ophthalmologist was consulted, the funduscopic examination showed bilateral grade IV retinopathy. Cardiomegaly with dyspneic on exertion and persistent tachycardia were present. In urine examinations, proteinuria was sustained and glycosuria was traced. B. U. N. was 9.4 mg/dl. Urinary catecholamine was 12480 mic.g./day ; urinary V. M. A. was 20.2 mg./day. Regitine test was positive but histamine test was not performed. Presacral air insufflation with nephrotomography showed egg sized soft tissue mass locating at just above the upper pole of left kidney. He was operated with transabdominal approach. There were bilateral pheochromocytomas on suprarenal areas. Two weeks after operation, he was discharged with good general condition and we report this case with review of literatures.
Blood Pressure ; Cardiomegaly ; Glycosuria ; Histamine ; Humans ; Hypertension ; Insufflation ; Kidney ; Male ; Ovum ; Phentolamine ; Pheochromocytoma* ; Polydipsia ; Polyuria ; Proteinuria ; Sweat ; Sweating ; Tachycardia

PURPOSE: This study is to describe authors'experience on mammographic findings of breast cancer and to know if there is difference between 35 years of age or younger and older groups. MATERIALS AND METHODS: Mammograms of 72 patients with breast cancer detected from January, 1991 to December, 1993 were retrospectively analysed. Mammographic findings were classified into mass only, mass with microcalcifications, microcalcifications only and others. Marginal characteristics of mass were classified into spiculated, poorly marginated and well marginated. Shape of microcalcifications were classified into casting, granular and mixed types. These findings were compared between 35 years of age or younger and older groups. RESULTS: Mammogram showed mass only in 33 patients(46%), mass with microcalcifications in 26 patients (36%), microcalcifications only in seven(10%) and other findings in six(8%). Other findings were architectural distortion, asymmetric high density and incidental breart carcinoma from paraffinoma in one patient respectively, and dense breast in three patients. The margins of the breast mass were spiculated in ten(17%) poorly marginated in 30(51%), well-marginated in 19(32%). Shape of microcalcifications were casting type in 13(40%), granular in 14(42%) and mixed in six(18%) cases. 3 patients had dense breast with which mammography did not demonstrate the lesion. 3 patients without mammographically demonstrable lesions due to dense breasts were under 35 years in age. and there was statistically significant difference between the two groups(p-value<0.05). Microcalcifications only was more common findings in 35 years of age or younger. CONCLUSION: The most important mammographic findings of breast cancer were mass and microcalcifications. Architectural distortion and asymmetric high density were additional findings. In 35 years of age or younger, microcalcifications only was an important finding because mass lesions are frequently masked by dense breast. Thus other imaging modalities, such as ultrasonography, were required.
Breast Neoplasms* ; Breast* ; Humans ; Mammography ; Masks ; Retrospective Studies ; Ultrasonography

This paper concerns professional socialization of medical students. Professional socialization, in the context of this paper, means the process through which a layperson becomes a doctor equipped with professional identity and values. While medical education does not include such process in the curriculum, medical students obtain certain values and identity informally. The dependent variables were professional values and professionalism. The former means the desirable attributes required to conducting professional works such as humane attitudes, science-oriented mind, capability for organizational management. The latter means socio-political reasoning with which doctors can rationalize their privileges such as autonomy. A specially designed questionnaire was developed. The data were collected from five medical schools for 1,318 students in 1994. A total of 1,070 cases were finally included in the statistical analysis. The students emphasized the human factor in the professional values. Their attitude did not change with the grade. Other independent variables such as motives for entering a medical school, socioeconomic status, satisfaction with medical education, etc. also did not influence professional values. It implies that professional values were not consolidated among the students. However, the factors of professionalism change significantly with the grade. It implies that the students paid more attention to socio-political issues related to doctor`s interests as the grade went up. And the factor scores for professionalism were higher for those students who had more positive attitude towards doing medical practice for profit, expected higher income, and were more conservative about social reform. Other independent variables did not influence professionalism. It seems that the students also give emphasis on professionalism, like current medical doctors, mainly because of their concern with recent unfavorable changes in economic conditions of medical care providers.
Curriculum ; Education, Medical ; Humans ; Surveys and Questionnaires ; Schools, Medical ; Social Class ; Socialization* ; Students, Medical*

We retrospectively analyzed the CT (10 cases) and MR (5 cases) findings in 10 patients with radiation-induced pulmonary injury. On CT studies, 8 cases showed fibrotic change and 6 of them also showed solid consolidation with bronchiectasis. The differential diagnosis of radiation-induced injury from residual or recurrent tumor was possible on CT studies which was impossible on plain chest radiograph (2 cases) or MR study(1 case). On MR studies, 4 cases showed solid consolidation with bronchiectasis and fibrosis. The signal intensity was siointense compared with that of the muscle on T1WI (5 cases), and hyperintense of PDWI and T2WI(3 cases). The lesions enhanced well on Gd-DTPA enhanced study (4 cases). The residual or recurrent tumor showed the same signal intensity and degree of enhancement with radiation-induced injury (2 cases). CT and MR are useful for the evaluation of the anatomic details of the large overlapped area of increased density of the radiation-induced pulmonary injury on plain chest radiograph. But MR study is not superior to CT on the differentiation of the residual or recurrent tumor and radiation-induced injury because the tumor may show the same signal intensity and degree of enhancement with radiation-induced injury.
Bronchiectasis ; Diagnosis, Differential ; Fibrosis ; Gadolinium DTPA ; Humans ; Lung Injury* ; Radiography, Thoracic ; Retrospective Studies