No abstract available.
Delivery of Health Care*

No abstract available.
Diarrhea*

No abstract available.
Education* ; Insurance* ; Primary Health Care*

BACKGROUND: Rapid progress in medical science and technology has lengthened the average span of life in general population and accelerated the increase in the elderly. This gave rise to the expansion of chronic degenerative disease in the elderly, and then led to an increase in the utilization rate of health care facility and medical fee in sequence. METHODS: In order to grope for an effective control program of chronic degenerative disease and to find out the characteristics of disease structure and utilization patterns of health care facility in the elderly, the author analysed the 6,072,196 cases of insured medical record of Federation of Korean Medical Insurance Societies from January 1st to December 31st of the year 1991. RESULTS: Essential hypertension(5.94%) is the most common disease in the elderly. And what follows are gastritis and duodenitis(4.29%), acute bronchitis and bronchiolitis(3.68%), acute upper respiratory infection of multiple or unspecified site(3.47%) and diabetes mellitus(3.21%). Twenty most frequent diseases constitute the top 50.27% and one hundred constitute over 85% of all frequency of health care facility utilization. There are different patterns of diseases between two sexes. Pulmonary tuberculosis, chronic liver disease and cirrhosis, malignant neoplasm of stomach, chronic obstructive pulmonary disease, occlusion of cerebral arteries, sprains and strains of knee and leg, malignant neoplasm of trachea, bronchus and lung, other open wound of head, erythematosquamous dermatosis are more than 1.5 times higher in male by the standardized frequency ratio. There is a significant dissimilarity of disease structure between primary and other types of health care facility, which presents the point of reinforcement in primary care. The author has also noted elderly patients prefer secondary or tertiary health care facility in case of essential hypertension, diabetes mellitus, pulmonary tuberculosis, heart failure, duodenal ulcer, chronic liver disease and cirrhosis, funtional gastrointestinal disorder, hypertensive heart disease and chronic obstructive pulmonary disease which seems to be not so critical in most cases. CONCLUSIONS: Patients of chronic degenerative disease tend to pursue the high quality of medical care and irregularly utilize health care delivery system.
Aged* ; Bronchi ; Bronchitis ; Cerebral Arteries ; Delivery of Health Care* ; Diabetes Mellitus ; Duodenal Ulcer ; Fees, Medical ; Fibrosis ; Gastritis ; Head ; Heart Diseases ; Heart Failure ; Humans ; Hypertension ; Insurance ; Knee ; Leg ; Liver Diseases ; Lung ; Male ; Medical Records ; Primary Health Care ; Pulmonary Disease, Chronic Obstructive ; Skin Diseases ; Sprains and Strains ; Stomach ; Trachea ; Tuberculosis, Pulmonary ; Wounds and Injuries

BACKGROUND: Many of the major life events that appear to affect biologic system and health occur within the context of the family and can have a profound psychosocial and biologic impact on family memebers. So, the present study attempted to examine the relations of family function with stressful life events, depression, and physical and psychological symptoms reported by patients. METHODS: Design : Cross sectional, observational study. Participants : 41 healthy adult males from a family medicine ambulatory care unit in a tertiary hospital located in Guro completed a series of psychometric instruments that include the Family APGAR(Adaptation, Partnership, Growth, Affection, and Resolve), FACESIII(Family Adaptability and Cohesion Evaluation Scale), Modified 46-item Stressful Life Events Scale, Lee's 98 items Stressful Life Event Scale, Korean version of BEPSI(Brief Encounter Psychosocial Instrument) and BDI(Beck's Depression Inventory Scale). RESULTS: Family APGAR was negatively correlated with stress related life events(both in total and negative events, -0.30, -0.37, respectively; p<0.05) and BEPSI(-0.56; p<0.0001). No significant correlation could be found between family function and positive life events. Family APGAR also revealed significant negative correlation with BDI(-0.61; p<0.0001). Among the three family types, severe dysfunctional family demonstrated highest level of stressful life events score, perceived stress, and depression(p<0.05). CONCLUSIONS: The higher the assessment of the family function(Family APGAR), the lower the level of stressful life events, perceived stress and depression. There, knowledge of the family function, stress, and coping could be useful to family physicians in the whole person approach of their patients.
Adult* ; Ambulatory Care ; Depression* ; Humans ; Male* ; Observational Study ; Physicians, Family ; Psychometrics ; Tertiary Care Centers

BACKGROUND: This study intends to clear that the current cost reimbursement system of Korean medical insurance of health care. METHODS: By using insured medical record of Federation of Korean Medical Insurance Societies used in the demand tendency research of the type of services from feburary 1st to 28th of the year 1990, authors analyze the characterist,ic of components of charges per case in the type of health care facilities. RESULTS: The charge per case in the out-patient care of primary health care facility is 13,498 won, which is 54.6% by comparison with the secondary health care facility and 30.7 % by comparison wit,h the tertiary health care facility. Among these charges the amount of the cost for medical examinations and oral drugs are 73.9% in the primary health care facility and 71.8% in the secondary and 67.5% in the tertiary. Consequently, the services in the primary care are chiefly composed with the medical examinations and oral drugs. In addition to this point the author also finds that the charge per case is 3.5 times, the cost for oral drugs is 5.6 times larger than those of primary care, and therefore tertiary health care facility conduct various diagnostic examinations and prescript more expensive. CONCLUSIONS: There is a difference of basic medical cost ratio between primary, secondary and tertiary health care facility. These points can be lead to the presumption that the diseases under the structure of current medical insurance are overlapped irrespective of the charact.erisitcs of the type of health care facilites, and this is profitable to the tertiary health care facilities which can conduct various types of services. In conclusion, the frame a policy is needed to encourage primary care which are nothing but simple structure of charges.
Delivery of Health Care ; Humans ; Insurance* ; Medical Records ; Outpatients ; Primary Health Care

No abstract available.

No abstract available.

No abstract available.
Abortion, Induced* ; Contraception* ; Female

Our experience with recurrent dislocation of the patella on ten knees in eight patients seen at Seoul National University Hospital during the last 2 years and eight months is reported. Five were female and three male. The age ranged from seven to 27 years. In four of the patients the onset was attributable to a definite history of trauma, while in one patient the dislocation was considered due to developmental anomalies and in another it was clearly congenital Still another patient had a progressively short limb due to premature closure of the distal femoral epiphysis with accompanying flexion-valgus deformity of the knee, presumably caused by an unrecognized infection during early childhood One adolescent girl had bilateral knock knees. The knock knees were treated successfully by supracondylar osteotomy and one post-traumatic knee by classical Roux-Goldthwait procedure with equally excellent result, The rest were treated by Greens vastus medialis transfer with division of the iliotibial band or reefing of the medial joint capsule when necessary. In one knee dislocation recurred, probably due to avulsion of the transferred vastus, and two knees had residual subluxation and limitation of flexion. The results on the remaining seven knees were excellent.
Adolescent ; Congenital Abnormalities ; Dislocations ; Epiphyses ; Extremities ; Female ; Genu Valgum ; Humans ; Joint Capsule ; Knee Dislocation ; Knee ; Male ; Osteotomy ; Patella ; Quadriceps Muscle ; Seoul