This study examined the effects of referral requirements for insurance patients which have been enforced since July 1, 1989 when medical insurance coverage was extended to the whole population except beneficiaries of medical assistance program. The requirements are mainly aimed at discourag - ing the use of to Vii; ry care hospitals by imposing restrictions on the patient's choice of a medical service facility. The expectation is that such change in the pattern of medical care utilization would produce several desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities. In this study, these effects were assessed by the change in the number of out-patient visits and bed-days per illness episode and the share of each type of facility in the volume of services and the amount of expenditures after the implementation of the new referral system. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for the patients treated during the first six months of 1989, prior to the enforcement of referral requirements, and those of the patients treated during the first six months of 1990, after the enforcement. The 1989 sample included 299,824 claims (3.6% of total) and the 1990 sample included 332,131(3.7% of total). The data were processed to make the unit of analysis an illness episode instead of an insurance claim. The facilities and types of care utilized for a given illness episode are defined to make up the pathway of medical care uti lization. This pathway was conceived of as a Markov Chain process for further analysis. The conclusion emerged from the analysis is that the enforcement of referral requirements resulted in less use of tertiary care hospitals, and thereby decreased the volume of services and the amount of insurance expenses per illness episode. However, there are a few points that have to be taken into account in relation to the conclusion. The new referral system is likely to increase the use of medical services not covered by insurance, so that its impact on national health expenditures would be different from. that on insurance expenditures. The extension of insurance coverage must have inereased patient load for all types of medical service organizations, and this increase may be partly responsible for producing the effects attributed to the new referral system. For example, excessive patient load for tertiary care hospitals may lead to the transfer of their patients to other types of facilities. Another point is that the data for this study correspond to very early phase of the new system. But both patients and medical care providers would adapt themselves to the new system to avoid or overcome its disadvantages for them, so as that its effects could change over time. Therefore, it is still necessary to closely monitor the impact of the referral requirements.
Health Expenditures ; Humans ; Insurance Coverage ; Insurance* ; Markov Chains ; Medical Assistance ; Outpatients ; Patient Care ; Referral and Consultation* ; Tertiary Healthcare

Until now there are few available epidemiologic data of osteoporosis in Korea, and the severity of osteoporosis-related health problem has not been widely recognized yet. But the numbers of the old people are increasing in Korea, and in 2000, the proportion of people over 65 will be up to about 6.8% of total population. Therefore, osteoporosis, one of the most common metabolic bone disease among the old people, will be one of the most important public health problem. on this background this study was performed to find out risk factors of the development of osteoporosis in Korean women through case-control approach. The subject of this study were selected among the women one general hospital in seoul and were checked bone density from sep. 1988 to sep. 1993. Those who were diagnosed to have hypertension, diabetes mellitus, thyroid disease, breast disease, or liver disease, which are thought to influence bone density, were excluded. Also excluded those who are age-unknown. Finally the subjects were 2,139 women aged between 18 and 79. We operatively defined patient group as those whose bone density is below 1.03 g/cm2, 90% of average bone density of women of 4th decade who visited the same hospital. And we defined control group as whose bone density is above 1.15g/cm2. we randomly selected 201 women from the patient group and 202 from the control. As independent variables we chose age, menarche age, menopause age, menopause type, the number of siblings, the number of pregnancies, body mass index, taking oral pill or not, feeding type, and educational state. Multiple logistic regression analysis was done to see the influence of these variables on the risk of osteoporosis. Results are as follows; 1. menopausal status was statistically significant risk factor to all women irrespective of her age, while obesity and later menopause age were food to be statistically significant protective factors. 2. The more siblings and pregnancies, the greater the risk of osteoporosis, but these factors were not statistically significant. This result is not consistent with other studies. Further studies are strongly needed.
Body Mass Index ; Bone Density ; Bone Diseases, Metabolic ; Breast Diseases ; Case-Control Studies* ; Diabetes Mellitus ; Female ; Hospitals, General* ; Humans ; Hypertension ; Korea ; Liver Diseases ; Logistic Models ; Menarche ; Menopause ; Obesity ; Osteoporosis* ; Outpatients* ; Pregnancy ; Public Health ; Risk Factors* ; Seoul* ; Siblings ; Thyroid Diseases

The rapid increase in the elderly population exercises large pressures on the Korean health care system. A nationwide survey showed that over 80% of the elderly were suffering from one or more chronic diseases and about 20% of the elderly had problem in ADL or IADL in 2001. Medical utilization and expenditures per NHI claims of the elderly has increased faster than that of the non-elderly. The elderly, about 7% of the population, used up 17.7% of the NHI expenditures in 2001. The rapid population aging is expected to put more severe stresses on the Korean health care system over the coming decades. Korea has long had a reputation for being laggardly as a welfare state and is famous for its tradition of family care for the elderly. However, the social and cultural changes in Korea imply that we can no longer depend heavily on family support for long-term care of the elderly, without developing the formal caregiving system. Korean government has now searching a comprehensive solution to the problem of caring for fragile older people. This paper critically reviews the policy and action plan for long-term care for elderly proposed by the MOHSA and suggests some recommendation for efficient and highly qualified long-term care services.
Activities of Daily Living ; Aged ; Aging* ; Chronic Disease ; Delivery of Health Care* ; Exercise ; Health Expenditures ; Health Policy ; Humans ; Korea* ; Long-Term Care

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*

OBJECTIVES: To investigate compliance of hypertension patients using modified Theory of Reasoned Action(TRA). METHODS: The data were collected for 7-12 April 1997, by interviewing 190 hypertension patients in Hwachon, Kangwon-do. The analytical techniques employed include contingency table analysis and logit analysis. RESULTS: 15.1% of patients were unaware of the fact that he/she has hypertension and 11.2% did not know that he/she should take drug. 26.8% of patients took drug continuously, 20.1% had drug intermittently, and 53.1% had never have treatment. In the contingency table analysis, several variables were found to be significantly related to patient compliance. They included variables for attitude towards the consequences of taking drugs, normative beliefs, systolic BP at the enrollment, knowledge of how to take hypertensive drugs, variables for general health behavior and experience with having health worker's home visit. The logit analysis was performed by two steps. First step uses experience with drug treatment of hypertension as the dependent variable, and second step uses continuity of treatment. Included in the predictors that are significantly related to the former analysis are subjected norms produced by combining normative beliefs and motivation to comply, knowledge of how to take hypertensive drugs, and opinion about natural recovery of diseases. The only significant determinant of continuous treatment was knowledge of how to take hypertensive drugs. CONCLUSIONS: The results of analysis suggest the usefulness of TRA as a framework for the study of compliance of hypertensive patients. The findings have some practical implication as well. One is that efforts for enhancing compliance should be directed not only patients but also to other persons influencing patient's attitude and behavior. It also suggest that correct understanding of hypertension treatment is essential to perform the appropriate patient role.
Compliance ; Gangwon-do ; Health Behavior ; House Calls ; Humans ; Hypertension* ; Motivation ; Patient Compliance*

The incidence of community-associated, methicillin-resistant, Staphylococcus aureus (CA-MRSA) has increased in North America and Europe. One of most important reasons is the spread of Panton-Valentine leukocidin (PVL) positive CA-MRSA strains. On the other hand, CA-MRSA is not associated with the PVL positive strain in South Korea. Few cases of PVL positive CA-MRSA infections were reported in South Korea. We encountered a case of a submandibular abscess caused by MRSA in an otherwise healthy 29-year-old foreign female resident in a military camp. The CA-MRSA infection was confirmed by culture after abscess aspiration. Staphylococcal cassette chromosome mec (SCCmec) typing, multilocus sequence typing and spa typing revealed type IV, ST8 and t008, respectively. The PVL gene was also identified.
Abscess ; Bacterial Toxins ; Community-Acquired Infections ; Europe ; Exotoxins ; Female ; Hand ; Humans ; Incidence ; Leukocidins ; Methicillin ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Military Personnel ; Multilocus Sequence Typing ; North America ; Republic of Korea ; Sprains and Strains ; Staphylococcus ; Staphylococcus aureus