No abstract available.
*Delivery of Health Care ; Health Policy ; Humans

After a year of court trials initiated by the immediate family of a patient in a permanent vegetative state, the National Supreme Court of Korea ruled that the family have the right to decide for the removal of ventilator from the patient. This was a particularly significant court case that established a precedent for the Korean society as a whole, since there currently is no statutory framework regarding rights to self-determination to refuse any extraordinary means of treatment in Korean legal system. While much of Korean healthcare providers and the government itself have focused on designing and developing a comprehensive blueprint for Advance Health Directives for patients, the recent outcome has created an important opportunity for all parties of the Korean society. Therefore, the Korean government and legislature will need to systematically study and establish a procedural preparation for legislation. The providers will also have to carefully examine the moral and ethical dimensions of Advance Directives to promote the patients' interests in accordance with civil rights of the patients. Lastly and most importantly, the individuals must reflect on our own moral values, regardless of their current health. To exercise their own will and to relieve their relatives from difficult decisions, they must also educate themselves about living will and healthcare proxy, and elucidate their value history with family. No one can exactly lay out the course of life to death, but it is possible to steer the final journey of life to a more humane death. A society must value the life itself, but the journey to death should also be made humane by respecting one's own choice.
Advance Directives ; Civil Rights ; Delivery of Health Care ; Health Personnel ; Human Rights ; Humans ; Korea ; Living Wills ; Persistent Vegetative State ; Proxy ; Supreme Court Decisions ; Ventilators, Mechanical

The purpose of this study was to assess the impact of AIDS-related knowledge and attitudes of prostitutes on condom use from diverse 'sex markers' in Korea. The data were collected by interviewers at five different 'sex markets'. During March 1993, research assistants at the Institute of Health Services Research interviewed 371 prostitutes visiting sexually transmitted disease (STD) clinics. Multiple regression method was used in identifying the determinants of condom use. The level of condom use was regressed on personal characteristics of prostitutes, AIDS-related perceptions, and market type. Prostitutes' level of condom use turned out to be different across the markets featuring diverse types of services and fees. Neither perceived vulnerability nor perceived seriousness of AIDS had significant effects on condom use. Our findings suggested that the many AIDS-preventive educational efforts by STD clinics are ineffective. Hence, individual STD clinics need to develop AIDS-preventive education programs which are suitable for the unique circumstances of their respective 'sex markets'.
Acquired Immunodeficiency Syndrome/prevention & control* ; Adolescence ; Adult ; Condoms* ; Female ; Human ; Middle Age ; Perception ; Prostitution*

This study was undertaken to explain weight control behavior and intention of obese children and adolescents as measured by the elements of the health belief model. A total of 732 obese students from 28 schools in Seoul metropolitan area and their mothers were assessed with a self-administered questionnaire. The analyzed results are as follows; l. Among obese students, 45.3% of male students and 57.2% of female students, a significantly higher portion than male students, reported that they had tried to lose weight within the recent year. Exercise was the most frequently used method to lose weight followed by diet control, drug use, and specialized clinic visits, in descending order. 2. Male students were more likely to try to lose weight if they perceived a low threat level and their mother had a job, and female students were more likely to try to lose weight if they were younger in age, perceived a low threat level and had strong external motivating factors. 3. Female students showed a significantly higher level of intention to obesity control than male students, and the intention level of their mothers also showed the same trend. 4. In male students, the degree of weight dissatisfaction, weight control experience, the level of obesity related beliefs of students, the educational level of the mother and economic status of the family were significant predictors of intention to obesity control, and in females, age, the level of obesity related beliefs of students and intention of their mothers were significant. In the mothers of male students, obesity index of students, age of the mother and the level of obesity related beliefs of the mother were significant predictors of intention of the mother, and in the mothers of female students, obesity index of students, occupational status of the mother and obesity related beliefs of the mother were significant. 5. According to the path model of intention to obesity control, the degree of weight dissatisfaction had the most powerful effect in male students, and perceived net benefit level was the most important variable in female students. Since the weight control behavior and intention of obese students were more predictable by the degree of weight dissatisfaction than the obesity index, we can conclude that only the students dissatisfied with their weight are well motivated for obesity control. There can be a discrepancy between the mother and her child's beliefs and intention status(especially in male students), so the therapists should also assess the student's opinion as well as the mother's. In female students, the perceived net benefit level was the most important predictor of intention to obesity control, therefore the intervention program should pay particular attention to the positive benefits of weight control rather than negative aspects(threats) of obesity.
Adolescent* ; Ambulatory Care ; Child* ; Diet ; Drug and Narcotic Control ; Employment ; Female ; Humans ; Intention* ; Male ; Mothers ; Obesity ; Surveys and Questionnaires ; Seoul

In this thesis, Korean prisoners' health behavior and the characteristics of their medical utilization were surveyed and analysed. Because prisoners are inclined to be mediators of communicable diseases or unhealthy behaviors between prison institution and the outside world, health care for prisoners is directly related to the national population. Data were collected through a self-administered survey of 5 Korean prisons out of a total of 38 correctional facilities and analysed in accordance with a causal model based on a path frame, by serial multiple regressions on health behavior, health status, and medical utilization, etc. According to the survey analysis, while prisoners were generally concerned with their health much more than they were before imprisonment, they perceived that their health status had deteriorated after imprisonment, and that their need for health services was increasing gradually during their time in prison. In the path analysis on the causal relations among variables related to the prisoners' health status and medical utilization, the prisoners' characteristics affected their health concern and health behavior, and subsequently affected their health status and medical utilization, respectively. To sum up these exploratory studies on prisoners' health behavior and health service utilization, some efforts to organize a health care system embracing the correctional institution and health care administration should be made on the level of establishing a health care delivery system for special social groups like prisoners.
Adult ; Female ; Health Services/utilization* ; Human ; Korea ; Male ; Patient Acceptance of Health Care* ; Prisoners*

In recent years, the Korean Medical Association has undertaken the feat of establishing the Korean Standard Terminology of Medical Procedures with the dedicated help of 32 medical academic societies. However, because the project is being conducted by several different circles, it has yet to see a clear system of classification. This thesis, therefore, proposes the three principles of scientific properties, usefulness and ideology as the basis for classification system and has developed the Classification System of Medical Procedures in Korea upon their foundation. The methodology and organization of this thesis as follows. First, by adopting scientific classification system of Feinstein(1988), an analysis of the classification systems of the medical procedures in the United States, Japan, Taiwan, Who Was carried out to reveal the framework and the basic principles in each system. Second, the direction of classification system has been constructed by applying the normative principle of medical field in order to show the future direction of the medical field and realize its ideology. Third, a finalized framework for the classification system will be presented as based on the direction of classification system. Of the three basis principles mentioned above, the analysis on the principles of usefulness was left out of this thesis due to the difficulty of establishing specific standards of analysis. The results of the study are as follows. The overall structure of the thesis is aimed at showing the 'Prevention-Therapy-Rehabilitation' quality of comprehensive health care and consists of six chapters; I. Prevention and Health Promotion. II. Evaluation and Management . III. Diagnostic Procedures. IV. Endoscopy. V. Therapeutic Procedures. VI. Rehabilitation. Chapter three Diagnostic Procedures is divided into four parts; Functional Diagnosis, Visual Diagnosis, Pathological Diagnosis, Biopsy and Sampling. Chapter five Therapeutic Procedures is divided into Psychiatry, Non-Invasive Therapy, Invasive Therapy, Anaesthesia and Radiation Oncology. Of these sub-divisions, Functional Diagnosis, Biopsy and Sampling, Endoscopy and Invasive Therapy employs the anatomical system of classification. On the other hand, Visual Diagnosis, Pathological Diagnosis, Anesthesia and Diagnostic Radiology, namely those divisions in which there is little or no overlapping in services with other divisions, used the classification system of its own division. The classification system introduced in this thesis can be further supplemented through the use of the cluster analysis by incorporating the advice and assistance of other specialists.
Anesthesia ; Biopsy ; Classification* ; Comprehensive Health Care ; Diagnosis ; Endoscopy ; Hand ; Health Promotion ; Japan ; Korea* ; Radiation Oncology ; Rehabilitation ; Specialization ; Taiwan ; United States

This article describes methods used to produce a RBRVS (resource-based relative value scales), a common scale from two specialties (internal medicine and general surgery) and explains the newly developed extrapolation process within each specialty. To produce a common scale, we selected six 'same' services as linking services common to both specialties. Then we used the bi-weighted least squares method to locate all the same services on a single, common scale. By using the same method, we tried to extrapolate all the services within each specialty, not by the method of Kelly et al, dividing all the services within the specialty into families (small homogeneous groups of services) to apply charge-based ratios. To compare both methods, we extrapolated all the services of general surgery according to each method. With the correlation analysis to compare both results to American RVUs, we found that general surgery's RVUs from our own extrapolation method turned out to be more highly correlated with American RVUs than from Kelly's extrapolation method. Consequently, extrapolation with bi-weighted least squares method gave reasonable results.
Human ; *Internal Medicine ; Least-Squares Analysis ; *Relative Value Scales

After the introduction of National Medical Insurance in 1989, the medical demand has rapidly increased. The impact of increased medical demand was followed by an increase in the number of claims in need of review. We studied a new, fair method for reducing the number of claims reviewed. we analysed 90,583 outpatient claims submitted between september and october; claims were made for services given August of 1994. We finally suggested a screening system for claims review using a statistical method of discriminant analysis of the medical costs. The results were as follows. 1. In the cut-off group, age, days of medication, number of hospital or clinic visits, and total change were significantly high The cut-off rates according to the hospital-type and existence of accompanied disease were significantly different. 2. According to ICD, the cut-off rate was highest in peripheral enthesopathies and allied syndromes(20.76%), lowest in acute sinusitis(0.93%). The mean charges were significantly different according to ICD and existence of cut-off. 3. we build discriminant functions by ICD with such discriminant variables as patient age, sex, existence of accompanied disease, number of hospital or clinic visits, and 9 detailed hospital or clinic charges included in claim. 4. we applied the discriminant function for screening those claims that were expected to be cut-off. The sensitivities comprised from 40% to 70%, and specificities from 70% to 95% by ICD. Acute rhinitis had highest sensitivity(100.00%)and other local infections of skin and subcutaneous tissue had highest specificity(98.45%). The excepted number of cut-off was 17,762(19.61%). The total sensitivity was 49.62%, the total specificity was 82.57% and the error rate was 19.66%. We lacked economic analysis such as cost-benefit analysis. But, if the few method of screening claims using discriminant analysis were applied, the number of claims in need of review will reduce considerably.
Ambulatory Care ; Cost-Benefit Analysis ; Humans ; Insurance Claim Review* ; Insurance* ; Mass Screening ; Methods* ; Outpatients ; Rheumatic Diseases ; Rhinitis ; Sensitivity and Specificity ; Skin ; Subcutaneous Tissue

This paper tested by using Micro TSP, an empirical econometric analysis to approve officially a hypothesis of price elasticity of the demand for medical care services in Korean national medical insurance and the economic effect of health care delivery system with time-series datas of Medical Insurance statistical yearbook(1981-1993). The results suggest that the korean medical insurance system shows moral hazard due to the change of coinsurance and the economic effect according to intervention of the health care delivery system, but it is different by insurers regardless of the same structure of the medical insurance scheme.
Deductibles and Coinsurance ; Delivery of Health Care ; Elasticity* ; Insurance ; Insurance Carriers ; National Health Programs*

In recent years, the physician's professionalism seemed to be facing or experiencing a phase of change. To investigate this phenomenon, social perception and attitude toward physicians were surveyed and analyzed. The subjects consisted of three types of sample group, namely, the general public, physicians, and medical students. Data were collected through interviews, mailing, and self-administered questionnaire surveys to each sample, respectively. The results of analysis showed us that social evaluation of physicians in Korean society exhibited ambivalent perceptions toward physicians. The physician's occupational status was generally evaluated by the three samples as being in a higher stratum in the social structure. But there were great gaps between their perceptions of the change in the physician's occupational status. While the general public perceived that the physician's status might improve in the future, physicians and medical students predicted an absolute declination of the status. Although the general public sympathized with the physician's characteristics as a professional group, an apparent tendency to assume the attitude of a fairly equal relationship toward physicians has increased. The transitional change in the physician's professionalism could be observed through the ubiquity in the perception of the patient's rights in doctor-patient relationships. Such phenomena are believed to have caused physicians to think that not only has their status declined in recent years but also that this declination of social status would continue in the future.
Attitude ; Human ; *Physician-Patient Relations ; Professional Practice/*trends ; Public Opinion ; Questionnaires ; Social Perception ; Support, Non-U.S. Gov't