한 병원이 지역사회에 미치는 경제적 영향 분석

강임옥,이선희,김한중,Kang, Im-Ok,Lee, Sun-Hee,Kim, Han-Joong 대한예방의학회 1996 Journal of Preventive Medicine and Public Health Vol.29 No.4

Demand for high quality medical care has recently been increasing in step with high level of income and education. Patients prefer the use of large general hospitals to small community hospitals. Large hospitals, usually located at urban area, expand their capacities to cope with the increasing demand, therefore, they easily secure revenue necessary for growth and development of hospitals. However, small community hospitals are facing with serious financial difficulties caused from the reduction of patients in one hand and the inflation of cost in another. If small rural hospitals were closed, the closure would have negative impacts on local economies in addition to the decrease in access to medical care. Community leaders should have an insight on the contribution of community hospitals to local economies. They could make a rational decision on the hospital closure only with the understanding of hospital's contribution to the community. This study is designed to develop an economic model to estimate the contribution of rural hospital to local economies, and also to apply this model with a specific hospital. The contribution of a hospital to local economies consists of two elements, direct effect and multiplier effects. The direct impacts include hospital's local purchasing power, employee's local purchasing power, and the consumption of patients coming from outside the community. The direct impact induces multiplication effect in the local economy. The seed money invested to other industries grows through economic activities in the region. This study estimated the direct effect with the data of expenditure of the case hospital. The total effect was calculated by multiplied the direct effect with a multiplier. The multiplier was drown from the ratio of marginal propensity of income and expenditure. Beside the estimation of the total impacts, the economic effect from the external resources was also analyzed by the use of the ratio of patients coming outside the region. The results are as follows. 1. The direct economic contribution of the hospital to the local economy is 1,104 million won. 2. The value of multiplier in the region is 2.976. 3. The total economic effect is 3,286 million won, and the multiplication effect is 2,182 million won. 4. The economic contribution from the external resources is 245 million won which is 7.5% of the total economic effect.

요양병원 간병비 지급이 건강보험 진료이용량에 미치는 영향

강임옥 ( Im Ok Kang ),한은정 ( Eun Jeong Han ),이정석 ( Jung Suk Lee ) 한국보건행정학회 2009 보건행정학회지 Vol.19 No.2

Korean Government had performed three pilot programs to introduce the long term care insurance system. Persons aged 65 or older who are dependent on others for daily living could use long term care services in the pilot program. The long-term care insurance covered nursing home services, home care services and cash benefits. The cash benefits are included that for elderly at home and for patients in geriatric hospital. This study investigated whether there had been any change in the medical care utilization according to cash benefits for geriatric hospitalization. This study used National Health Insurance claims and Long term Care Insurance claims 2003 through 2006. Data were composed of subjects who undertook both insurance coverage. The subjects was divided into two groups. Case group included participants with the cash benefits of geriatric hospitalization. Control group included persons without the cash benefits selected by random sampling according to the distribution of case group. This study showed that the amount of medical care utilization of the case group is more significantly increased than the control group after adjusted their health condition and functional condition. This result will be helpful for making decisions on whether the cash benefit of geriatric hospitalization can be introduced into long term care insurance system.

노인인구의 간호요양원(Nurisng Home) 필요예측에 관한 연구

강임옥(Im Ok Kang) 한국간호행정학회 2000 간호행정학회지 Vol.6 No.2

가정간호서비스 이용 노인환자의 간호요양원(Nursing home) 필요 예측에 관한 연구

강임옥(Im Ok Kang) 한국간호행정학회 1999 간호행정학회지 Vol.5 No.3

의료보험서비스 가격의 적절성에 관한 연구 : 소득계층간 접근형평성 관점에서

전기홍,최귀선,강임옥,Chun, Ki-Hong,Choi, Kui-Son,Kang, Im-Ok 대한예방의학회 1998 Journal of Preventive Medicine and Public Health Vol.31 No.3

By expanding health insurance, customers will carry a smaller burden of medical costs. As a result, the number of visits to a physician increase and this result in the improvement of medical accessibility. But medical care utilization may be changed not only by insurance status but also by socio-demographic factor, economic status and other factors. The question thus remains, at which level of accessibility and what price of medical care service in health insurance will the customer and the medical care service be satisfied. The price of medical care service ls comprised of the customer's out-of-pocket money and the costs not covered by health insurance. If the price of medical care services in health insurance are appropriate, medical care utilization should not differ because of the difference in income status or the acuteness of illness. But If the price is not adequate, low income groups will receive relatively low medical care utilization, particularly in the case of chronic disease. The purpose of this study is to evaluate the differences in medical care utilization among the various income groups and those with varying acuteness of illness. The major hypotheses to test in this study are : (i) whether there are differences in medical care utilization among different income groups exist, (ii) whether differences in medical care utilization among different income groups exist with the hospital type. (iii) whether differences in medical care utilization among different income groups exist with the acuteness of illness and with age. The data was collected from the JongRo District Health Insurance Society in Seoul. A total of 118,336 persons were selected as the final sample for this study. The major findings of this study were as follows; 1. The volume of ambulatory utilization among users was statistically significant by income level. 2. Among different income groups, the volume of ambulatory utilization was statistically significant by the acuteness of illness. 3. Higher income groups with chronic diseases had a greater volume of ambulatory utilization than other groups.

우리나라 병원의 평균재원기간의 추이

조우현,전기홍,강임옥,Cho, Woo-Hyun,Chun, Ki-Hong,Kang, Im-Ok 대한예방의학회 1996 예방의학회지 Vol.29 No.1

The purpose of this study was to examine the trends of length of hospital stay (LOS), which is most likely to be a major attribute to hospital performance. From 1984 to 1994, an average LOS of each hospital was analyzed by factors such as medical departments, bed size, occupancy rate, region and ownership. This study was analyzed changing rate of LOS during 11 years. This rate was calculated by simple regression, which was used only with hospital without missing data during 11 years. This study findings are as follows. 1. The results indicated that the average LOS was steadily increased until 1990 but it was slightly decreased after 1990. 2. This trend could be found in all hospital scale and all group of occupancy rate. Specifically this trends of LOS were found in internal medicine, corporate owned hospitals, and hospitals in major city. But LOS of individual owned hospital was continuously increased until 1994. 3. Means of changing rates of LOS were calculated from 1984 to 1994. If we devided it into two parts, before 1990 and after 1990, most changing rates of LOS before 1990 except individual owned hospital were found positive sign. The changing rates after 1990 were negative sign but small hospital(lesser then 200 bed), individual owned hospital, national & public hospital and hospital in small urban have little change of LOS after 1990. Finally from this results we thought that most hospitals in Korea began to be concerned with LOS. Nevertheless LOS of several hospital such as small hospital or individual owned hospital was increased. And this trend may be caused by a few patients, low occupancy rate, or low profit. This trend of LOS is different from that of other countries. Perhaps this phenomenon is resulted from the reimbursement method. Because of fee for service reimbursement system in Korea the hospitals didn't need to shorten LOS in order to save the cost and increase the profit. Therefore reform of hospital cost reimbursement method will be needed to reduce hospital cost in Korea. We thought that the Korean health authority should consider the reimbursement method by unit of bundle of services, for example DRG and prepayment in the United States. This study presents some limitations such as no insight of severity of disease, case-mix measurement of hospital, and other clinical characteristics that can. possibly affect LOS. However, this study reports an important trend in LOS from 1984 to 1994.

치매노인의 서비스 희망과 이용의 일치 여부에 영향을 미치는 요인

박종연 ( Chong Yon Park ),강임옥 ( Im Ok Kang ),이상이 ( Sang Yi Lee ),서수라 ( Su Ra Seo ),서남규 ( Nam Kyu Suh ),박형근 ( Hyeung Keun Park ) 한국보건행정학회 2007 보건행정학회지 Vol.17 No.2

Korean government is preparing the long-term care financing and delivery system in order to cope with rapid population aging. The system should be designed to provide demented patients with an appropriate services that the patients want to take, and considered to be necessary for them. In this regard, this study aims to analyse empirically a relationship between the types of long-term care services that demented patients wanted to take and they actually received during 2004. The caregivers of 609 dementia patients, who were randomly selected in a manner of proportional allocation from a nationwide claim database of the Korean National Health Insurance Corporation, were interviewed in September, 2005. Independent variables include soeio-demographic characteristics, Activities of Daily Living(ADL) and Instrumental Activities of Daily Living(IADL). To explore the correspondence of the types of long-term care services that demented patients wanted to take and that they actually received, and its affecting factors, we conducted chi-square test and logistic regression analysis. Main findings are as follows. First, while only 20% of study subjects wanted home services as a long-term care services, those who wanted to use the long-term care facilities and general hospital were 37%, 43% respectively. Second, the correspondence rate was just 38% on average, and extremely low in the demented patients who wanted to use long-term care facilities. Third, the demented patients who resided in urban areas and received relatively high level of education showed high correspondence rate. Fourth, the high ADL score was closely related to low correspondence rate.

방문요양 행위 업무량의 상대적 가치 측정

한성옥,박은철,강대룡,강임옥,Han, Seong-Ok,Park, Eun-Cheol,Kang, Dae-Ryong,Kang, Im-Ok 대한예방의학회 2008 예방의학회지 Vol.41 No.5

Objectives : The purpose of this study was to measure the workload of home visit care activities and their relative values. This study examined also factors that affect the workload of home visit care activities. Methods : The participants of this study were 126 home-helpers of 50 home visit care agencies at the 2nd Long-term Care Insurance Demonstration Project. The workload of home visit care activities was divided into total work and four dimensions ; physical efforts, mental efforts, stress and time. Home visit care activities consisted of four categories with 24 items. We used magnitude estimation method to measure their relative values of the four dimensions. The participants answered the relative values of each activities based on the reference service. We used the activity for supporting their elderly's evacuation as the reference service. Results : Most of the respondents were over 40 years old female. They consumed most their time supporting elderly's going out. They consumed their highest physical, mental efforts, and stress for activities of coping with emergency situation. The Pearson correlation coefficients showed significant relationships between workload and each dimensions. This study showed that all four dimensions are statistically significant predictors of workload of home visit care activities. Also, we found that the home-helper's career affects the workload of home visit care activities. Conclusions : The workload of home visit care activities could be explained by physical efforts, mental efforts, stress and time.

노인장기요양보험 재가서비스 이용자의 시설서비스 이용 결정요인

한은정(Eun-Jeong Han),강임옥(Im-Ok Kang),권진희(Jinhee Kwon) 한국노년학회 2011 한국노년학 Vol.31 No.2

다른 사람의 도움을 받아야 하는 노인도 적절한 재가서비스를 받으면서 가능한 오래 가정에 머물 수 있다면 그들의 삶의 질을 향상시키고 비용을 절감할 수 있다고 알려져 있다. 이 연구는 노인장기요양보험제도를 시행한 후, 재가서비스 이용자가 시설서비스로 전환하여 입소하는 것에 대한 결정요인을 살펴보고자 한 종적 연구이다. 이 연구는 장기요양급여 이용자와 주수발자를 대상으로 한 '2009년 노인장기요양서비스 만족도 조사' 자료를 활용하였다. 이 연구의 분석대상자는 총 1,230명으로, 이들은 시도별, 장기요양등급별, 의료보장형태별로 비례할당으로 추출된 것이다. 종속변수는 연구대상자가 재가서비스를 이용하다가 시설로 입소하는 데까지 걸린 시간이고, 이것은 노인장기요양급여DB를 연계하여 파악하였다. 또한 이 연구는 Cox Proportional Hazard Model을 이용하여 hazard ratio를 산출하였다. 연구결과에 의하면, 다른 변수들을 보정한 후에도 이용자가 골절을 앓고 있는 경우에는 시설에 입소할 확률이 유의하게 높은 것으로 나타났다. 또한 통계적으로 유의하지는 않았지만 저하된 인지기능의 항목수가 많을수록 시설에 입소할 확률이 높은 것으로 나타났다. 이러한 영향요인들을 감안하여 향후에는 이용자의 욕구를 충족시키는 재가서비스 이용체계를 구축하고 보완하는 정책개발이 필요하다. If frail elderly could use home care services adequately, quality of their life might improve and their costs of service would be decreased. The purpose of this study is to examine the factors on institutionalization of elderly using home care services in Korean long-term care insurance system. This study used the data of '2009 satisfaction survey of Korean long-term care system'. The survey proceeded using sampling data by region, level of long-term care need, and insurance type among beneficiaries from August 2009 to September 2010. The onset dates of institutionalization of 1,230 participants were ascertained from long-term care insurance claim data. This study calculated hazard ratio through Cox Proportional Hazard Model. The results showed that if elderly using home care services suffer a fracture, the hazard ratio of institutionalization is higher significantly. Although not significant, if older persons have more items of damaged cognitive functions, the hazard ratio of institutionalization is higher. The results have policy implications to supplement of home care service system and postpone institutionalization of elderly.

방문요양서비스에 대해 인지하는 서비스의 질과 만족도, 재이용의사 간의 관계 분석

권진희(Jinhee Kwon),한은정(Eun-Jeong Han),강임옥(Im-Ok Kang) 한국노년학회 2010 한국노년학 Vol.30 No.2

이 연구는 노인장기요양보험에서 제공하는 재가급여 중 큰 비중을 차지하는 방문요양에 대한 이용자 만족도를 파악하고, 방문요양 이용자 만족도가 서비스 질과 재이용의사와 어떠한 관계를 갖는지를 살펴보고자 한 것이다. 이 연구의 대상자는 장기요양등급 판정 과정을 거쳐 장기요양서비스를 이용할 수 있는 자격을 부여받은 자(1~3등급) 가운데 현재 노인장기요양보험 재가서비스의 한 종류인 방문요양서비스를 이용하고 있는 자 중 일부를 표본추출하여 선정하였다. 방문요양서비스 이용자는 1,020명(이용자 본인 241명, 주수발자 779명)이었고, 최종 연구대상자는 주수발자를 제외한 이용자 본인 241명으로 정하였다. 설문문항들의 신뢰도 평가결과 Cronbach's α 값이 0.951을 보여 매우 높은 내적 일치도를 보였다. 인지하는 서비스의 질을 구성하는 3개 차원은 만족도와 재이용의사와 양의 상관관계를 보였다. 특히 서비스 내용 및 과정과 만족도는 상관계수가 0.801로 강한 양의 상관관계를 보였다. 대상자가 인지하는 방문요양서비스의 질은 서비스에 대한 만족도와 서비스 재이용의사와 서로 관련이 있고 이에 영향을 미치는 것으로 보인다. 특히 서비스 내용 및 과정과 만족도 간의 상관관계는 다른 차원 간의 관계보다 더 강한 양의 관계를 보이는 것으로 나타났다. 방문요양서비스 제공기관이 이용자의 만족도를 높이고 재이용률을 높이기 위해서는 이용자가 인지하는 장기요양서비스의 체계적인 질관리 특히, 서비스 내용 및 과정에 중점을 두어야 할 것이다. The main objective of this study is to determine the relationships among home help service user's perceived service quality, overall satisfaction and purchase intention. The data were gathered from users who have used home help service in long-term care system. A national cross-sectional descriptive survey was conducted in December 2008, using proportionate quota sampling. Finally, 241 home help service users wrote informed consents and completed questionnaires which included characteristics of beneficiaries, perceived quality of service(13 items), overall satisfaction(1 item) and purchase intention(1 item). The Structural Equation Modeling(SEM) analysis was conducted to find a causal relationship of perceived quality, overall satisfaction and purchase intention. This study shows firstly, the quality of service was categorized into three dimensions, that is, contract, service contentㆍprocess, and solution of problem or complain. Secondly, the reliability and validity of service quality items were satisfied. Finally, in the total effect of perceived quality and satisfaction for purchase intention, overall satisfaction(path coefficients=0.333) and service contentㆍprocess(0.301) is more higher than other variables. These findings imply that service quality is an antecedent of overall satisfaction and purchase intention. Therefore, the quality of service including service content process should be emphasized in home help service facilities for long-term care.