의료생활협동조합 의원의 일차의료서비스 질 평가

최윤구,김경우,최용준,성낙진,김재용,박진하,홍승권,이재호,일차의료연구회 대한가정의학회 2010 Korean Journal of Family Medicine Vol.31 No.10

Background: In South Korea, major health care problems have been occurred under the structural background that medical services are mainly provided by private medical institutions. Primary health care, which is very crucial in public health, has been overlooked, and is disorganized and fragmented. In the mean time, health cooperative movement was initiated by local residents and medical doctors to overcome health care problems in 1987. We conducted this study to evaluate the role of health cooperative clinics and obtain lessons for the future primary care policy. Methods: During April to June in 2006, survey was performed by a trained interviewer at the waiting rooms of 3 health cooperative clinics, in the process of development of the Korean Primary Care Assessment Tool (KPCAT). The KPCAT consists of 5 domains (21 items): first contact (5), coordination function (3), comprehensiveness (4), family/community orientation (4), and personalized care (5). Subjects were patients (or guardians) who had visited their health cooperative clinics on six or more occasions over a period of more than 6 months. We compared primary care scores of each domain between members and non-members of health cooperative clinics by student t-test. Effect of having a membership on each primary care domains was examined by multiple regression analysis. Results: Among the participants (N = 100), members of health cooperatives were 48, and non-members 52. Total average scores of 5 primary care domains of the KPCAT were 78.0 ± 13.5 on 100 point scale. (82.0 ± 13.1 in members, and 74.3± 13.0 in nonmembers; P = 0.004) Among primary care domains, personalized care was the highest (91.4 ± 11.0), and coordination function the lowest (61.0 ± 33.1) in score. Significant differences between members and nonmembers were noted in coordination function (68.9 vs. 53.7, P = 0.021) and comprehensiveness (78.4 vs. 67.2, P = 0.008). These differences were continued after adjusting by multiple regression analysis for socio-demographic variables including age,sex, income, education, number of disease, and duration since the first visit. Conclusion: In the health cooperative clinics whose primary care performance has been considered exemplary in the context of health care in South Korea, primary care scores assessed by members were higher than those by non-members. The significant differences of scores in coordination function and comprehensiveness between members and nonmembers suggest that the future primary care policy should be focused to strengthen these two domains of primary care. 연구배경: 우리나라 보건의료체계는 의료기관의 사적소유가지배적이며 공공성이 결여되어 있는 문제를 안고 있다. 국민건강증진과 질병예방에 기여하는 일차보건의료는 간과되어왔고, 조직화되어 있지 못하고 분절화되어 제공되고 있다. 이러한 보건의료 문제 상황을 극복하기 위하여 지역 주민과 의료인이 함께 운영하는 의료생활협동조합(의료생협) 운동이시작(1987)되었다. 의료생협은 일차의료의 바람직한 대안으로 평가되기도 한다. 본 연구는 의료생협이 수행하는 일차의료기관으로서의 역할에 대해 평가하여 향후 일차의료 정책을위한 교훈을 얻고자 시행하였다. 방법: 한국 일차의료 평가 도구(the Korean Primary Care Assessment Tool, KPCAT) 개발을 위하여 2006년 4월부터 6월까지 수집된 자료 중에서, 인천시, 안산시, 안성시에 위치한 의료생협세 곳의 자료를 분석하였다. 의료생협을 상용치료원으로 이용하는(방문한 지 6개월이 경과하고 6회 이상 방문한) 환자또는 보호자가 평가 주체로 참여하였다. KPCAT의 5개 영역즉, 최초 접촉, 포괄성, 조정 기능, 전인적 의료, 가족/지역사회지향성에 대해서, 영역별 점수를 구하고 의료생협 조합원 여부에 따라 영역별 점수를 비교하였으며, 인구사회학적인 변수를 통제한 후의 변화를 관찰하였다. 통계분석을 위해, 영역별 점수비교에는 t-검정을, 그리고 인구사회학적 변수의 통제에는 다중회귀분석을 이용하였다. 결과: 의료생협을 상용치료원으로 이용하는 지역주민 100명이 본 연구에 참여하였다. 의료생협 조합원은 48명, 비조합원은 52명이었다. KPCAT 일차의료 속성영역 5개 평균점수를 100점 척도로 나타내었을 때, 의료생협의원의 일차의료평균점수는 78.0±13.5 (조합원 82.0±13.1, 비조합원 74.3±13.0;P=0.004)이었다. 일차의료 영역들 중에서 점수가 높은 것은 전인적 의료(91.4±11.0), 최초접촉(89.3±11.5)이었으며, 점수가낮은 것은 조정기능(61.0±33.1), 포괄성(72.6±21.4)이었다. 조합원 여부에 따라 유의한 차이를 보인 영역은 조정기능(68.9vs. 53.7, P=0.021)과 포괄성(78.4 vs. 67.2, P=0.008)이었다. 이 같은 차이는 연령, 성, 소득, 교육수준, 질병의 수, 첫 방문 후 경과기간 등의 변수를 다중회귀분석으로 통제한 후에도 지속되었다. 결론: 우리나라 보건의료 맥락에서 모범적인 일차의료기관으로 평가되는 의료생협의원에서, 주치의 서비스를 받는 조합원이 평가한 의료생협의 일차의료서비스 질은 기존 방식의진료를 받는 비조합원이 평가 한 것보다 우수하였다. 특히 조정기능과 포괄성 영역에서의 유의한 차이가 있는 점은, 향후주치의제도 도입 등 일차의료 정책 수립 시에, 일차의료의 조정기능과 포괄성 영역을 강화시키는 데 역점을 두어야 한다는 점을 시사한다.

Multidisciplinary Practice Experience of Nursing Faculty and Their Collaborators for Primary Health Care in Korea

김미자,정향인,안양희 한국간호과학회 2008 Asian Nursing Research Vol.2 No.1

Purpose This study aimed to describe the range of participation of nursing faculty members and their collaborators in multidisciplinary primary health care in Korea and to analyze facilitators, benefits, barriers, and learned lessons. Methods An exploratory descriptive research design was utilized. A total of 13 nursing faculty members and 13 multidisciplinary collaborators were interviewed face to face using a brief questionnaire and semi-structured interview guide. Descriptive statistics, comparative analysis, and content analysis were used for data analysis. Results About 43% of the nursing faculty had multidisciplinary primary health care experience. Facilitators included a government-funded research/demonstration project, personal belief and expertise in primary health care, and well-delineated role boundaries. Benefits included improved quality of life, more convenient community life, meeting multifaceted needs of community residents, and enhanced research activities. Barriers were lack of teamwork; territoriality and self-protective behaviors; lack of insight into primary health care among stakeholders; nurses undervaluing their work; and the rigid bureaucratic system of public health centers. Learned lessons were the importance of teamwork and its synergistic benefits, the importance of conducting clinically relevant research, having the government’s support in the improvement of public health, developing health policies through multidisciplinary primary health care (M-D PHC) work, and respecting each other’s territory and expertise. Conclusion Teamwork should be included in all health professions’ curricula, and nursing clinical practicums should include primary health care in all specialty areas. More faculties should engage in multidisciplinary primary health care. The benefits of a multidisciplinary approach to primary health care outweigh the difficulties experienced by multidisciplinary team members. The findings of this study may be useful for future multidisciplinary primary health care work worldwide. [Asian Nursing Research 2008; 2(1):25–34] Purpose This study aimed to describe the range of participation of nursing faculty members and their collaborators in multidisciplinary primary health care in Korea and to analyze facilitators, benefits, barriers, and learned lessons. Methods An exploratory descriptive research design was utilized. A total of 13 nursing faculty members and 13 multidisciplinary collaborators were interviewed face to face using a brief questionnaire and semi-structured interview guide. Descriptive statistics, comparative analysis, and content analysis were used for data analysis. Results About 43% of the nursing faculty had multidisciplinary primary health care experience. Facilitators included a government-funded research/demonstration project, personal belief and expertise in primary health care, and well-delineated role boundaries. Benefits included improved quality of life, more convenient community life, meeting multifaceted needs of community residents, and enhanced research activities. Barriers were lack of teamwork; territoriality and self-protective behaviors; lack of insight into primary health care among stakeholders; nurses undervaluing their work; and the rigid bureaucratic system of public health centers. Learned lessons were the importance of teamwork and its synergistic benefits, the importance of conducting clinically relevant research, having the government’s support in the improvement of public health, developing health policies through multidisciplinary primary health care (M-D PHC) work, and respecting each other’s territory and expertise. Conclusion Teamwork should be included in all health professions’ curricula, and nursing clinical practicums should include primary health care in all specialty areas. More faculties should engage in multidisciplinary primary health care. The benefits of a multidisciplinary approach to primary health care outweigh the difficulties experienced by multidisciplinary team members. The findings of this study may be useful for future multidisciplinary primary health care work worldwide. [Asian Nursing Research 2008; 2(1):25–34]

Association of Primary Care Physician Supply with Population Mortality in South Korea: A Pooled Cross-Sectional Analysis

Koh Hyeonseok,Kwon Soonman,Cho Belong 대한가정의학회 2024 Korean Journal of Family Medicine Vol.45 No.2

Background: Primary care physicians perform a comprehensive role by providing continuous, patient-centered, and accessible healthcare and establishing connections with specialized care. However, the association between the supply of primary care physicians and mortality rates in South Korea has not been thoroughly investigated.Methods: This study utilized data from 229 si-gun-gu in South Korea from 2016 to 2020. The densities of primary care physicians, physicians in functional primary clinics, specialists in primary care facilities, and active physicians per 100,000 people were independent variables. Age-adjusted all-cause mortality and cause-specific mortality rates per 100,000 individuals were the dependent variables. Negative binomial regression, negative binomial regression with a pseudo-panel approach, and geographically weighted regression were used to analyze the data.Results: Our study revealed a significant negative association between the density of primary care physicians and all-cause mortality. An increase in a primary care physician per 100,000 population was significantly linked to a 0.11% reduction in all-cause mortality (incidence rate ratio, 0.9989; 95% confidence interval, 0.9983–0.9995). Simi-lar associations have been observed between mortality rates owing to cardiovascular diseases, respiratory tract dis-eases, and traffic accidents.Conclusion: This study provides evidence that having a higher number of primary care physicians in South Korea is associated with lower mortality rates. Future research should consider better indicators that reflect the quality of primary care to better understand its impact on population health outcomes. These findings emphasize the signifi-cance of strengthening primary care in the South Korean healthcare system to improve the overall health and well-being.

A Study Community Health Practitioner Role Consolidation and Its Effect on Maternal and Child Health Program in Korean Rural Communities

Hong,Yeo Shin 서울대학교 간호대학 간호과학연구소 1988 간호학 논문집 Vol.3 No.1

본 연구는 한국의 보건진료원 제도를 중심으로한 일차보건의료 전달체계의 운영상의 문제를 분석 파악하고 지역사회조직을 하부조직으로 활용하는 대안이 모아건강관리에 미치는 효과를 분석하기 위해 시도되었으며 기본연구설계는 두군의 실험군과 한 개의 대조군을 두어 실험효과를 검증하는 준 실험설계로서 사전조사, 실험중재, 사후조사의 3단계 연구진행을 양평군, 이천군, 안성군을 대상으로 시행하였으며 총 15개 보건진료소장과 120여명의 마을지도자 및 이들관할지역의 표본으로 총 1,256 가구가 연구대상으로 참여하였다. 본 연구의 기본가정은 보건진료원을 중심한 일차보건의료접근의 실효를 얻기 위해서는 마을주민의 협조가 절대적이며 주민의 협조는 조직을 통해 활성화될 수 있고 보건진료원 업무중 지역사회중심활동의 비율이 높아질수록 주민의 협조가 높아지고 지역주민의 질병예방과 치료 및 건강증진을 위한 사업이 증진될 수 있다는 것이며 지역사회조직의 특성에 따라 사업별로 효과에 서로 다르게 작용할 수 있다는 가정하에 실험군 1은 공식적 조직인 반상회 조직을, 실험군 2는 비공식 조직으로서 어머니회, 자모회, 교회조직, 종친회모임등의 마을 자생조직을 각기 보건진료원 중심으로 전개되는 일차보건의료사업에 협조하는 하부조직으로 활용함으로서 사업효과를 증대시키려는데 목적을 두었으며 사업전후 비교 및 실험군과 대조군과 비교를 통해 실험사업의 효과를 규명하려 하였다. 1983년에서 1986년까지 3년간 진행된 본 연구의 결과를 요약하면 다음과 같다. 1. 보건지료원 사업활동은 모아보건면에 있어 산전산후 관리 가족계획 및 분만개조율을 보건진료원 활동기록과 지역주민의 건강관리 행태조사에서 공히 월등히 높였고 특히 유아예방접종율에 있어 괄목할만한 차이를 보였다. 2. 실험군과 대조군간의 비교에서 보면 첫째로 지역사회조직활동, 보건교육, 발달계측 및 발달사정, 학교보건환경위생관리 등 지역사회 중심활동에 있어 제1 실험군인 양평군에 있어 그 활동이 두드러지게 나타났으며 모아건강관리측면에서 가족계획성과를 제외한 모든 부문에서 공식조직인 반상회를 활용한 영평군에서 사업효과가 크게 증대되었음을 나타내었다. 3. 가족계획부문사업효과에 있어서는 동질성이 높은 여러가지 비공식마을 자생조직을 활용한 이천군지역에서 보건진료원의 활동량과 관계없이 월등히 큰차로 사업효과가 증대되었음을 알 수 있다. 4. 지역간 차이에 작용하는 사업의 변수로서는 지역의 도시화와 의료시설 특히 병원이용의 편의와 관련된 변수를 들 수 있고 특히 병원분만율과 산전, 산후 진찰율은 밀접한 관계가 있는 것으로 나타났으나 가정분만의 경우에도 보건진료원의 직접간접 도움이 산전, 산후관리 및 예방접종 등 영유아 건강관리에 크게 영향하는 것을 알 수 있다. 본 연구결과에서 얻은 중요결론은 기본가정에서와 같이 보건진료원의 지역 중심조직활동과 지역주민 특히 지역조직등을 이끄러가는 지역지도자들과의 긴밀한 협조관계는 보건진료원의 역할정착을 도웁고 일차건강관리의 궁극적 목표에 접근하도록 하는 촉매가된다는 것을 재확인할 수 있었으며 마을 지도자들에게 부여된 역할중 건강정보전달자로서의 역할은 쉽게 수용되고 그 효과가 빨리 나타나는 반면 보건교육자, 응급치료자로서의 역할기대는 쉽게 수용되지 않아 역할대상자 역할 개발이 동시에 이루어져야 하고 역할변화에 많은 시간과 용기가 부여되어야 한다는 점과 장기적인 안목에서 지역주민의 자조적 능력개발을 위한 의료인들의 교육적 지원적 역활확대 내지 역할변화를 통해서만 건강한 국민, 건강한 국가건설의 목표에 도달하는 길이 열릴 수 있다는 점이다. Central to the purpose of this study was to find means to effectively consolidate community health practitioner roles as envisioned in Special Act and assess their effect on health status of people and productivity in CHP activities specifically on maternal and child health program. The basic strategy for this study was to elicit community cooperation with the role performance of community health practitioner in the provision of primary health care. Thus this study was proposed to test the feasibility and effectiveness of an experimental primary health care program in the remote Korean rural communities incorporating existing nonhealth community organizations as substructures for health care service delivery in conjunction with the activities of community health practitioners who have been specially trained and deployed by the Health Ministry of the Korean government. The project specifically addresses itself to the problem of how existing nonhealth community organizations can be effectively used as village level substructure for primary health care service to facilitate the effectiveness of Community Health Practitioner in her role function and expand the health care services to currently underserved target populations. The study was designed as an action research with alternative experimental input and evaluation of the effect of the experimentation. The study was carried out in three distinctive stages of problem analysis, solution development and implementation and final evaluation of the effect of experimental input. The study was carried out in three country areas, namely, Ansung, Incheon and Yand Pyung, incorporating 15 CHP posts and their catchment areas for three years begining in April 1983. Study sample of 1,256 households were obtained by random sampling of 20% of total households registered in town offices within the catchment areas of 15 community health practitioner posts. Included in the sample were 431 households in Icheon, 429 in Yang Pyung and 396 in Ansung. This action research was designed as a quasi-experimental study with two experimental groups and one control group to compare the effect of alternative experimental input. The result of the experimentation is analyzed through pre and post-test comparison and intergroup comparison. Experimental group I incorporated Bansang Hoe (villager's meeting), a formal official organization with monthly regular meetings, as the substructure for primary health care serveic by CHPs. Experimental group II incorporated various informal community groups such as mothers' club, 4-H club, church group, agricultural cooperatives, extension workers, clan meeting and village movement committee as the substructure. The control did not incorporate any special substructure. The three alternative solutions namely of formal and informal organizations, and control group were compared in terms of their effectiveness in expanding CHP productivity, improvement in health indices and improving efficiency in cost-effectiveness of PHC services. The results of analysis of the data from household surveys and CHP activity records all indicate that primary health care services by the CHPs are best incorporated with Bansang Hoe as the formal and official community organization. Unless the informal organizations are considerably improved in its structure and greatly activated, much efforts put into organizing, training, and stimulating through those organizations would be wasted. In all categories of services, CHPs in Yang Pyung with cooperation from Ban chiefs have had best performances in the delivery of services especially in the area of maternal and child health including family planning. This difference in CHP performance between groups were well reflected in the outcome of household surveys as related to the amount of care received and health practices exercised by community people. In Korean rural communities, power seem to be concentrated in formal and official line positions, and Bansang Hoe as an official villager's meeting possess potentialities that none of other informal organizations can compete with. Thus, cooperations from officers of the formal community organizations can effect great influences on the success of Primary health care charged by CHPs. Other lessons that the project team has gained from the study were; 1) the offect of educational input appears so slowly that within the 15 months period of experimentation the activities of community health leaders did not increase to the level of satisfaction except for the role fo communicator; 2) in order to develope and enact a new role in communities, a concurrent development of counter roles among community people is needed; and 3) with elevated local officer's interest through project involvement, satisfaction of CHPs in their service activities has increased and satisfaction on the part of community people for their services has been improved as a consequence.

일차의료의 개념과 가치, 그리고 한국의 현실과 과제

최용준,이재호,고병수,조경희 대한의사협회 2013 대한의사협회지 Vol.56 No.10

Primary care is an essential part of a whole health system. It is the first contact point for medical care in the community, where many people are likely to obtain their own impression of the health system. Primary care has its own attributes, such as first contact, continuity, comprehensiveness, and coordination, which are yardsticks for measuring its excellence. Regarding the value of primary care, many studies have reported extensive evidence of the advantages of primary care at individual and societal levels. Health systems with strong bases of primary care are better than those with weak ones in terms of cost, health outcomes, and quality of care. However, primary care in South Korea has continuously shrunk or been weakened for several decades. As people age and chronic illnesses become prevalent, more attention is being paid to primary care than ever before, and several policy options have been proposed. Therefore, if the medical community wishes to invigorate primary care, it should play a pivotal role in formulating and implementing primary care policies by envisioning primary care, establishing related data infrastructure, and continuing the discussion on long term goals like training primary care physicians.

의료생활협동조합 한의원의 일차의료서비스 수준 평가

성태경,임병묵,Seong, Taekyung,Lim, Byungmook 대한예방한의학회 2013 대한예방한의학회지 Vol.17 No.2

Objectives : Health cooperative movement is of increasing concern among medical consumers and professionals in Korea. Most health cooperative clinics provide Western Medicine and Korean Medicine(KM) to patients. This study aimed to evaluate the primary care level of health cooperative KM clinics and compare it with local KM clinics in Korea. Methods : Face to face survey was performed at the 3 health cooperative KM clinics and 5 local KM clinics with the Korean Primary Care Assessment Tool (KPCAT). The KPCAT consists of 5 domains (21 items): first contact (5), coordination function (3), comprehensiveness (4), family/community orientation (4), and personalized care (5). Subjects were patients or guardians who had visited KM clinics five times or more during the last 3 months. We compared primary care scores of each domain between health cooperative KM clinics and local KM clinics. Results : Data were collected from 200 respondents (100 patients from health cooperative KM clinics and 100 local KM clinics). Total average scores of the KPCAT for health cooperative clinics and local KM clinics were $81.1{\pm}12.0$ and $75.4{\pm}9.5$, respectively. Among primary care domains, personalized care was the highest ($89.2{\pm}12.0$, $89.6{\pm}8.4$, respectively), and comprehensiveness function was the lowest ($68.5{\pm}22.5$, $54.5{\pm}22.0$, respectively). Significant differences between two groups were noted in comprehensiveness function (68.5 vs. 54.5, P=0.000), family-community orientation (79.5 vs. 73.0, P=0.004), first contact(89.2 vs 84.0, p=0.001) and coordination function(74.0 vs 68.7, p=0.025). Conclusions : Based on the patients assessment, health cooperative KM clinics provide more primary care-oriented services than local KM clinics. This means that health cooperative clinic can be one of alternatives to strengthen the primary health care in Korea. Future researches are recommended to measure patients satisfaction and treatment effectiveness in the health cooperative clinics.

일차의료 강화를 위한 교육수련제도 개편방안

김경우,박훈기,이승화 대한의사협회 2013 대한의사협회지 Vol.56 No.10

Primary care physicians who can deliver high quality primary care services are essential for strengthening the primary health care system. In Korea, primary care was regarded as substandard services practiced by any medical doctor without postgraduate education in primary care. The current and future health care systems are challenged by increasing complexity and co-morbidity and healthcare costs in medical care. The developed countries are preparing for the future by increasing support for basic, postgraduate, and continuing medical education in primary care. To strengthen the primary care in Korea, basic medical education programs should require experience in primary care clinics with a teaching and education function. Postgraduate primary care medical education must be enhanced to be qualified to practice in the community. The recognition of the importance of primary care and the need for changes in the current education and healthcare system among medical professionals and other stakeholders and support systems such as legislation and finance for primary care medical education.

일차의료 표준모형과 질 평가체계

이재호,이상일,고병수,임종한 대한의사협회 2013 대한의사협회지 Vol.56 No.10

During the past several decades, population aging and chronic diseases have been common burdens to nearly all the world’s countries. To meet future health care needs, many coun-tries have tried to improve the efficiency and equity of the health care system by reforming pri-mary care. In the UK, which has already achieved a high level of strength in primary care, the Quality and Outcomes Framework (2004) was introduced and a great deal of the National Health Service (NHS)budget has been invested in primary care. In the US, a country with a low level of strength in primary care, to transform primary care practices to model practices, medical home movements such as the Patient-Centered Medical Home (PCMH) have been initiated after the development of the joint principles of the PCMH (2007) by 4 major societies of primary care. In Australia, despite having achieved high levels of health outcomes among the OECD countries, the Practice Incentives Program (PIP) has been introduced to respond to concerns about quality and coordination of care and prevention in 1998. In South Korea, a country with a very weak infrastructure in primary health care, where primary care has never been explicitly defined at the national level, the government is trying to improve quality in chronic care by using small financial incentives. The authors assert that a standard model and a quality appraisal framework for the organization of primary care are necessary to achieve the goals of primary care reform in this country.

한국 일차의료 분야 보건의료서비스 연구의 현황

최용준,이희영,박종헌 대한의사협회 2016 대한의사협회지 Vol.59 No.11

Primary care is a key component of a health care system and many countries have been making efforts to strengthen their primary care. We aimed to outline the status of health service research on primary care in Korea. In Medline and nine Korean databases, we searched the original articles published in peer-reviewed journals through December 2015, and summarized and classified the articles. Their publication year, journal name, research methods and research topics were presented. The main categories of research topics were health care delivery, utilization, quality, workforce, resources, financing, and others. The total number of research papers was 297, and these were mainly published in domestic Korean journals (92.6%). The most frequently adopted research methods were quantitative ones, and various types of data were used. The most two common topics were health care delivery and quality of care. Diversity of data sources, lack of public research funding and low participation of primary care physicians were also found. A clarification of the scope of health services research and refinement of topic classification will be beneficial. In short, this study provides a basis for building a primary care health services research database and can be used as a data source for subsequent research. It is also necessary to set research priorities for the development and evaluation of primary care policy.

Association between Types of Usual Source of Care and User Perception of Overall Health Care Service Quality in Korea

Nak-Jin Sung,Jae-Ho Lee 대한가정의학회 2019 Korean Journal of Family Medicine Vol.40 No.3

Background: Patients’ perceptions of care tend to correlate with the quality of care provided. Different health care systems and service environments may show different associations between types of usual source of care (USC) and overall service quality assessment. We attempted to analyze this association as a benefit of having a USC.Methods: This study used the 2012 Korea Health Panel data version 1.1 as representative national household sur-vey data. The total number of subjects aged 18 years or more was 12,708. The number of subjects in the final analy-sis was 10,665. Multiple logistic regression analysis was used to assess the association between types of USC and overall health care service quality. The main outcome variable was users’ ratings of the quality of health care ser-vice.Results: People having a usual doctor (n=1,796) were more likely to positively assess the quality of health care they received than those not having a USC (n=7,920; odds ratio [OR], 1.39; 95% confidence interval [CI], 1.20–1.60) or with those having only a place as a USC without a usual doctor (n=949; OR, 1.29; 95% CI, 1.05–1.58) after adjust-ment for demographic characteristics and health-related variables.Conclusion: People having a usual doctor rated overall health care service quality as high, which might be due to benefits of primary care attributes related to usual doctors. Further studies are needed to elucidate the causal rela-tionship. This finding implies that health policies encouraging people to have a usual doctor are needed in Korea.