Who Are the People Willing to Pay for Physician Home Visits?

Chang-O Kim,장숙랑 대한의학회 2020 Journal of Korean medical science Vol.35 No.20

Background: Since the recently announced Community Care Policy, there has been an opinion that Korea needs to establish an alternative medical model such as physician home visits. This study aimed to assess the need and willingness to pay (WTP) for physician home visits among the community-dwelling Korean older population and to determine the most important factors that influence older adults to decide to use a physician home visit service. Methods: A total of 797 people aged 60 years or older who were randomly selected from a nationwide dataset using a multi-stage stratified sampling method answered a questionnaire on the need and WTP for physician home visits. Results: A total of 39.3% of participants reported that they would like a physician home visit when they need help. Among older adults who needed physician home visits (n = 313), the WTP amount for physician home visits was 21,982 ± 17,546 KRW. Logit and Tobit regression analyses showed that the higher valuated need and WTP for physician home visits was associated with a lower level of physical/psychosocial functioning measured by EuroQol-five dimensions score (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01–1.27; P = 0.035) and a higher level of satisfaction when using community-based services such as public health centers (OR, 1.32; 95% CI, 1.02–1.72; P = 0.034), social welfare centers and Gyeong-ro-dang (OR, 1.61; 95% CI, 1.04–2.50; P = 0.033; β = 8.39; standard error, 3.63; P = 0.021). Conclusion: This study provides evidence that the decision to pay for a physician home visit service is based upon the complex interactions among an individual's physical and psychosocial functioning, personal experiences of service utilization, and demographic factors. The value for physician home visits should be qualified based on the empirical data of WTP, which comes from a consumer-centered perspective.

From Visiting a Physician to Expecting Antibiotics: Korean Perspectives and Practices toward Respiratory Tract Infections

Leila Freidoony,김춘배,Hamid Haghani,박명배,장세진,김상하,고상백 대한의학회 2017 Journal of Korean medical science Vol.32 No.2

Antibiotic resistance is steadily rising worldwide. Respiratory tract infections (RTIs) are common indications, mostly imprudent, for antibiotic prescriptions in outpatient setting. In Korea, antibiotic prescription rate for RTIs is still high. As physician visit and antibiotic prescribing are influenced by patient's perceptions and beliefs, we aimed to explore the general public's perspectives and practices toward RTIs and to develop the ‘RTI clinical iceberg.’ A cross-sectional survey was conducted in Wonju Severance Christian Hospital (WSCH) among 550 adults attending outpatient departments during January 2016. Differences in distributions between groups were examined using two-tailed Pearson χ2 test. Using the Andersen's behavioral model as a conceptual framework, we constructed logistic regression models to assess factors associated with physician visit. Of 547 participants with complete questionnaires, 62.9% reported having experienced an RTI in the previous six months; 59.3% visited a physician for the illness, most commonly because the symptoms were severe or prolonged, and approximately 16% of them expected an antibiotic prescription from the visit. Perceptions of symptoms severity, the need factor, most strongly influenced physician visit. Predisposing and enabling factors such as inappropriate expectations for antibiotic for a sore throat or having national health insurance also influenced physician visit. Almost all participants who reported asking for an antibiotic were prescribed one, with a 37.1% non-adherence rate. Conclusively, public education on self-care for RTI symptoms that addresses their main concerns may reduce physician visits. Improving physician-patient relationship and informing patients about the lack of antibiotic benefit for most RTIs may also reduce antibiotic prescriptions.

거동불편 대상자를 위한 방문진료의원 모형: 1년 6개월간의 운영사례 보고

김창오,홍종원,조미희,최은희,장숙랑 한국노년학회 2020 한국노년학 Vol.40 No.6

This case study sought to explore whether home-based primary care can be an effective model for homebound older adults and people with disabilities in South Korea. The number of older adults with disabilities is expected to increase rapidly in the near future according to population aging trends. Thus, a care model in which doctors go directly to the patient’s home could address many complex medical needs and concerns. The Visiting Doctors Program of Medical Home was begun in March 2019 by two doctors and one nurse. Thus far, 2,070 home visits have been conducted to a total of 292 homebound older adults and people with disabilities. It was witnessed that there has been high patient satisfaction, reduced nursing home admission, development of various types of home healthcare services, establishment of a community care network, and support for in-home hospice care as achievements. The Visiting Doctors Program has developed a successful care model despite having a completely different operating structure from traditional outpatient clinics, with care only provided during in-home visits. The Visiting Doctors Program can be operated within the current health insurance fee system in South Korea. Comprehensive analyses and in-depth follow-up studies are needed to design disseminating models of home-based primary care.

환자만족이 의료이용에 미치는 영향-환자-의사 커뮤니케이션 만족을 중심으로

윤혜정,유명순 한국병원경영학회 2019 병원경영학회지 Vol.24 No.4

Purpose: Importance of patient satisfaction related to patient-centeredness has been emphasized, and it is known to have effect on various health outcomes including health resource utilization. However, the effect of patient satisfaction has been discussed mostly in terms of hospital marketing in Korea. This study aims to examine the effect of patient satisfaction in patient-physician communication on healthcare utilization in a nationally representative adult population of South Korea. Method: Patient satisfaction with physician communication is assessed using 4 items in the 2011 Korea Health Panel Survey. Generalized linear regression analysis is conducted using 9,325 adultsʼ healthcare utilization in 2012. Findings: Adjusting for the socio-demographic, economic factors, individual health status, health behaviors and healthcare utilization in 2011, more satisfied individuals, more likely to utilize the outpatient service, especially in clinical setting. Practical Implications: The study findings suggests that in context of South Korea healthcare system such as insufficient medical consultation time and the absence of health delivery system, patient satisfaction as a subjective healthcare quality indicator would have effect on the individualʼs outpatient visit. This study contributes to stimulate patient satisfaction research and discussion in South Korea to further explore its relationship with potential and various health related outcomes. Further implications of the study are discussed.

The Cyclical Change in the Use of Language Learning Strategies: A Case Study of Korean Physician

강수자 한국현대영어영문학회 2017 현대영어영문학 Vol.61 No.4

This qualitative case study reports on a visiting Korean physician’s use of language learning strategies during his stay in an English speaking country. The participant was a Korean physician who stayed in the United States for his sabbatical year. The data was collected from interviews, observations, and the participant’s notes. From an inductive analysis of the data, this study reveals a cyclical change in the use of language learning strategies. The changes occurred in terms of the degree of focus, rather than a clear-cut distinction. The changes during the 12 month period can be divided into three stages. In the first stage, the participant depended more on authentic language use strategies, such as seeking out native speakers of English and watching TV. In the second stage, he depended more on the set of strategies that he had used to study written English in Korea: note-taking, looking up words in the dictionary, and memorization. Interestingly, in the third stage, he focused again on the more authentic language use strategies used in the first stage and employed confirmation strategies to check if his English expressions and usages were correct and appropriate.

The Cyclical Change in the Use of Language Learning Strategies: A Case Study of Korean Physician

( Kang Su-ja ) 한국현대영어영문학회 2017 현대영어영문학 Vol.61 No.4

This qualitative case study reports on a visiting Korean physician’s use of language learning strategies during his stay in an English speaking country. The participant was a Korean physician who stayed in the United States for his sabbatical year. The data was collected from interviews, observations, and the participant’s notes. From an inductive analysis of the data, this study reveals a cyclical change in the use of language learning strategies. The changes occurred in terms of the degree of focus, rather than a clear-cut distinction. The changes during the 12 month period can be divided into three stages. In the first stage, the participant depended more on authentic language use strategies, such as seeking out native speakers of English and watching TV. In the second stage, he depended more on the set of strategies that he had used to study written English in Korea: note-taking, looking up words in the dictionary, and memorization. Interestingly, in the third stage, he focused again on the more authentic language use strategies used in the first stage and employed confirmation strategies to check if his English expressions and usages were correct and appropriate. (Pai Chai University)

의료보험 본인부담금 인상에 따른 외래이용 변화

전기홍,김한중,Chun, Ki-Hong,Kim, Hang-Jung 대한예방의학회 1992 예방의학회지 Vol.25 No.1

The level of copayment increased in order to stabilize the financial condition of the health insurance on 1986. An important question regarding the policy was whether the increase in the level of copayments reduced the utilization of medical services in the poor selectively. In spite of the importance of the research question, no study has been reported. This study was designed to find out changes in numbers of physician visits, to explain characteristics influencing the difference of utilization before and after the program. Finally the interaction effect between the program and the level of income was examined for the abover question. A total of 10,421 persons from eight institutions was selected as the study sample. Research findings are as follows. 1. The number of physician visits decreased by ten percent as a result of increasing the level of copayment. 2. The decrease was remarkable in some groups such as children, rural area and large family. 3. The most important factor which explained the difference was the number of physician visits before the introduction of the new program. The more numbers of physian visits during the last year were, the more numbers of physian visits decreased after the program. 4. The interaction term between the program and the level of income was statistically significant in the multiple regression model which explained physician visits and its coefficient was negative. It means that an increase in copayment did not reduced the number of physician visits in the poor, selectively. 5. It can be concluded that imposing adequate copayment reduces the use of medical services as well as medical costs without serious damage in access especially for the poor people.

근로자재해보장책임보험과 실손의료보험이 산재 근로자의 외래 의료이용에 미치는 영향

유창훈,강성욱,권영대 한국사회보장학회 2023 사회보장연구 Vol.39 No.3

본 연구는 산재 근로자를 대상으로 산재요양 종결 이후에 근로자재해보장책임보험과 실손의료보험이 의료이용에 미치는 영향을 분석하였다. 산재보험패널조사의 2018년도 자료를 이용하여 산재요양 종결자 2,109명을 대상으로 음이항회귀분석을 활용하여 근로자재해보장책임보험과 실손의료보험이 외래방문 횟수에 미치는 영향을 분석하였다. 분석 결과, 근로자재해보장책임보험과 실손의료보험 가입이 외래방문 횟수에 정(+)의 영향을 미치는 것을 확인하였다. 이는 근로자재해보장책임보험의 소득효과나 실손의료보험의 보험효과로 인해 의료이용 증가가 발생하였을 가능성을 보여준다. 한편, 근로자재해보장책임보험이나 실손의료보험이 산재보험, 국민건강보험 등 공적보험의 미충족 의료수요를 일부 해소하였을 가능성도 생각해볼 수 있다. 본 연구 결과는 산재 근로자의 건강 영향요인과 의료이용 행태의 이해를 바탕으로 산재 근로자의 연속적 건강관리체계를 마련하고 공적 보험의 보장성 강화 정책을 개발하는데 기여할 것으로 판단된다. This study analyzed the effects of employer’s liability insurance and indemnity medical insurance on medical use after the end of industrial accident treatment for industrial accident workers. To this end, this study analyzed the effects of employer’s liability insurance and indemnity medical insurance on the number of outpatient visits using negative binomial regression analysis for 2,109 people who completed industrial accident care. As a result of the study, it was confirmed that subscribing to employer’s liability insurance and indemnity medical insurance had a positive effect on the number of outpatient visits, which can take into account the possibility of an increase in medical use due to the income effect of employer’s liability insurance or insurance effect of indemnity medical insurance. Another reason can be explained by the possibility that employer’s liability insurance or indemnity medical insurance will partially resolve the unmet medical demand for public health insurance such as industrial accident insurance and national health insurance. However, in order to understand a clear causal relationship, additional research is needed on the influencing factors of unmet medical care or on the extending tracking period. This study is expected to contribute to the establishment of a continuous health management system for industrial workers and the development of policies to strengthen public insurance coverage based on the understanding of the health influencing factors and medical use behavior of industrial workers.

A Study on the Pattern of Health Care Utilization by Age and Sex in Korea

Kim, Yong-Ik Seoul National University 1988 The seoul journal of medicine Vol.29 No.4

민간의료보험이 의료 이용에 미치는 영향 : 한국의료패널(2008-2010)을 이용한 Two-Stage 분석

유창훈,강성욱,최지헌,오은환,권영대 보건의료산업학회 2014 보건의료산업학회지 Vol.8 No.2

This paper examined the effects of private health insurance(PHI) on the health care utilization among the Korean. The used data was the three waves of Korea Health Panel (2008, 2009, 2010), and the number of subjects was 13,951 persons. Authors employed two-stage least square panel model where the instrument variables for controlling for endogeneity of PHI were number of insurance planner per 100,000 in resident area and whether subject worked on financial profession. The results showed that healthcare expenditure of outpatients who purchasing PHI was higher than that of outpatients without PHI, and there was no difference in admission between the two groups. This article recommended the Korean government to monitor the effects of PHI on the health care utilization in order to improve the efficiency of health care finance.