Willingness to Pay for Hospice Care Using the Contingent Valuation Method

PURPOSE: It is necessary to develop a proper payment system for more health care facilities to provide hospice and palliative cares. In deciding the proper level of payment for hospice per diem fee, willingness to pay (WTP) may provide one of the critical information. This study was conducted to determine WTP for hospice care and to analyze those factors affecting WTP. MATERIALS AND METHODS: A contingent valuation method with a double-bounded dichotomous-choice model was used. Interview survey was organized and conducted by a survey company from April 4 to 18, 2008. The mean WTP was calculated through an infinite integration of survival functions. RESULTS: The average willingness to pay was found to be 42,240 Korean won (KRW) (USD 35), with the amount becoming higher as hospice services were deemed more necessary or where average monthly household income was higher. The amount was also higher among male respondents than females. CONCLUSION: To compare this WTP with actual cost (32,500 KRW) (USD 27) for hospice care. To facilitate hospice service, hospice specific payment system should be developed. This study provides information regarding the general public's preference of hospice service and their WTP for hospice care, and it may be useful in the decision-making process.

Degree of Compliance with Polypharmacy and Its Influential Factors in Rural Elderly Patients with Chronic Diseases in South Korea

BACKGROUND: This study was to verify the necessity of a control program developed to improve compliance, by conducting a research on the status of medication compliance in the elderly with chronic diseases in rural area and analyzing the related variables. METHODS: The organized questionnaire and pill-count were used to collect information on personal details, physical status, drugs taken in the elderly over 65 years old suffering from more than two chronic diseases in one rural area. RESULTS: The mean age of the subjects was 73.13+/-6.36 (65~93), and the number of the subjects in compliance group was 60 (77.9%) and the accuracy of self-report which was identified by pill-count was 0.86. Polypharmacy and visiting several clinics were the main factors that decided a low- degree of compliance, with OR of 5.92 (95% CI 1.11~31.44, P=0.037), and 4.25 (95% CI 1.03~17.53, P=0.045), respectively. CONCLUSION: Systematic efforts are necessary and plans must be established without delay to increase compliance in the elderly in the rural, expansively to manage chronic diseases in stay-at-home elders.

Strategies to Improve Nutritional Management in Primary School Lunch Program

The Korea School Lunch Program mandates that school meals should safeguard the health and well-being of our children. School meals provide a nutritious diet that contains at least 1/3 of the daily Recommended Dietary Allowances of necessary nutrients at reasonable prices. This study was performed to assess the nutritional management of primary school meals, and to provide basic data for improvement of school meal nutritional guidelines. Three hundred and thirty six dietitians who worked at primary schools were recruited using a stratified sampling method. A survey was done by e-mail with a set of questionnaires about nutritional meal management. During school lunch planning, dietitians referred nutrition standards with priority, followed by students' food preferences and food hygiene. They considered energy as a most important nutrient during primary school lunch planning, followed by protein and calcium. Protein is usually over-served, whereas iron, vitamin A and calcium are usually under-served during primary school meal planning. For first and second grade primary students, grains, meat and vegetable side dishes seemed to be large compared to their eating capacity. Over 92% of school dietitians agreed the needs of food group standards for primary school lunch program. For making a checklist of the school lunch program, energy, protein and calcium were highly recommended, and meat.fish.egg group, vegetable.fruit group and dairy group were also highly recommended by school dietitians. Cooking method was also highly recommended. School dietitians proposed that remodeling of school kitchens and new cooking machine were the most important factors for improving school lunch system. These results suggest that food standards should be established for health-oriented nutritional management of primary school lunch programs. Nutritional checklists could include nutrient-rich foods and food groups, and items about cooking methods.

Strategies to Improve Nutritional Management in Primary School Lunch Program

The Korea School Lunch Program mandates that school meals should safeguard the health and well-being of our children. School meals provide a nutritious diet that contains at least 1/3 of the daily Recommended Dietary Allowances of necessary nutrients at reasonable prices. This study was performed to assess the nutritional management of primary school meals, and to provide basic data for improvement of school meal nutritional guidelines. Three hundred and thirty six dietitians who worked at primary schools were recruited using a stratified sampling method. A survey was done by e-mail with a set of questionnaires about nutritional meal management. During school lunch planning, dietitians referred nutrition standards with priority, followed by students' food preferences and food hygiene. They considered energy as a most important nutrient during primary school lunch planning, followed by protein and calcium. Protein is usually over-served, whereas iron, vitamin A and calcium are usually under-served during primary school meal planning. For first and second grade primary students, grains, meat and vegetable side dishes seemed to be large compared to their eating capacity. Over 92% of school dietitians agreed the needs of food group standards for primary school lunch program. For making a checklist of the school lunch program, energy, protein and calcium were highly recommended, and meat.fish.egg group, vegetable.fruit group and dairy group were also highly recommended by school dietitians. Cooking method was also highly recommended. School dietitians proposed that remodeling of school kitchens and new cooking machine were the most important factors for improving school lunch system. These results suggest that food standards should be established for health-oriented nutritional management of primary school lunch programs. Nutritional checklists could include nutrient-rich foods and food groups, and items about cooking methods.

A Case of Pacemaker Syndrome

Although ventricular pacing alone initially had deemed adequate for most clinical situations, some patients did not do well after ventricular pacing was initiated, and developed various symptoms attributed to this mode of pacing. The pacemaker syndrome is complex of clinical signs and symptoms related to the adverse hemodynamic and electrophysiologic consequences of ventricular pacing in the absence of other causes. Neurologic symptoms or those congestive heart failure predominated. We recently experienced a case of pacemaker syndrome in a 44-year-old female who had suffered sick sinus syndrome and was implanted with dual chamber pacing system being programmed to VVI pacing. She complained of chest discomfort, dyspnea, and near-fainting in a day after being programmed to VVI. Blood pressure was decreased to 9/60mmHg. Electrocardiography showed toPwave onT wave, representing retrograde ventriculoatrial conduction. The symptoms and signs were disappeared immediately after the pacing system was programmed to DDD pacing.