The Current Status of Adult Day Care in Korea: Operation, Staffing, and Service / 간호학회지

PURPOSE: The purpose of this study was to describe the operation, staffing, and services provided at adult day care centers in Korea. METHODS: The study was a cross-sectional descriptive survey. The subjects were 209 centers among 280 centers registered in Korea (response rate 74.6%). The data was collected from August to December in 2006. RESULTS: 48.8% of centers were located in a city area. The centers were based on the Social Model 65.5% of the centers were open Monday to Friday, an average of 7~8 hours per day. Dementia, stroke or frail elderly could use the center, and 57.4% of centers were used for dementia and stroke elderly together. The enrollment of elderly was 13.5. The number of total staff was 8.27, the number of RN's and social workers was 0.67, and 2.54 respectively. The social services(Meal preparation 98.6%, Special event 98.1%, Transportation, 97.1%) were provided more than the health services(Physical therapy 98.1%, ADL training 95.2%, Counseling 84.7%, Vaccination 82.8%, Health monitoring 78.9%, Health education 78.5%, Bathing 66.1%, and Speech therapy 28.2%). CONCLUSION: These results suggest we have to develop a health-focused adult day health care model based on the needs of elderly and their families. Nurses will have an important role in adult day health care.

Prescription pattern for treatment of hemorrhoids under the universal coverage policy of Thailand.

The Universal Coverage Policy (UCP) or "30 Baht Scheme" was launched in Thailand in 2001. The policy caused a cutback in the budgets of all public hospitals and health service centers. Traditional medicine was then viewed as an alternative to save costs. This study examines whether this had any influence on hemorrhoid treatment prescription patterns, ratio of traditional/modern medicine, or the cost of hemorrhoid treatment after the UCP was implemented at a community hospital. The traditional medicine prescribed was Petch Sang Kart and the modern alternative was Proctosedyl. All hemorrhoid prescriptions at a community hospital from October 2000 to January 2003 were surveyed. Segmented Regression Analysis was applied to evaluate prescription trends, the ratios between the types of medicine, and the hemorrhoid treatment cost. A total of 256 prescriptions were analyzed. The average number of traditional medicine prescriptions per month were more than modern medicine (41 versus 16). During the study period, the trend of modern medicine use and the treatment cost was decreased (p < 0.01). The ratio of traditional/modern medicine increased 0.2 times (p = 0.02).

Patterns, appropriateness, and predictors of antimicrobial prescribing for adults with upper respiratory infections in urban slum communities of Bangkok.

Upper respiratory tract infections (URIs) are the most common infections worldwide. Their frequent inappropriate treatment with antibiotics is likely to increase antibiotic resistance, contribute to morbidity and mortality, and waste scarce resources. Using data from registration books and prescriptions, we measured patterns and assessed appropriateness and predictors of antibiotic prescribing for viral and bacterial URIs treated in health centers located in two slum communities in Bangkok, Thailand. Based on recorded diagnoses and symptoms, 91% of the patients probably had viral URIs; 60% of viral and 89% of bacterial URI patients were prescribed an antibiotic. Compliance with the national treatment guideline was 36.4% for treatment of viral URIs and only 1.7% for treatment of bacterial URIs. Amoxicillin was the most frequently prescribed antibiotic regardless of diagnosis. Among viral URI patients, those who were young, male, and self-paying were more likely to receive antibiotics; part-time physicians were more likely to prescribe antibiotics for these patients. Among patients with bacterial URIs, those who paid for drugs by themselves were more likely to receive antibiotics compared to patients covered by the national health insurance plan. We used these formative results as input to the design of health center and community interventions to encourage more appropriate prescribing for URI among adults.

Cost of delivering child immunization services in urban Bangladesh: a study based on facility-level surveys.

This facility-based study estimated the costs of providing child immunization services in Dhaka, Bangladesh, from the perspective of healthcare providers. About a quarter of all immunization (EPI) delivery sites in Dhaka city were surveyed during 1999. The EPI services in urban Dhaka are delivered through a partnership of the Government of Bangladesh (GoB) and non-governmental organizations (NGOs). About 77% of the EPI delivery sites in Dhaka were under the management of NGOs, and 62% of all vaccinations were provided through these sites. The outreach facilities (both GoB and NGO) provided immunization services at a much lower cost than the permanent static facilities. The average cost per measles-vaccinated child (MVC), an indirect measure of number of children fully immunized (FIC-the number of children immunized by first year of life), was 11.61 U.S. dollars. If all the immunization doses delivered by the facilities were administered to children who were supposed to be immunized (FVC), the cost per child would have been 6.91 U.S. dollars. The wide gap between the cost per MVC and the cost per FVC implies that the cost of immunizing children can be reduced significantly through better targeting of children. The incremental cost of adding new services or interventions with current EPI was quite low, not significantly higher than the actual cost of new vaccines or drugs to be added. NGOs in Dhaka mobilized about 15,000 U.S. dollars from the local community to support the immunization activities. Involving local community with EPI activities not only will improve the sustainability of the programme but will also increase the immunization coverage.

Cost of primary health care in universal insurance at Health Center 16, Bangkok Metropolitan Administration.

The purpose of the present study was to illustrate the cost of services in health promotion and prevention, out patient (OPD) and dental care in Health Center (No. 16) Bangkok Metropolitan Administration. The analysis of the cost components could be used as key data for future planning, budgeting and resources preparing for the short and long terms. The cost centers were categorized to be executive, services and supporting unit. The simultaneous equation method was employed to allocate all costs from other associated cost centers to the service unit. The unit cost per visit was 372.76 baht, while the unit cost per capitation was 532.83 baht. The unit cost of health promotion and prevention per capitation was 288.95 baht, whereas the unit cost of OPD care per capitation was 183.47 baht and the unit cost of dental care per capitation was 55.37 baht. The labor cost accountedfor 83.67 per cent, capital cost 6.09 per cent and material cost 10.24 per cent of the total cost. Unit costs of OPD and dental care were lower than the proposed budget while the unit cost of health promotion and prevention was higher. This could be due to some patients seeking OPD care from King Chulalongkorn Hospital instead, while the health promotion and prevention offering was more than that normally offered in other Health Centers. The improvement of labor efficiency and the decrease of labor cost would be the short and long run strategies respectively.

Costs of publicly provided maternity services in Rosario, Argentina

OBJECTIVE: This study estimates the costs of maternal health services in Rosario, Argentina. MATERIAL AND METHODS: The provider costs (US$ 1999) of antenatal care, a normal vaginal delivery and a caesarean section, were evaluated retrospectively in two municipal hospitals. The cost of an antenatal visit was evaluated in two health centres and the patient costs associated with the visit were evaluated in a hospital and a health centre. RESULTS: The average cost per hospital day is $114.62. The average cost of a caesarean section ($525.57) is five times greater than that of a normal vaginal delivery ($105.61). A normal delivery costs less at the general hospital and a c-section less at the maternity hospital. The average cost of an antenatal visit is $31.10. The provider cost is lower at the health centre than at the hospital. Personnel accounted for 72-94 percent of the total cost and drugs and medical supplies between 4-26 percent. On average, an antenatal visit costs women $4.70. Direct costs are minimal compared to indirect costs of travel and waiting time. CONCLUSIONS: These results suggest the potential for increasing the efficiency of resource use by promoting antenatal care visits at the primary level. Women could also benefit from reduced travel and waiting time. Similar benefits could accrue to the provider by encouraging normal delivery at general hospitals, and complicated deliveries at specialised maternity hospitals

Expenses of health facilities in rural and urban health care centers in Zanjan

Expenses of health facilities have a great impact on their quality. The present study was conducted to determine the expenses of each health facility in rural and urban health care centers in Zanjan province in 2001.For this descriptive study, 26 minor health care centers in small villages, 6 rural and 5 urban health care centers were selected through randomized sampling. Expenses were determined according to the type of facility, the exact center, and also type of expense. Thus, expenses of usable materials and equipment, specific equipment, drugs, building repairs, vehicles, personnel, and other equipment were all determined in accordance to the population.Expenses of minor health care centers in small villages, rural and urban health care centers were 49, 330, and 44 million Rials, respectively. Personnel expenses were by far the most common type of expenses that comprised 25.7, 21.5, and 31.3% of the aforementioned centers' expenses, respectively. Unfortunately, government has not allocated enough budgets for these health care centers. Meanwhile, paying further attention to the managing aspects of such centers could be helpful to control their expenses. Similar studies are highly recommended in other centers

Costs-effectiveness of the urban health center in Nakhon Ratchasima: a case study on diabetes and hypertension.

Health care reforms in Thailand are looking for a better health infrastructure within the urban setting. The urban health center is one of the models tried in many provinces. This study compared the costs--effectiveness of the urban health center in Nakhon Ratchsima with the Maharaj Nakhon Ratchasima Hospital, using diabetes and hypertension as tracer conditions. The point estimates by a retrospective review and cross-sectional study revealed that the overall costs (provider plus patient costs) of the urban health center for these tracers were lower than the costs of the Maharaj Hospital. The effectiveness of treatment at the urban health center was also better. It was concluded that the urban health center should be considered as a better alternative of primary care institution within the urban area.

Cost of health services provided at a primary health centre.

BACKGROUND. Information on the cost of health services is essential for good planning and management and leads to an efficient use of resources. Very little information on this is available in India. We estimated the distribution of costs incurred on the Primary Health Centre, Chhainsa, Haryana by the type of service provided and their average unit costs. METHODS. We calculated the total costs incurred in running the primary health centre for one year using standard costing methods. This cost was apportioned under different heads on the basis of time and space utilization. The number of activities carried out, between April 1991 and March 1992, was obtained from the monthly reports of the centre maintained by the health assistant and supervised by the medical officer. RESULTS. The total cost incurred for one year was Rs 777,020 (US$ 24,250). Curative care accounted for 32% of the total costs followed by communicable disease control (17%), child care (17%), maternal care (11%) and family welfare (10%). An expenditure of Rs 24 was incurred on each outpatient. The cost of giving full primary immunization to a child was estimated at Rs 131, while Rs 127 was incurred on providing antenatal, natal and postnatal care to each pregnant woman. Tuberculosis-related activities in the community cost Rs 3 per head per year and malaria-related activities Rs 2 per head per year. The cost incurred annually on family welfare services to an eligible couple was Rs 19. CONCLUSIONS. Our findings suggest that the cost estimates from this primary health centre are comparable with the estimates from other developing countries. These cost estimates may be used to determine user fees by health agencies or for premiums for community health insurance schemes.

Cost analysis of eye camps and camp-based cataract surgery.

BACKGROUND. Although cataract accounts for half the blindness in the world, the resources available are not sufficient to meet the existing need for operations. The most effective low cost cataract surgery is probably performed in community camps. METHODS. We estimated the costs incurred in performing cataract operations in makeshift comprehensive eye care camps. Both the capital and recurrent inputs were costed at current market rates. RESULTS. Rupees 1,508,600 (US$ 47,100) was spent on conducting 17 camps during April 1992 to March 1993. Recurrent inputs were responsible for 83% of the total costs. Sixty per cent of the recurrent inputs were borne by non-governmental organizations. The total capital expenditure was borne by the mobile ophthalmic units. Food and drugs for patients (40%), and staff salaries and allowances (35%) were the major recurrent expenditure, while 60% of the capital expenditure was accounted for by vehicles. The unit cost of cataract surgery was Rs 772 (US$ 23). CONCLUSIONS. We suggest that comprehensive eye camps are cost-effective.