The Effect of Copayment on Medical Aid Beneficiaries in Korea

PURPOSE: This study was to ascertain whether there are differences in health care utilization and expenditure for Type I Medical Aid Beneficiaries before and after applying Copayment. METHODS: This study was one-group pretest posttest design study using secondary data analysis. Data for pretest group were collected from claims data of the Korea National Health Insurance Corporation and data for posttest group were collected through door to-door interviews using a structured questionnaire. A total of 1,364 subjects were sampled systematically from medical aid beneficiaries who had applied for copayment during the period from December 12, 2007 to September 25, 2008. RESULTS: There was no negative effect of copayment on accessibility to medical services, medication adherence (p=.94), and quality of life (p=.25). Some of the subjects' health behaviors even increased preferably after applying for copayment including flu prevention (p<.001), health care examination (p=.035), and cancer screening (p=.002). However, significant suppressive effects of copayment were found on outpatient hospital visiting days (p<.001) and outpatient medical expenditure (p<.001). CONCLUSION: Copayment does not seem to be a great influencing factor on beneficiaries'accessibility to medical services and their health behavior even though it has suppressive effects on outpatients' use of health care.

Case Management for Medical Aid Beneficiaries in Korea: Findings from Case-control Study

PURPOSE: This study was to evaluate effects of case management provided for 7 months for medical aid in Korea. METHODS: This study was a retrospective comparative study using secondary data analysis. Data from two pre-existing survey were reanalyzed. The data were collected through door to-door interviews using the structured questionnaire. For the medical service use, claims data from the Korea National Health Insurance Corporation was used. Subjects were 73 in the intervention group and 118 in the control group. RESULTS: There was no significant change in the intervention group in self-care ability (p = .296), medication adherence (p = .194) or quality of life (p = .903) compared to those of the control group. For hospital visiting days, it appeared to decrease in the intervention group (p = .038) but with no significant difference from that of the control group (p = .157). Neither were there significant differences in medical expenditures (p = .605). CONCLUSION: Although the effect of case management in this study appeared extremely limited, the short intervention period and characteristics of the medical aid beneficiaries and the limit of controlling only the demand side were discussed as factors to be considered. Nurses have been carrying out professional roles in case management in Korea. However more efforts are needed to develop case management as an area for nursing specialization.

Comparison of Case Management between Tele Care Regions and General Care Regions in Korean Medicaid / 간호행정학회지

PURPOSE: The purpose of the study was to compare recipients' health behavior, attitude to using medicaid, medication compliance, and the changes in hospital cost and visit-day of in-patient and out-patient care between tele-care regions (TCR) and general care regions (GCR) in Korean medicaid. METHOD: The design of the study was ex-post facto comparing recipients in TCR and GCR. The sample included 625 persons in TCR and 410 persons in GCR. To collect materials, the case manager interviewed recipients of medicaid and filled out questionnaires which were analyzed through SAS/PC 9.1. RESULTS: In studying health behavior and medication, compliance was not significant. However, the attitude to using medicaid was significantly more positive in TCR than in GCR. In out-patients, the change of hospital visit-day was not significant between TCR and GCR, but TCR showed a reduction in hospital cost compared to GCR. For in-patient recipients, GCR showed a greater reduction in changes in hospital cost and visit-day compared to TCR. CONCLUSIONS: The results of the study show that attitudes to using medicaid via telephone are positive and results are more effective than hospital visit consultation, and the cost of out-patient care could be reduced.

Survey on the Occupational Disabled Status using Functional Assessment Tools / 산업간호학회지

PURPOSE: The purpose of this study was to investigate the actual condition of the disabled due to Occupational accidents based on the functional evaluation tool. METHOD: The data were collected from 2 Workers Accident Medical Corporation, 311 subjects between February and August, 2007. The tool comprised of six components including physical function, cognitive function, communication, emotional and disturbing behavior, nursing skills and rehabilitation needs. RESULTS: Among the disabled, the average point of physical function of 5 was found in 61.92% and to express and understand were evaluated as normal in 36.69% and 33.44%, respectively. Also, hearing and vision were evaluated as normal in 53.50% and 37.98%, respectively. 19.01% of the disabled had emotional problems and 13.78% had disturbing behavior. Most disabled were in need of nursing skills with 97.73% ROM and activities. The 78.18% and 76.90% of disabled were in need of rehabilitation because of right and left leg in full movement disorders, respectively. CONCLUSION: The evaluation score for the disabled caused by Occupational accidents was diverse showing 10 to 19 points and 140 to 150 points. The result means the care cost should be determined depending on the care needs of the disabled because there is such a diverse range of care needs for them.

Development of a Tool for Predicting Nursing Times in Occupational Accident Patients / 산업간호학회지

PURPOSE: This study aims to develop a tool to predict occupational health patients' nursing needs or nursing time. METHOD: A tool was composed based on the materials and opinion of experts, and to verify the reliability and validity of the tool, nursing time of total 311 inpatients in 2 occupational health hospitals were surveyed. RESULTS: The developed tool was total 151 items and composed of physical function, cognitive function, communication, emotional and disturbance behavior, nursing skill, and rehabilitation need. The reliability of the tool was high, showing Cronbach's alpha coefficient of 0.95. But several items should be deleted for low corrected item-total correlation. According to the multiple regression analysis, physical function and rehabilitation need were shown to be the most powerful predictive variables for nursing time. CONCLUSION: The developed tool was appeared to have high reliability and validity. But further refinement of the tool is needed.

On-the-Job Experiences of Medical Aid Managers / 산업간호학회지

PURPOSE: The purpose of this phenomenological study was to understand the job experiences of the medical aid client managers METHOD: The data were collected through an in-depth interview from twelve medical aid client managers. It was analyzed using the phenomenological method proposed by Colaizzi (1978). Their feedback was categorized into five items such as 'settlement in the unknown place,' 'exhaustion from work,' 'difficulties in dealing with people,' 'achievement of professionalism and accomplishment,' and 'vision on the new aspect.' CONCLUSION: Medical aid client managers played diverse roles and they had a role conflict due to unstable position amid feeling proud with new vision on their roles. The results of this study suggested that systematic development of job training programs and description on the duty are needed. Moreover, appropriate legal basis for the duty of medical aid client managers is to be established. Finally, based on this research, more acknowledgement from the Korean nursing society is needed for the new emerging professional job.

On-the-Job Experiences of Medical Aid Managers / 산업간호학회지

PURPOSE: The purpose of this phenomenological study was to understand the job experiences of the medical aid client managers METHOD: The data were collected through an in-depth interview from twelve medical aid client managers. It was analyzed using the phenomenological method proposed by Colaizzi (1978). Their feedback was categorized into five items such as 'settlement in the unknown place,' 'exhaustion from work,' 'difficulties in dealing with people,' 'achievement of professionalism and accomplishment,' and 'vision on the new aspect.' CONCLUSION: Medical aid client managers played diverse roles and they had a role conflict due to unstable position amid feeling proud with new vision on their roles. The results of this study suggested that systematic development of job training programs and description on the duty are needed. Moreover, appropriate legal basis for the duty of medical aid client managers is to be established. Finally, based on this research, more acknowledgement from the Korean nursing society is needed for the new emerging professional job.

A Comparative Study on the Effects of an Individual Intervention Program and a Group Intervention Program on the Demented Elderly and Their Families

PURPOSE: This study was to compare the effects of individual and group intervention programs on the demented elderly and their families. METHODS: The programs were applied to two groups, one by home visiting and the other by group intervention. The groups were composed of 14 elders and 12 elders, respectively, with their families. The programs were applied twice a week, ninety minutes per session for four weeks. Programs consisted of cognitive therapy, music and art therapy, and massage for the demented elderly, education on dementia, cognitive-behavioral intervention for problematic behavior, methods to lessen stress, and counselling for the families. RESULTS: AER, problematic behavior, QOL of pts and QOL, caregiving burden, and relationship with the pts of caregivers were improved after each program but not significantly except QOL of pts (Z=-3.37, p=.00) in the group intervention. When the two interventions were compared with each other, the group intervention program was more effective than the home visiting program in all variables but not significantly except QOL of pts (U=32.00, p=.00). CONCLUSION: In summary, both the individual and group intervention programs were helpful to both pts and families, and even though tthere was no statistically significant difference between the two intervention programs except in QOL of pts, the group intervention was more effective.

The Development of Community Health Service for the Demented Elderly in Cooperation Between Private Medical Facilities and Public Health Centers

PURPOSE: This research was carried out to present an ideal cooperative model between the public and private health sectors for the management of community dementia patients. METHOD: In this study a public-private cooperative council was formed, basic data for dementia patients and their families were collected, and a dementia service program was carried out in cooperation between the two sectors. RESULTS: The survey data shows the majority of the registered patients were undergoing a chronic diseases which would make the dementia health service inefficient. The cooperative public-private council adopted the reinforcement of medical service to the public enrolled dementia patients. The intensive medical service program showed effects on the health status of the dementia patients. CONCLUSION: The results of this study pointed out that change of the health insurance program supportive to the private sectors to be made; a referral system for the public health sector to the private sector should be established; and expanding the capacity of the visiting health program in the public health sector is needed.

Effects of an Integrated Stress Management Program(ISMP) for the Elders in a Rural Community / 기본간호학회지

PURPOSE: This study was done to develop and evaluate the Integrated Stress Management Program (ISMP) for elders in rural communities. METHOD: ISMP consists of 6 educational programs to improve self-management behavior and therapeutic recreational activities and was developed by analyzing the published reports and through multidisciplinary cooperation.Effectiveness of the ISMP was evaluated by implementing the program with 53 rural elders living at home, one session a week of, 2 hours per session over, 6 weeks from March 14 to April. 22, 2005. RESULTS: After participating in the program, participants' perceived levels of stress decreased(t=2.940, p<.05), and mood state (t=4.229, p<.001), life satisfaction(t=-4.911, p<.001), and perceived social support (t=-2.891, p<.05) increased significantly. CONCLUSION: The results of this study demonstrated that the ISMP is an effective program for relieving stress level, and increasing positive mood, life satisfaction, and social support for elders in a rural community.

Factors Related to Vision Disturbances in the Elementary School-Age Children / 아동간호학회지

The vision disturbances of school-age children has been recognized as and important school health problem. The purpose of this study is to describe the current status of the visual health and to explore the related factors for the decrease in visual acuity in the elementary school age children. The study subjects were 697 children (Boys: 338, Girls: 359) of 4th to 6th grade in two school in urban area. The visual acuity data of the school health examination in 1999 and 2000 were utilized for analysis. The questionnaire for children and parents was used for survey. The findings were as follows. 1. The prevalance rate of the children with the visual acuity less than 0.7 on the left eye were 26.84% ( Grade 4), 31.30% (Grade 5), and 38.39% (Grade 6). The rate on the right eye were 28.31% (Grade4), 30.37% (Grade 5), and 37.92% (Grade 6). There was a significant difference in the rate of the visual acuity less than 0.7 according to grade (p < .01). 2.The rate of visual acuity decrease was 40.12%. 3. The factors related to the decrease in the visual acuity were grade, sex, genetic factor, posture, and the awareness of the visual acuity. There was more decrease in the visual acuity when the children were in higher grade (O.R= 1.06), girls (O.R=2.29). Children having parents with better vision (Father: O.R=1.26; Mother O.R= 1.25) showed better vision. On the other hand, when the children have siblings with glasses, there was more decrease in the visual acuity (O.R=2.31). Students with good posture during study (sitting on the chair) and watching TV to the lower direction showed less decrease in the visual acuity. Also, when the students know their visual acuity, the rate of decrease were lower. The variables which odds ratio were statistically significant were sex (p < .01), siblings with glasses (p < .01), and awareness of visual acuity (p < .01).

Sleep Disturbances of Community Elderly in Korea / 간호학회지

Sleep disturbance is a typical health problem of the elderly. The purpose of this study was to explore the extent of sleep disturbance of Korean elderly, and to identify the influencing and predicting factors. A total of 15216 subjects were interviewed. To measure the quality of sleep, "The Korean Sleep" Scale was used, and as influencing factors on sleep, physical health, emotional and social activity variables were included. In this study, the percentage of a change of sleep pattern was 59.2%, and it was higher in elderly women and in above 80 yrs. But only 10.4% of subjects regarded a change of sleep pattern as a problem, and it was higher in elderly women. Total sleeping time was shorter in female and it was shortest in 65-69yrs. The higher age, the presence of Ds, the longer sickdays, the lower level of ADL and IADL, the more depressive, the more tedious during the daytime, and the less frequent engagement in exercise, the lower quality of sleep measured by KSS. Predicting variables of quality of sleep included depression, boredness during the daytime, sex, the presence of Ds, IADL, the frequency of exercise during a week, and age. These seven variables explained 13% of total quality of sleep. The extent of change of sleep pattern in the elderly is very high. Continuous efforts to increase quality of sleep of the elderly by intervening in factors influencing quality of sleep are needed.

The Effect of Hand-Massage on the Relaxation of Dementia Patients / 간호학회지

The agitation of dementia patient is a factor which aggravates the care-givers' burdon, and it is needed to develop intervention methods. Hall and Buckwalter hypothesized that an increase in agitation behavior occur when persons experience high levels of stress. This study was conducted to explore the efficacy of hand massage in producing relaxation and decreasing agitation behaviors in persons with dementia. Hand massage was administered once a day in afternoon for 8days to 24 patients and 4days to 23 patients. There was no difference in result between the two groups. Significant differences were found in systolic blood pressure, pulse rate, emotional state from pre to post -intervention with the use of hand massage. The change of systolic blood pressure was 26% explained by ADL, MMSE-K and institutionalized period. The most significant variable was institutionalized period. The change of diastolic blood pressure was 11% explained by ADL, and it was significant. But no decrease in agitation behavior was observed and no increase in functional capacity.

The Experience of Nursing Staff on the Dementia Patients' Aggressive Behavior / 간호학회지

Providing care to the dementia elderly with behavioral problem is a major issue in nursing homes today. This study was aimed to explore the nursing staffs' response to aggressive dementia patients, and the effect that the aggressive behavior had on Nsgstaff. The interviews used a semi-structured questionnaire are were carried out from May to July, 1999. The subjects were 23 nursing personnel working in the nursing homes for dementia elderly. The result are as follows; 1. The types of aggressive behavior cited by the subjects was "physical", "linguistic", and "sexual". 2. The factors that caused the behavior were "symptoms of disease", "under- conditioning", "context of nursing care", "unsatisfied need", "relationship to other patients", "change of outer environment", and "invasion of one's own privacy". 3. The response of the subjects were "unhappiness", "stress", "anger", "exaggeration", "anxiety", and "fear". 4. The management strategies listed by nursing personnel used to alleviate aggressive behavior were "ignorance" "patience" "leaving the area" "soothing sounds" "verbal punishment" "restriction and isolation" and "various management skill appliance" "adaptation". 5. The effect that aggressive behavior and were "disturbance of relationship to elderly" "decline in the amount and quality of nursing care" "interruption of task performance" "job exhaustion" "desire to leave the job" "physical impact" "stress on the cognition of others" "anxiety about health and one own future" "interference to family life'. The findings of this study will be useful in understanding the difficulties of nursing personnel when confronting the aggressive behavior of dementia partients. It also is useful as basic data in preparing efficient intervention program for these difficulties.

The Experience of Nursing Staff on the Dementia Patients' Aggressive Behavior / 간호학회지

Providing care to the dementia elderly with behavioral problem is a major issue in nursing homes today. This study was aimed to explore the nursing staffs' response to aggressive dementia patients, and the effect that the aggressive behavior had on Nsgstaff. The interviews used a semi-structured questionnaire are were carried out from May to July, 1999. The subjects were 23 nursing personnel working in the nursing homes for dementia elderly. The result are as follows; 1. The types of aggressive behavior cited by the subjects was "physical", "linguistic", and "sexual". 2. The factors that caused the behavior were "symptoms of disease", "under- conditioning", "context of nursing care", "unsatisfied need", "relationship to other patients", "change of outer environment", and "invasion of one's own privacy". 3. The response of the subjects were "unhappiness", "stress", "anger", "exaggeration", "anxiety", and "fear". 4. The management strategies listed by nursing personnel used to alleviate aggressive behavior were "ignorance" "patience" "leaving the area" "soothing sounds" "verbal punishment" "restriction and isolation" and "various management skill appliance" "adaptation". 5. The effect that aggressive behavior and were "disturbance of relationship to elderly" "decline in the amount and quality of nursing care" "interruption of task performance" "job exhaustion" "desire to leave the job" "physical impact" "stress on the cognition of others" "anxiety about health and one own future" "interference to family life'. The findings of this study will be useful in understanding the difficulties of nursing personnel when confronting the aggressive behavior of dementia partients. It also is useful as basic data in preparing efficient intervention program for these difficulties.

Development and Validation of Korea Sleep Scale A / 간호학회지

The purpose of study was to develop and validate Korean Sleep Scale A which can be easily administrated by nurse for a wide range of adult subjects. Dimensions of adult concept were derived by literature review. Previously developed sleep scales were also analyzed in order to develop scales items. The Korean sleep scale A was structured as a 15 item, 4 point like type scale. The Scale was tested an 298 female and male adult subjects after pilottest and content validation. The results showed reliability by internal consistency of Cronbach's alpha=75 Construct validity was tested by factor analysis and known group technique. Factor analysis showed 4 factor-sleep pattern, sleep evaluation, sleep result, and cause of sleep disturbance. Theses four factors explained 55.9% of total variance. Correlations between factors ranged from .15-.32. There was correlation among Korean Sleep Scale A score, Verran and Snyder-Halpern(VSH) Sleep Scale scale, and sleep satisfaction scale score, r= .71(p=.00), r=.51(p=.03), respectively. These study results partially support reliability, construct validity, and criterion related validity of Korean Sleep Scale A. Further validation study is required with other subjects and other settings.

Comparative Study on the Health Behaviour and Related Factors of the Korean Elderly and non-elderly Adults / 성인간호학회지

The aim of this study is to help understanding of the health behaviour of elderly and to promote the development of nursing intervention enhancing health behaviour. This study trys to accomplish this goal by narrating and comparing health behaviours of several age groups and investigating related factors of health behaviour. Concrete Objects are as follows : first, to investigate whether elderly do active health behaviour, and what is the content of health behaviour. Second, to compare factors influencing health behaviour of each group. Subjects are 409 adult community residents. A group(20~39) are 123. B group(40~59) are 117. C group(60~) are 169. The results of this study are as belows. 1. The health state of elderly(C) is worse than other age groups. Health fear and health concern of C is less than A and B. But the rate of practicing health behaviour of C is higher than A and B. 2. The question of what is the most important health factor ; (1) [Regular life and diet] is considered the most important by all age groups(A-30.1%, B-27.4%, C-40.7%). Next is [exercise and rest]. And all age groups thnk that [happy mind] is among health factors. (2) [Frequent outgoing](5.7%), [hard working], [economic stability], [disease control] is also mentioned by elderly. 3. Ill-health behaviour : [smoking], [drinking], [stress], [irregular life and diet] are mentioned by all age groups. Elderly considers [confining at home](7.0%), [having nothing to do](5.6%), [motionless lying] as Ill-health behaviour. 4. The rate of practicing health behaviour : A is 73.2%, B is 74.4%, and C is 78.1%. Health behaviour is mainly made up of the items reflecting physical health concept. 5. The rate of peopl eating food or medicine in last 6 months to promote health : A is 30.3%, B is 45.4%, and C is 54.2%. 6. (1) The rate of health fear is highest at B(80.3%). (2) [Disease contract and worsening] is first item of health fear. A and B mention [can't live healthy], [declining of physical strength], [being fatty], [smoking], [stress], [loss of mobility]. C mention [loss of mobility], [deterioration of vision and hearing], [declining of cognitive function]. (3) The reasons of health fear are [maintenance of living], [cases of other people], [hardship of children] (A and B group), [confining of activity], [hardship of children] (C). 7. [Sex(p=.05)], [health concern(p=.04)] are significant variables in health behavior in all respondents. But they are different among each age groups. [Economic activity(p=.02)], [health concern(p=.05)] (B group), [education level(p=.05)], [having disease or not(p=.05)] (C group) are significant variables. In B group, [the more educated(p=.8)], [the healthier(p=.03)] and [having person to discuss with(p=.05)] were more concerned about health. This study shows the necessity of another detail study to compare health concept and behavior of different age groups, and the variables affecting health behavior. And it is suggested that the results of the study may be applied in planning health program, and in promoting participation of community residents in the program.