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This study analyzed the factors affecting the health-related quality of life of patients with benign prostatic hyperplasia (BPH) according to age. We also aimed to determine appropriate strategies to improve their quality of life. Data from the Korea Health Panel Survey (2009-2016) were used in this study. A total of 3806 patients with BPH were divided into 2 groups: younger adults (aged under 65 years) and older adults (aged over 65 years). In addition, a logistic regression analysis was conducted to identify factors affecting the quality of life of young and older patients with BPH. In younger adult patients with BPH, the higher the level of education, the higher the quality of life by a factor of 1.379, and the more intense the physical activity, the lower the quality of life by a factor of 0.791. Also, the longer the sitting time, the lower the quality of life by a factor of 0.765. In contrast, for older adult patients with BPH, the quality of life improved by factors of 1.601 and 2.921, respectively, for health insurance and higher income level. In addition, it was found that the quality of life decreased by a factor of 0.754 in patients who drink alcohol. In order to improve the quality of life of the middle-aged adult population with BPH, it is necessary to reduce sitting time through constant physical activity. Moreover, the cost of medical care should be reduced and the quality of life increased through reductions in surgical treatment, as the burden of medical expenses will degrade the quality of life for older adults.

To investigate the effects of public and private health insurance on self-rated health (SRH) status within the National Health Insurance (NHI) system based on socioeconomic status in South Korea. The data were obtained from 10 867 respondents of the Korea Health Panel (2008-2011). We used hierarchical panel logistic regression models to assess the SRH status. We also added the interaction terms of socioeconomic status and type of health insurance as moderators. Medical aid (MA) recipients were 2.10 times more likely to have a low SRH status than those who were covered only by the NHI, even though the healthcare utilization was higher. When the interaction terms were included, those not covered by the NHI and had completed elementary school or less were 16.59 times more likely to have a low SRH status than those covered by the NHI and had earned a college degree or higher. Expanding healthcare coverage to reduce the burden of non-payment and unmet use to improve the health status of MA beneficiaries should be considered. Particularly, the vulnerability of less-educated groups should be focused on.

South Korea recently expanded its coverage rate of long-term care insurance (LTCI) by adding a “dementia special grade” in 2014 to improve care service accessibility and extend health life for older adults with dementia. In this study, we propose a multifaceted policy to reduce the suicide risk among older adults with dementia by evaluating the effectiveness of using the long-term care services (LTCS). A sample of 62,282 older adults was selected from the “Older Adults Cohort DB” of the National Health Insurance Service. We conducted Kaplan–Meier and Cox regression to represent the yearly survival curve from 2002 to 2015 according to the individual characteristics. Difference-in-difference estimation was conducted to identify the effect of LTCS on suicide rates by using LTCS before and after 2014. The suicide risk of older adults using LTCS was about 0.256-times lower than those who did not use it (OR = 0.296, 95% CI = 0.183–0.478), whereas it increased after the expansion of the dementia grading (OR = 2.131, 95% CI = 1.061–4.280). To prevent the risk of suicide among older adults with dementia, not only did the mortality rate vary depending on the sex, activities of daily living (ADL), and type of caregiver at the individual level but appropriate national intervention and management, such as improving the accessibility of LTCS, are also needed.

This study aimed to construct and test structural equation modeling of the causal relationship between quality of healthcare, patient satisfaction, and intent to revisit perceived by patients using regional hub public hospitals. In this study, data of 2,951 outpatients and 3,135 inpatients were collected using the “2018 Regional Hub Public Hospital Operational Evaluation.” A structural equation model was used to understand the relationship between patient satisfaction and intent to revisit, and bootstrap analysis was performed. In the direct effect, outpatients were presented in the order of the physician’s practice service, the hospital’s environment, and patient satisfaction. Inpatients were in the order of the physician’s practice service and, medical staff’s kindness and consideration,; patient satisfaction was shown in this order. In the indirect effect, the outpatients were presented in the order of physician’s practice service, medical staff’s kindness and consideration, and hospital’s physical environment. Inpatients were introduced in the order of medical staff’s kindness and consideration, nurse’s practice service, physician’s practice service, and patient satisfaction. Regional hub public hospitals need high-quality medical services and efforts from all departments to treat patients with sincerity to improve patient satisfaction and increase intent to revisit.

Background: South Korea has the highest older adults’ suicide rate in the world. This study proposed a multifaceted policy to reduce the suicide risk among older adults with dementia by evaluating the effectiveness of the expanded long-term care insurance coverage.Methods: About 62,282 older adults with dementia were selected as study samples from the National Health Insurance Service’s “Older Adults Cohort DB (2002 to 2015).” This study confirmed how the demographic characteristics, health status, and the long-term care services (LTCS) of older adults with dementia affect their suicide. Data analysis was conducted with the Kaplan-Meier, Cox-regression to represent the yearly survival curve from 2002 to 2015, and the suicide rate was identified by demographic characteristics, health status, and policy. Also, difference-in-differences (DID) estimation was conducted to analyze the effect of LTCS on suicide rates by comparing statuses before and after 2014.Results: The results revealed statistically significant differences in sex, activities of daily living, cognitive ability, caregivers, and use of LTCS (Log-rank test pp Conclusions: This study not only identified differences in suicide rates depending on the sex, ADL, and type of caregiver at the individual level, but also confirmed that national policies and long-term care services could protect their lives. It highlights the importance of national level management to prevent suicide among older adults with dementia and offers effective policy suggestions.

Background: The purpose of this study was to construct and test structural equation modeling of the causal relationship between quality of healthcare, patient satisfaction, and intent to revisit perceived by patients using regional hub public hospitals.Methods: In this study, data of 2,951 outpatients and 3,135 inpatients were collected using the “2018 Regional Hub Public Hospital Operational Evaluation.” A structural equation model was used to understand the relationship between patient satisfaction and intent to revisit, and bootstrap analysis was performed.Results: In the direct effect, outpatients were presented in the order of doctor's communication, hospital environment, and patient satisfaction. Inpatients are doctor’s communication, staff consideration, and patient satisfaction are shown in this order. In the indirect effect, the outpatients were presented in the order of doctor's communication, staff consideration, and the hospital's environment. Inpatients were presented in the order of staff consideration, nurse’s communication, doctor’s communication, and patient satisfaction.Conclusions: Regional hub public hospitals need high-quality medical services and efforts from all departments to treat patients with sincerity to improve patient satisfaction and increase intent to revisit.

This study aimed to analyze the factors affecting the unmet medical needs of patients with benign prostate enlargement (BPE) based on Andersen&rsquo, s behavioral model. The data were taken from the 2009&ndash, 2016 Korea Health Panel Study and 3003 participants were used for analysis. &ldquo, Unmet medical needs&rdquo, was used as a dependent variable. Independent variables were predisposing variables: age, educational attainment, and marital status, enabling factors: income, job type, and insurance type, and need factors: lying in a sickbed, activity limitation, subjective health status, and having chronic diseases. Results showed that younger patients experienced a higher probability of unmet medical needs. Those with higher educational attainment had a lower chance of experiencing unmet medical needs. Patients with national health insurance were less likely to experience unmet medical needs. In addition, patients who experienced lying in a sickbed had a higher probability of experiencing unmet medical needs. Therefore, in order to reduce the unmet medical needs of patients with BPE, it is necessary to allow patients to be treated early and give them accurate information about the disease. In addition, access to medical care should be strengthened through continuous care focused on primary care.

Objectives The environment of long-term care hospitals (LTCHs) is critical to the management of the quality of their services and to patient safety, as highlighted by international studies. However, there is a lack of evidence on this topic in South Korea. This study aimed to examine the factors affecting healthcare quality in LTCHs and to explore the effectiveness of their quality management. Methods This study used a mixed methods approach with quantitative data collected in a national survey and qualitative data from semi-structured interviews with practice-based managers. The samples included 725 nationally representative LTCHs in South Korea for the quantitative analysis and 15 administrators for the in-depth interviews. Results A higher installation rate of patient-safety and hygiene-related facilities and staff with longer-tenures, especially nurses, were more likely to have better healthcare quality and education for both employees and patients. Conclusion The need for patient-safety- and hygiene-related facilities in LTCHs that serve older adults reflects their vulnerability to certain adverse events (e.g., infections). Consistent and skillful nursing care to improve the quality of LTCHs can be achieved by developing relevant educational programs for staff and patients, thereby strengthening the relationships between them.

Although people in the social media age can access health information easier, they have difficulty judging conflicting rational information or summarizing the large amounts of health information available. Conflicting health information occurs when contrary assertions or information about a certain health issue comes from different information sources. This study examined the background knowledge and the current phenomenon of why conflicting health information occurs in real-world conditions. We also reviewed causes and solutions by reviewing the literature. In particular, we recommend a method that solves problems that patients have including cancer survivors who cannot themselves be active in seeking health information. Thus, we categorized the specific types of conflicting health information and analyzed the sociodemographic factors and information carrier factors that have an impact on the health information-seeking behavior of individuals.

Recent changes in the medical paradigm highlight the importance of patient-centered communication. However, because of the lack of awareness of dental clinics and competency of medical personnel, the quality of medical services in terms of the communication between doctors and patients has not improved. This study analyzed the impact of health communication and medical service quality, service value, and patient satisfaction on the intention to revisit dental clinics. The study participants were outpatients treated at 10 dental clinics in Seoul. The research data were collected using a questionnaire during visits to these dental clinics from December 1 to December 30, 2016. A total of 600 questionnaires were distributed (60 copies to each clinics) and 570 valid questionnaires were used for the analysis. The influence of the factors was determined using structural equation modeling. The factors influencing service value were reliability (β = 0.364, p < 0.001), expertise (β = 0.319, p < 0.001), communication by doctors (β = 0.224, p < 0.001), and tangibility (β = 0.136, p < 0.05). In addition, the factors influencing patient satisfaction were reliability (β = 0.258, p < 0.001), tangibility (β = 0.192, p < 0.001), communication by doctors (β = 0.163, p < 0.001), and expertise (β = 0.122, p < 0.01). Further, service value (β = 0.438, p < 0.001) raised patient satisfaction, which was found to influence the intention to revisit dental clinics (β = 0.383, p < 0.001). Providing accurate medical services to inpatients based on smooth communication between doctors and patients improves patient satisfaction. In addition, doctors can build long-term relations with patients by increasing patients’ intention to revisit through patient-oriented communication.

The long-term care insurance (LTCI) has been implemented to help the government take responsibility for social prevention and protection measures to maintain and improve older adults' health and well-being since 2008. This study aimed to evaluate the effects of LTCI on mortality of elders in South Korea. The data used from the national representative Elderly Cohort Database for 2009 to 2013. We analyzed longitudinal panel data from 61,235 persons aged 65 years and older. We generated Kaplan-Meier survival curves and Cox proportional hazard models by use and type of long-term care services (LTCSs) (e.g., non-user, facility, and in-home benefits) and income level. The covariate-adjusted approximate mortality rates by LTCSs type for facility and in-home benefits group compared to non-LTCS users were 0.761 and 0.803, respectively. The approximate mortality rates were higher in the middle low- (Hazard Ratio [HR] = 1.131, p .001), low- (HR = 1.125, p .001), and middle- (HR = 1.122, p .001) than the high income group. In particular, the disparities in mortality by income gap in in-home care users of LTCS was greater than that of facility care users in Korea. Consequently, these findings point to the need for program improvements to the quality and quantity of the in-home LTCSs for elderly Koreans. Ensuring a "continuum of care" through education for service providers and stronger relationships with the recipients' families could improve overall quality. There is a particular need to devote more attention to the needs of low-income elderly who currently lack sufficient the health coverage.

In South Korea, the number of workers suffering from mental illnesses, such as depression, has rapidly increased. There is growing concern about depressive symptoms being associated with both working conditions and psychosocial environmental factors.To investigate potential psychosocial environmental moderators in the relationship between working conditions and occupational depressive symptoms among wage workers.Data were obtained from the wage worker respondents (n = 4,095) of the Korean National Health and Nutrition Examination Survey of 2009. First, chi-square tests confirmed the differences in working conditions and psychosocial characteristics between depressive and non-depressive groups. Second, multivariate logistic regression analysis was performed to examine the moderating effects of the psychosocial environmental factors between working conditions and depressive symptoms.After adjusting for potential covariates, the likelihood of depressive symptomatology was high among respondents who had dangerous jobs and flexible work hours compared to those who had standard jobs and fixed daytime work hours (OR = 1.66 and 1.59, respectively). Regarding psychosocial factors, respondents with high job demands, low job control, and low social support were more likely to have depressive symptoms (OR = 1.26, 1.58 and 1.61, respectively).There is a need to develop non-occupational intervention programs, which provide workers with training about workplace depression and improve social support, and the programs should provide time for employees to have active communication. Additionally, companies should provide employees with support to access mental healthcare thereby decreasing the occurrence of workplace depression.

Dissemination of spa services across the globe and its market saturation drive demand for differentiated communication methods. This study aims to explore the influential factors on spa goers' repeated visits and their practical applications in the health and wellness spa industry. The identified factors were used as the measurement variables to examine the relation with spa goers' repeated visits. The proposed concept was tested by a mixed method combining a self-administered questionnaire and semistructured interview with 54 survey participants and 6 interviewees. It was meaningful to use a sample of the UK spa goers from the southwest region since global spa trends stem from the EU spas, and the United Kingdom is one of the market leaders. The data were analyzed using frequency, percentage, multiple logistic regression analysis, and coding process. The survey findings demonstrated that the most significant influential factor on the repeated spa visits is a memorable experience of which showed 13.7 times higher probability than the reference up-to-date facility. The details of memorable experiences were discovered throughout the interviews that include the rediscovery of self, feeling of connectedness, recharge for positive emotions, self-reward through escapism, and experience of noncommercialized local products and attractions. Therefore, using experiential marketing methods can be effective spa service marketing.

We examined relationships between sitting time and obesity or abdominal obesity according to sex and socioeconomic status in elderly people. We analyzed data from the Korean National Health and Nutrition Examination Survey 2013, and 1565 participants were included in the study. Multivariate logistic regression analysis was used to examine relationships between sitting time and obesity or abdominal obesity according to sex and socioeconomic status. Sitting time was positively correlated with body mass index in men and women and waist circumference in men. When considering socioeconomic factors, men who sat for 5 hours or longer and fell within the lowest income were more likely to have obesity and abdominal obesity relative to men who sat for 5 hours or shorter and earned higher incomes (odds ratio [95% confidence interval] = 1.80 [1.14-2.84] and 1.63 [1.02-2.61] respectively), and women who sat for 5 hours or longer and fell within the lowest educational level were more likely to have obesity relative to women who sat for 5 hours or less and were educated to a higher level (1.24 [1.01-1.85]). Strategies to reduce sedentary behavior would help to prevent obesity in older men who earn low incomes and women with lower levels of educational attainment.

Along with rapid population aging, the importance of chronic disease management increases with high growth of national healthcare expenditures, and efficient spending on healthcare is required to reduce unnecessary utilizations. For that reason, this study examined the association of annual healthcare expenditure with age and disease duration of chronic patients. Furthermore, the study investigated the effect of usual source of care (USOC) to suggest directions for preventive management of chronic disease. Using Korean Health Panel Study data, this study selected 1481 outpatients, who had out-of-pocket costs for hypertension or diabetes, and their total healthcare and chronic disease management (CDM) costs were examined. With patient aging, CDM cost decreased while the total healthcare cost increased, but longer duration of hypertension or diabetes resulted in increases in both CDM and total healthcare costs. In addition, the moderating effect of USOC indicated that elderly patients had increased CDM costs when they had a regular site for healthcare. In contrast, patients with longer duration had reductions in both CDM and total healthcare costs while having a regular doctor increased CDM cost. The results of this study could be an evidence for future policies to suggest proper preventive management plans for specific subjects.

Objectives This study analyzes the influence of the financial structure of pharmaceutical companies on R&D investment to create a next-generation profit source or develop relatively cost-effective drugs to maximize enterprise value. Methods The period of the empirical analysis is from 2000 to 2012. Financial statements and comments in general and internal transactions were extracted from TS-2000 of the Korea Listed Company Association (KLCA), and data related to stock price is extracted from KISVALUE-Ⅲ of NICE Information Service Co., Ltd. Stata 12.0 was used as the statistical package for panel analysis. Results The current ratio had a positive influence on R&D investment, the debt ratio had a negative influence on R&D investment, and return on investment and net sales growth rate did not have a significant influence on R&D investment. Conclusion It was found in this study that the higher liquidity ratio, the greater the R&D investment. The stability of pharmaceutical companies has a negative influence on R&D investment. This finding is consistent with the prediction that if a company faces a financial risk, it will be passive in R&D investment due to its financial difficulties.

Objectives : The aim of this study was to analyze the influence of foreign and institutional investors in the pharmaceutical industry on R&D investments. Methods : The empirical analysis was done for the years 2009 to 2013 which examined the period after the influence of the financial crisis. Financial statements and comments in general and internal transactions were extracted from the TS-2000 of the Korea Listed Company Association. STATA 12.0 was used as the statistical package for the panel analysis. Results : The results show that the shareholding ratio of foreigner investors turned out to have a statistically significant influence on R&D investment. No statistical significance was found in the shareholding ratio of institutional investors. Conclusions : The findings of this study, which indicate that a higher shareholding ratio of foreigner investors leads to greater R&D investment, indicate that foreign investors directly or indirectly impose pressure on a manager to make R&D investments for the long-term.

The purpose of this study is to analyze the influence of the cash flow of pharmaceutical companies on R&D investment. 143 pharmaceutical companies listed in the KOSDAQ market from 2009 to 2013. Financial statements and comments in general and internal transactions were extracted from TS-2000 of the Korea Listed Company Association (KLCA), and data related to stock price was extracted from KISVALUE-III of NICE Information Service Co., Ltd. STATA 12.0 was used as the statistical package for panel analysis. The summary of the findings and the interpretation of the significance of this are as follows: First, the current ratio (internal finance) had a positive influence on R&D investment. Second, the debt ratio (external finance) had a negative influence on R&D investment. The pharmaceutical company prefers internal funds to external funds due to the asymmetry of information in the loan markets. In other words, this shows why internal finances have a significant influence on R&D investment at pharmaceutical companies.

Health service quality is increasingly emphasized, and primary care service is no exception in this. This study identified patients' perception of quality considering convergence factors associated with increased utilization among patients over the age of 65 using community health centers. A total of 307 respondents were included in the analysis. The results showed that positive perceptions on facility and environment, patient-centered care, technical knowledge and skills of physicians, and emotional support with nurses and non-medical workers were statistically and significantly associated with higher utilization. In order to increase utilization of primary care service at community health centers, they need to manage and improve these factors. Key Words : Health service quality, Elderly, Community health center, Convergence factors * 이 연구는 2014년도 고려대학교 보건과학연구소 특별연구비를 지원받아 수행되었음.Received 9 June 2015, Revised 22 July 2015Accepted 20 August 2015Corresponding Author: Mankyu Choi(Korea University) Email: mkchoi@korea.ac.krⒸ The Society of Digital Policy & Management. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is ISSN: 1738-1916 properly cited.

본 연구는 우리나라 코스닥 제약기업을 대상으로 소유구조가 제약기업의 연구개발투자(R&D)에 미치는 영향을 분석하였다. 실증분석을 위한 표본은 2000년부터 2012년까지 상장된 기업들 중 코스닥 제약기업을 대상으로 하였으며사용된 전체 표본은 13개년 자료로써 358개 관측치를 가진 불균형패널자료이다. 본 연구에 사용된 주요 변수들 중 개별기업 별 재무자료는 상장회사 협의회의 TS-2000을, 임원현황 및 주주분포 등은 금융감독원 전자공시 시스템의 각 기업 사업보고서 자료를 통해 자료를 직접 수집하였으며 기업나이, 기업크기 등은 NICE신용평가정보의 KISVALUE-Ⅲ 등의 자료를 참고하였다. 연구결과, 첫째 주요주주율과 외국인투자율은 연구개발투자에 긍정적인 영향을 미쳤다. 둘째, 사외이사율은 연구개발투자에 부정적인 영향을 미쳤다. 셋째, 기관투자율은 통계적으로 유의한 결과를 미치지 못했다.

The study aimed to figure factors affecting employment needs of people with mental disabilities as the employment needs may differ according to income and occupational ability among people with mental disabilities who are classified economically inactive population. Study subjects included 298 economically inactive populations among registered people with mental disability. And the data from 2008-2010 Panel Data of Employment of Person with Disability were analyzed with logistic regression analysis. The result of the study is as follows. It has been found that interested in vocational education of mentally disabled when the graduated from junior high school, the types of intellectual disability, hope education participation rate was high. And then, Mental disabilities with employment needs, male, head of household, when the graduated from junior high school, when ability to increase physical activity and mental disabilities type of autism spectrum disorder when employment desires were. Based on these results, to increase the economic participation of people with mental disabilities, provide vocational rehabilitation services that reflect the needs of people with mental disabilities and employer-driven professional activity is proposed.

In this study, the relationship between social support and adolescent mental health was examined. A primary aim was to investigate how family, school, and friends affect adolescent mental health including depression, stress, and anger issues. This study also intended to investigate the indirect effect of these factors through the mediator, problem drinking. The study used survey data collected from the "2010 The Study on Mental Health of Korean Adolescents" conducted by National Youth Policy Institute, and 942 subjects were selected for this study. The study hypotheses were tested using SEM (Structural Equation Modeling) analysis. Analyses revealed that the appropriate functions and roles of the family members had the effect of promoting mental health of adolescents. Inappropriate functions and roles of the family members induced problem drinking, and this eventually had a negative impact on mental health causing depression, stress, and angel problems. Results also showed that having more friends who drink alcohol or smoke cigarette had no direct effect on the mental health of adolescents; however, there was an indirect effect through the mediator variable, problem drinking. The finding of this study revealed the need and importance of appropriate social support system and environment in order to promote mental health of adolescents.

This study investigated the individual and social determinants of the public’s phobia of infectious diseases in South Korea, where collective action was recently fueled by the public phobia over mad cow disease (bovine spongiform encephalopathy [BSE]). Gender-specific multivariate regression was used to compare the public perception of BSE and highly pathogenic avian influenza (HPAI). The analysis results differentiated between the determinants of the phobia for the 2 diseases, BSE and HPAI (N = 1002). As with HIV/AIDS and leprosy, the public fear of HPAI was expressed as a disease phobia that seeks to ensure the social exclusion of infection sources, whereas the fear of BSE was influenced by social and communication factors. Therefore, BSE, unlike previous HPAI, can be rapidly amplified amid the growing distrust in health communication, in which case the social determinants of disease phobia are associated with communicator trust, social values, and political attitude toward diseases rather than disease perception.

This study recognizes the seriousness of mental health damage in the aged these days including stress, depression, suicidal ideation and intends to verify structural relationship between mental health and those expected to affect it such as health behavior, quality of life, and subjective consciousness of health. According to the results of this study, first, as the aged`s quality of life is higher, it has more effect to reduce stress, depression, or suicidal ideation. Also, quality of life enhances subjective consciousness of health and improves mental health. Second, although health behavior measured by smoking, problematic drinking, obesity, or moderate exercise and sleep did not show direct effect on mental health, it has indirect effect on it with subjective consciousness of health as mediation. Based on the result of this study, in order to improve the aged`s mental health, it is needed to consider the enhancement of their life quality in advance and make systematic efforts to change their health behavior.

In order to effectively attain the objectives of an organization, it is important for the leader to provide an environment where members can co-exist and mutually advance, and also to have an emotional impact on them. This study examines the structural relationship among emotional intelligence in leadership, organizational commitment, job satisfaction, turnover intention, and organizational performance effects of emotional leadership in the nursing profession of a general hospital. A structured questionnaire was sent to 550 nurses in 11 general hospitals in Seoul Metropolitan City, among which 350 responses were used in the analysis. The independent variable, emotional intelligence in leadership, was measured by 18 items, including self-awareness, self-regulation, social awareness and relationship management. The dependent variable, organizational effectiveness, consisted of 46 items, including 15 items regarding organizational commitment, 20 items on job satisfaction, 3 items on turnover intention and 8 items on organizational performance. The structural equation modeling technique was used to identify the impact of emotional intelligence in leadership on organizational effectiveness. The results of the analysis show that the emotional intelligence in leadership of superior nurses has a significant impact on the nurses`organizational commitment and job satisfaction. While the direct effect on turnover intention and organizational performance was not significantly high, organizational commitment and job satisfaction were parameters in low turnover intention and high job performance. In conclusion, emotional intelligence in leadership is critical as nursing services in hospitals are based on interpersonal relationships. Therefore, by developing appropriate programs and training, hospitals can anticipate improved self-awareness, self-regulation, social awareness and relationship management of nurses, and further improve the effectiveness of the nursing profession.

This study examines the effects of private health insurance (PHI) on the incidence of catastrophic health expenditures (CHE) for households with a patient with cancer. This study uses 1-year data from 2013 and households with cancer patients as the unit of research rather than individual household members. The sample thus includes 468 households with members with cancer who also used emergency, outpatient and hospitalisation services. Households with PHI had a lower incidence of CHE for all thresholds than those without did. At the 10% threshold, the incidence became significantly lower, by 0.59 and 0.60 times, respectively, if householders had higher education and income levels. Moreover, the incidence of CHE was higher by 8.71 times if the householders are female, and lower by 0.84 times if the householders did not have a spouse at the 20% threshold. From the analysis of households with cancer patients that hold PHI as the key variable, these households showed a lower incidence of CHE than the others did. PHI provides healthcare payments not secured through national health insurance (NHI) and protects households from health expenditures, thereby complementing NHI to a certain degree.

Hospitals engage in medical referral system relations voluntarily, by virtue of their own service capacities. These capacities include medical technology, equipment supply, and patient management, which are assessed individually by medical institutions in efforts to control costs and maintain efficiency in tertiary hospitals. This study assessed referral networks according to the institutional isomorphism theory of new economic sociology. As a result, the referral networks were shown to exhibit emergent structural hierarchy via cumulative clustering by established year and were not affected by attributive variables such as region, bed number, and year of establishment. In particular, the networks evidenced institutional isomorphism with certain central hospitals. As a consequence, personal indices were shown to decrease in accordance with its period, and only the structural index increased. Normative pressures cause organizations to become hierarchically homogenized, in accordance with the principle of organizational learning in specialized fields. Therefore, normative isomorphism on the basis of public domains should be considered an inherent factor in the development of referral networks.

This study assessed the risky sexual behavior of a group of adult men and women with sexual experience within the past 1 year who, while in a relationship with a stable partner, reported having sex with another person. The data were collected in 2003 using a nationally representative, multi-stage stratified probability sample (n = 1,271) of women and men in South Korea. Via hierarchical regression models, we assessed the gendered effects of socioeconomic characteristics, health behavior, sex behavior, and safe sex attitude factors. According to the results, for groups with concurrent sexual partnership experience, if the subject was a single person with smoking and drinking who had engaged in sex resulting in unwanted pregnancy, and anal sex initiated before the age of 17, the likelihood of engaging in concurrent sexual partnerships was statistically significant. Furthermore, our gender-elaborated analysis demonstrated that the majority of sexual risk was borne by women. When the partners of concurrent sexual partnerships are categorized by type, the key characteristic of a casual relationship or relationship with female sex workers is one-night-stand sex, accompanied by drinking. This study found that, for groups with concurrent sexual partnerships experience, there is a statistical association between health risky variables and risky sexual behavior. We should attempt to intervene in these concurrent sexual partnerships groups for the effective management of sexually transmitted infections.

As the Korean Government began to perceive healthcare as one of foundational industries for national dynamics, there has been mounting advocacy for the introduction of for-profit hospitals with a view to bringing efficiency in healthcare services industries and improvement of their international competitiveness. The Government is now considering the issue from all angles in favor of permitting for-profit hospitals. However, There have been few precedent studies on this subject to provide helpful data for the discussion and in the health policy making. This study used private hospitals - for-profit and nonprofit - in Florida, USA as study subjects to accumulate basic data that may be utilized for those involved in debates and health policy making relating to the introduction of for-profit hospitals in Korea. Among all the private general hospitals in Florida, those surveyed by AHA(American Hospital Association) for four consecutive years from 2001 and 2004 and others reported about to MCR(Medicare Cost Report) included in the collected data for analysis. In total 139 private general hospitals consisting of 73 for-profit hospitals and 66 nonprofit hospitals were included in the collected analysis data. Results of analysis revealed no significant difference between for-profit hospitals and nonprofit hospitals in the usage aspects of healthcare services including the average length of stay and the ratio of Medicare vs Medicaid patients. However, financial performances indicated by such factors. as the pre-tax return on assets and the pre-tax operating margin showed to be significantly higher in for-profit hospitals compared with nonprofit hospitals. And the ratio of personnel expenses and the turn period of total assets showed to be significantly lower in for-profit hospitals. Based on the hypothesis that arguments about the introduction of for-profit hospitals have considerably different viewpoints depending on the size of hospital represented by the number of bed, these two hospital types were compared again using the number of beds as a controlled factor, but the results were similar. We, therefore, could conclude that the for-profit hospitals in Florida included in this study could, in their for-profit operation, improve their financial performance by pursuing cost reduction and effectively utilizing their assets without limiting the amount and the range of their services or avoiding less medically protected groups such as Medicare and Medicaid patients.

In this study, the determinants of hospital profitability were evaluated using a sample of 142 hospitals that had undergone hospital standardization inspections by the South Korea Hospital Association over the 4-year period from 1998 to 2001. The measures of profitability used as dependent variables in this study were pretax return on assets, after-tax return on assets, basic earning power, pretax operating margin, and after-tax operating margin. Among those determinants, it was found that ownership type, teaching status, inventory turnover, and the average charge per adjusted inpatient day positively and statistically significantly affected all 5 of these profitability measures. However, the labor expenses per adjusted inpatient day and administrative expenses per adjusted inpatient day negatively and statistically significantly affected all 5 profitability measures. The debt ratio negatively and statistically significantly affected all 5 profitability measures, with the exception of basic earning power. None of the market factors assessed were shown to significantly affect profitability. In conclusion, the results of this study suggest that the profitability of hospitals can be improved despite deteriorating external environmental conditions by facilitating the formation of sound financial structures with optimal capital supplies, optimizing the management of total assets with special emphasis placed on inventory management, and introducing efficient control of fixed costs including labor and administrative expenses.

Financial ratios are key indicators of an organization`s financial and business conditions. Among various financial indicators, profitability, financial structure, financial activity and liquidity ratios are frequently used and analyzed. Using the structural equation modeling(SEM) technique, this study examines the structural causal relationships among key financial indicators. Data for this study are taken from complete financial statements from 142 hospitals that passed the standardization audit undertaken by the Korean Hospital Association from 1998 to 2001 for the purpose of accrediting teaching hospitals. In order to improve comparability, ratio values are standardized using the Blom`s normal distribution. The final model of the SEM has four latent constructs: financial activity(total asset turnover, fixed asset turnover), liquidity(current ratio, quick ratio, collection period), financial structure(total debt to equity, long-term debt to equity, fixed assets to fund balance), and profitability(return on assets, normal profit to total assets, operating margin to gross revenue, normal profit to gross revenue). While examining several model fit indices(Chi-square (df)

This study was attempted to identify the liquidity trends and determinants of private hospitals in Korea different. Data used in this study were collected from 98 hospitals with complete general data of present conditions as well as financial statements(balance sheets, income statements). They were chosen from hospitals that passed the standardization audit undertaken by the Korean Hospital Association from 1996 to 2000 for the purpose of accrediting training hospitals. The dependent variables in this study were used current ration and quick ratio as a proxy indicator for liquidity. The independent variables were ownership type, hospital type, location, bed size, period of establishment, short-term liabilities to total assets, long-term liabilities to total assets, borrowings to total assets, fixed asset ration, net profit to total assets, operating margin to gross revenue, growth rate of net worth to total assets, total asset turnover, and business risk(volatility of profit). The major findings of this study were as follows. Trends of liquidity(current ratio, quick ratio) had been continuously decreased. Especially, There were very distinct decreasing trends of personal hospitals and less than 300beds, which weakened liquidity. The factors had significant effect on current ratio were short-term debt to total assets(-), fixed asset ratio(-), business risk(+). High short-term debt to total assets, high fixed asset ratio and high business risk significantly decreased in liquidity. The factors that significantly affected on quick ratio were short-term debt to total assets(-), borrowings to total assets(+), fixed asset ratio(-), business risk(+).

Purpose: Objectives of this study were to investigate the association between efficiency and quality of health care in Long-term Care Hospitals (LTCH) and determine related factors that would enable achievement of both high efficiency and high quality at the same time. Methods: Major data sources were the “2012 Korean Assessment of Propriety by Long-term Care Hospitals” obtained from the Health Insurance Review & Assessment Service. Cost variables were supplemented by a National Tax Service accounting document. First, data envelopment analysis was performed by generating efficiency scores for each LTCH. Second, matrix analysis was conducted to ascertain association between efficiency and quality. Lastly, kruskal-wallis and mann-whitney tests were conducted to identify related factors. Results: First, efficiency and quality of care are not in a relationship of trade-offs; thus, LTCH can be confident that high efficiency-high quality can be achieved. Second, LTCH with a large number of beds, longer tenure of medical personnel, and adequate levels of investment were more likely to have improved quality as well as efficiency. Conclusion: It is essential to enforce legal standards appropriate to the facilities, reduce turnover of nursing staff, and invest properly in human resources. These consequences will help LTCH to maintain the balance of high efficiency-high quality in the long-run.

There has been little conceptual understanding as to how community capacity works, although it allows for an important, population-based health promotional strategy. In this study, the mechanism of community capacity was studied through literature reviews to suggest a comprehensive conceptual model. The research results found that the key to community capacity prevailed in how actively the capacities of individuals and their communities are able to interact with one another. Under active interactions, community-based organizations, which are a type of voluntary association, were created within the community, and cohesion among residents was enhanced. In addition, people were more willing to address community issues. During the process, many services were initiated to meet the people's health needs and strengthen their social and psychological ties. The characteristics of community capacity were named as the contextual multilevel effects. Because an increase in community capacity contributes to a boosted health status, encourages health behaviors, and eventually leads to the overall prosperity of the community, more public health-related attention is required.

Objectives : This study was to determine how the perception and the satisfaction of outpatients who utilized clinics and hospitals are structurally related with their willingness to utilize the same institution in the future. Methods : Three hundred and ten responses (via convenient sampling) were collected from 5 hospitals and 20 clinics located in Seoul listed in the Korea National Hospital Directory 2005 . Service quality was utilized as the satisfaction measurement tool. For analysis, we used a structural equation modeling method. Results : The determining factors for general satisfaction with medical services are as follows: medical staff, reasonability of payment, comfort and accessibility. Such results may involve increased competition in the medical market and increased demands for quality medical services, which drive the patients to visit hospitals on their own on the basis of changed determining factors for satisfaction. Conclusions : The structural equation model showed that the satisfaction of outpatients with the quality of medical services is influenced by a few sub-dimensional satisfaction factors. Among these sub-dimensional satisfaction factors, the satisfaction with medical staff and payment were determined to exert a significant effect on overall satisfaction with the quality of medical services. The structural relationship in which overall satisfaction perceived by patients significantly influences their willingness to use the same institution in the future was also verified.

Objectives : There are very few researches on North Korea's academic activities. Furthermore, it is doubtful that the available data are reliable. This study investigated research activities and knowledge structure in the field of Preventive Medicine in North Korea with a network analysis using co-authors and keywords. Methods : The data was composed of the North Korean Journal of preventive medicine ranged from Vol. 1 of 1997 to Vol. 4 of 2006. It was the matrix of 1,172 articles by 1,567 co-authors. We applied R procedure for keywords abstraction, and then sought for the outcome of network forms by spring-KK and shrinking network. Results : To comprehend the whole networks explicitly demonstrated that the academic activities in North Korea s preventive medicine were predisposed to centralization as similar as South Korea's, but on the other aspect they were prone to one-off intermittent segmentation. The principal co-author networks were formulated around some outstanding medical universities seemingly in addition to possible intervention by major researchers. The knowledge structure of network was based on experimentation judging from keywords such as drug, immunity, virus detection, infection, bacteria, anti-inflammation, etc. Conclusions : Though North Korea is a socialist regime, there were network of academic activities, which were deemed the existence of inducive mechanism affordable for free research. Article keywords has laid greater emphasis on experiment-based bacterial defection, sustainable immune system and prevention of infection. The kind of trend was a consistent characteristic in preventive medicine of North Korea haying close correlation with Koryo medical science.