Changes in health care utilization patterns in a rural area by the introduction of health care delivery system and health insurance

의학과/석사[한글] 醫療傳達體系 및 醫療保險 導入이 農村住民의 醫療利用度 및 醫療理容樣相에 미치는 影響을 알아 내고저 實驗的 模型을 設定하여 硏究하였다. 硏究地域으로는 京畿道 江華郡 4個面을 選擇하였다. 4個面中 1個面에는 醫療傳達體系만을 導入하고 1個面에는 醫療傳達體系 導入과 同時에 醫療保險 加入을 誘導하였으며 對照群 2個面에는 새로운 醫療傳達體系나 醫療保險을 導入하지 않았다. 資料蒐集은 實驗事業 導入前後 2次에 걸쳐서 實施하였다. 事前調査는 實驗事業 導入前인 1975年 11月에 3,037名으로부터 事後調査는 導入後 2年이 경과한 1977年 11月에 3,733名으로부터 施行하였다. 1, 2次 調査 모두 같은 方法으로 面接調査하여 醫療必要度 및 醫療理容에 관한 事項을 蒐集하였다. 醫療傳達體系 導入群, 醫療保險 加入群 및 對照群間에 實驗事業 導入前後 醫療利用率 및 醫療利用樣相을 比較 考察하여 다음과 같은 結果를 얻었다. 1. 事前調査에서는 皮調査者의 13.4%가 2週동안 急性疾患을 앓았으며 慢性疾患 有病率이 24.2% 인데 비해 事後調査에서는 2週동안 急性疾患 發生率 12.2%, 慢性疾患 有病率 21.4%로 事前調査에서보다 감소된 경향을 보여주었다. 2. 住民의 醫師訪問回數로 測定된 醫療利用率은 醫療傳達體系 導入群에서 導入前 年間 1人當 0.6回로부터 導入後 1.1回로 增加되었으나 對照群에서 역시 같은 시기에 0.5回로부터 1.3回로 增加되어 비슷한 추세를 보였다. 事後調査에서 醫療保險 加入群의 醫療利用率은 年間 1人當 1.6回로서 같은 시기에 調査된 對照群, 醫療傳達體系 導入群의 醫療利用率보다 높았다. 3. 月間 家口收入에 따른 醫療利用率을 事後調査에서 보면 對照群의 境遇 高所得群이 低所得群보다 높은 醫療利用率을 보인데 반해 醫療傳達體系 導入群이나 醫療保險 加入群에서는 月間 家口收入에 관계없이 平準化된 醫療利用率을 보였다. 4. 家口主 敎育程度別 醫療利用率은 對照群에서는 敎育程度가 높을수록 利用率이 增加하는 不均衡을 보였으나 醫療傳達體系 導入群이나 醫療保險 加入群은 平準化된 醫療利用率을 보였다. 5. 對照群에서는 버스타는 道路와의 距離가 멀수록 현저히 醫療利用率이 감소하였으나 醫療傳達體系 導入群이나 醫療保險 加入群에서는 遠距離地域에서도 比較的 높은 醫療利用率을 보였다. 6. 疾病 自覺者中 醫師利用率은 事後調査에서 事前調査에서보다 約 2倍 더 增加되었으며 事後調査에서 醫療保險 加入群이 12.2%로 가장 높은 率을 보였다. 7. 實驗事業群의 治療處別 醫療利用樣相을 對照群과 比較한바 醫療傳達體系 導入群에서는 藥局 利用은 별 變化가 없었고 醫師利用 部分이 약간 증가하고 其他 治療處 즉 한약방등에서의 治療率이 감소하였다. 이에 반해 醫療保險 加入群에서는 藥局利用, 其他利用이 줄고 相對的으로 醫師利用이 增加되어 33.1%나 되었다. 以上의 結果를 綜合해 볼 때 韓國 農村地域에 醫療傳達體系만을 導入했을때는 醫療均霑은 이룰 수 있으나 醫療擴大에는 별로 影響을 미치지 못하고 醫療傳達體系와 醫療保險을 同時에 導入할 때 비로소 醫療擴大 및 均霑을 모두 達成할 수 있다는 結論을 내릴 수 있다. [영문] To measure the changes in health care utilization patterns by the introduction of health care dalivery system and health insurance, a field experimental study model was designed. Four myuns in Kang Wha gun were cohsen for the experiment. Health care delivery system only was introduced to one Myun and health insurance program as well as health care delivery systems was introduced to another myun. Two myuns out of 4 myuns were selected as control. In order to compare the utilization patterns and rates before and after the experiment, two health interview surveys in two year interval were conducted: one in November 1975 from 3,037 persons and another one in November 1977 from 3,733 persons. The following results were obtained. 1. The incidence rates of self-reported acute diseases for the past 2 weeks were 13.4% before the program(1975) and 12.2% after the program(1977). The prevalence rates of self-reported chronic diseases were 24.4% in 1975 and 21.4% in 1977. 2. In the area the health care delivery system only was introduced, the physician visits per person per year increased from 0.6 in 1975 to 1.1 in 1977(after the program). In the control area also, physician visits per person per year increased from 0.5 in 1975 to 1.3 in 1977. The group health insurance was introduced showed the highest physician visits after the program(1.6 visits per person per year). 3. While the Medical care utilization rate of the lower-income family group was significantly lower than that of the higher-income family group in the control area, the rates in the areas where the health care delivery system and health insurance were introduced showed even between low and high income groups. 4.In the control area, physician visits of the groups with highly educated head of household were higher than that of groups with less educated head of household. The rates, however, were similar regardless of educational levels of head of household in the experimental areas. 5. In the control area, the longer the distance from the resident village to the bus road, the lower the rates of physician visits. Even though those groups lived in an area inconvenient to transportration, the rates for physician visits increased in the experimental group. 6. The treatment rates by physician among diseased persons for the past 2 weeks after the experiment were two times higher than that before the experiment. The health insurance program group showed the highest rate, 12.2%. 7. Medical care utilization patterns of the experimetal area by sources of treatment among the treated patients were compared with that of control area. In the area the health care delivery system was introduced the physician utilization was increawed, while patients treated at the drugstore remained at a nearly constant. In the group the health insurance and the health care delivery system were introduced, patients treated at a drugstore or by other sources were significantly decreased and the rate treated by physician was increased. With the above results, the following conclusions were drawn: The introduction of health care delivery system only contributed equal distribution of medical care among different socieconomic classes but affects only slightly to the rate for physician care and visits. The introduction of a health care delivery system and an appropriate financing mechanism together improve both distribution and utilization of medical care.restrictio

A Study of the Pregnant Woman's Attitude toward Maternal Health Services in a Rural Area

보건학과/석사[영문] [한글] A Study of the Pregnant Woman's Attitude toward Maternal Health Services in a Rural Area Kim, Ki Soon Department of Public Health, Graduate School, Yonsei University (Directed by Professor Jae Mo Yang) A survey was made, in September 1972, of the pregnant woman's attitude toward maternal health services among women eligible for maternal health services during 1972 in Hachungmyun, Kojegun, Kyungsangnamdo. the purpose of this study was to find a better way of providing health services in this area so that as many pregnant women as possible could participate in the maternal health program of the Koje Community Health and Development Project. A total of 222 women were studied; of these 119 women delivered after January 1st, 1972 and 103 women were pregnant as of September 1st, 1972. The results were as follows: 1. The prevalence rate of self-reported illnesses during the last pregnancy was 48.2%; of these 29% of the sick women received treatment while the rest (71%) received none. As to the sources of treatment, 16% of the 29% received treatment from a hospital, 11% from a drug store and 2% from a herb doctor. 2. 38% of the women received prenatal check-ups, but most only once and 3% received prenatal check-ups more than 3 times. 3. 99% of the women used their homes as the place for delivery of their most recent babies and only 1% were delivered at a hospital. 4. During labor, 12% of the women were attended by a person with medical experience, two thirds of whom were unlicensed. 5. For cutting the umbilicus of the newborn, 82% of women used an unsterilized scissor or knife at home, while 7% of women used the home delivery kit distributed by the government maternal health program. 6. 74% of women expressed a desire to participate in the prenatal care services of the Koje Community Health and Development Project. 7. When asked to state their choice as to the preferral type of practitioner delivering the prenatal health care, 64% of women chose a female doctor, 32% chose a midwife and only 2% chose a male doctor. As to their attitude about undergoing a vaginal examination by a male doctor, during the prenatal check-up, 19% expressed a willingness to do so but 62% stated that they would refuse. On the other hand 76% and 74% respectively stated that they would be willing to undergo such an examination by either a female doctor or a midwife. 8. For W00($1.25), the cost of prenatal care including drug fee; 59% of women thought that such a charge was fair or too low while 2% of women thought that it was too expensive. 9. As to the location of the prenatal check-up, 47% of women expressed a willingness to come to the clinic for their check-up while 34% of women felt that a team from the Project should come to their village for prenatal care. 10. The willingness to travel to the clinic for prenatal care increased with the women's level of education; in contrast, the willingness to travel decreased with an increase in age, with an increase in their distance from the clinic, and in habituated group to traditional customs related to pregnancy. 11. In regard to their next delivery, 95% of women considered their homes the preferred place of delivery, and only 1% of women hoped for a hospital delivery. 12. Of those who wanted a home delivery, 27% asked that the birth be attended at their home by staff personnel of the Koje Community Health and Development Project.restrictio

Preschoolers' story retelling abilities according to age

언어병리학 협동과정/석사[한글]이야기 능력은 연령이 증가함에 따라 발달한다. 4세가 되면 본격적인 이야기 발달이 이루어지기 시작하여 6세가 되면 완성도가 높아진다. 이러한 정상 아동의 이야기 발달 정보는 언어장애 아동의 진단 평가 및 치료 교육에서 유용하다. 따라서 본 연구에서는 4～6세 아동을 대상으로 이야기 회상 산출을 통해 연령 간 이야기 문법 총점, 낱말로 본 평균절길이(MLC-w), 형태소로 본 평균절길이(MLC-m)의 차이를 알아보았다.본 연구는 4～6세 정상 아동 60명을 대상으로 하였으며, 검사 도구는 배소영의 ‘그네 이야기’와 ‘공 이야기’를 사용하였다. 자료 수집은 검사자가 아동에게 그림카드를 보여주고 이야기를 들려준 다음, 그림카드를 제거하고, 아동이 이야기를 회상하여 산출하도록 하였다. 분석은 이야기 문법 총점과 낱말로 본 평균절길이(MLC-w), 형태소로 본 평균절길이(MLC-m)를 산출하여 연령 간 평균의 차이가 있는지를 보았다. 본 연구를 통해 얻은 결과는 다음과 같다.1. 이야기 문법 총점은 연령에 따라 유의미하게 증가하는 것으로 나타났다. 4세 집단은 5세, 6세 집단에 비해 유의하게 낮았으며, 5세 집단은 6세 집단에 비해 유의하게 낮게 나타났다. 또한 이야기 문법 하위 범주별 회상 점수도 배경, 계기 사건, 내적 반응, 시도, 결과가 모두 연령에 따라 증가하는 것으로 나타났다.2. 낱말로 본 평균절길이(MLC-w)는 연령에 따라 유의미하게 증가하는 것으로 나타났다. 4세 집단은 5세 집단과 6세 집단보다 유의하게 짧게 나타난 반면, 4세 집단과 5세 집단은 유의한 차이가 나타나지 않았다.3. 형태소로 본 평균절길이(MLC-m)는 연령에 따라 유의미하게 증가하는 것으로 나타났다. 4세 집단은 5세, 6세 집단에 비해 유의하게 짧았으며, 5세 집단은 6세 집단에 비해 유의하게 짧게 나타났다. 낱말로 본 평균절길이(MLC-w)에서 4세 집단과 5세 집단이 유의한 차이를 나타내지 않은 것과 대조되는 결과이다. 이는 우리말이 조사, 어미와 같은 문법 형태소를 많이 포함하고 있기 때문에 낱말로 본 평균절길이(MLC-w)보다 형태소로 본 평균절길이(MLC-m)에서 연령에 따른 발달을 더 잘 나타낸 것으로 보인다.본 연구의 결과를 통해 이야기 문법과 평균절길이(MLC)로 학령 전기 아동의 이야기 회상 능력이 양적으로 증가하는 것을 알 수 있었다. 또한 이야기 평가시 이야기 문법과 평균절길이(MLC)로 분석하는 것이 이야기 발달을 보는데 적절하고 효율적임을 확인할 수 있었다.앞으로는 이야기 문법과 평균절길이(MLC)로 학령기 아동들에게도 연령에 따른 이야기 능력 발달을 볼 수 있는지에 대한 연구와 이야기 과제에서 정상 아동들의 실수 경향에 대한 연구가 이루어져야 할 것이다. 아울러 표준화된 이야기 검사 도구를 마련하기 위한 연구들도 진행되어야 할 것이다. [영문]Children's ability to tell stories increases as they grow older. Usually, children are able to express their views and opinions effectively by 3 years of age and their storytelling ability matures by 6 years of age. The storytelling ability of preschoolers is used in general to assess the ability of children with impaired language for the purposes of diagnosis and treatment. The aim of this study was to determine differences in children's story retelling abilities according to age by measuring the total scores of story grammar, MLC-w(Mean Length of Communication in words) and MLC-m(Mean Length of Communication in morphemes) during the story retelling task.The study subjects comprised 60 preschoolers aged 4 to 6 years. Two Korean stories, "The Swing story" and "The Ball story" written by Bae So-Young, were used as assessment tools along with matching story cards. The author showed the story cards to the children, told a story corresponding to cards, then removed the story cards and asked the children to retell the story they had just heard. When a child retold the story in her or his own words, the grammatical correctness, MLC-w and MLC-m were scored. The total scores of story grammar, MLC-w, and MLC-m were compared to determine the differences in story retelling abilities according to age. The study results are summarized as follows:1. The total scores of story grammar significantly increased with increasing age. The total scores of story grammar of the 4-year-olds was significantly lower than that of the older children (5 to 6 years). The 5-year-olds showed significantly lower than that the 6-year-olds. Moreover, the older age group outperformed the younger age groups in setting information, initiating event, internal response, attempt and the direct consequence increased among the subscales of story grammar.2. Age had a significant impact on MLC-w. The MLC-w spoken by the 4-year-olds was significantly shorter than that of the 6-year-olds, although it did not significantly differ from that of the 5-year-olds.3. Age also had a significant impact on MLC-m. The MLC-m spoken by the 4-year-olds was significantly shorter than that spoken by the older age groups. There were also significant differences in MLC-m between the 5- and 6-year-olds. This result contrasts with the insignificant difference in MLC-m between the 4- and 5-year-olds. The given grammatical functions of morphemes, such as the endings of words or particles, MLC-m was more significantly associated with age than MLC-w.The study found that preschoolers' ability to retell stories was positively correlated with age considering their increased story grammar abilities and MLC. The use of story grammar and MLC is therefore considered effective as an assessment scale to measure children's storytelling ability.Further study is needed to determine whether these assessment scales are effective to measure storytelling abilities in school children and to measure the mistakes made by normal children when they express their views and opinions. Further study is necessary to develop a standardized assessment tool that can be used for measuring child's storytelling abilities.ope

제품설계단계에서의 활동기준원가추정

학위논문(석사)--아주대학교 대학원 :산업공학과,2000textMaste