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Korea (Seoul) 34

JOURNAL OF POPULATION, HEALTH AND SOCIAL WELFARE

1993 - VOLUME 13, NUMBER 1

93.34.01 - English - Sung-Chul HWANG and Yoon-Hyeon LEE, Korea Institute for Health and Social Affairs, San 42-14, Bulgwang-Dong, Eunpyung-Ku, Seoul 122-040 (Korea)

A Study on Bypassing the Regional Medical Facilities for the Utilization of In-patient Care Services in Other Health Services Districts

The utilization pattern of medical care services has changed greatly since the implementation of the health care delivery system in 1989. Under the current system, the whole country is divided into eight health service regions and each of these is further divided into 10-20 health service districts in accordance with administrative boundaries. The insured are expected to use all health and medical facilities in their health service districts without any restriction except for tertiary hospitals, but visiting a tertiary hospital or using medical facilities in other health service districts requires a referral request from a primary care physician. Central to the system is rationalizing the utilization pattern of medical care services on the part of the consumers and regionalizing the distribution of medical resources on the basis of consumers' needs. The unequal distribution of medical resources in each Health Service District causes serious problems for the insured in bypassing medical facilities in their districts. This study investigates factors influencing bypassing medical facilities for the use of in-patient care services in other health service districts and determines the amount of medical resources in each one to meet in-patient care service needs. The findings of this study reveal that the absence of general hospitals largely determines the rate of bypassing and consumers residing in small cities or counties that are often considered to be inferior to large medical facilities show a high rate of bypassing. Implications of these findings have been discussed in conjunction with the way in which regional self-sufficiency of in-patient medical services could be accomplished in the near future. Possible re-arrangement of current health service districts has also been addressed in this paper. (KOREA (REPUBLIC OF), HEALTH SERVICES, HEALTH FACILITIES, REGIONALIZATION)

93.34.02 - English - Kee-Hey CHOUNG, Korea Institute for Health and Social Affairs, San 42-14, Bulgwang-Dong, Eunpyung-Ku, Seoul 122-040 (Korea)

An Analysis on Nutrition Education in Textbooks and the Curriculum in the Middle School

The main purpose of this study was to analyse the curricula of nutrition education in middle school in Korea and to compare the nutrition education contents in middle school textbooks in Korea and the USA. The second purpose was to provide reform measures for the contents of the textbooks. This study used a content analysis of fifteen textbooks in Korea and one in the USA and a curriculum analysis of the first to the fifth revision of textbooks in Korea. The results of the analysis were as follows: (1) Nutrition education lessons per week were reduced and taught only to female students. The fourth curriculum revision introduced vocational education. (2) In the first grade in middle school, the learning objective in nutrition was "management of balanced dietary life by acquiring knowledge of and the functions of food and nutrition". In the second grade in middle school, the learning objective was "to maintain improved dietary life by acquiring knowledge of the functions of food cooking and processing". The objectives of nutrition education in Korea were more concentrated on the cognitive domain than on the affective or psychomotor domain. (3) In Korea, the textbooks devoted only two out of nine chapters to nutrition education, but, in the USA, it was three out of six. (4) The contents of the Korean textbooks were more inadequate than in the US books which concentrated not only on the cognitive domain, but also on the affective and psychomotor domains. (5) The author suggests six reform measures for nutrition education: open up nutrition education to male students; extend the learning objectives to cover the affective and psychomotor domains; research, develop and evaluate curricula continuously; teach nutrition education independently; develop programmes for students and society; stimulate the interest of teachers, nutritionists, parents and students for the contents of this training and their improvement. (KOREA (REPUBLIC OF), NUTRITION, EDUCATION, TEACHING AIDS)

93.34.03 - English - Moon-Hee SUH and Dae-Hee CHO, Korea Institute for Health and Social Affairs, San 42-14, Bulgwang-Dong, Eunpyung-Ku, Seoul 122-040 (Korea)

Analysis of Contraceptive Use: 1968-1991

The contraceptive use rate in 1991 was 79.4%, by which time it had reached saturation point. The rapid increase in the rate was evaluated as one of the three major contributors in the decline of the total fertility rate to below the replacement level. The objective of this study is to analyze the determinants of contraceptive use by method in 1968, 1974, 1982, 1988 and 1991, using the method of logistic regression. The results show that the socio-demographic variables have a significant relationship with contraceptive use. This relationship was at its peak in 1968, dipped in 1988 and recovered in 1991. This disproves the idea that there may be a weak or no relationship between socio-economic variables and contraceptive use owing to the effect of popular contraceptive use and increased contraceptive availability. The relatively weak relationship in 1988 can be explained by the reinforced family planning programmes of the government during the 1980s. Based on the analysis, we can learn that, in spite of the high contraceptive use rate, part of the population is still subject to unwanted pregnancies, so the government should endeavour to provide qualitative services to improve the quality of life as well as to maintain an appropriate fertility level. (KOREA (REPUBLIC OF), CONTRACEPTIVE PRACTICE)

93.34.04 - English - Hyun-Oak KIM, Korea Institute for Health and Social Affairs, San 42-14, Bulgwang-Dong, Eunpyung-Ku, Seoul 122-040 (Korea)

A Study on the Welfare Needs of and Services for Those with Autism

In Korea, there is a lack of understanding of autism on the part of professionals as well as the public. Social services are lacking for those with autism except for some special educational services for pre-school and school-age autistic children. Furthermore, there are few legal or institutional grounds for promoting such services and responsibility is not assigned to implement them. The purpose of this study is to discover the welfare needs of those with autism and of their families and, thereafter, to explore social service measures to assist them. The author has reviewed a theoretical background for the social needs of the autistic and services for them, analyzed the current service system in Korea and its problems by studying the literature and interviewing those concerned with the autistic. He suggests some urgent and realistic measures: (1) the establishment of an autism service centre to be responsible for planning and implementing services for autistic persons and their families; (2) institutionalization of a mechanism for prevention and early identification of autism as part of the government MCH programme; (3) the establishment of a standard for pre-school education centres; (4) the organization of exclusive special classes for autistic children within the public school; (5) relaxation of the existing standard for welfare institutions in order to establish many small group homes under one welfare institution body; (6) a registration system for the handicapped including the autistic; (7) activation of community welfare centres as focal points for family support; (8) organization of all autistic persons' parents' associations established by region and institution to make a joint effort to secure the rights and interests of autistic persons. (KOREA (REPUBLIC OF), MENTAL HANDICAP, CHILD CARE)

93.34.05 - English - Ok-Hee PARK, Korea Institute for Health and Social Affairs, San 42-14, Bulgwang-Dong, Eunpyung-Ku, Seoul 122-040 (Korea)

Analysis of Three-dimensional Categorical Data in Social Science Research

Most data in the social sciences contain variables that have several categories and each cell, which is the combination of categories of each variable, represents frequency. Especially, there are many data whose types are contingency tables, cross-classified by some variables in several categories. These are called categorical data. Even though these categorical data have many categorical variables, most articles or reports in the social sciences only use at most two-dimensional contingency tables where the well-known Pearson C² and likelihood ratio G² are used to analyze independence of variables. This kind of analysis is only appropriate for discovering the relationship between two variables. It is therefore maintained in this article that it is good to make use of log-linear models for the analysis of high-dimensional categorical data. The author analyzes some log-linear models using the data in two recent articles in the Korean Journal of Sociology in which the data had been incorrectly analyzed because log-linear models were not used. (STATISTICAL ANALYSIS, DATA PROCESSING)

93.34.06 - English - Ka-Oak RHEE and Myo-Wook CHANG, Korea Institute for Health and Social Affairs, San 42-14, Bulgwang-Dong, Eunpyung-Ku, Seoul 122-040 (Korea)

A Practical Guide for Focus Group Discussion

As a form of qualitative research, the focus group is basically a group interview. Focus group discussion is the explicit use of group interaction to produce data and insights that would be less accessible without the interaction found in a group. This type of discussion is best viewed as a complement to other quantitative and qualitative research techniques and, independently, is used as a data collection research method. It is useful for: orientation towards a new field; generating hypothetical research sites or study populations; evaluating different research sites or study populations; developing interview schedules and questionnaires; obtaining participants' interpretations of results from earlier studies. The authors present focus group discussion methodology and give advice to researchers. As focus group discussion is new to the social sciences in Korea, the authors introduce specific techniques for planning and execution, processing and analysis, and give suggestions for writing reports on the discussions. (KOREA (REPUBLIC OF), SURVEYS, DATA COLLECTION, METHODOLOGY)

93.34.07 - English - Kong-Kyun RO, Nam-Hoon CHO, Department of Management Science, Korea Advanced Institute of Science and Technology (Korea), and Byoung-Woo LEE, Korea Institute for Health and Social Affairs, San 42-14, Bulgwang-Dong, Eunpyung-Ku, Seoul 122-040 (Korea)

Market and Non-market Activities and Their Effects on Health from the Perspective of the Allocation of Time

The relationship between occupation and health has been studied extensively in the past. However, the impact of non-market activities has rarely been taken into account in this type of study. The authors examine the intra-family dynamics in terms of each member's role as revealed by his/her allocation of time in market and non-market activities. Based on Becker's theory of the allocation of time and Lancaster's new theory of consumer behaviour, family activities are classified into three types: (1) income earning and other market activities in the economy; (2) leisure, consumption and miscellaneous activities; (3) household (production) chores. The study measures the proportionate amount of time spent on each category of activities and investigates the structural relation between major determinants of health and allocation of time. By treating the socio-economic status of each family as the contextual variables, the authors examine how the market and non-market activities of each family member, as reflected by his/her allocation of time, shape the perception about the relative cost-effectiveness of various inputs for health. Within the context of the family's socio-economic status, they examine how the knowledge and the relative ease or difficulty of financial, physical and cultural access to various types of health facilities are acquired. Finally, socio-economic and cultural contextual dependency is investigated not only as a co-determinant of health behaviour, but also as an environmental factor which influences the relationship between the allocation of time and health behaviour. (TIME BUDGET, HEALTH, FAMILY LIFE, WORKING LIFE)

1993 - VOLUME 13, NUMBER 2

93.34.08 - Korean - Moon-Hee SUH, Korea Institute for Health and Social Affairs, San 42-14, Bulgwang-Dong, Eunpyung-Ku, Seoul 122-040 (Korea)

Effects of Sociodemographic and Marriage Related Variables on Divorce and Remarriage among Korean Women

The number of divorces per 1,000 marriages increased rapidly from 1970 (3.9) to 1991 (11.7). Of course, this level is not very high when compared to Western countries, but it has increased dramatically during the last two decades due to the country's socio-economic development and improved female status, including women's increased access to employment. The author gives an update on the present status of first marriages ending in a divorce and remarriages and attempts to identify the determinants of divorce and remarriage amongst Korean women. The data used have been drawn from a sample of 7,462 non-single women aged between 15 and 49 who were interviewed during the 1991 national survey on fertility and health (Korean Institute for Health and Social Affairs - KIHASA). 1.6% of the women interviewed declared that their first marriage had been ended by a divorce after lasting for an average of 7.5 years; at the time of their divorce, they were aged on average 29.5 and had 1.3 children while the main reason for the divorce was incompatibility. The risk of divorcing depends firstly on the man's age at marriage (under 20 or over 35) and on the way of choosing their spouse (autonomous personal choice or marriage arranged by the parents without consulting the interested parties). Furthermore, the wife's education level, her age at marriage and the length of time spent getting to know each other before the wedding also had an impact on the risk of the first marriage ending in divorce. About 40% of the divorced women had remarried. Those who were youngest at the time of divorce, who had the shortest acquaintance period prior to marriage and who had no children were much more likely to get remarried. (KOREA (REPUBLIC OF), DIVORCE, REMARRIAGE)

93.34.09 - Korean - Minja-Kim CHOE, Karen O. MASON, East-West Center, Honolulu, Hawaii (U.S.A.), and Sae-Kwon KONG, Korea Institute for Health and Social Affairs, San 42-14, Bulgwang-Dong, Eunpyung-Ku, Seoul 122-040 (Korea)

Korean Women's Participation in the Labor Force Attitude and Behavior

The data used in this article were drawn from the Family Life Cycle Survey undertaken in 1986 by the Korean Institute for Health and Social Affairs (KIHASA). Using a national representative sample of 3,013 married women aged under 65, information on marriage, fertility, employment (before and after marriage), roles in the family and attitudes to employment were obtained. Although the authors have used only one survey, their aim is to study trends in the above phenomena over time. Married Korean women have, over three to four decades, developed a very liberal approach to working women. Most of them (57%) adhere to the idea that a woman has the right to choose freely whether they work or not, no matter their marital or fertility status: this proportion reaches 68% for those women who were brought up in urban areas, attended school for at least twelve years and worked before their marriage for non-family reasons. These high proportions of women favourable to female employment have surprised the authors, given the solid tradition of Korean families which means that females' first obligation is to be a wife and mother and in view of the recent nature of married women's massive participation in economic activities. Attitudes towards working women do not vary greatly from one generation of women to another. All the pointers are that this trend in opinions will continue in the future. However, recent trends in female employment are not directly due to a liberal change in mentalities. The authors suggest research paths which would identify the determinants preventing those women who wish to work from gaining employment. (KOREA (REPUBLIC OF), ATTITUDE, WOMEN'S STATUS, LABOUR FORCE PARTICIPATION)

93.34.10 - Korean - Jung-Ja NAM, Korea Institute for Health and Social Affairs, San 42-14, Bulgwang-Dong, Eunpyung-Ku, Seoul 122-040 (Korea)

Classification of Korean Juvenile Delinquent Behavior and an Analysis of the Related Factors

The author suggests classifying juvenile delinquency in Korea into seven categories and studies the determining factors of the various types of delinquency, using an integrated socio-psychological model. The data used came from a 1989 survey carried out on 1,412 11th-year pupils from 26 high schools. The theory which best descibes this phenomenon in Korea is the sociological theory which sees imperfect socio-affective relationships as the greatest determinant of juvenile delinquency. Socio-economic status, as well as several other variables studied herewith, is positively correlated to certain delinquent behavioral aspects and negatively correlated to some others. Gender is amongst the most important determinants. In the author's view, delinquent behavior is far too complex for one single theory or family of theories to be able to explain its diversity, which the integrated psycho-sociological approach appears to do in a satisfactory manner. (KOREA (REPUBLIC OF), JUVENILE DELINQUENCY, THEORY, PSYCHOLOGICAL FACTORS, SOCIOLOGICAL ANALYSIS)

93.34.11 - Korean - See-Won RYU, Korea Institute for Health and Social Affairs, San 42-14, Bulgwang-Dong, Eunpyung-Ku, Seoul 122-040 (Korea)

A Model of Food Mix for the Economically Dietary Intake

Within the constraints of a given budget, food consumption must be both economical and nourishing, especially for the poor, but most works by dieticians ignore the budgetary constraints. The author applies an optimising method by linear programmation to the determination of a healthy and economical diet which is adapted to Korean habits and the country's economy and he tests his model with actual data on rural population. (KOREA (REPUBLIC OF), DIET, ECONOMIC OPTIMUM)

93.34.12 - English - Nam-Hoon CHO, Korea Institute for Health and Social Affairs, San 42-14, Bulgwang-Dong, Eunpyung-Ku, Seoul 122-040 (Korea), and Nam-Kee AHN, Department of Economics, University of Pais Vasco (Spain)

Changes in the Determinants of Induced Abortion in Korea

In spite of the fact that the Korean National Family Progtramme reached its main target of reducing fertility and spreading contraceptive use, induced abortion remains frequent. This shows that, to a large extent, the current family planning programme needs to be re-thought in order to enable it to avoid unplanned pregnancies. The authors study the factors underlying induced abortion in Korea by examining trends in birth outcomes over time. They use data from the National Fertility and Family Health Survey undertaken by KIHASA in 1991. The frequency of abortion increased rapidly until the mid-1980s when there were almost as many abortions as there were births. From then on, abortion remained at this maximum level. At any give time, abortion was much more frequent for high-order births. From birth order 1 onwards, it is the sex distribution of children already born which is the main factor leading to a pregnancy outcome. The fact of already having a boy considerably increases the probability of terminating a pregnancy through abortion. The decline in the desired number of children and the continued strong preference for male children reinforce the importance of children's sex in deciding the outcome of a pregnancy. Women's education has an increasing tendency to increase the probability of abortion, but this effect declines regularly with time. Having a premarital pregnancy and living in urban areas are also factors which increase the tendency to abort. The author concludes that the main objectives of the family planning programme should be to move from the current quantitative approach, aimed at decreasing fertility, towards a qualitative approach with regard to health status, by emphasising the balance of the male/female ratio and the prevention of induced abortion. Furthermore, the family planning programme should be fully integrated to the mother and child health services in view of a qualitative improvement in population. The importance of family planning should not be underestimated on the pretext that the fertility level is low. (KOREA (REPUBLIC OF), INDUCED ABORTION, FAMILY PLANNING PROGRAMMES, FAMILY COMPOSITION)

93.34.13 - English - Sung-Chul HWANG, Korea Institute for Health and Social Affairs, San 42-14, Bulgwang-Dong, Eunpyung-Ku, Seoul 122-040 (Korea)

Conceptual and Methodological Issues in Measuring Patient Satisfaction: Concepts and Dimensions of Measuring Patient Satisfaction with Health Care

Interest in patient satisfaction with health care and research on this topic have grown considerably over the last twenty years, but in general without giving serious consideration to the complexity of this concept. Consequently, there is no conceptual framework which is widely accepted for gauging patient satisfaction. The author examines two theoretical models and pays particular attention to the conceptual clarity and their methodological pertinence: the "expectancy theory" and the "attitude theory". He confronts them with several classical theories of measurement and evaluation of a multi-dimensional concept and suggests various improvements to existing models. (METHODOLOGY, THEORETICAL MODELS, MEDICAL CARE, EVALUATION)

93.34.14 - English - In-Hwa PARK, Health Research Division, Korea Institute for Health and Social Affairs, San 42-14, Bulgwang-Dong, Eunpyung-Ku, Seoul 122-040 (Korea)

Population Aging and Its Health Implications in Korea

Korean population ageing is in its early stages and Korea can foresee a "golden period" towards the early 2020s where the dependency ratio will be at its minimum. Due to this fact, the health issues related to Korean population ageing have received very little attention. And yet, evolution of the population structure towards that characteristic of an ageing society will occur at a relatively rapid pace in the coming decades (population aged 65 and over: 7% in 2000, 14% in 2025). The author underlines the fact that, in the Korean demographic context, the "time of respite" must be put to good use, before ageing becomes a heavy public and private burden, when efficient policies and counter-attacks in the health and social welfare sectors can be prepared, on which the heaviest consequences of ageing will rely. Compared to the youngest adults, it is known that the elderly have more health problems and an increased tendency to suffer chronic illnesses. Furthermore, and in parallel to increased coverage of the national health welfare system, use of the health services has increased much more amongst the ederly than in the population as a whole. As the health problems of the elderly are different from those of the younger population, extra efforts aimed at the quantity and the quality of the health care offered to the elderly population are expected of the politicians and health practitioners. In a situation like this, the necessity of coordinating efforts for promoting health and controlling disease appears to be one of the major issues to deal with and to resolve throughout the duration of the Seventh Five-Year Development Plan. It is therefore clear that the ageing society of Korea must take the appropriate measures so that the co-ordinated actions of the government, communities and families provide the elderly with the best possible aid and services, taking into consideration the overall effects in the long term. Moreover, this process mush rely on a revision of the existing policies and programmes, emphasising the links between the elderly population and the overall population with regard to medical expenditure and the use of the health services. (KOREA (REPUBLIC OF), DEMOGRAPHIC AGEING, AGED, HEALTH POLICY)

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