Papers/Projects/Abstracts

The South Korean Health Care System

No health care system is perfect at its inception, especially in an underdeveloped nation like Korea. Due to decades of occupation by other nations (Japan and the U.S.), Korea did not fully play a role in its own politics the late 1950s. Until 1965, the South Korean people received health and welfare services primarily from foreign money, foreign staffing and Christian missionaries. As the politically inexperienced government matured and prospered, it began providing for its people. The three articles were reviewed for this paper discussed the obstacles facing the government and the efforts it has made to overcome them. Korea, like the United States, finances its medical assistance from the general government revenue. The high cost of health care and inflation has reduced the amount of money it can spend in healthcare. Korea has responded to high cost care by implementing strict provider reimbursement but, due to fragmented government financing and dominance in the private sector, there is little national control. Korea exemplified problems that arose from implementing a privatized model, decentralized administration, and fragmented government responsibility in a rapidly growing industrialized economy.

 The article Health Development Experiences in North and South Korea also focused on Korean health development issues. After the Korean War, the nation was geographically and politically divided, but the people remained racially homogeneous, that is, they came from the same ethnic group and genetic background. They shared the same language, history, and weather and environment. Despite these parallels, differences in their health status emerged although their health levels had been equivalent prior to the war. The authors Kim, Ahn, and Lee (2001), compared and contrasted the governments, economies, and health level factors (education, hygiene, nutrition and health system between the two countries in an effort to explain potential reasons for the differences in health status. They found that the South Koreans are healthier than those of North Korea. North Korea does not have a good economy. The authors explain that a strong economy is the most influential factor in determining health levels. The better a nations economic status becomes, the better the nutrition, education, hygiene, and health resources. Hence the major differences u\in health status between North and South Korea.

The final article described the changes in nutrition of the South Korean People as the country matured and adopted outside influences. It also demonstrated that an economically developed country has the funds and the resources to influence changes in the health of its citizens. The usual diet consists of low fat, high vegetable intake and grilled meat wrapped in leaves. While many still eat the traditional diet, there are many that have adopted the western fast foods. They have begun to see increases in hypertension, diabetes, hyperlipidaemia, cancer and neoplasms. The concern for public health brought about new programs to educate the public and promote the return to the healthy traditional diet.

The most important idea that is demonstrated in these three articles is the Iron Triangle: quality, cost and access. When just one of these is out of balance its impacts healthcare.   

   Predictors of Readiness for US Medical Department Special Medical Augmentation Response Team

Problem:  Since the end of the Cold War, the United States Army has faced an increase in deployments in support of humanitarian relief, disaster assistance and counter-terrorism missions.

Purpose: The purpose of this study was to identify predictors for readiness for Special Medical Augmentation Response Teams (SMART).

Independent Variables: Comprised of 4 constructs:

1.  Categories of Readiness:

         Training

          Personnel

          Logistics

2.     Fiscal Quarter

Quarter 1

Quarter 2

Quarter 3

Quarter 4

3.     Geographical Region

Regions 1 through 5

4.     Team (type e.g Trauma, NBC, etc)

Teams 1 through 5

Dependent Variables: Overall SMART readiness rating:  1-5; 1= most ready to 5= least ready

4 Hypotheses:

Categories of readiness are predictors of readiness for SMART

Fiscal Quarters are predictors of readiness for SMART

Geographical Regions are predictors of readiness for SMART

Team types are predictors of readiness for SMART

Sample Size: n = 300 readiness ratings taken from quarterly Medical Readiness Reports

Method of Selection of Sample:  Ratings were taken from quarterly Medical Readiness Reports (MRR) turned into U.S. Army Medical Command by the five U.S. based Army Regional Medical Commands (RMCs)

Reliability:  RMCs turn in MRR every quarter in accordance with Army Regulation 220-1 and MEDCOM Supplement 220-1

Validity:  Full model R²= .376, F(13, 286) = 13.24, p<.0001

Design of Model: This study reports an innovative application of multivariate approaches to predict readiness.  The sample consisted of 300 readiness ratings.  Medical readiness report data for fiscal year 2002 were used to estimate a multiple regression model of readiness for the categories of readiness, the quarters of the fiscal year, the geographical region, and the type of team.  Multivariate correlations between 17 independent variables and the dependent variable, overall readiness rating, were calculated.

Ethical Issues:  Privacy of regions for both ethics and security considerations.  All region unique identifiers were removed

Significant Findings:  Measures of categories of readiness, fiscal quarters, and regional variation were statistically significant.  Team type was not significant.

Recommendations: We recommend that the Directorate of Combat and Doctrine Development of the Army Medical Department Center and School (AMEDDC&S) develop detailed concepts, organizations, materiel, and doctrine for SMART to aid their mission of health service support across homeland defense operational continuum.  A SMART Mission Training Plan would provide commanders a tool to effectively measure the readiness of their teams to respond to a threat to our homeland.  The Lessons Learned Department of the AMEDDC&S should schedule and evaluate SMART external evaluations to ensure contingency plans are exercised.  The Lessons Learned Department should also track and document actual deployments and training exercises.  More specific task-oriented numerical readiness criteria should be developed within each readiness category to further eliminate subjective disparity among regions. 

Recommendations for further Research: Funding needs to be researched utilizing actual obligations of funds by the regional medical commands.  These obligated amounts should include additional dollars provided by the RMC in addition to the funding provided by the United States Army Medical Command.  Additional research is also needed in personnel turnover to discover the impacts of training and assimilating new members of SMARTS.  A cost study should be undertaken to determine the opportunity cost of trained and ready SMARTs compared to lost workforce time in the hospital.  The European Regional Medical Command and the specialty SMARTS should be studied separately due to their unique circumstances.

An Examination of Policies for an Aging Society

Abstract Entitlement programs (Medicare, Medicaid, and Social Security) for the elderly are an intricate part of American life. Politically, entitlement programs are the basis for some of the most heated debates in the Congress and in America as a whole. The subject of these debates centers on one of the following options that America must choose. First, do nothing and rely on a growing economy to finance entitlements. Second, increase benefits for the elderly and allow deficits in the budget. Thirdly, increase benefits for the elderly and fund them through tax increases. Another option would be to reduce spending in other government areas and spend the excess money on entitlements. Finally, the size and scope of entitlement programs could be changed, or the efficiency of the programs enhanced. This paper focuses attention on three major themes that support these options. The first theme, there is an ideological difference in the way Democrats and Republicans approach entitlement programs. Democrats traditionally favor large federal government programs, while Republicans tend lean toward small government and open market funding mechanisms. Second, due to the ideological differences, we must act now to affect change. Finally, the paper highlights the coming explosion in the proportion of retirees eligible for entitlement programs to the number persons who fund entitlement programs (people in the workforce). As the proportion tips more in favor of retirees, the nature of these programs may have to change due to funding constraints. The compromise may involve changing other government programs such as environmental programs if this problem is not addressed now.

Feasibility of AN Online Appointment System at Brooke Army Medical Center

Brooke Army Medical Center (BAMC) is state-of-the art health care center that prides itself on providing a high quality health care environment. Beneficiary expectations will eventually require web-based transactions.  The purpose of this paper was to examine the feasibility of implementing an online appointment system at BAMC. Tricare Online is the DOD answer to e-health and web-based appointments. It is standard for all Medical Teaching Facilities and will be the platform on which to operate a web-based patient appointment system. After a review of all factors, we concluded BAMC should implement the Tricare Management Agency model of web-based appointments. Benefits of this model are (1) reduced overall cost for BAMC, (2) standardization of appointment booking through TMA, (3) empowerment of beneficiaries by enhancing access to care, (4) improved quality of care and outcomes, (5) built in security features and (6) streamlined healthcare delivery (Kelly, 2002). Based upon lessons learned from proprietary models in terms of high maintenance costs and rigid flexibility to adapt to the dynamic health care environment, the preferred choice is the standardized product. TMAs standardized model had the potential to be the legacy system of the future because it is government owned and more readily adaptable to the federal health care system. Implementation method aside, the value of online patient appointment is obvious. In San Antonio alone, over 55civilain facilities have implemented some form of web-based access among their services.

The Veterans Administration Medical Care System 

The Veterans Administration (VA) Healthcare System has undergone significant changes over long and storied history of serving this nations veterans. They have witnessed the good times, seeing their budget grow facilitating the expansion of services and benefits to veterans. More recently however, they have experienced periods of contraction where services and benefits are more closely scrutinized. In order to effectively understand the market forces that have effected many of these changes, a thorough analysis of the VA Medical Care System was conducted, beginning with an analysis of Strengths, Weaknesses, Opportunities and Threats to the VA. We found that the VA has a solid mission, vision and values from which to make strategic decisions and build upon their strategy. Their current strategy matches a key strength (quality home health) with one of their biggest threats the aging veterans populations). As a result they appear to have done both a good internal and external environmental assessment in order to emphasize their strengths as they have done. We would recommend that they consider matching some of their excess resources with any other shortfalls experienced by the DOD healthcare system. This venue would not only allow the VA to maintain many of their services, it would put them in a resource-sharing situation that could potentially aid them financially. In short, we expect the VA to continue to be a viable organization and to be successful in implementing their strategy.