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JKM > Volume 35(1); 2014 > Article
Minjung, Buoungmook, Wungseok, and Myoungsoon: Institutional Analysis on Organizational Changes of Korean Medicine Hospitals

Abstract

Objectives

Korean medicine hospitals, since they first emerged in the early 1970s, have rapidly become a new member of the hospital population. As it was a new organizational frame for traditional medicine, we tried to analyze the changes of Korean medicine hospitals coping with institutional environment and their relative positioning in the whole health care sector.

Methods:

On the basis of Scott and his colleagues’ identification of the three components of institutional environments, changes in organizational logics, actors, and governance of Korean medicine hospitals during the period from 1971 to 2010 were analyzed.

Results:

First, Similar to previous literature on institutional eras of Korean health sector, three distinct periods were characterized: the foundation of Korean medicine hospitals to consolidate the legal status (1971∼1986), a rapid increase of entrepreneurial hospitals through cultural-cognitive legitimacy (1987∼2001), and the reinforcement of specialization and competition (2002∼present).

Conclusions:

Results suggested that: (1) changes in institutional environments had a heavy impact on structural and behavioral changes among Korean medicine hospitals, but the pace was slower than that of western medicine hospitals. (2) In structure, Korean medicine hospitals have positioned themselves as unofficial long-term care hospitals, focusing on chronic diseases (e.g. cerebrovascular disease).
Our study demonstrated that organizational theories can provide useful framework for the analysis of Korean medicine and related policies. Indeed, one of the most important implications of this study is that understanding changes in institutional environments is important to understand the process of how members of the health care sector live, grow, change, decline and survive.

Fig. 1
The foundation of KM hospitals by ownership
* Data: Korea Oriental Medical Hospital Association, 1999.
Reconstitution from Yoon17
jkm-35-1-145-14f1.tif
Fig. 2
The quantitative expansion of Korean medicine hospitals
* Data: National Health Insurance Statistical Yearbook
jkm-35-1-145-14f2.tif
Fig. 3
Medical professions in KM Korean medicine hospitals
* Data: National Health Insurance Statistical Yearbook
jkm-35-1-145-14f3.tif
Fig. 4
Increase of Evidence-based researches about Korean medicine
* Searched by (Korea AND (traditional medicine OR oriental medicine) AND evidence)
jkm-35-1-145-14f4.tif
Fig. 5
The number of newspaper articles about herbal medicine safety and quality
* Data from Chosun-ilbo archive
jkm-35-1-145-14f5.tif
Fig. 6
The visit days of cerebrovascular diseases inpatient care
* Data from Health Insurance Review and Assessment service
KM: Korean medicine
LC: Long-term care
jkm-35-1-145-14f6.tif
Table 1
The Institutional Changes surrounding Korean Medicine Hospitals
Institutional environment of Healthcare sector1)
professional dominance (1952–1976) government involvement (1977–1999) coexistence of competing institutional logics (2000-current)
 
Korean Medicine Hospitals
The foundation of Korean medicine hospitals to consolidate the legal status (1971–1986) A rapid increase of entrepreneurial hospitals through cultural-cognitive legitimacy(1987–2001) Reinforcement of specialization and competition (2002∼current)
Logics
  • Need for establishing educational system of Korean medicine

  • Increasing accessibility to Korean medicine services(expansion of hospital beds)

  • Specialization and competition

  • Efficiency&Safety (rationalization for hospital beds)

Actors
  • The Association of Korean Medicine (AKOM)

  • Colleges of Korean medicine

  • Korean government

  • The Korean Medical Hospital Association (KOMHA)

  • Associations of Medical Specialties for Korean medicine

  • Professional executives

Governance
  • Licensing system

  • Organized service delivery

  • Government involvement in service delivery

  • Entrepreneurialism

  • Evidence-based medicine

  • Management practice

Examples of policies
  • Permission for Korean medicine hospitals in medical law(’73)

  • National health insurance for Korean medicine(’87)

  • Board system of Korean medicine specialist(’00)

  • Supporting policy for the foundation of long-term care hospitals(’02)

  • Permission for cooperative practice between Western medicine and Korean medicine(’09)

  • Introduction of Specialized hospitals (’11)

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